ORCID Profile
0000-0002-0149-444X
Current Organisation
Aalborg University
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Publisher: Springer Science and Business Media LLC
Date: 19-08-2014
DOI: 10.1007/S11096-014-9993-Y
Abstract: Adherence to evidence based medicines in patients who have experienced a myocardial infarction remains low. In idual's beliefs towards their medicines are a strong predictor of adherence and may influence other factors that impact on adherence. To investigate if community pharmacists discussing patients' beliefs about their medicines improved medication adherence at 12 months post myocardial infarction. This study included 200 patients discharged from a public teaching hospital in Queensland, Australia, following a myocardial infarction. Patients were randomised into intervention (n = 100) and control groups (n = 100) and followed for 12 months. All patients were interviewed between 5 to 6 weeks, at 6 and 12 months post discharge by the researcher using the repertory grid technique. This technique was used to elicit the patient's in idualised beliefs about their medicines for their myocardial infarction. In the intervention group, patients' beliefs about their medicines were communicated by the researcher to their community pharmacist. The pharmacist used this information to tailor their discussion with the patient about their medication beliefs at designated time points (3 and 6 months post discharge). The control group was provided with usual care. The difference in non-adherence measured using a medication possession ratio between the intervention and control groups at 12 months post myocardial infarction. There were 137 patients remaining in the study (intervention group n = 72, control group n = 65) at 12 months. In the intervention group 29 % (n = 20) of patients were non-adherent compared to 25 % (n = 16) of patients in control group. Discussing patients' beliefs about their medicines for their myocardial infarction did not improve medication adherence. Further research on patients beliefs should focus on targeting non-adherent patients whose reasons for their non-adherence is driven by their medication beliefs.
Publisher: Informa UK Limited
Date: 19-02-2013
DOI: 10.3109/13561820.2013.769093
Abstract: Interprofessional education (IPE) programs aim to improve collaboration between health- and social-care professionals and to optimize clinical outcomes. Such programs are complex to design, and evaluation of effectiveness is difficult. Combining qualitative and quantitative data may provide greater understanding of how a program affects participants and what aspects are influential on attitudes and behavior. This qualitative study used semi-structured interviews and interpretative phenomenological analysis to explore undergraduate student perspectives on what attributes of a 4-week IPE program they considered contributed to a successful learning experience. Due to the fact that the students were not formally assessed, the realistic context of the activities and the quality of the facilitators created an environment where the students felt empowered to interact freely without fear of reproach. Learning the roles of other professions and their contribution to a healthcare team broadened the students' perspectives on healthcare and increased their sense of self-worth and pride in their professions. In addition, being able to identify the relevance of the learning experience to their future practice motivated the students. This information can be used to create optimal learning environments for facilitating the development of successful future healthcare teams.
Publisher: Wiley
Date: 03-2002
Publisher: Wiley
Date: 09-2002
Publisher: Wiley
Date: 09-2009
DOI: 10.1002/J.2055-2335.2009.TB00453.X
Abstract: Statin use has been associated with muscle toxicity and clinically significant muscle symptoms. To investigate if high‐dose statin users have a greater incidence of myalgia than low‐to‐moderate dose statin users. A questionnaire‐based interview of participants at a hospital and community pharmacy in Brisbane. Data were gathered on the history of statin use, presence of myalgia, analgesic use and self‐reported adherence. Participants were excluded if they had a chronic degenerative musculoskeletal condition, such as rheumatoid arthritis or osteoarthritis. 192 participants were included in the study – 65 (34%) in the low‐to‐moderate dose group and 127 (66%) in the high‐dose group. Excluding participants with a pre‐existing painful condition (n = 72), myalgia was reported by 24 (37%) patients in the low‐to‐moderate dose group and 42 (33%) in the high‐dose group (p = 0.22). 8 (12%) patients in the low‐to‐moderate dose group used analgesics compared to 24 (19%) in the high‐dose group (p = 0.34). Adherence in both groups was the same when assessed using the Morisky scale. There was no significant difference in myalgia between the high and low‐to‐moderate dose statin groups. The incidence of myalgia in statin users was higher than reported in previous studies.
