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Publisher: Springer Science and Business Media LLC
Date: 05-12-2013
DOI: 10.1007/S11096-012-9730-3
Abstract: Hospitalisation often leads to increased medication regimen complexity for older patients increased complexity is associated with medication non-adherence. There has been little research into strategies for reducing the impact of hospitalisation on medication regimen complexity. To investigate the impact of pharmacist medication review, together with an educational intervention targeting clinical pharmacists and junior medical officers, on the increase in medication regimen complexity that occurs during hospitalisation. Two acute general medicine wards and two subacute aged care (geriatric assessment and rehabilitation) wards at a major metropolitan public hospital in Melbourne, Australia. A before-after study involving patients aged 60 years and over was undertaken over two 5-week periods. During the pre-intervention period patients received usual care. During the intervention period, clinical pharmacists were encouraged to review patients' medication regimen complexity prior to discharge, and make recommendations to hospital medical officers to simplify regimens. Prior to the intervention period, pharmacists attended an interactive case-based education session about medication regimen simplification, and completed an assessment task. A similar, but briefer, education session was delivered to junior medical officers. The primary endpoint was change in medication regimen complexity index (MRCI) score (a validated measure of regimen complexity) between admission and discharge for regularly scheduled long-term medications, adjusted for age, length of hospital stay, number of medications and regimen complexity prior to admission. Three hundred ninety-one patients were included (mean age 80.6 years, mean 7.4 regularly scheduled long-term medications on admission). The mean increase in MRCI score between admission and discharge was significantly smaller in the 205 intervention patients than in the 186 usual care patients (2.5 vs. 4.0, p = 0.02 adjusted difference 1.6, 95 %CI 0.3, 2.9). The intervention had greatest impact in patients discharged from subacute wards (mean adjusted difference: 2.7), not using a dose administration aid after discharge (mean adjusted difference: 2.6), and not discharged to a residential care facility (mean adjusted difference: 1.9). Mean differences in MRCI scores were equivalent to ceasing one to two medications. An educational intervention and clinical pharmacist medication review reduced the impact of hospitalisation on the complexity of older patients' medication regimens.
Publisher: Wiley
Date: 18-04-2011
Publisher: Springer Science and Business Media LLC
Date: 05-02-2010
Abstract: The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy (HAPPY). The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense ® ). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data. To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention. Australian New Zealand Clinical Trial Registry ACTRN12609000705280
Publisher: SAGE Publications
Date: 09-2004
DOI: 10.1345/APH.1D479
Abstract: Medication regimen attributes, such as the number of drugs, dosage frequency, administration instructions, and the prescribed dosage forms, have been shown to influence patient outcomes. No single tool for quantifying the complexity of general medication regimens has been published in the medical literature. To develop and validate a tool to quantify the complexity of prescribed medication regimens. Literature findings and the expertise of the authors were used for developing the tool. Eight pharmacy researchers helped in establishing the tool's face and content validity. The new tool was tested on 134 medication regimens from patients with moderate to severe chronic obstructive pulmonary disease. Six regimens with a spread of scores on the tool were presented to a 5–member expert panel that subjectively ranked these regimens to confirm the tool's criterion-related validity. The relationships between scores on the tool and various independent variables were tested to judge the tool's construct validity. Two raters scored 25 regimens using the tool to test its inter-rater and test—retest reliabilities. A 65–item Medication Regimen Complexity Index (MRCI) was developed. The expert panel had strong agreement (Kendall's W = 0.8 p = 0.001) on their in idual rankings of the 6 regimens. The panel's consensus ranking had perfect correlation with the MRCI ranking. The total MRCI score had significant correlation with the number of drugs in the regimen (Spearman's Rho = 0.9 p 0.0001), but not with the age and gender of the patients. Inter-rater and test—retest reliabilities for the total score and scores for in idual sections on the MRCI were ≥0.9. The MRCI is a reliable and valid tool for quantifying drug regimen complexity with potential applications in both practice and research.
Publisher: Springer Science and Business Media LLC
Date: 08-12-2015
DOI: 10.1007/S40266-015-0332-3
Abstract: There has been limited research into potentially inappropriate medication (PIM) use and anticholinergic burden in patients attending memory clinics. The aim of this study was to explore the use of PIMs related to cognitive impairment (PIMcog), anticholinergic cognitive burden (ACB) and concomitant use of anticholinergic medications with cholinesterase inhibitors (ChEIs) in patients attending memory clinics. Cross-sectional analysis of baseline data from the Prospective Research In MEmory clinics (PRIME) study was performed. Participants were community-dwelling patients who attended nine memory clinics and had a diagnosis of mild cognitive impairment or dementia. PIMcog were defined as any medication considered potentially inappropriate for patients with cognitive impairment according to the Beers or STOPP criteria. Clinically significant ACB was defined as total score of ≥3 on the ACB scale. A total of 964 patients, mean age 77.6 years, were included. PIMcog were used by 206 (21.4%) patients. Anticholinergics and sedatives were the most common PIMcog. PIMcog use was associated with higher number of medications (adjusted OR 1.26 95% CI 1.19-1.33) and with not having completed secondary level education (adjusted OR 1.71 95% CI 1.01-2.89). One hundred and thirteen (11.7%) patients had a clinically significant ACB score (≥3). ChEIs were used by 575 patients and 65 (11.3%) of these had an ACB score ≥3. There was no statistically significant difference in ChEI use between patients with and without an ACB score ≥3. PIMcog use, clinically significant anticholinergic burden, and concurrent use of anticholinergics with ChEIs were prevalent in patients attending memory clinics. Efforts are needed to improve prescribing for people with cognitive impairment.
Publisher: Wiley
Date: 31-10-2006
Publisher: Oxford University Press (OUP)
Date: 08-03-2011
Publisher: Springer Science and Business Media LLC
Date: 12-09-2008
DOI: 10.1007/S11096-008-9248-X
Abstract: The aim of this study was to explore patients' perspectives and experiences of pharmacist supplementary prescribing (SP) in Scotland. A survey in primary and secondary care in Scotland. Pharmacist supplementary prescribers (n = 10) were purposively selected across Scotland. All pharmacists distributed questionnaires to 20 consecutive patients as they attended appointments during October to December 2006. Reminders were mailed to all 20 patients by each pharmacist 2 weeks after initial distribution. The questionnaire contained items on: attitudes towards pharmacist SP derived from earlier qualitative research consultation satisfaction derived from a validated scale developed initially for general practitioners, with the term 'doctor' being replaced by 'pharmacist prescriber' and demographics. Closed and Likert scales were used as response options. One pharmacist withdrew. The patient response rate was 57.2% (103/180). The median age was 67 years (interquartile range 56.5-73 years), with 53.4% being female. Most (76, 73.8%) consulted with the pharmacist in a general practice setting. Patients reported positive consultation experiences with 89.3% agreeing/strongly agreeing that they were satisfied with the consultation, 78.7% thought the pharmacist told them everything about their treatment and 72.9% felt the pharmacist was interested in them as a person. Most patients were positive in their attitudes, agreeing that they would recommend a pharmacist prescriber to others and that they had trust in the pharmacist. However, 65% would prefer to consult a doctor. Most patient respondents were satisfied with, and had a positive attitude towards, pharmacist prescribing consultations. However, most patients would still elect to see a doctor given the choice.
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.SAPHARM.2013.08.005
Abstract: Medication-related problems (MRPs) are a concern in primary care settings. Pharmacists based in the community or community pharmacies are able to identify, resolve and prevent MRPs however, the lack of a formal partnership with physicians and poor access to patients' medical records are limitations. In Australia, delivery of pharmacist services within general practice clinics is rare. To evaluate the effectiveness of consultations by pharmacists based within primary care medical practices. A prospective, before-after intervention study was conducted at two primary health care (general practice) clinics in Melbourne, Australia. Participants were clinic patients who had risk-factors for MRPs (e.g. polypharmacy). Patients received a consultation with the pharmacist in a private consulting room at the clinic or in their home. The pharmacist reviewed the patient's medication regimen and adherence, with full access to their medical record, provided patient education, and produced a report for the general practitioner. The primary outcome was the number of MRPs identified by the pharmacist, and the number that remained unresolved 6 months after the pharmacist consultation. Secondary outcomes included medication adherence, health service use, and patient satisfaction. Eighty-two patients were recruited and 62 (75.6%) completed the study. The median number of MRPs per patient identified by the practice pharmacist was 2 (interquartile range [IQR] 1, 4). Six months after review, this fell to 0 (IQR 0, 1), P < 0.001. The proportion of patients who were adherent to their medications improved significantly, according to both the Morisky (44.1% versus 62.7%, P = 0.023) and the Tool for Adherence Behaviour Screening (TABS) (35.6% versus 57.6%, P = 0.019) scales. There was no significant effect on health service use. Patients were highly satisfied with the pharmacist consultations. Consultations undertaken by pharmacists located within primary health care clinics were effective in identifying and resolving MRPs. The consultations were well received by patients and were associated with improvements in medication adherence.
Publisher: SAGE Publications
Date: 02-2012
DOI: 10.1345/APH.1Q572
Publisher: Informa UK Limited
Date: 25-04-2012
DOI: 10.3109/02770903.2012.678024
Abstract: To investigate how pregnant women manage their asthma during pregnancy and factors influencing their behavior. In-depth interviews (telephone or face-to-face) with a purposive s le of 23 asthmatic women at various stages of pregnancy and with varying severity of asthma. Five major themes were discerned relating to health behavior of pregnant women with asthma. Many of the participants decreased or discontinued their asthma medications themselves and refrained from taking doses when necessary during pregnancy without consulting their doctors. Reasons behind their decisions revolved around lack of support and information about what to do, concerns about the safety of the medications, past experiences, and desire for an "all natural" pregnancy. Asthma monitoring during pregnancy was seen as a low priority for some women and their doctors. Communication between pregnant women and health professionals regarding asthma management was poor. The health behavior of pregnant women with asthma could be explained using the Health Beliefs Model. Pregnant women are not well supported in managing asthma during pregnancy, despite being concerned about outcomes. Interventions, education, and more support are warranted and wanted by pregnant women with asthma to optimize pregnancy and neonatal outcomes.
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.SAPHARM.2013.08.006
Abstract: Integration of pharmacists into primary care general practice clinics has the potential to improve interdisciplinary teamwork and patient care however this practice is not widespread. The aim of this study was to review the effectiveness of clinical pharmacist services delivered in primary care general practice clinics. A systematic review of English language randomized controlled trials cited in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and International Pharmaceutical Abstracts was conducted. Studies were included if pharmacists had a regular and ongoing relationship with the clinic delivered an intervention aimed at optimizing prescribing for, and/or medication use by, clinic patients and were physically present within the clinic for all or part of the intervention, or for communication with staff. The search generated 1484 articles. After removal of duplicates and screening of titles and abstracts against inclusion criteria, 131 articles remained. A total of 38 studies were included in the review and assessed for quality. Seventeen studies had common endpoints (blood pressure, glycosylated hemoglobin, cholesterol and/or Framingham risk score) and were included in meta-analyses. Twenty-nine of the 38 studies recruited patients with specific medical conditions, most commonly cardiovascular disease (15 studies) and/or diabetes (9 studies). The remaining 9 studies recruited patients at general risk of medication misadventure. Pharmacist interventions usually involved medication review (86.8%), with or without other activities delivered collaboratively with the general practitioner (family physician). Positive effects on primary outcomes related to medication use or clinical outcomes were reported in 19 studies, mixed effects in six studies, and no effect in 13 studies. The results of meta-analyses favored the pharmacist intervention, with significant improvements in blood pressure, glycosylated hemoglobin, cholesterol and Framingham risk score in intervention patients compared to control patients. Pharmacists co-located in general practice clinics delivered a range of interventions, with favorable results in various areas of chronic disease management and quality use of medicines.
Publisher: Springer Science and Business Media LLC
Date: 09-08-2012
Abstract: Medication-related problems are a serious concern in Australian primary care. Pharmacist interventions have been shown to be effective in identifying and resolving these problems. Collaborative general practitioner-pharmacist services currently available in Australia are limited and underused. Limitations include geographical isolation of pharmacists and lack of communication and access to patient information. Co-location of pharmacists within the general practice clinics is a possible solution. There have been no studies in the Australian setting exploring the role of pharmacists within general practice clinics. The aim of this study is to develop and test a multifaceted practice pharmacist role in primary care practices to improve the quality use of medicines by patients and clinic staff. This is a multi-centre, prospective intervention study with a pre-post design and a qualitative component. A practice pharmacist will be located in each of two clinics and provide short and long patient consultations, drug information services and quality assurance activities. Patients receiving long consultation with a pharmacist will be followed up at 3 and 6 months. Based on s le size calculations, at least 50 patients will be recruited for long patient consultations across both sites. Outcome measures include the number, type and severity of medication-related problems identified and resolved medication adherence and patient satisfaction. Brief structured interviews will be conducted with patients participating in the study to evaluate their experiences with the service. Staff collaboration and satisfaction with the service will be assessed. This intervention has the potential to optimise medication use in primary care clinics leading to better health outcomes. This study will provide data about the effectiveness of the proposed model for pharmacist involvement in Australian general practice clinics, that will be useful to guide further research and development in this area. Australian New Zealand Clinical Trials Registry: ACTRN12612000742875
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/20503121211032480
Abstract: To investigate pregnant women’s attitudes and behaviours towards hypertensive disorders of pregnancy and their treatment. Face-to-face, in-depth interviews were undertaken with 27 pregnant women diagnosed with and being treated for hypertensive disorders of pregnancy to investigate attitudes and behaviours regarding the conditions and their treatment. Written consent was obtained in idually from each participant, and the interviews ranged from 16 to 54 minutes. Data collection was continued until thematic saturation was reached. Thematic analysis was employed to interpret the data. Four major themes emerged around beliefs and behaviours of pregnant women regarding treatment of their hypertension: understanding of hypertensive disorders of pregnancy and their implications, risks versus benefits of antihypertensive medication during pregnancy, trust in medical professionals and adherence to medication. The women’s level of understanding of hypertensive disorders of pregnancy and their implications determined whether they were able to make informed decisions about their treatment. Prior experiences and concern for preservation of the pregnancy played major roles in the perception of the risk/benefit balance of using antihypertensive medication during pregnancy. The degree of trust in the treating medical professionals varied according to the perception of their confidence and knowledge. Sound understanding of the condition, a positive risk/benefit balance regarding antihypertensive medication use during pregnancy, and trust in medical professionals contributed to adherence to medication. Good communication with healthcare professionals is important to achieve optimal treatment.
Publisher: Springer Science and Business Media LLC
Date: 03-2017
DOI: 10.1007/S11882-017-0684-3
Abstract: Multiple electronic devices exist that provide feedback on the accuracy of patient inhaler technique. Our purpose is to describe the inhaler technique feedback provided by these devices, including specific technique steps measured, how feedback is displayed, target of feedback (patient, provider, researcher), and compatibility with inhaler type (metered-dose inhaler [MDI], diskus, etc.). We identified eight devices that provide feedback on inhaler technique. Only one device assessed all evidence-based MDI technique steps. Most devices provide limited real-time feedback to patients, if any feedback at all. Technologies to assess inhaler technique are advancing and hold great potential for improving patient inhaler technique. Many devices are limited in their ability to detect all evidence-based technique steps and provide real-time user-friendly feedback to patients and providers. Usability tests with patients and providers could identify ways to improve these devices to improve their utility in clinical settings.
Publisher: Hindawi Limited
Date: 19-06-2014
DOI: 10.1111/JCPT.12185
Abstract: About half of all patients taking antihypertensives discontinue treatment by 12 months. There is potential for substantial health gains at both in idual and population levels through improved treatment adherence. The objective was to evaluate a community pharmacist intervention to improve adherence with antihypertensive medicines with a view to improving blood pressure (BP) control. prospective, non-blinded, cluster-randomized, controlled trial. adults with primary hypertension who obtained antihypertensives in the previous 6 months. Patients with poor refill adherence were preferentially identified with the help of a purpose-built software application. package comprising BP monitor training on BP self-monitoring motivational interviewing medication use review prescription refill reminders. six months. change in proportion self-reporting medication adherence. Secondary outcome: BP changes. Participants (n = 395 intervention - 207 control - 188) had a mean age of 66.7 years 51.1% were males. The proportion of adherent participants increased in both groups but was not significantly different between groups [57·2% to 63·6% (control) vs. 60·0% to 73·5% (intervention), P = 0·23]. The mean reduction in systolic BP was significantly greater in the intervention group (10·0 mmHg vs. 4·6 mmHg P = 0·05). The proportion of patients who were non-adherent at baseline and adherent at 6 months was 22·6% (95%CI 5·1-40·0%) higher in the intervention group (61·8% vs. 39·2%, P = 0·007). Among participants with baseline BP above target, reduction of systolic BP was significantly greater in the intervention group [by 7·2 mmHg (95%CI 1·6-12·8 mmHg) (P = 0·01)]. Among participants non-adherent at baseline and above target BP, the proportion reporting adherence at 6 months was significantly greater in the intervention group [56·8% vs. 35·9%, P = 0·039). This community pharmacist intervention resulted in improved adherence to antihypertensive medication and reduced systolic BP.
Publisher: Oxford University Press (OUP)
Date: 07-06-2010
Abstract: To develop and validate an assessment tool, based on the 'Royal College of General Practitioners' (RCGP) Video Assessment Tool', for assessment of pharmacist prescribers' consultation skills. Competency areas of the RCGP tool were left unchanged but performance criteria for each were modified to reflect pharmacist prescribing. Each criterion and the overall consultation were rated from 1 (poor) to 5 (excellent). A purposive s le of 10 experienced prescribing pharmacists was selected. Each pharmacist identified, recruited and consented two patients. Video recordings of consultations were assessed independently by two randomly assigned GPs, experienced in the use of the RCGP tool, using the newly developed scale. Inter-rater reliability was assessed. Construct validity was assessed by comparing the assessor score with a patient satisfaction score. Spearman's rho was used to test the correlation between the two scores. The RCGP tool was modified to give the 'Pharmacist Consultation Assessment Tool' (PharmaCAT). The median overall PharmaCAT consultation rating was 3. There was good agreement between the two assessors for total scores (intraclass correlation coefficient=0.694). Fourteen (78%) patient satisfaction questionnaires were returned most (n=13, 93%) agreed/strongly agreed that they were entirely satisfied with the consultation. Correlations between average total scores on PharmaCAT and the patient satisfaction questionnaire were weak (Spearman's rho=0.142 and 0.242 for both assessors). The PharmaCAT has been tested in the pharmacist prescriber setting. The tool had discriminatory power across different domains and inter-rater reliability. The PharmaCAT has potential to be used as a formative and/or summative assessment tool.
Publisher: Springer Science and Business Media LLC
Date: 23-10-2007
DOI: 10.1007/S11096-007-9172-5
Abstract: To explore the views and experiences of pharmacists and their mentoring designated medical practitioners (DMPs) about the 'period of learning in practice' (PLP) as part of supplementary prescribing (SP) training. Two focus groups (n = 5 and 7) of SP pharmacists were organised in Scotland. The experiences and views of DMPs (n = 13) were explored using one-to-one telephone interviews. The focus groups and interviews were transcribed verbatim and analysed using the framework approach. Views and experiences of pharmacists and DMPs about the PLP. Planning the PLP in consultation with the DMP was found to be crucial for an optimal learning experience. Pharmacists who did not have a close working relationship with the medical team had difficulties in identifying a DMP and organising their PLP. Participants stressed the importance of focusing on and achieving the core competencies for prescribers during the PLP. Input from doctors involved in the training of others, review of consultation videos, and formal independent assessment including clinical assessment at the end of the PLP might improve the quality of the PLP. Forums for discussing experiences during the PLP and gathering information might be valuable. Our findings have implications for prescribing training for pharmacists in the future. The PLP should focus on core competencies with input from doctors involved in the training of others and have a formal assessment of consultation skills. Support for pharmacists in organising the PLP and forums for discussing experiences during the PLP would be valuable.
Publisher: AMPCo
Date: 2018
DOI: 10.5694/MJA17.00664
Abstract: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers' experiences with and preferences for smoking cessation. Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. 1050 patients attended baseline interviews (February 2015 - April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1%) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation in 37% of cases COPD was not confirmed, and no definitive result was obtained for 9.8% of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6% of participants without prior diagnosis 95% CI, 15.1-20.5%). 690 participants (65.7%) were current smokers, of whom 360 had attempted quitting during the previous 12 months 286 (81.0% of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%) were the most frequently employed pharmacological treatments side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17%) e-cigarettes were tried by 38 (11%). 187 current smokers (27.6%) would consider using e-cigarettes in future attempts to quit. COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. Australian New Zealand Clinical Trials Registry ACTRN12614001155684.
Publisher: Oxford University Press (OUP)
Date: 03-2007
Abstract: Objective To investigate the challenges experienced by pharmacists in delivering supplementary prescribing (SP) services, to explore their perceptions of benefits of SP and to obtain feedback on both SP training and implementation. Method A postal questionnaire focusing on prescribing training, early experiences of prescribing and general demographics was sent in September to November 2005 to all SP pharmacists (n = 488) in Great Britain after excluding a pilot s le (n = 30). The biggest benefits and challenges of SP, and reasons for not practising SP, were identified. Responses to a general open question were content analysed for major themes. Key findings A total of 401 responses (82.2%) was received 195 (48.6%) had started practising SP of which 154 (79%) had written at least one prescription. This paper focuses primarily on perceived benefits and challenges to the implementation of SP, and the responses to the open question. Better patient management (n = 58 29.7%) was identified as the main benefit of SP and inadequate funding (n = 27 13.8%) as the biggest challenge in delivering SP service. The main reasons for not commencing SP were: no organisational recognition of SP (n = 37 18%) lack of funding (n = 33 16%) non-availability of prescription pads (n = 22 10.7%), and change of jobs (n = 18 8.7%). The comments to the open question (n = 145 36.2%) were regarding: SP training perceived benefits of SP and barriers to SP. Respondents highlighted the need for greater emphasis on clinical skills development as part of the SP course. Conclusion Despite optimism among SP pharmacists, the need for support in terms of infrastructure and integration into the healthcare team has been identified. Our findings also inform the need for modifications in the structure, content and delivery of the prescribing course for pharmacists. Greater publicity of pharmacists' roles in medication management, support from the medical profession and healthcare organisations, and high standards by early practitioners are warranted for the success of SP by pharmacists.
Publisher: Hindawi Limited
Date: 26-02-2013
DOI: 10.1111/JCPT.12017
Abstract: Pharmacists frequently see patients with asthma in the community who have suboptimal management. This study aimed to compare the uptake and effectiveness of pharmacist-initiated mailed and face-to-face interventions for patients whose asthma may not be well managed. Seventy-one community pharmacies in South Australia, Tasmania and Victoria (Australia) installed a software application that data-mined dispensing records, generating a list of patients who had received six or more asthma reliever inhalers in the preceding 12 months. The pharmacists were randomized, by pharmacy, to perform either a mailed or face-to-face intervention, whereby these patients received educational material and a referral to their general practitioner (GP) for an asthma management review. Matching patients from each pharmacy were also randomly assigned to a control group for 'usual care'. A total of 1483 patients were identified and grouped as follows: 510 (34·4%) mailed intervention, 480 (32·4%) face-to-face intervention and 493 (33·2%) controls. Significantly fewer face-to-face interventions were offered than mailed interventions (66·6% vs. 89·4%, respectively χ(2) = 64·2, P < 0·0001). There were significant improvements in the preventer-to-reliever ratio after the intervention period (P < 0·0001) in each group. In a per-protocol analysis, the magnitude of improvement in the face-to-face intervention group was greater than in the mailed intervention group. The reverse was true in an intention-to-treat analysis. The improvement in the P : R ratios was mainly due to significant decreases in reliever usage. Community pharmacy dispensing records can effectively identify patients with suboptimal asthma management, who can then be referred to their GP for review. Time constraints in busy pharmacies may limit the uptake and effectiveness of face-to-face interventions in the 'real world' setting, making mailed interventions an attractive option.
Publisher: BMJ
Date: 09-2017
DOI: 10.1136/BMJOPEN-2017-016985
Abstract: Up to half of all smokers develop clinically significant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence-based guidelines for managing COPD in primary care. We describe the methodology of a cluster randomised controlled trial (cRCT) evaluating the efficacy and cost-effectiveness of an interdisciplinary model of care aimed at reducing the burden of smoking and COPD in Australian primary care settings. A cRCT is being undertaken to evaluate an interdisciplinary model of care (RADICALS — Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers). General practice clinics across Melbourne, Australia, are identified and randomised to the intervention group (RADICALS) or usual care. Patients who are current or ex-smokers, of at least 10 pack years, including those with an existing diagnosis of COPD, are being recruited to identify 280 participants with a spirometry-confirmed diagnosis of COPD. Handheld lung function devices are being used to facilitate case-finding. RADICALS includes in idualised smoking cessation support, home-based pulmonary rehabilitation and home medicines review. Patients at control group sites receive usual care and Quitline referral, as appropriate. Follow-ups occur at 6 and 12 months from baseline to assess changes in quality of life, abstinence rates, health resource utilisation, symptom severity and lung function. The primary outcome is change in St George’s Respiratory Questionnaire score of patients with COPD at 6 months from baseline. This project has been approved by the Monash University Human Research Ethics Committee and La Trobe University Human Ethics Committee (CF14/1018 – 2014000433). Results of the study will be disseminated in peer-reviewed journals and research conferences. If the intervention is successful, the RADICALS programme could potentially be integrated into general practices across Australia and sustained over time. ACTRN12614001155684 Pre-results.