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.PEC.2015.11.004
Abstract: This meta-analysis investigated whether beliefs in the necessity and concerns of medicine and the necessity-concerns differential are correlated with medication adherence on a population level and in different conditions. An electronic search of Web of Science, EMBASE, PubMed and CINAHL was conducted for manuscripts utilising the Beliefs about Medicines Questionnaire and comparing it to any measure of medication adherence. Studies were pooled using the random-effects model to produce a mean overall effect size correlation. Studies were stratified for condition, adherence measure, power and study design. Ninety-four papers were included in the meta-analysis. The overall effect size(r) for necessity, concerns, and necessity-concerns differential was 0.17, -0.18 and 0.24 respectively and these were all significant (p<0.0001). Effect size for necessity was stronger in asthma and weaker in the cardiovascular group compared to the overall effect size. Necessity and concerns beliefs and the necessity-concerns differential were correlated with medication adherence on a population level and across the majority of included conditions. The effect sizes were mostly small with a magnitude comparable to other predictors of adherence. This meta-analysis suggests that necessity and concern beliefs about medicines are one important factor to consider when understanding reasons for non-adherence.
Publisher: Wiley
Date: 16-12-2019
DOI: 10.1111/NEP.13214
Abstract: Immunosuppressant medication non-adherence can result in allograft rejection and loss. The aim of this study was to investigate the prevalence of non-adherence and barriers to adherence with immunosuppressant medications, in an adult renal transplant cohort. Kidney transplant recipients completed a self-report survey consisting of five validated questionnaires (Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS), Beliefs about Medicines Questionnaire, Immunosuppressant Therapy Barrier Scale, Brief-Illness Perception Questionnaire, and Multidimensional Health Locus of Control Scale), and provided sociodemographic information. Adherence was categorised according to BAASIS, with adherence barriers compared between the groups. One hundred and sixty-one patients in total completed the survey. Eighty-six participants (55%) were categorised as non-adherent, with 45% delaying doses, and 25% skipping doses. Non-adherent patients were more likely to forget doses (P = 0.005), and more likely to skip doses when their daily routine changed (P < 0.001) or when short of money (P = 0.03). Additionally, non-adherent patients had less self-reported understanding about their graft than adherent patients (P = 0.008). Adherence was not associated with a patient's medicine beliefs or perception of locus of control. Over half the patients self-reported non-adherence. The main modifiable barriers leading to non-adherence were forgetfulness and skipped doses. Personalised interventions focused on habit forming may improve adherence in this population.
Publisher: Baishideng Publishing Group Inc.
Date: 28-08-2008
Publisher: Springer Science and Business Media LLC
Date: 13-09-2016
Publisher: Wiley
Date: 12-2001
Publisher: Wiley
Date: 21-02-2014
DOI: 10.1111/BCP.12194
Publisher: Oxford University Press (OUP)
Date: 06-2012
DOI: 10.1111/J.2042-7174.2012.00213.X
Abstract: To describe the effect of integrating a pharmacist into the general practice team on the timeliness and completion of pharmacist-conducted medication reviews. A pharmacist was integrated into an Australian inner-city suburb general practice medical centre to provide medication reviews for practice patients. A retrospective analysis of medication reviews with two time periods was conducted: pre-integration of the practice pharmacist and post-integration of the practice pharmacist. In an effort to obtain a measure of external validity the data were compared to data from the Division of General Practice in which the medical centre is located. There were 70 patients referred for medication review in the pre-integration phase and 314 patients referred in the post-integration phase. The time to complete the medication review process was significantly reduced from a median of 56 days to 20 days with a practice pharmacist. Prior to having a practice pharmacist 52% of patients did not have the service billed by the general practitioner, which was reduced to 6% during the post-integration phase. The results from this trial show that the integration of a pharmacist into the general practice team was associated with an increase in the timeliness and completion rate of medication reviews.
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1016/J.CLINTHERA.2007.04.001
Abstract: The use of an NSAID by in iduals with heart failure increases the likelihood of exacerbating the problem. Patients with heart failure were interviewed using a standardized questionnaire to determine their perceptions of the risks involved with the use of an NSAID. Of the 28 patients interviewed, 2 had been advised to avoid a particular medicine, but could not remember which medicine. The use of an analgesic that could exacerbate their heart failure was regarded as high risk (score >5 on a scale of 1-10) by 22 (79%) of the patients. In this small s le, most patients with heart failure were not aware of the risks of using NSAIDs. However, based on their responses, most patients would avoid the use of NSAIDs once educated about the adverse effects that these drugs might have on their heart failure.
Publisher: Wiley
Date: 03-2002
Publisher: University of Otago Library
Date: 30-06-2022
Abstract: Introduction: The COVID-19 pandemic has necessitated the rapid transition of many face-to-face health services to alternate modes of service delivery. The objective of this study was to explore the benefits, challenges and perceived quality of a telehealth service delivery model from the perspective of clients and students. Further, students’ perceptions relating to the quality of the educational experience were also explored. Methods: The study was set in a student-led interprofessional health and wellness clinic in rural Queensland, Australia. A qualitative case study design was used, including semi-structured student interviews and client open-response survey data. Participants were nursing and allied health students who completed a student-led interprofessional clinic placement and adults with low to rising risk of chronic disease who attended the clinic for telehealth delivered services. Results: Themes identified following analysis included: new or adapted skills needed for success challenges, limitations and the need for resources, training and support quality interprofessional education experiences can be achieved in telehealth coming away with a new set of skills the important role of the client for success and benefits and disadvantages of telehealth for clients. Conclusions: The findings support that telehealth-based service-learning models are a feasible way to deliver health and wellness services from the perspective of students and clients and provide students with important skills for rural health service delivery.
Publisher: Informa UK Limited
Date: 06-02-2023
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.PEC.2018.10.010
Abstract: The aim was to better understand how beliefs influence medication adherence in asthma. All participants were prescribed an inhaled corticosteroid for a diagnosis of asthma. Each participant completed a survey consisting of: Beliefs about Medicines Questionnaire (BMQ), Brief-Illness Perception Questionnaire (B-IPQ) and Multi-dimensional Health Locus of Control Scale (MHLCS). Adherence to inhaled corticosteroids was elicited using the Medication Adherence Report Scale (MARS). Multiple linear regression with interaction effects was used to identify significant predictors of medication adherence and interactions between beliefs. A total of 198 participants completed the survey. The mean(±SD) MARS score was 19.2(±4.5). A multivariable model (adjusted R The findings of this study contribute to a better understanding of the role of beliefs in medication adherence in asthma. Certain beliefs meaningfully interrelate and change the relationship they have with medication adherence. If these beliefs are causally related to medication adherence and can be intervened upon, the findings are useful for providing targets to personalise adherence support.
Publisher: Springer Science and Business Media LLC
Date: 26-09-2013
DOI: 10.1007/S11096-012-9701-8
Abstract: There is a growing body of evidence which supports that a pharmacist conducted medication review increases the health outcomes for patients. A pharmacist integrated into a primary care medical centre may offer many potential advantages in conducting medication reviews in this setting however research describing this is presently limited. To compare medication review reports conducted by pharmacists practicing externally to a medical centre to those medication review reports conducted by an integrated practice pharmacist. The secondary objective was to compare medication review reports conducted by pharmacists in the patient's home to those conducted in the medical centre. A primary care medical centre, Brisbane, Australia. A retrospective analysis of pharmacist conducted medication reviews prior to and after the integration of a pharmacist into a medical centre. Types of drug related problems identified by the Pharma cists, recommended intervention for drug related problems made by the pharmacist, and the extent of implementation of pharmacist recommendations by the general practitioner. The primary drug related problem reported in the practice pharmacist phase was Additional therapy required as compared to Precautions in the external pharmacist phase. The practice pharmacist most frequently recommended to add drug with Additional monitoring recommended most often in the external pharmacists. During the practice pharmacist phase 71 % of recommendations were implemented and was significantly higher than the external pharmacist phase with 53 % of recommendations implemented (p < 0.0001). Two of the 23 drug related problem domains differed significantly when comparing medication reviews conducted in the patient's home to those conducted in the medical centre.