Publisher: Wiley
Date: 10-02-2017
Publisher: Wiley
Date: 05-09-2012
Publisher: Oxford University Press (OUP)
Date: 10-03-2014
DOI: 10.1111/IJPP.12105
Publisher: Springer Science and Business Media LLC
Date: 19-03-2014
Publisher: Wiley
Date: 13-01-2016
DOI: 10.1111/ADD.13239
Abstract: To evaluate the effectiveness of a pharmacist-led multi-component smoking cessation programme (GIVE UP FOR GOOD) compared with usual care in hospitalized smokers. Randomized, assessor-blinded, parallel-group trial. Three tertiary public hospitals in Australia. A total of 600 adult in-patient smokers [mean ± standard deviation (SD), age 51 ± 14 years 64% male] available for 12 months follow-up. Multi-component hospital pharmacist-led behavioural counselling and/or pharmacotherapy provided during hospital stay, on discharge and 1 month post-discharge, with further support involving community health professionals (n = 300). Usual care comprised routine care provided by hospitals (n = 300). Two primary end-points were tested using intention-to-treat analysis: carbon monoxide (CO)-validated 1-month sustained abstinence at 6-month follow-up and verified 6-month sustained abstinence at 12-month follow-up. Smoking status and pharmacotherapy usage were assessed at baseline, discharge, 1, 6 and 12 months. Sustained abstinence rates for intervention and control groups were not significantly different at both 6 months [11.6% (34 of 294) versus 12.6% (37 of 294) odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.55-1.50] and 12 months [11.6% (34 of 292) versus 11.2% (33 of 294) OR = 1.04, 95% CI = 0.63-1.73]. Secondary end-points, self-reported continuous abstinence at 6 and 12 months, also agreed with the primary end-points. Use of pharmacotherapy was higher in the intervention group, both during hospital stay [52.3% (157 of 300) versus 42.7% (128 of 300) P = 0.016] and after discharge [59.6% (174 of 292) versus 43.5% (128 of 294) P < 0.001]. A pharmacist-led multi-component smoking cessation intervention provided during hospital stay did not improve sustained abstinence rates at either 6 or 12 months compared with routine hospital care.
Publisher: Springer Science and Business Media LLC
Date: 21-05-2013
Abstract: Intensive smoking cessation interventions initiated during hospitalisation are effective, but currently not widely available. Strategies are needed to integrate smoking cessation treatment into routine inpatient care. Pharmacist-led interventions for smoking cessation are feasible and efficacious in both ambulatory and community pharmacy settings. However, there is a lack of evidence from large scale studies of the effectiveness of pharmacist guided programs initiated during patient hospitalisation in achieving long-term abstinence. This study aims to evaluate the effectiveness of a pharmacist-led system change intervention initiated during hospitalisation in Australian public hospitals. A multi-centre, randomised controlled trial will be conducted with 12 months follow-up. Smokers, 18 years or older, will be recruited from the wards of three Victorian public hospitals. Participants will be randomly assigned to a usual care or intervention group using a computer generated randomisation list. The intervention group will receive at least three smoking cessation support sessions by a trained pharmacist: the first during the hospital stay, the second on or immediately after discharge and the third within one month post-discharge. All smoking cessation medications will be provided free of charge during the hospital stay and for at least one week after discharge. Participants randomised to usual care will receive the current care routinely provided by the hospital. All measurements at baseline, discharge, one, six and 12 months will be performed by a blinded Research Assistant. The primary outcome measures are carbon monoxide validated 7-day point prevalence abstinence at six and 12 months. This is the first large scale study to develop and test a pharmacist-led system change intervention program initiated during patient hospitalisation. If successful, the program could be considered for wider implementation across other hospitals. ACTRN12612000368831
Publisher: SAGE Publications
Date: 12-2006
DOI: 10.1345/APH.1H355
Abstract: Data on medication utilization among residents of sheltered housing complexes (SHCs) are limited. To evaluate the extent of nonadherence to prescribed medications among residents of SHCs and identify factors associated with nonadherence. A 58 item, pre-piloted questionnaire with validated items for patient self-assessment of medication risk adherence disability health beliefs, experiences, and behavior and general items on demographics, health, and medication use was mailed to 1137 SHC residents in Aberdeen, Scotland. Predictors of nonadherence (Morisky score ) were identified using logistic regression. Of the 695 (61.1%) respondents, 645 (mean ± SD age, 78.2 ± 7.8 y) reported using prescribed drugs. Nonadherence was reported by 176 of 627 (28.1%) residents. The predictors of nonadherence were: disagreeing with the statement, “I ensure I have enough medicines so that I don't run out” (OR 0.48 95% CI 0.30 to 0.77), agreeing with the statements, “I make changes in the recommended management to suit my lifestyle” (OR 1.32 95% CI 1.09 to 1.60) and “I get confused about my medicines” (OR 1.39 95% CI 1.10 to 1.77), younger age (OR 0.96 95% CI 0.94 to 0.99), not getting help from someone to use the medications correctly (OR 2.20 95% CI 1.21 to 3.99), and agreeing with the statement, “I am concerned about the side effects from my medicines” (OR 1.31 95% CI 1.05 to 1.63). Over one-quarter of SHC residents were found to be nonadherent to prescribed drugs. Risk factors for nonadherence include younger age, confusion about drugs, lack of support for drug supply and administration, interference of treatment recommendations with lifestyle, and a perceived view of risks outweighing benefits in using recommended drug therapy.
Publisher: MDPI AG
Date: 08-11-2017
Publisher: Springer Science and Business Media LLC
Date: 03-11-2011
Abstract: Poorly controlled asthma can lead to maternal and fetal complications. Despite the known risks of poorly controlled asthma during pregnancy and the need for stepping up therapy when appropriate, there are concerns that management is suboptimal in primary care. Our objective was to investigate the management of asthma during pregnancy by general practitioners providing shared maternity care. A pre-piloted, anonymous mail survey was sent to all general practitioners (n = 842) involved in shared maternity care at six maternity hospitals in Victoria, Australia. Respondents were asked about their perceived safety of in idual asthma medications during pregnancy. Approach to asthma management during pregnancy was further explored using scenarios of pregnant women with stable and deteriorating asthma and poor medication adherence. Inhaled corticosteroids (ICS) were perceived to be the safest and were the preferred preventive medication in first trimester (74.1%), whilst leukotriene receptor antagonists were the least preferred (2.9%). A quarter (25.8%) of respondents would stop or decrease patients' ICS doses during pregnancy, even when their asthma was well controlled by current therapy. In addition, 12.1% of respondents were not sure how to manage deteriorating asthma during pregnancy and opted to refer to another health professional. Almost half the respondents (48.9%) reported encountering medication nonadherence during pregnancy. A lack of confidence and/or knowledge among general practitioners in managing deteriorating asthma in pregnancy was observed despite a good understanding of the safety of asthma medications during pregnancy, compliance with evidence-based guidelines in the selection of preventive medications, and self reported good asthma knowledge.
Publisher: SAGE Publications
Date: 20-09-2018
Abstract: Background: Medication errors commonly occur when patients move from the community into hospital. Whereas medication reconciliation by pharmacists can detect errors, delays in undertaking this can increase the risk that patients receive incorrect admission medication regimens. Orthopedic patients are an at-risk group because they are often elderly and use multiple medications. Objective: To evaluate the prevalence and nature of medication errors when patients are admitted to an orthopedic unit where pharmacists routinely undertake postprescribing medication reconciliation. Methods: A 10-week retrospective observational study was conducted at a major metropolitan hospital in Australia. Medication records of orthopedic inpatients were evaluated to determine the number of prescribing and administration errors associated with patients’ preadmission medications and the number of related adverse events that occurred within 72 hours of admission. Results: Preadmission, 198 patients were taking at least 1 regular medication, of whom 176 (88.9%) experienced at least 1 medication error. The median number of errors per patient was 6 (interquartile range 3-10). Unintended omission of a preadmission medication was the most common prescribing error (87.4%). There were 17 adverse events involving 24 medications in 16 (8.1%) patients that were potentially related to medication errors 6 events were deemed moderate consequence (moderate injury or harm, increased length of stay, or cancelled/delayed treatment), and the remainder were minor. Conclusion and Relevance: Medication errors were common when orthopedic patients were admitted to hospital, despite postprescribing pharmacist medication reconciliation. Some of these errors led to patient harm. Interventions that ensure that medications are prescribed correctly at admission are required.
Publisher: Springer Science and Business Media LLC
Date: 04-06-2006
DOI: 10.1007/S11096-006-9018-6
Abstract: To investigate community pharmacists' awareness, views and attitudes relating to independent prescribing by community pharmacists and their perceptions of competence and training needs for the management of some common conditions. Community pharmacies in Scotland. A pre-piloted postal questionnaire was mailed to 500 randomly selected community pharmacies in Scotland for completion by the 'main pharmacist'. Scottish community pharmacists' awareness, views and attitudes towards independent prescribing by community pharmacists perceived competence and training needs in relation to diagnosis and treatment of conditions in four therapeutic areas perceptions about patient accessibility to medicines and safety of independent prescribing by community pharmacists and attitudes towards becoming an independent prescriber. The items regarding perceptions and attitudes were subjected to Principal Components Analysis (PCA) to identify the domains. Univariate analysis was performed on in idual items in the questionnaire against total scores on the identified domains significant variables in univariate analysis were further analysed in linear regression models. A response rate of 43.4% (217/500) was achieved. Despite expressing confidence in their abilities to become independent prescribers and feeling competent in diagnosing and treating those conditions listed in the questionnaire, clinical training prior to implementation of independent prescribing was regarded important by 211 (97.7%) respondents, while 191 (88.4%) regarded clinical training in drugs used for treating the conditions to be important. Gaining improved patient consultation skills and ability to communicate prescribing actions to GP practices were regarded to be important by 125 (57.9%) and 172 (80.0%), respectively. In PCA, three domains--confidence in independent prescribing, satisfaction with the current methods of supply, and requirements for the process of independent prescribing were identified. Practising more hours per week as a pharmacist (p = 0.01), supplementary prescribing training (p = 0.02), and involvement in Scottish Executive pharmaceutical care model schemes (p = 0.02), were found to be associated with greater 'confidence in independent prescribing'. High awareness of independent prescribing and perceived competence in diagnosing and selecting appropriate drugs for treating many common conditions were identified. Prescribing training with emphasis on evidence-based medicine, generic issues of prescribing and diagnostic and consultation skills is warranted before independent prescribing is undertaken by community pharmacists.
Publisher: SAGE Publications
Date: 05-05-2009
DOI: 10.1345/APH.1L609
Abstract: Nonmedical (ie, nonphysician) prescribing is a key development in the UK that has brought about many changes in prescribing policy and practice. Systematic research into the views of the general public toward such developments is limited. To determine the awareness of, views on, and attitudes of members of the Scottish general public toward nonmedical prescribing, with an emphasis on pharmacist prescribing. A questionnaire was mailed in November 2006 to a random s le of 5000 members of the general public in Scotland aged 18 and over, obtained from the UK electoral roll. The questionnaire contained items on awareness of nonmedical prescribing, levels of comfort with specific health professionals, and attitudes toward pharmacist prescribing. Response rate was 37.1%. More than half of the in iduals who responded were taking prescribed drugs. Nine hundred and seventy-eight (56.6%) were aware that trained health professionals could write prescriptions for medicines previously only prescribed by physicians. Awareness was associated with: increasing age (p 0.001), having a health professional in their immediate family (p 0.001), self-rated general health (p 0.005), and a higher education level (p 0.01). In logistic regression, all factors were retained as independent predictors of awareness (p 0.001). Comfort levels for nonmedical prescribing were highest for pharmacists (median 4, IQR 3–5 [1 = low, 5 = high]), closely followed by nurses, and lowest for radiographers (median 2, IQR 1–4) (p .001). While more than half of the respondents supported pharmacists having a prescribing role, fewer felt that pharmacists should prescribe the same range of drugs as physicians. There were concerns about lack of privacy in a pharmacy, despite acknowledging its enhanced convenience. Our results indicate that more than half of the respondents were aware of nonmedical prescribing. A higher proportion was more comfortable with prescribing by pharmacists and nurses than with other healthcare professionals. Several issues relating to aspects of clinical governance were highlighted, specifically education and data handling.
Publisher: Public Library of Science (PLoS)
Date: 19-09-2017
Publisher: Wiley
Date: 06-2017
DOI: 10.1111/JPC.13554
Abstract: The prevalence of asthma worldwide among older children varies between 10 and 20%. One of the most effective therapies to treat asthma and prevent exacerbations is inhaled corticosteroids (ICSs). Systemic corticosteroids are known to decrease bone mineral density and increase the risk of fractures among children, but little is known about the effect of ICSs on fracture risk in children with asthma. The aim of this study was to investigate the fracture rates in children with asthma using ICSs. A survey on fracture history and risk, bone health and asthma was administered by a researcher to children aged 6-18 years attending a tertiary care children's hospital in Melbourne, Australia over a 6-month period. Fracture risks were compared in children on low or high dose ICS with those not on any ICS and non-asthmatics. A total of 216 healthy control participants were compared with 211 children with asthma - 22% (n = 46) on low dose ICS therapy, 44% (n = 94) on high dose ICS and 34% (n = 71) not on any ICS. There was no difference in the incidence of fractures between children with asthma (24.6% n = 53) and healthy controls (24% n = 51) (χ ICS use was not associated with fracture risk in children with asthma.
Publisher: Hindawi Limited
Date: 04-01-2011
DOI: 10.1111/J.1365-2710.2009.01157.X
Abstract: Changes to medication regimens and failure to involve patients in management of their medications whilst in hospital may result in medication errors or non-adherence at home after discharge. Self-administration of medications programmes (SAMP) have been used to address this issue. The objective of this study was to assess the impact of a SAMP on elderly hospital inpatients' competence to manage medications and their medication adherence behaviours. The SAMP comprised three stages: education, progressing to supervised self-administration and finally to independent self-administration. Decisions to progress patients to the next level, and whether they passed or failed the SAMP, were made by the ward pharmacist and nursing staff. The Drug Regimen Unassisted Grading Scale (DRUGS) was used to assess patients' competence to manage medications at various time points. Tablet count and the Tool for Adherence Behaviour Screening (TABS) were used as adherence measures. Participants (n = 24) with a mean age of 77.4 years, were mainly female and generally had a high level of functioning. They were prescribed a mean of 9.0 medications at the time of commencing the SAMP. Twenty-two of the 24 participants successfully completed the SAMP. DRUGS scores at discharge improved significantly (P<0.001) compared with that before commencement of medication self-administration. Participants reported a significant decrease (P = 0.02) in non-adherent behaviour and a trend towards improved adherent behaviour (P=0.08) after participation in the SAMP. An inpatient SAMP improved elderly patients' ability to competently manage and adhere to their prescribed medications regimen. This finding needs to be confirmed in a larger controlled trial.
Publisher: Elsevier BV
Date: 11-2005
Abstract: To identify the predictors of medication adherence in patients with COPD and contrast the health beliefs, experiences, and behaviors of COPD patients self-reporting good adherence with those of patients reporting suboptimal adherence to their medications. Cross-sectional self-administered questionnaire. Ambulatory care. Patients with chronic respiratory ailments identified through respiratory support groups and from a pulmonary rehabilitation database. A 30-item questionnaire comprising items pertaining to health beliefs, experiences, and behaviors along with a valid self-reported measure of adherence-the medication adherence report scale (MARS)-was administered to 525 ambulatory patients with chronic lung conditions. A total of 276 usable responses were received (52.6%). The mean age of the respondents was 71 years, and there were slightly more male patients (54.4%). COPD was the underlying disease condition in 90.6% of the respondents two thirds of the respondents had comorbid conditions. The respiratory condition was managed by both general practitioners and respiratory specialists in 61.2% of cases. One third of the respondents self-reported complementary and alternative medicine use. The mean score (+/- SD) on the MARS among the respondents was 23.37 +/- 2.09. One hundred two patients self-reported perfect adherence on the MARS. Differences in knowledge about the illness and treatment, faith in and satisfaction with the treatment and doctors, concerns about the treatment, and intentional and unintentional deviations from the recommended treatment were detected between the adherent and less adherent groups. In multivariate analysis, "I vary my recommended management based on how I am feeling" and "I get confused about my medications" were found to be significant independent predictors of nonadherence. Patients' acceptance of the disease process and recommended treatment, knowledge about and faith in the treatment, effective patient-clinician interaction, and routinization of drug therapy are critical for optimal medication adherence in patients with COPD.
Publisher: Informa UK Limited
Date: 12-09-2016
DOI: 10.3109/02770903.2015.1080268
Abstract: Pregnancy alters the severity of asthma unpredictably. Uncertainty still exists about longitudinal changes in pulmonary function during pregnancy in both healthy and asthmatic women. This study aimed to compare pulmonary function changes during pregnancy in healthy and asthmatic women and to determine the relationship between pulmonary function and asthma-related quality of life during pregnancy. A secondary aim was to investigate the application of forced expiratory volume in 6 s (FEV6) for monitoring asthma during pregnancy. Pregnant women with (n = 20) and without asthma (n = 20) had pulmonary function tests at 8-20, 21-28 and 29-40 weeks gestation. Those with asthma also completed the Asthma Control Questionnaire (ACQ) and mini Asthma Quality of Life Questionnaire (mAQLQ) at each visit. Pulmonary function declined in both groups at follow-up #1 (more markedly in those with asthma) but then improved at follow-up #2 (more markedly in those with asthma). In those with asthma, ACQ scores increased, while mAQLQ scores declined at follow-up #1 whilst at follow-up #2 these changes were in the opposite direction. FEV6 and forced vital capacity (FVC) were highly correlated (r = 0.88, p < 0.01) in asthmatics. Pulmonary function changes during second and third trimesters were more pronounced in asthmatics than in healthy women. FEV6 monitoring may assist pregnant women and their health professionals in optimizing asthma management. The changes in pulmonary function in women with asthma were not significantly associated with changes in asthma control or asthma-related quality of life.
Publisher: Wiley
Date: 19-12-2016
DOI: 10.1111/JGS.14682
Abstract: To systematically review clinical outcomes associated with medication regimen complexity in older people. Systematic review of EMBASE, MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Hospitals, home, and long-term care. English-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants' overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff. Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization.
Publisher: Springer Science and Business Media LLC
Date: 22-05-2013
DOI: 10.1007/S11096-013-9792-X
Abstract: Under UK legislation, suitably qualified non-medical professionals can practise as prescribers. Few studies have explored the views of the general public towards non-medical prescribing. The aim was to explore the views of the Scottish general public on non-medical prescribing. General community in Scotland. A pre-piloted survey was mailed to a random s le of 5,000 members of the general public in Scotland. In addition to the items on awareness of and attitudes towards non-medical prescribing, respondents were asked to 'give any other comments, issues or concerns you have in relation to health professionals other than doctors prescribing.' Responses were subjected to content analysis. Key themes identified from content analysis. The overall questionnaire response rate was 37.1 % (n = 1,855) of which 27.2 % (n = 505) provided comments. Most were directly related to pharmacist prescribing (n = 312) while others referred to non-medical prescribers generically (n = 172) or other healthcare professionals (n = 79). Nine themes were identified: perception of knowledge and training support for a limited range of non-medical prescribing access to medical records motivation and convenience confidence, faith and trust privacy and confidentiality risks, controls and continuity of care supervision and conflict of interest communication and cooperation. The findings identify support for non-medical prescribing but indicate the need for non-medical prescribers to engage more with the general public. The comments also provide insight into the challenges for non-medical prescribers, as they strive to fulfil their extended healthcare roles.
Publisher: Springer Science and Business Media LLC
Date: 31-10-2011
Abstract: The majority of retirement village residents are at risk of medication misadventure. In a recent survey of retirement village residents in Victoria, two-thirds had at least one medication-related risk factor, and hence were eligible to receive a government-subsidised Home Medicines Review (HMR). However, only 6% of eligible residents had received a HMR in the previous 12 months. Reasons for the poor uptake of HMR, and interventions for improving HMR uptake, have been identified and developed with input from stakeholders. The trial will test the effect of P harmacist-conducted H MR to A ddress the R isk of M edication-related E vents in R etirement Villages (PHARMER) in improving the uptake of HMRs among retirement village residents. This is a multicentre prospective cluster randomised controlled trial. Ten retirement villages in Victoria, Australia will be recruited for this trial. Retirement villages will be selected in consultation with the Residents of Retirement Villages Victoria Inc. (RRVV), based on geographical locations (e.g. northeast or southwest), size and other factors. Residents from selected villages will be recruited with the help of RRVV Resident Liaison Officers using a range of strategies. Randomisation will be by geographical location to minimise contamination. Participating villages and residents will be allocated to either Pharmacist Intervention Group (PIG) or Usual Care Group (UCG). Each group will include five retirement villages and will have at least 77 residents in total. The intervention (PHARMER) comprises educating residents regarding HMR, and using a risk assessment checklist by residents to notify their General Practitioners of their medication risk. Uptake of HMR and medication adherence will be assessed in both PIG and UCG at three and six months using telephone interviews and questionnaires. This study is the first to develop and test an intervention to improve the uptake of HMR among Australian residents in retirement villages, with a view to decreasing medication risk. A multi-faceted interventional approach will be used as suggested by stakeholders. The trial is expected to be complete by late 2011 and results will be available in 2012. Australian New Zealand Clinical Trials Registry ( ACTRN12611000109909 )
Publisher: Informa UK Limited
Date: 21-06-2017
DOI: 10.1080/17476348.2017.1340836
Abstract: Tobacco remains the key modifiable risk factor for the development of a number of diseases, including cardiovascular disease, cerebrovascular disease, lower respiratory infections, chronic obstructive pulmonary disease, tuberculosis and cancer. Among priority populations, smoking prevalence remains high, smokers tend to relapse more often and earlier and fewer are able to sustain quit attempts. This systematic review provides an update on the literature. Areas covered: Twenty-four randomized controlled trials published from 2010-2017, in English language, were identified after searching on Medline, Ovid, Embase and PsycINFO databases. Studies reported on the effectiveness of smoking cessation interventions among six disadvantaged groups known to have high smoking rates: (i) homeless, (ii) prisoners, (iii) indigenous populations, (iv) at-risk youth, (v) people with low income, and (vi) those with a mental illness. Narrative review and assessment of methodological quality of included papers was undertaken. Expert commentary: There is a growing evidence base of methodologically robust studies evaluating a variety of behavioural smoking cessation interventions for priority populations. Multi-component interventions and those examining behavioural interventions incorporating mindfulness training, financial incentives, motivational interviewing and extended telephone-delivered counseling may be effective in the short-term, particularly for smokers on low incomes and people with a mental illness.
Publisher: AMPCo
Date: 04-2012
DOI: 10.5694/MJA12.10130
Publisher: Springer Science and Business Media LLC
Date: 04-07-2014
DOI: 10.1007/S40266-014-0194-0
Abstract: The aim of the study was to evaluate the impact of a drug use evaluation (DUE) program on osteoporosis management in general practice. A DUE program, led by pharmacists integrated into two general practice clinics in Melbourne, Australia, was undertaken as part of the Pharmacists in Practice Study. Data on use of anti-osteoporosis medicines and calcium and vitamin D supplements were collected at baseline and 12 months. Following the baseline audit, an intervention comprising prescriber feedback, group education and in idual case-conferences with prescribers, and patient education mail-outs was implemented. The primary outcome was the proportion of patients with a diagnosis of osteoporosis and without contraindications to anti-osteoporosis medicines who were prescribed an anti-osteoporosis medicine. Feedback from practice staff and pharmacists was explored qualitatively to evaluate the acceptability of the program. The proportion of patients without documented contraindications to osteoporosis therapies who were prescribed an anti-osteoporosis medicine increased significantly (134/227 [59.0 %] vs. 168/240 [70.0 %], p = 0.002). The proportion of patients for whom vitamin D and/or calcium supplement use was documented also increased significantly (145/227 [63.9 %] vs. 205/240 [85.4 %], p = 0.002). Practice staff and pharmacists were generally positive about the DUE program. A practice pharmacist-led DUE program improved the management of osteoporosis in general practice.