Publisher: Wiley
Date: 09-2015
DOI: 10.1002/JPPR.1121
Publisher: Informa UK Limited
Date: 26-07-2022
Publisher: Springer Science and Business Media LLC
Date: 09-10-2020
Publisher: Wiley
Date: 03-2012
Publisher: Springer Science and Business Media LLC
Date: 21-06-2012
DOI: 10.1007/S11096-012-9655-X
Abstract: To identify Heart Failure patients' beliefs towards their medications and how these beliefs relate to adherence. Patients attending a multi-disciplinary, community based heart failure clinic on the Gold Coast, Australia were interviewed using a questionnaire composed of fours parts: repertory grid technique Beliefs About Medicines Questionnaire (BMQ) Medicines Adherence Reporting Scale (MARS) demographic details. Patients were ided into those categorised as adherent (MARS score ≥ 23) and those categorised as non-adherent (MARS score < 23). Necessity beliefs scores from BMQ and the frequency of statements generated from the repertory grid portion of the questionnaire were compared between these two groups. Forty-three patients were interviewed with a mean age (±SD) of 64 (±17) years and thirty-six (83.7 %) were male. Thirty-seven (86.0 %) patients were categorised as adherent the remaining six (14.0 %) as non-adherent. The 43 patients generated a total of 262 statements about their medicines. The three most common themes identified were Related to fluid (36.6 %), Helps the heart (31.7 %) and Related to weight (13.7 %). There was a significantly higher median necessity score in the adherent group compared to the non adherent group (22.0 vs. 19.5, p = 0.0272). Patients with a strong necessity score also had significantly higher self reported adherence compared to patients with a strong concerns score (21.5 vs. 18.0, p = 0.006). This study suggests that patients with heart failure possessing a strong belief in the necessity of their treatment regimen are more likely to demonstrate better adherence.
Publisher: Wiley
Date: 22-02-2018
DOI: 10.1111/BCP.13514
Publisher: Wiley
Date: 30-03-2017
DOI: 10.1111/HEX.12558
Publisher: Wiley
Date: 05-06-2018
DOI: 10.1111/BCP.13633
Publisher: Wiley
Date: 09-2012
DOI: 10.1002/J.2055-2335.2012.TB00166.X
Abstract: Integrating pharmacists into general practice is not a novel concept. However, it is new to Australia and evidence supporting this role is limited. To seek the views of pharmacists, general practitioners and consumers on integrating pharmacists into general practice. Questionnaires were used to elicit the opinions of pharmacists, general practitioners and consumers on integrating pharmacists into general practice. 1038 participants (829 pharmacists, 167 consumers, 42 general practitioners) completed the survey. Commonly agreed roles for pharmacists in general practice included drug information and medication review. Perceived barriers to service provision included the pharmacist's clinical ability and turf protection. Remuneration was viewed as a facilitator and a barrier. Perceived facilitators included additional training for pharmacists and an existing rapport with the general practitioners. There was support for integrating pharmacists' professional activities into general practice. These findings will guide the development of a new model of integrated primary care with practice pharmacists.
Publisher: Elsevier BV
Date: 09-2017
Publisher: Wiley
Date: 06-2003
Publisher: Wiley
Date: 12-2005
DOI: 10.1002/J.2055-2335.2005.TB00362.X
Abstract: Re‐exposure to a drug to which one is allergic is a preventable adverse drug event. There is a reliance on the patient to provide accurate information on their allergies for the purpose of complete documentation. To investigate the relationship between patients' understanding of their drug allergy and documentation of their allergy status in their hospital records. A structured interview of inpatients identified whether they had a drug allergy. Patients were then assessed on their ability to distinguish the symptoms of an allergic reaction from those of an adverse effect and stratified into groups based on their level of understanding. Review of drug charts and medical records identified both the presence and quality of documentation. Of the 250 patients interviewed, 95 (38%) had previously experienced a true allergic reaction to a drug. A good understanding of the symptoms associated with an allergic reaction was demonstrated by 48 (51%). 50 (53%) patients had their allergy documented on their medication chart and 69 (73%) in their medical records. 18 (19%) patients had no documentation of their allergy status. There was a trend that good understanding of allergy may lead to improved completeness of documentation but this did not reach statistical significance. Patients' understanding of drug allergy improved the quality of documentation. System changes need to ensure proper training of staff to take and record drug allergies.