Publisher: Springer Science and Business Media LLC
Date: 31-07-2015
Publisher: SAGE Publications
Date: 28-06-2011
DOI: 10.1345/APH.1P764
Abstract: To review the safety of regular preventive asthma medications during pregnancy. The following databases were searched from inception to February 2011: Ovid MEDLINE, PubMed, Cochrane Library, EMBASE and CINAHL Plus. The search was limited to human studies published in the English language. Titles of all articles were screened for relevance. Abstracts of relevant articles were scrutinized to confirm relevance before obtaining full text. Selected articles were read by 2 authors and the accuracy of the data extracted was confirmed. Thirty-three articles were included in the final review. Small s le size, missing data, inadequate control for confounding factors, and poor documentation of dosage range were common limitations of the studies reviewed. The use of inhaled corticosteroids, cromolyns, and long-acting β 2 agonists during pregnancy was not associated with any particular adverse event, although the fluticasone/salmeterol combination has been associated with poor outcomes in postmarketing studies. Congenital malformations have been reported with leukotriene receptor antagonist exposure during pregnancy, but those women also had exposure to other medications, including oral corticosteroids. Some negative outcomes of preventive asthma medications have been reported, although their direct link with medication use is inconclusive. Selection of preventive medications for asthma management during pregnancy should be based on an assessment of the risks and benefits of medication use versus the risks of poorly controlled asthma.
Publisher: Wiley
Date: 07-2012
DOI: 10.5694/MJA12.10653
Publisher: Springer Science and Business Media LLC
Date: 29-11-2013
DOI: 10.1007/S11096-013-9877-6
Abstract: Measurement of adherence is complex and many methods, both direct and indirect are used there is no universal gold standard. In this article, we share our experiences in a randomised controlled study, the Hypertension Adherence Program in Pharmacy trial, evaluating a community pharmacy-based intervention for improving adherence to antihypertensive medication. Several objective and subjective measures of adherence (Morisky score, TABS score, MedsIndex, Medicines Possession Ratio) were used, but produced varying results, limiting confidence in the conclusions that could be drawn. Despite using a specifically designed data mining software program to identify potentially nonadherent patients from dispensing records, many participants were found to be adherent by the self reported Morisky scale. A lesson to be learned when targeting people for interventions to improve adherence is that information from dispensing records should be supplemented by other methods in order to identify patients most in need of assistance.
Publisher: Oxford University Press (OUP)
Date: 12-2007
Abstract: The aim of this research was to investigate in a national s le of pharmacists, who have not yet applied for a supplementary prescribing (SP) course, their planned participation in training, and attitudes towards pharmacist SP. Setting Great Britain. A postal questionnaire was sent to 4300 pharmacists (approximately 10% of all Great Britain registered pharmacists). The questionnaire had five sections: awareness of SP training perceptions of aspects of SP training actions taken relating to SP training based on ‘stage of change’ model attitudes towards implementing SP into practice and demographics. Within demographics, respondents were asked to denote themselves as innovators, early adopters, early majority, late majority and laggards, based on receptivity to change. Non-respondents were mailed up to two reminders. The response rate was 55.1% (2371/4300). Of the 1707 with patient contact but who had not commenced training, almost all (1668, 97.7%) were aware of pharmacist SP. A minority had taken any significant SP training action, with most being at the precontemplation/contemplation stage of change. However, most respondents either strongly agreed/agreed that practising SP would improve patient care, but strongly disagreed/disagreed that they had sufficient pharmacist/technical support. Two-hundred and forty-three (73.0%) of the ‘venturesome’ pharmacists (the innovators) and 291 (79.5%) of the ‘role models’ (the role models) had either never thought about training or had not yet explored training options further. Following logistic regression, predictors of prescribing training actions were: awareness of local networks for SP receptivity to change knowledge of colleagues who had undertaken or were currently undertaking SP training postgraduate qualifications intrinsic (professional) factors such as professional duty to become a prescriber and extrinsic (infrastructure) factors such as sufficient IT support. We have demonstrated that pharmacists are aware of SP courses and that certain factors are associated with actions relating to prescribing training. However, the practice setting(s) require(s) attention to ensure readiness to support such innovations in areas such as IT and administrative support. These issues have implications for education providers, the NHS and policy makers and the extension into independent prescribing. Issues based on receptivity to change and models of change require further investigation.
Publisher: Wiley
Date: 22-11-2016
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1016/J.PEC.2005.11.010
Abstract: To develop and validate a questionnaire to screen for potential nonadherence in patients with chronic ailments. Themes from qualitative interviews with chronic obstructive pulmonary disease patients were used in developing content of the questionnaire. The questionnaire was distributed to 525 ambulatory patients with chronic lung diseases. Principal components analysis was performed to identify the subscales in the questionnaire. Internal consistency, validity and stability of the subscales were also evaluated. The 30-item Beliefs and Behaviour Questionnaire (BBQ) measures beliefs, experiences and adherent behaviour on five-point Likert-type scales. Two hundred and eighty patients (53.3%) with a mean age of 71.1 years responded to the questionnaire. The 'beliefs' section had a two-factor solution-'confidence' and 'concerns' with internal consistencies of 0.82 and 0.45, respectively. The two domains identified from the section 'experiences'-satisfaction' and 'disappointment' had internal consistencies of 0.85 and 0.52, respectively. The 'behaviour' section, separately entitled the Tool for Adherence Behaviour Screening (TABS), had a two-factor solution--'adherence' and 'nonadherence', with internal consistencies of 0.80 and 0.59, respectively. All the domains demonstrated comparable reliabilities across two different patient populations. Their temporal stabilities ranged between 0.62 and 0.94. The validity, reliability and utility of the BBQ and the TABS, a sub-scale of the BBQ that screens both intentional and unintentional nonadherence to pharmacological and non-pharmacological disease management, have been established. The BBQ and the TABS have potential applications in screening adherence beliefs, experiences and behaviour in both clinical practice and research.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2017
DOI: 10.1097/BOT.0000000000000872
Abstract: This study investigates orthopaedic trauma patients smoking cessation history, intentions to quit, receipt of smoking cessation care during hospital admission, and patient-related factors associated with receipt of smoking cessation care. An online cross-sectional survey of orthopaedic trauma patients was conducted in 2 public hospitals in New South Wales, Australia. Prevalence of smoking and associated variables were described. Logistic regressions were used to examine whether patient characteristics were associated with receipt of smoking cessation care. Eight hundred nineteen patients (response rate 73%) participated. More than 1 in 5 patients (21.8%) were current smokers (n = 175). Of the current smokers, more than half (55.3%) indicated making a quit attempt in the last 12 months and the majority (77.6%) were interested in quitting. More than a third of smokers (37.4%) were not advised to quit 44.3% did not receive any form of nicotine replacement therapy and 24.1% reported that they did not receive any of these 3 forms of smoking cessation care during their admission. Provision of care was not related to patient characteristics. The prevalence of smoking among the s le was high. Respondents were interested in quitting however, the provision of care during admission was low. Smoking cessation interventions need to be developed to increase the provision of care and to promote quit attempts in this Australian population. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Publisher: Wiley
Date: 17-09-2023
DOI: 10.1002/HPJA.658
Abstract: Understanding smoking behaviors in hospital patients who smoke may improve inpatient cessation treatments. This study aimed to describe smoking‐related behaviors, past‐quit attempts, and self‐reported difficulties experienced in quitting among those who enrolled in a smoking cessation trial of varenicline. Baseline data were obtained from adult hospitalized smokers (average ≥ 10 cigarettes/day in 4‐weeks prior to hospitalization) who enrolled in a randomized, placebo‐controlled trial of varenicline ± nicotine lozenges at five Australian public hospitals. A logistic regression model tested the association between participant characteristics and quitting in the previous 12 months. Participants' (n = 320 57% male, 52.5 ± 12.1 years old) motivation and confidence in quitting were high. A total of 120 participants (37.5%) had attempted quitting in the previous 12‐months. Prior hospitalization ( P = .008) and employment status ( P = .015) were significantly associated with past quit attempts. No statistically significant differences were noted in the reason for hospitalization or the level of nicotine dependence between participants who attempted quitting in the previous 12 months and their counterparts. Smoking cessation pharmacotherapy was used by 55% of those attempting to quit nicotine replacement therapy (65.2%) and varenicline (16.7%) most common. Stress or anxiety, urges to smoke and a lack of motivation were the difficulties experienced in past quit attempts. Those who had a prior hospitalization and were unemployed had significantly greater odds of reporting past quit attempts. Further research is needed to investigate the degree of adherence among inpatient smokers with the smoke‐free hospital policies and the frequency of NRT provision and uptake on admission.
Publisher: BMJ
Date: 09-2013
Publisher: Informa UK Limited
Date: 02-08-2022
Publisher: Wiley
Date: 13-11-2013
DOI: 10.1111/AJO.12148
Abstract: Tobacco smoking is the most important preventable cause of many adverse pregnancy outcomes. Some women continue to smoke during pregnancy although the harmful effects are evident. To characterise pregnant smokers and to understand their smoking behaviours and preferences for smoking cessation. Pregnant women (≥18 years) attending the antenatal clinics of two large Victorian maternity hospitals completed a prepiloted questionnaire which included items regarding socio-demographics, smoking habits and attitudes towards quitting. Smoking status was self-reported by 1899 participants 125 (6.6%) were current smokers and 604 (31.8%) were ex-smokers. There were 87 (69.6%) daily smokers and 38 (30.4%) occasional smokers. Smokers mainly had medium (54 43.2%) or heavy nicotine dependence (45 36%). Current smokers were younger, Australian born, not living with a partner, from a lower socio-economic background, multigravida and had a smoker in their household or among friends. Although pregnant smokers were aware of the possible complications of smoking, their motivation and confidence to quit (median) on a 10-point scale were 7 and 4, respectively. The majority of smokers preferred to stop smoking gradually (74 71.2%). The preferred methods for quitting were medications (49 47.6%) and hypnotherapy (35 34.0%). Patches (28 29.5%) were the preferred dosage form, and nicotine replacement therapy (25 28.1%) was the preferred medication. Less than half reported that their health professionals discouraged smoking during pregnancy. Health professionals should be more proactive in identifying smokers and offering smoking cessation support in pregnancy. Multidisciplinary smoking cessation interventions for pregnant smokers are warranted.
Publisher: AMPCo
Date: 11-2017
DOI: 10.5694/MJA17.00686
Abstract: Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities. Advances in the management of COPD are updated quarterly in the national COPD guidelines, the COPD-X plan, published by Lung Foundation Australia in conjunction with the Thoracic Society of Australia and New Zealand and available at copdx.org.au. Main recommendations: Spirometry detects persistent airflow limitation (post-bronchodilator FEV1/FVC < 0.7) and must be used to confirm the diagnosis.Non-pharmacological and pharmacological therapies should be considered as they optimise function (ie, improve symptoms and quality of life) and prevent deterioration (ie, prevent exacerbations and reduce decline).Pulmonary rehabilitation and regular exercise are highly beneficial and should be provided to all symptomatic COPD patients.Short- and long-acting inhaled bronchodilators and, in more severe disease, anti-inflammatory agents (inhaled corticosteroids) should be considered in a stepwise approach.Given the wide range of inhaler devices available, inhaler technique and adherence should be checked regularly.Smoking cessation is essential, and influenza and pneumococcal vaccinations reduce the risk of exacerbations.A plan of care should be developed with the multidisciplinary team. COPD action plans reduce hospitalisations and are recommended as part of COPD self-management.Exacerbations should be managed promptly with bronchodilators, corticosteroids and antibiotics as appropriate to prevent hospital admission and delay COPD progression.Comorbidities of COPD require identification and appropriate management.Supportive, palliative and end-of-life care are beneficial for patients with advanced disease.Education of patients, carers and clinicians, and a strong partnership between primary and tertiary care, facilitate evidence-based management of COPD. Changes in management as result of the guideline: Spirometry remains the gold standard for diagnosing airflow obstruction and COPD. Non-pharmacological and pharmacological treatment should be used in a stepwise fashion to control symptoms and reduce exacerbation risk.
Publisher: Wiley
Date: 03-2011
DOI: 10.1111/J.1445-5994.2009.02133.X
Abstract: Information on the management of chronic obstructive pulmonary disease (COPD) in Australia, especially the extent of adherence to the COPD-X Plan, is sparse. To evaluate COPD patient adherence to treatment recommendations and healthcare provider adherence to the COPD-X Plan. Cross-sectional study of patients admitted to a secondary care hospital with an acute exacerbation of COPD over a 6-month period. Data were collected from patient interviews and medical notes. Participants (n= 45) aged 72 ± 11.5 years (mean ± SD) had a mean FEV(1) % predicted 52.2 ± 18.7. At the time 11 (24.4%) patients continued to smoke 25 (55.6%) had never participated in a pulmonary rehabilitation programme and 23 (51.1%) self-reported poor adherence to some COPD medications. Inhaler technique was deemed suboptimal in 25 (55.6%) patients. Only 11 (24.4%) patients had received any instructions from their doctor regarding management of exacerbations. The use of medications not supported by the COPD-X guidelines were: long-term prednisolone (11, 24.4%) and prophylactic antibiotics (3, 6.7%). Management of COPD in Australia by both patients and providers remains suboptimal despite the publication and wide dissemination of the COPD-X Plan, suggesting the need to intensify both patient and provider education in COPD management.