Publisher: Wiley
Date: 16-08-2020
DOI: 10.1111/JEP.13263
Abstract: The aim of this study was to investigate the feasibility of a structured patient-centred educational exchange to facilitate a shared conversation about stroke prevention medications. Participants (18 years or older) with a principal diagnosis of stroke or transient ischaemic attack were purposively s led from the stroke unit of a 780-bed teaching hospital in Australia and consented to participate in the study. A patient-centred educational exchange was conducted face to face at the bedside before discharge and by telephone post discharge. The structure of these sessions was adapted from academic detailing, an educational strategy, which includes identifying experience, listening to the needs of the audience, and tailoring messages to influence behaviour. To facilitate sharing of needs, three questionnaires, validated as research tools, were used to identify participants' experience, perceptions, and beliefs. The identified perceptions were used to personalize educational messages. The outcomes of the study were to provide descriptions of patients' perceptions necessities and concerns about their condition and medications, provide ex les of personalized responses to these, evaluate acceptability by patients, and determine the time taken to share the information. Sixteen participants completed both the bedside session (average duration 27 minutes) and the telephone follow-up (average duration 23 minutes). The strongest patient concern identified was having another stroke. Personalized responses included emphasizing long-term treatment in response to the perception that stroke will last for a short time, reinforcement of necessity for medications, and further exploration of concerns. The questionnaires engaged the participants, allowing them to share perceptions and beliefs, facilitating a patient-centred educational exchange in a timely manner.
Publisher: AMPCo
Date: 16-07-2018
DOI: 10.5694/MJA17.01017
Publisher: Wiley
Date: 31-10-2008
DOI: 10.1111/J.1440-1843.2007.01169.X
Abstract: COPD is a chronic illness with frequent episodic exacerbations that require admission to hospital. The aim of this study was to identify risk factors (or predictors) for hospital admission in a s le of rural COPD patients. COPD patients from the Goulburn and Crookwell areas of New South Wales, Australia, were included in the study. Patients were ided into two groups: those with two or fewer admissions, and those with three or more admissions in the last year. Patient interviews were conducted, and data were collected on demographics, consumption of health resources, COPD severity measures (BODE score) and quality of life. There were 32 patients recruited with a median age of 68 years, and 21 (65.6%) were male. There were no significant differences in risk factors (or predictors) identified between the two groups. A statistical difference was found between the two groups, with patients with three or more hospital admissions having a higher BODE score (P = 0.004), poorer quality-of-life score (P = 0.015) and reduced exercise tolerance (P = 0.001). In this small s le of COPD patients, there were no clear differences in terms of risk factors for COPD admission between the two groups. The BODE score was found to be a useful predictor of disease severity and likelihood of hospital admission.
Publisher: Springer Science and Business Media LLC
Date: 08-2012
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.SAPHARM.2018.11.003
Abstract: Medication harm is experienced by up to 30% of hospitalised patients, of which 7% experience severe harm. Pharmacist review can mitigate this harm. However, in increasingly busy hospitals, with high patient throughput, and scarce resources, there is a need to prioritise patients. Current methods are cumbersome, include many risk factors and are not evaluated in the clinical setting. To determine key criteria used by hospital pharmacists and investigate perspectives related to patient prioritisation for potential medication harm in the hospital setting. This study used two methods focus groups and a cross-sectional survey of Australian hospital pharmacists. Focus groups were used to identify criteria and perspectives related to prioritisation and were analysed thematically. Criteria from focus groups, and a systematic review, were used to design the survey. The survey was distributed via the Society of Hospital Pharmacists of Australia. The top 10 prioritisation criteria, and associated sub-criteria selected by over 50% of respondents were ranked. Combination of criteria used most frequently on a day-to-day basis were identified. Twenty clinical pharmacists participated in four, one-hour, audio recorded focus groups. Using inductive thematic analysis of transcripts three themes were identified 1) prioritisation criteria, 2) barriers to, and 3) facilitators of patient prioritisation, with five sub-themes and 26 codes. Pharmacists identified a number of barriers such as a lack of relevant handover information. Organisational demands, such as patient discharge and medications supply also influenced priority and could act as barriers to a pharmacist enacting their prioritisation plan. A total of 231 pharmacists completed the survey. High priority criteria included, renal impairment, use of high-risk medications and therapeutic drug monitoring. Pharmacists described prioritisation as a multifactorial process with a focus on high-risk medications and renal impairment. These findings will inform the development of a predictive risk score for patient prioritisation.
Publisher: BMJ
Date: 11-2016
Publisher: Springer Science and Business Media LLC
Date: 20-07-2017
Publisher: Springer Science and Business Media LLC
Date: 26-10-2014
Publisher: Wiley
Date: 08-2017
DOI: 10.1111/IMJ.13505
Abstract: Many patients with chronic disease do not possess the knowledge and skills required to access and interpret appropriate health information. A pilot study in people with liver cirrhosis (n = 50) identified that only 54% of patients could recall being given written information by a clinician and 64% had self-sought information, most commonly using the Internet. Many patients reported difficulties understanding the material and the majority wanted more accessible information. A pilot chronic disease educational booklet was well received by the study participants with 85% reporting it was helpful and 78% using it in between clinic appointments.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.SAPHARM.2015.10.007
Abstract: Medication counseling sessions are key times for a pharmacist to speak to patients about their medications and the changes made to their therapies during their hospital stay. To explore hospital pharmacists' perceptions of their roles and goals in patient medication counseling, and perceived barriers and facilitators to achieving their goals. Hospital pharmacist focus groups were held in two tertiary referral hospitals. Eligible pharmacists had provided medication counseling within the previous six months in inpatient and/or outpatient settings. Interested pharmacists attended a focus group designed to elicit their opinions and perceptions of patient medication counseling. Focus groups were audio recorded and transcribed verbatim. Inductive thematic analysis was applied to the data to identify initial patterns (codes) which were then organized into common overarching themes using NVivo(®) software. The codes were reviewed for reliability by pharmacists independent of the focus groups. Six, 1-h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was determined after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. A number of themes emerged from these codes around the goals, roles, and the barriers and facilitators to meeting these goals. Pharmacists' patient-centered goals in medication counseling were to build rapport, to empower patients and to improve patients' experience, health and safety. These goals would be accomplished through specific roles such as being an assessor, educator and problem-solver. Pharmacists frequently cited time pressures caused by systemic (hospital), and pharmacy specific processes as key challenges to achieving their goals. Factors that enabled pharmacists to meet their goals were those related to effective interprofessional collaboration and the quality of professional practice (such as training, expanded roles and advanced planning for discharge). Hospital pharmacists emphasized patient-centered goals in medication counseling and outlined the challenges to meet those goals. The findings from this study will be used to develop strategies for effective communication and inform pharmacy practice changes to improve patient care.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.SAPHARM.2015.10.008
Abstract: Medication counseling opportunities are key times for pharmacists to speak to patients about their medications and any changes made during their hospital stay. Communication Accommodation Theory (CAT) posits that an in idual's goals drive their communication behavior. The way in which pharmacists communicate with patients may be determined by the goals they set for these medication counseling sessions. To examine hospital pharmacists' goals in patient medication counseling within the CAT framework. Hospital pharmacist focus groups were held in two teaching hospitals. Interested pharmacists attended a focus group designed to elicit their goals in patient medication counseling. Focus groups were audio recorded and transcribed verbatim. NVivo(®) software was used to assist in coding and organization. The codes were reviewed for reliability by pharmacists independent of the focus groups. An inductive thematic analysis was applied to the data. Six 1 h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was achieved after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. Patient-centered themes constructed from these codes were to build rapport, to empower patients and to improve patients' experience, health and safety. Exemplars provided by pharmacists for the goals of building rapport and empowering patients were aligned with five CAT communication behaviors (approximation, interpretability, discourse management, emotional expression and interpersonal control). Patient-centered goals described by hospital pharmacists for medication counseling aligned well with CAT behaviors necessary for effective communication. Further research using the CAT framework to examine the effectiveness of hospital pharmacist-patient exchanges that include both participants' perspectives is required to better understand how well pharmacists communicate with patients.