Publisher: Wiley
Date: 05-2012
DOI: 10.1111/J.1445-5994.2010.02287.X
Abstract: Many Australian hospitals have recently introduced smoke-free policies. The aim of this study was to determine the smoking habits of hospital inpatients and to investigate the scope for an inpatient smoking cessation programme. A cross-sectional survey of adult inpatients of a tertiary-referral hospital who were smoking just before admission. The questionnaire contained items on general demographics, views on quitting, past quit attempts and validated scales - Fagerström test of nicotine dependence, Biener's contemplation ladder and Velicer's smoking decisional balance. Participants' (n= 125) median age was 53 years and had smoked for 35.0 ± 17.2 years. The majority were male (n= 84 67.2%) and 45 (36.3%) lived with someone who smoked. Participants self-reported 4.5 ± 7.3 past attempts to quit. Only 61 (49.6%) said that their health professionals ever discussed options to assist quitting. Forty-nine (39.2%) reported accessing smoking areas during their hospital stay. Participants scored 4.5 ± 2.5 on the Fagerström test. Forty-two (33.8%) ranked themselves very high (9 or 10) on the contemplation ladder. The mean difference between the Velicer's subscales -'cons' (α= 0.81) and 'pros' (α= 0.80) was 3.2 ± 10.6 in favour of quitting. Fifty-four (43.9%) participants were interested in starting smoking cessation therapy during their hospital stay. Nicotine patches (31 25.4%) were the preferred dosage forms to assist quitting followed by oral tablets (23 18.9%) and chewing gum (20 16.4%). Our findings could guide the design of inpatient smoking cessation interventions. Greater efforts from health professionals are essential for informing people about smoking cessation options, promoting their uptake, potentially resulting in higher quit rates.
Publisher: Oxford University Press (OUP)
Date: 13-01-2016
DOI: 10.1111/IJPP.12246
Publisher: Oxford University Press (OUP)
Date: 11-06-2014
DOI: 10.1111/IJPP.12047
Abstract: Pharmacists working collaboratively with general practitioners (GPs) in primary-care settings can improve patient outcomes however, there are challenges to the implementation of collaborative services. A possible solution is the co-location of pharmacists within general practice clinics. To elicit the views of GPs and pharmacists on the integration of pharmacists into general practice in Australia. Semi-structured, in idual interviews with a s le of 11 GPs and 16 pharmacists. Four major themes emerged: the current GP–pharmacist relationship the role of the general practice pharmacist the pros and cons of integration and the barriers to and facilitators for integration. Most participants had experienced positive inter-professional relationships, though there were limitations in the collaborative services currently provided. Various methods of integration were discussed, including the co-location of pharmacists within practices. The potential roles for practice pharmacists were deemed to be multifaceted and in some cases allowed for role expansion. Although these roles were thought to offer potential benefits to practice staff, patients and pharmacists, they were also perceived to be potentially disadvantageous. The integration of pharmacists into general practice was believed to be hindered by limited funding and infrastructure and by practitioner perceptions. Various facilitating factors were proposed that could help ensure viability of the role. Various roles and methods of integration were identified for pharmacists in general practice however, a number of barriers and facilitators to integration would need to be considered to ensure viability of services. Future research should explore different methods of collaboration and trial their implementation.
Publisher: Elsevier BV
Date: 05-2014
Abstract: Uncontrolled asthma during pregnancy is associated with maternal and perinatal hazards. A pharmacist-led intervention directed at improving maternal asthma control, involving multidisciplinary care, education, and regular monitoring to help reduce these risks, was developed and evaluated. A randomized controlled trial was carried out in the antenatal clinics of two major Australian maternity hospitals. Sixty pregnant women 20 weeks gestation who had used asthma medications in the previous year were recruited. Participants were randomized to either an intervention or a usual care group and followed prospectively throughout pregnancy. The primary outcome was Asthma Control Questionnaire (ACQ) score. Mean changes in ACQ scores from baseline were compared between groups at 3 and 6 months to evaluate intervention efficacy. The ACQ score in the intervention group (n = 29) decreased by a mean ± SD of 0.46 ± 1.05 at 3 months and 0.89 ± 0.98 at 6 months. The control group (n = 29) had a mean decrease of 0.15 ± 0.63 at 3 months and 0.18 ± 0.73 at 6 months. The difference between groups, adjusting for baseline, was -0.22 (95% CI, -0.54 to 0.10) at 3 months and -0.60 (95% CI, -0.85 to -0.36) at 6 months. The difference at 6 months was statistically significant (P .001) and clinically significant ( 0.5). No asthma-related oral corticosteroid use, hospital admissions, emergency visits, or days off from work were reported during the trial. A multidisciplinary model of care for asthma management involving education and regular monitoring could potentially improve maternal asthma outcomes and be widely implemented in clinical practice. Australian and New Zealand Clinical Trials Registry No.: ACTRN12612000681853 URL: www.anzctr.org.au.
Publisher: Wiley
Date: 06-12-2011
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.SAPHARM.2013.10.001
Abstract: Emergency departments (EDs) face increasing service demands and the imposition of treatment targets which has led to continual process redesign and changes in staff skill mix and functions. To identify extended ED pharmacist roles that could improve medication management and to implement and evaluate one such role change. A focus group of clinicians sought to redesign processes around ED medication management. Preparation of medication charts for patients admitted from ED was selected. Baseline data were obtained to define elements of existing medication charting processes. Suitably trained ED pharmacists' trialled the effectiveness of making therapeutic suggestions on a medication chart 'sticker' or by direct 'consultation' with medical staff. At the conclusion of the study focus groups at each site evaluated clinical staff perceptions of the change. Focus group participants thought that ED pharmacists could undertake extended roles in analgesia, nausea control, antibiotic cover, addiction management and preparation of medication charts for admitted patients. In the pre-intervention audit (n = 140), 74% required at least one intervention by the ward pharmacists to address medication discrepancies. Ward pharmacists detected 292 medication discrepancies (median 1, IQR 0-3). In the 'sticker' intervention the ED pharmacist made 84 therapeutic suggestions of which 66 (78.6%) were accepted by medical staff. In the 'consultation' intervention 230 therapeutic suggestions were made of which 219 (95.2%) were accepted. The qualitative evaluation found that pharmacist-prepared medication charts within the processes established were deemed safe, timely, accurate, complete and legible. Support exists for ED pharmacists to expand their medication-related roles. ED pharmacists can safely prepare medication charts in a timely fashion and their therapeutic suggestions within a 'consultative' framework are more beneficial than written advice. However, issues relating to resourcing, hours of service, service focus, statutory restrictions and training support for extended roles require resolution.
Publisher: SAGE Publications
Date: 06-2007
DOI: 10.1345/APH.1H650
Abstract: A period of learning in practice (PLP) is an integral part of supplementary prescribing training for pharmacists in Great Britain. During the PLP, a designated medical practitioner (DMP) supervises and supports the trainee to develop competence in prescribing. To evaluate the views and experiences of supplementary prescribing pharmacists and DMPs regarding the PLP and identify their perceived support needs during the PLP. Prepiloted questionnaires were mailed in September 2006 to all pharmacists who had started their supplementary prescribing training at The Robert Gordon University, Aberdeen, Scotland (n = 242) and their DMPs (n = 232). Nonrespondents were sent up to 2 reminders. Responses were analyzed using descriptive and comparative statistics responses to open questions were analyzed thematically. Responses were received from 186 (76.9%) pharmacists and 144 (62.1%) DMPs. Just over half of the pharmacists agreed/strongly agreed that they knew what was expected of them and their DMPs during the PLP, but less than half agreed/strongly agreed that it was important to communicate with pharmacist colleagues in the prescribing course. One hundred twelve (60.2%) pharmacists had their consultation skills reviewed by their DMPs during the PLP. Opportunities for professional development and teamwork were regarded as major positive experiences by both pharmacists and DMPs. Organizational, attitudinal, and time barriers were also reported. There was considerable interest among both pharmacists and DMPs for an Internet-based support network during the PLP. Information on the roles and responsibilities of pharmacists and DMPs during the PLP should be enhanced. The Internet could be a useful medium for communication during the PLP. Input from a multidisciplinary team of healthcare professionals and review of consultation videos could further enhance the PLP experience. Un período de aprendizaje en la práctica (PAP) es parte integral del adiestramiento de prescripción suplementaria (PS) para farmacéuticos en Gran Bretaña. Durante el PAP, un profesional médico designado (PMD) supervisa y ofrece apoyo a la persona que se adiestra para desarrollar la facultad de prescribir.
Publisher: European Respiratory Society (ERS)
Date: 20-02-2019
DOI: 10.1183/13993003.01530-2018
Abstract: We evaluated the effectiveness of an interdisciplinary, primary care-based model of care for chronic obstructive pulmonary disease (COPD). A cluster randomised controlled trial was conducted in 43 general practices in Australia. Adults with a history of smoking and/or COPD, aged ≥40 years with two or more clinic visits in the previous year were enrolled following spirometric confirmation of COPD. The model of care comprised smoking cessation support, home medicines review (HMR) and home-based pulmonary rehabilitation (HomeBase). Main outcomes included changes in St George's Respiratory Questionnaire (SGRQ) score, COPD Assessment Test (CAT), dyspnoea, smoking abstinence and lung function at 6 and 12 months. We identified 272 participants with COPD (157 intervention, 115 usual care) 49 (31%) out of 157 completed both HMR and HomeBase. Intention-to-treat analysis showed no statistically significant difference in change in SGRQ at 6 months (adjusted between-group difference 2.45 favouring intervention, 95% CI –0.89–5.79). Per protocol analyses showed clinically and statistically significant improvements in SGRQ in those receiving the full intervention compared to usual care (difference 5.22, 95% CI 0.19–10.25). No statistically significant differences were observed in change in CAT, dyspnoea, smoking abstinence or lung function. No significant evidence was found for the effectiveness of this interdisciplinary model of care for COPD in primary care over usual care. Low uptake was a limitation.
Publisher: SAGE Publications
Date: 04-2006
DOI: 10.1345/APH.1G204
Abstract: Medication lists offer an alternative source of data on comorbidities and disease burden. To develop and validate the Medication-Based Disease Burden Index (MDBI). A list of medications corresponding to the leading causes of global death was pilot tested and finalized by an expert panel. The resulting index was tested on drug regimens of patients at risk of medication misadventure. Criterion validity of the index was established against Charlson's index and Chronic Disease Score (CDS). Sensitivity, specificity, predictive validity, convergent and discriminant validity, and interrater and test–retest reliabilities of the index were also assessed. The MDBI consisting of specific medications for 20 chronic medical conditions and corresponding disability weightings was developed. The MDBI was tested on 317 patients with mean ± SD Charlson's index scores of 2.8 ± 2.2 and CDS scores of 7.3 ± 2.8. Mean MDBI scores (0.33 ± 0.28) demonstrated significant correlations with Charlson's index scores (r = 0.31 p 0.001) and CDS (r = 0.53 p 0.001). MDBI had satisfactory sensitivity and high specificity. Age of the patients and number of medications had significant correlation with the MDBI scores, but the MDBI scores were not significantly different in males and females. MDBI scores could successfully predict death and planned or unplanned readmissions (OR = 4.7, 95% CI 1.4 to 15.5 p = 0.01). MDBI demonstrated high inter-rater (intraclass correlation coefficient [ICC] = 0.99) and test–retest reliabilities (ICC = 0.98). Initial testing suggests that MDBI could offer an alternative low-cost and convenient method for quantifying disease burden and predicting health outcomes.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
DOI: 10.1186/1471-2458-12-1094
Abstract: Uncontrolled asthma during pregnancy is associated with the maternal hazards of disease exacerbation, and perinatal hazards including intrauterine growth restriction and preterm birth. Interventions directed at achieving better asthma control during pregnancy should be considered a high priority in order to optimise both maternal and perinatal outcomes. Poor compliance with prescribed asthma medications during pregnancy and suboptimal prescribing patterns to pregnant women have both been shown to be contributing factors that jeopardise asthma control. The aim is to design and evaluate an intervention involving multidisciplinary care for women experiencing asthma in pregnancy. A pilot single-blinded parallel-group randomized controlled trial testing a Multidisciplinary Approach to Management of Maternal Asthma (MAMMA©) which involves education and regular monitoring. Pregnant women with asthma will be recruited from antenatal clinics in Victoria, Australia. Recruited participants, stratified by disease severity, will be allocated to the intervention or the usual care group in a 1:1 ratio. Both groups will be followed prospectively throughout pregnancy and outcomes will be compared between groups at three and six months after recruitment to evaluate the effectiveness of this intervention. Outcome measures include Asthma Control Questionnaire (ACQ) scores, oral corticosteroid use, asthma exacerbations and asthma related hospital admissions, and days off work, preventer to reliever ratio, along with pregnancy and neonatal adverse events at delivery. The use of FEV 1 /FEV 6 will be also investigated during this trial as a marker for asthma control. If successful, this model of care could be widely implemented in clinical practice and justify more funding for support services and resources for these women. This intervention will also promote awareness of the risks of poorly controlled asthma and the need for a collaborative, multidisciplinary approach to asthma management during pregnancy. This is also the first study to investigate the use of FEV 1 /FEV 6 as a marker for asthma control during pregnancy. Australian New Zealand Clinical Trials Registry (ACTRN12612000681853)
Publisher: Springer Science and Business Media LLC
Date: 07-09-2010
Publisher: Wiley
Date: 31-03-2016
DOI: 10.1111/RESP.12773
Abstract: Poorly controlled asthma during pregnancy is hazardous for both mother and foetus. Better asthma control may be achieved if patients are involved in regular self-monitoring of symptoms and self-management according to a written asthma action plan. Telehealth applications to optimize asthma management and outcomes in pregnant women have not yet been evaluated. This study evaluated the efficacy of a telehealth programme supported by a handheld respiratory device in improving asthma control during pregnancy. Pregnant women with asthma (n = 72) from two antenatal clinics in Melbourne, Australia, were randomized to one of two groups: (i) intervention-involving a telehealth programme (management of asthma with supportive telehealth of respiratory function in pregnancy (MASTERY(©) )) supported by a handheld respiratory device and an Android smart phone application (Breathe-easy(©) ) and written asthma action plan or (ii) control-usual care. The primary outcome was change in asthma control at 3 and 6 months (prenatal). Secondary outcomes included changes in quality of life and lung function, and perinatal/neonatal outcomes. At baseline, participants' mean (± standard deviation) age was 31.4 ± 4.5 years and gestational age 16.7 ± 3.1 weeks. At 6 months, the MASTERY group had better asthma control (P = 0.02) and asthma-related quality of life (P = 0.002) compared with usual care. There were no significant differences between groups in lung function, unscheduled health-care visits, days off work/study, oral corticosteroid use, or perinatal outcomes. Differences between groups were not significant at 3 months. Telehealth interventions supporting self-management are feasible and could potentially improve asthma control and asthma-related quality of life during pregnancy.
Publisher: Wiley
Date: 07-02-2018
DOI: 10.1111/DAR.12661
Abstract: Nicotine replacement therapy (NRT) is recommended as a smoking cessation aid for hospitalised smokers. We examined factors associated with NRT use during hospitalisation and after discharge, and NRT uptake when systematically offered free of cost. A nested analysis was conducted using data from a clinical trial that evaluated the effectiveness of a pharmacist-led smoking cessation intervention in 600 hospitalised smokers. NRT was used at least once by 285 (48%) participants during hospitalisation and by 287 (48%) participants during the 12 months post-discharge. Heavy smokers and those who expressed interest in using NRT for their next quit attempt at baseline interview were more likely to use NRT during hospitalisation [odds ratio (OR) 1.94, 95% confidence interval (CI) 1.38, 2.74 OR 2.09, 95% CI 1.48, 2.95] and after discharge (OR 1.70, 95% CI 1.20, 2.41 OR 1.97, 95% CI 1.39, 2.79). Those using six or more medications were more likely to use NRT during hospitalisation (OR 1.65, 95% CI 1.05, 2.61). Post-discharge NRT users were more likely to have been initially admitted for a respiratory or cardiac problem (OR 1.51, 95% CI 1.05, 2.18). When NRT was offered free of cost to a subset of patients (n = 300), 157 (52%) used NRT during hospitalisation. Nicotine dependence and interest in using NRT predicted its use (OR 2.26, 95% CI 1.38, 3.70 OR 2.58, 95% CI 1.58, 4.20). Targeting heavy smokers, those with cardio-respiratory conditions and those interested in using NRT regardless of regimen complexity could improve NRT uptake.
Publisher: European Respiratory Society (ERS)
Date: 18-02-2021
DOI: 10.1183/23120541.00934-2020
Abstract: “Treatable traits (TTs)” is a precision medicine approach for facilitating multidimensional assessment of every patient with chronic airway disease, in order to determine the core traits associated with disease outcomes where targeted treatments may be applied. To determine the prevalence of TTs in chronic obstructive pulmonary disease (COPD) and which traits predict future decline in lung function and quality of life (QoL). A 4-year longitudinal evaluation was conducted using data from 3726 participants in the English Longitudinal Study of Ageing (ELSA). TTs were identified based on published recommendations. Traits that predicted decline in lung function and QoL were analysed using generalised estimating equations. Overall, 21 TTs, including pulmonary (n=5), extra-pulmonary (n=13) and behavioural/lifestyle risk-factors (n=3) were identified. In multivariate analyses, the traits of chronic bronchitis (β −0.186, 95% CI −0.290 to −0.082), breathlessness (β −0.093, 95% CI −0.164 to −0.022), underweight (β −0.216, 95% CI −0.373 to −0.058), sarcopenia (β −0.162, 95% CI −0.262 to −0.061) and current smoking (β −0.228, 95% CI −0.304 to −0.153) predicted decline in forced expiratory volume in 1 s (FEV 1 ). Of the seven traits that predicted decline in QoL, depression (β −7.19, 95% CI −8.81 to −5.57) and poor family and social support (β −5.12, 95% CI −6.65 to −3.59) were the strongest. The core TTs of COPD associated with a decline in lung function and QoL were identified. Targeting these impactful traits with in idualised treatment using a precision medicine approach may improve outcomes in people with COPD.
Publisher: Oxford University Press (OUP)
Date: 09-06-2011
DOI: 10.1111/J.2042-7174.2011.00130.X
Abstract: To evaluate the views of patients across primary care settings in Great Britain who had experienced pharmacist prescribing. All Royal Pharmaceutical Society of Great Britain (RPSGB) prescribers (n = 1622) were invited to participate. Those consenting were asked to invite up to five consecutive patients who had experienced their prescribing to participate. Patients were mailed one questionnaire and a reminder. The questionnaire included five sections: demographics you and your pharmacist prescriber you and your general practitioner your views and experiences based on your most recent pharmacist prescriber consultation and additional views. Of the 482 (29.7%) pharmacists who responded, 92 (19.1%) were eligible to participate, of whom 49 (53.3%) consented. Of those excluded, 193 (49.5%) were prescribing in secondary care and 171 (43.8%) were not prescribing. Between September 2009 and March 2010, 143 patients were recruited. Patient response rate was 73.4% (n = 105/143). Consultation settings were largely general practice (85.7%) or community pharmacy (11.4%). Attitudes were overwhelmingly positive with the vast majority agreeing/strongly agreeing that they were totally satisfied with their consultation and confident that their pharmacist prescribed as safely as their general practitioner (GP). Pharmacists were considered approachable and thorough, and most would recommend consulting a pharmacist prescriber. A slightly smaller majority would prefer to consult their GP if they thought their condition was getting worse and a small minority felt that there had been insufficient privacy and time for all their queries to be answered. Patients were satisfied with, and confident in the skills of, pharmacist prescribers. However, the s le was small, may be biased and the findings lack generalisability.
Publisher: Wiley
Date: 11-07-2017
DOI: 10.1111/AJO.12499
Abstract: Hypertensive disorders are among the most common medical problems in pregnancy. Compliance with clinical practice guidelines has potential to translate to significant maternal and perinatal health benefits. To evaluate compliance with Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) clinical guidelines for management of hypertension during pregnancy. Inclusion criteria: women with hypertension in pregnancy who gave birth at a tertiary obstetric centre in 2010. Compliance with SOMANZ guidelines was assessed, as well as uptake of findings from the 'Induction of labour versus expectant monitoring for mild gestational hypertension re-ecl sia after 36 weeks' gestation' (HYPITAT) trial. Of 5624 women, 516 (9.2%) were identified with hypertension (49 chronic hypertension (CH) 457 gestational hypertension (GH) or pre-ecl sia (PE)). Thresholds to diagnose hypertension and initiate anti-hypertensive treatment were consistent with SOMANZ recommendations. Among women with CH, only 12.2% were prescribed aspirin prior to 16 weeks as PE prophylaxis. Of women with PE, 37 (18.6%) had known risk factors for development of PE at the initial visit yet only nine (24.3%) received aspirin. Of the 244 women who met HYPITAT inclusion criteria at 36 weeks, 174 (77.7%) were managed expectantly nine (5.2%) developed severe adverse outcomes. Current management guidelines for hypertension treatment were generally followed, although aspirin prophylaxis was frequently overlooked, resulting in up to 19 excess PE cases. Uptake of recommendations from the HYPITAT trial was low however, severe complications were fewer than expected. Overall, this suggests that clinicians appropriately weigh up the likely maternal risk compared to infant benefits of deferred delivery in each case, a key recommendation of HYPITAT-II.
Publisher: OMICS Publishing Group
Date: 06-2011
DOI: 10.4066/AMJ.2011.698
Publisher: SAGE Publications
Date: 25-05-2018
Abstract: Pharmacists have a key role to play in optimisation of medication regimens and promotion of medication safety. The role of specialist pharmacists as part of the multidisciplinary palliative care team, especially in the primary care setting, is not widely recognised. To explore the perspectives of stakeholders about the gaps in the current model of community palliative care services in relation to medication management and to assess their opinions pertaining to the role of a specialist palliative care pharmacist in addressing some of those gaps. Qualitative study utilising three focus groups involving 20 stakeholders. Thematic analysis was carried out using a framework approach and interpreted in the context of the Chronic Care Model for improving primary care for patients with chronic illness. Setting was a large regional Australian palliative care service. Participants included palliative care consumers and clinicians specifically patients, caregivers, physicians, nurses and pharmacists. Five major themes emerged from the focus groups: access to resources, medicines and information shared care challenges of polypharmacy informal caregiver needs and potential roles of a palliative care pharmacist. Gaps in access to medicines/resources, training for generalist practitioners, communication between treating teams and lack of support for patients and carers were cited as factors adversely impacting medication management in community-based palliative care. While community-based palliative care is an essential aspect of meeting the health care demands of an ageing society, the current model has several gaps and limitations. An appropriately qualified and skilled pharmacist within the palliative care team may help to address some of the gaps in relation to medication access and appropriateness.
Publisher: Oxford University Press (OUP)
Date: 09-07-2010
Abstract: information on medication use and risk factors among older people residing in retirement villages and their uptake of medication reviews are scant. to identify medication use issues and risk factors for medication-related problems among retirement village residents and to evaluate the uptake of government-subsidised Home Medicines Review (HMR) services in this population. cross-sectional, mail survey. retirement villages in Victoria, Australia. members of the Residents of Retirement Villages of Victoria residing in retirement villages (2,116, aged 54-100 years). a questionnaire was developed incorporating validated scales and items to measure medication risk, medication adherence, co-morbidity, disability, information on medication use, health and the uptake of HMR services. Questionnaires were mailed to participants for self-completion and returned using reply-paid envelopes. of the 2,116 respondents (70.7% response rate), 2,006 (94.8% 95% confidence interval (CI) 93.9-95.7%) reported using prescribed medications. Three or more health conditions were present in 993 (46.9% 95% CI 44.8-49.0%) respondents. Five or more regular medications were used by 988 (46.7% 95% CI 44.6-48.8%) respondents. Twelve or more tablets/capsules per day were used by 229 (10.8% 95% CI 9.5-12.1%) respondents. The use of narrow therapeutic index medications was reported by 264 (12.5% 95% CI 11.1-13.9%) respondents. Changes to medication regimens in the previous 3 months were reported by 356 (16.8% 95% CI 15.2-18.4%) respondents. One or more medication-related risk factors were seen in 1,374 (64.9% 95% CI 62.9-66.9%) respondents. Of these at-risk residents, 76 (5.5% 95% CI 4.5-6.5%) reported receiving an HMR in the previous 12 months, who were older (P < 0.001), were using more medicines (P < 0.001) and had greater disability (P = 0.002). reasons for the low uptake of medication reviews in retirement village residents despite the high prevalence of medication risk require further investigation.
Publisher: Wiley
Date: 31-10-2006
Publisher: BMJ
Date: 03-2016
Publisher: MDPI AG
Date: 28-07-2017
Publisher: Oxford University Press (OUP)
Date: 14-10-2015
DOI: 10.1093/HER/CYV050
Abstract: Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists for behavioural components of a complex educational intervention for CVD prevention. After receiving training to improve lifestyle and medicines adherence, pharmacists recruited 70 patients aged 50-74 years without established CVD, and taking antihypertensive or lipid lowering therapy. Patients received five counselling sessions, each at monthly intervals. Researchers assessed biomedical and behavioural risk factors at baseline and six months. Pharmacists documented key outcomes from counselling after each session. Most patients (86%) reported suboptimal cardiovascular diets, 41% reported suboptimal medicines adherence, and 39% were physically inactive. Of those advised to complete the intervention, 85% attended all five sessions. Pharmacists achieved patient agreement with most recommended goals for behaviour change, and overwhelmingly translated goals into practical behavioural strategies. Barriers to changing behaviours were regularly documented, and pharmacists reported most behavioural strategies as having had some success. Meaningful improvements to health behaviours were observed post-intervention. Findings support further exploration of pharmacists' potential roles for delivering interventions with complex behaviour change requirements.
Publisher: Wiley
Date: 09-06-2023
DOI: 10.1111/JGS.18452
Abstract: Diagnosis of dementia may change peoples' goals of care. In people with diabetes, this may lead to relaxing treatment targets and reducing the use of diabetes medications. The aim of this study was to examine changes in diabetes medication use before and after initiating medication for dementia. A national cohort of people aged 65–97 years, living with dementia and diabetes, and a general population cohort with diabetes matched for age, sex, and index date were extracted from the Australian national medication claims database. Trajectories of diabetes medication use, expressed as mean defined daily dose (DDD) each month for each in idual from 24 months before to 24 months after the index date, were estimated using group‐based trajectory modeling (GBTM). Cohorts were analyzed separately. People with dementia ( N = 1884) and the matched general population ( N = 7067) had a median age of 80 years (interquartile range 76–84) and 55% were female. In both models, people exhibited one of five diabetes medication trajectories, with 16.5% of people with dementia and 24.0% of the general population assigned to trajectories that represented deintensification. In the general population model, those on deintensifying trajectories were older than those on stable trajectories (median 83 vs. 79 years). In the dementia cohort model, those on high or low deintensifying trajectories were slightly older (median age 81 or 82, respectively, vs. 80 years) and had at least 1 more comorbidity (median 8 or 7, respectively, vs. 6) than those on stable trajectories. Initiating medication for dementia does not appear to be a trigger for deintensification of diabetes treatment regimens. Deintensification was more common in the general population people living with dementia are potentially overtreated for diabetes.
Publisher: Springer Science and Business Media LLC
Date: 14-12-2011
DOI: 10.1007/S00228-011-1181-6
Abstract: Despite the increased use of complementary and alternative medicine (CAM) by breast cancer patients, there is little published information regarding CAM use in the Scottish breast cancer population. A questionnaire comprising five sections--demographics perceived health status, prescribed medicines use, indications, satisfaction and expenditure on CAMs attitudes towards and factors associated with CAM use and attitudinal statements--was issued to patients attending the Aberdeen Breast Clinic. A total of 453 questionnaires were distributed and 360 (79.5%) returned. Respondents were prescribed a mean of 3.2 medicines (95% CI 2.83-3.47). With regard to CAM use, 33.1% of respondents reported current use, 36.4% prior use, and 30.6% reported never having used CAMs. The key indications for use were general well being, boosting immune system and cancer prophylaxis, with high levels of satisfaction reported. The strongest association for CAM use was use by friends and family and higher educational attainment (p < 0.001). Supplements with estrogenic activity, such as soya or red clover, were taken by 29% of respondents. Herbs (echinacea, pomegranate, peppermint, chamomile, grapefruit, garlic, ginseng) that have the potential to interact with adjuvant endocrine therapies (tamoxifen, anastrazole, letrozole, exemestane) were being taken by 38% of treated patients. The level of CAM use by Scottish breast cancer patients is similar to that reported from other countries, although there are marked differences in the type, nature and frequency of specific CAM therapies. Higher patient education level and use by family and friends were significantly associated with CAM use. The high level of use of potentially disease modifying or interacting herb supplements may be of concern.
Publisher: Oxford University Press (OUP)
Date: 17-02-2012
DOI: 10.1111/J.2042-7174.2012.00189.X
Abstract: To explore stakeholder perspectives on a government-subsidised Home Medicines Review (HMR) service and factors affecting the uptake of HMRs for older residents of retirement villages in Australia. Thirty-two in-depth interviews and four focus groups were undertaken with a purposive s le of 32 residents of retirement villages, 10 pharmacists, nine general practitioners (GPs) and a general practice nurse. Data were transcribed verbatim and analysed using the framework approach. Three major themes were identified: participants' perceptions of the HMR service, barriers to the uptake of HMRs and strategies for increasing the uptake of HMR. Residents had positive, negative or mixed perceptions, whereas health professionals were generally positive about the benefits of the service. Barriers to the uptake of HMRs were related to GPs, pharmacists, patients and the healthcare system. A strategy recommended by multiple stakeholders for increasing the uptake of HMRs was to use a multi-faceted intervention targeting residents and their health professionals. Multiple barriers to the uptake of HMRs and multiple strategies for increasing the uptake of HMRs were identified. These findings could inform the design of interventions to improve uptake of HMRs by residents and health professionals, in turn leading to better medicine use and safety.
Publisher: JMIR Publications Inc.
Date: 30-05-2017
DOI: 10.2196/MENTAL.7435
Abstract: eHealth presents opportunities to provide population groups with accessible health interventions, although knowledge about Internet access, peoples’ interest in using the Internet for health, and users’ characteristics are required prior to eHealth program development. This study surveyed hospital patients to examine rates of Internet use, interest in using the Internet for health, and respondent characteristics related to Internet use and interest in using the Internet for health. For patients who smoke, preferences for types of smoking cessation programs for use at home and while in hospital were also examined. An online cross-sectional survey was used to survey 819 orthopedic trauma patients (response rate: 72.61%, 819/1128) from two public hospitals in New South Wales, Australia. Logistic regressions were used to examine associations between variables. A total of 72.7% (574/790) of respondents had at least weekly Internet access and more than half (56.6%, 357/631) reported interest in using the Internet for health. Odds of at least weekly Internet usage were higher if the in idual was born overseas (OR 2.21, 95% CI 1.27-3.82, P=.005), had a tertiary education (OR 3.75, 95% CI 2.41-5.84, P .001), or was a nonsmoker (OR 3.75, 95% CI 2.41-5.84, P .001). Interest in using the Internet for health increased with high school (OR 1.85, 95% CI 1.09-3.15, P=.02) or tertiary education (OR 2.48, 95% CI 1.66-3.70, P .001), and if household incomes were more than AUS $100,000 (OR 2.5, 95% CI 1.25-4.97, P=.009). Older in iduals were less interested in using the Internet for health (OR 0.98, 95% CI 0.97-0.99, P .001). Online interventions may be a potential tool for health care in this hospitalized population. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001147673 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366829& isReview=true (Archived by WebCite at qg26u3En)
Publisher: BMJ
Date: 17-04-2015
Publisher: SAGE Publications
Date: 10-2006
DOI: 10.1345/APH.1H227
Abstract: Pharmacists in Great Britain can undertake supplementary prescribing (SP) after training at a higher education institution and completing a “period of learning in practice” in accordance with the Royal Pharmaceutical Society of Great Britain (RPSGB) curriculum. To explore SP pharmacists' early experiences of prescribing and their perceptions of the prescribing course. A questionnaire was mailed to all RPSGB prescribers (N = 518, on June 1, 2005 30 used in pilot questionnaire). Predictors of pharmacists starting to practice SP were identified in univariate analysis, and significant variables were further tested in multivariate analysis. The respondents (n = 401 82.2%) were mainly female (270 67.3%), had more than 20 years' experience as a pharmacist (123 30.7%), worked in hospital settings (160 39.9%), and focused on cardiovascular conditions (143 35.7%) during their period of learning in practice. The median course satisfaction score, on a scale of 3 to 15 (lowest to highest), was 10. Practicing SP was self-reported by 195 (48.6%) respondents, 154 (79%) of whom had written a prescription. Ninety (58.4%) of the first prescriptions were written in primary care settings. Better patient management was regarded as the major benefit by 139 (71.3%) of those engaged in SP, while funding issues were identified by 71 (36.4%) as major barriers in implementing the practice. Lack of organizational recognition of SP was the main reason given (37 18%) for those not commencing the practice. Independent predictors of those practicing SP included a longer time since registering as prescriber (p 0.001) confidence of pharmacists in their prescribing abilities (p 0.001) practicing in a setting other than community pharmacy (p = 0.001) and training in cardiovascular conditions or multiple conditions during the period of learning in practice (p = 0.005). Pharmacists have made progress in implementing SP, which is perceived by pharmacist prescribers as beneficial for both patients and themselves. Pharmacists need more support in terms of infrastructure and integration into the healthcare team to overcome some of the barriers to implementing SP.
Publisher: American Thoracic Society
Date: 03-2012
Publisher: Wiley
Date: 11-06-2022
DOI: 10.1111/ADD.15949
Abstract: In Australia, patterns of use of smoking cessation medications and factors associated with their dispensing are currently not known. This study aimed to measure the demographic and clinical factors associated with varenicline dispensing compared with nicotine replacement therapy (NRT) and bupropion among first‐time users of Pharmaceutical Benefits Scheme (PBS) subsidised smoking cessation medicines in Australia and to characterise those who discontinued varenicline treatment prematurely. Retrospective, population‐based study. Logistic regression was used to identify factors associated with varenicline dispensing compared with NRT and bupropion. Sensitivity analyses estimated the proportion of in iduals who completed the recommended 12 weeks of varenicline treatment. First‐time users of PBS subsidised smoking cessation medicines in Australia. In iduals first dispensed a smoking cessation medicine between 2011 and 2019 were identified from a 10% random s le of the national dispensing claims data. The outcome for the regression analysis was the dispensing of varenicline compared with NRT and bupropion. The dispensing of a smoking cessation medicine was identified using the World Health Organization Anatomical Therapeutic Chemical Classification System and PBS item codes. Independent variables included demographic and clinical characteristics such as sex, age, concessional status, year of treatment initiation and comorbidities identified using the Rx‐Risk index. The proportion of people who discontinued varenicline treatment after the initiation pack was determined using prescription refill data. A total of 94 532 people had their first PBS subsidised smoking cessation medicine. Of these, 62 367 (66.0%) were dispensed varenicline, 29 949 (31.7%) NRT and 2216 (2.3%) bupropion. The odds of varenicline dispensing were higher in males (OR, 1.18 95% CI, 1.14–1.21), but lower in older adults (0.86 [0.82–0.90] in above 30 years to 0.49 [0.47–0.52] in 61 years and above), among concession beneficiaries (0.44 0.43–0.46), and those with congestive heart failure (0.60 0.53–0.68), depression (0.61 0.54–0.69), anxiety (0.70 0.66–0.73), psychotic illness (0.39 0.37–0.42), and chronic obstructive pulmonary disease (0.87 0.82–0.92). The majority (37 670 60.4%) of those dispensed varenicline discontinued treatment after the initiation pack. Anxiety and psychotic illnesses were significantly more prevalent in those who discontinued treatment. Only 2804 (4.5%) of those dispensed varenicline completed 12 weeks of treatment. In iduals dispensed varenicline in Australia appear to be healthier compared with those who are dispensed nicotine replacement therapy or bupropion.
Publisher: Oxford University Press (OUP)
Date: 23-04-2010
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2008
End Date: 2011
Funder: Department of Health
View Funded ActivityStart Date: 2008
End Date: 2011
Funder: Department of Health
View Funded ActivityStart Date: 2011
End Date: 2013
Funder: Pfizer Australia
View Funded ActivityStart Date: 2008
End Date: 2011
Funder: Department of Health
View Funded ActivityStart Date: 2011
End Date: 2014
Funder: Australian Research Council
View Funded ActivityStart Date: 2014
End Date: 2018
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2014
End Date: 2017
Funder: National Health and Medical Research Council
View Funded Activity