Publisher: Hindawi Limited
Date: 10-2002
DOI: 10.1046/J.1365-2710.2002.00436.X
Abstract: To compare variability of blood glucose concentration in patients with type II diabetes with (cases) and without (controls) myocardial infarction. A secondary objective was identification of predictive factors for higher blood glucose on discharge from hospital. A retrospective matched case-control study. Medical notes of 101 type II diabetic patients admitted with a myocardial infarction (MI) and 101 type II diabetic patients (controls) matched on gender and age with no MI were reviewed. Blood glucose concentrations over two consecutive 48-h periods were collected. Demographic data and therapy on admission/discharge were also collected. Patient characteristics were comparable on recruitment excluding family history of cardiovascular disease (P=0.003), dyslipidaemia (P=0.004) and previous history of MI (P=0.007). Variability of blood glucose in cases was greater over the first 48 h compared with the second 48 h (P=0.03), and greater when compared with controls over the first 48 h (P=0.01). Cases with blood glucose on discharge >8.2 mmol / L (n=45) were less likely to have a history of previous MI (P=0.04), ischaemic heart disease (P=0.03) or hypertension (P=0.02). Type II diabetics with an MI have higher and more variable blood glucose concentrations during the first 48 h of admission. Only cardiovascular 'high risk' patients had target blood glucose set on discharge. The desirability of all MI patients with diabetes, having standardized-glucose infusions to reduce variability of blood glucose, should be evaluated in a randomized controlled trial.
Publisher: Springer Science and Business Media LLC
Date: 26-07-2005
Publisher: Public Library of Science (PLoS)
Date: 22-05-2018
Publisher: Springer Science and Business Media LLC
Date: 11-10-2018
DOI: 10.1007/S00228-018-2567-5
Abstract: The multiplicity in terms and definitions of medication-related harm has been a long-standing challenge for health researchers, clinicians, and regulatory bodies. The purpose of this narrative review was to report the ersity of terms compare definitions, classifications, and models describing medication harm and suggest which may be useful in both clinical practice and the research setting. A narrative review of key studies defining and/or classifying medication harm terminology was undertaken. This review found that numerous terms are used to describe medication harm, and that there is a lack of consistency in current definitions, classifications, and applications. This lack of consistency applied across clinical jurisdictions and regulatory terminologies. A number of limitations in current definitions and classifications were identified. These included the exclusion of key types of medication harm events, ambiguous wording, and a lack of clarity and consensus on subclassifications. In general, there was some overlap in key models from the literature and these were presented to describe similarities and differences. Without uniformity quantifying, comparing, combining, or extrapolating medication harm data, such as a rate of harm in a specific population, is a challenge for those involved in medication safety and pharmacovigilance. There is a pressing need for further discussion and international consensus on this topic. Adoption of standard descriptors by practitioner groups, regulatory and policy organisations would foster quality improvement and patient safety.
Publisher: Hindawi Limited
Date: 10-1986
DOI: 10.1111/J.1365-2710.1986.TB00861.X
Abstract: The in vivo concentration-time profiles of chlorhexidine and noxythiolin bladder irrigations were determined by utilizing high-performance liquid chromatography techniques following a once daily irrigation. A total of 14 chlorhexidine irrigations established a mean concentration of 0.006% w/v, 2-3 h post irrigation. A total of 12 noxythiolin irrigations established a mean concentration of 0.266% w/v, 2-3 h post irrigation, which correlated to a mean formaldehyde concentration of 0.0119% w/v at 2-3 h, as estimated from N-methylthiourea. For both solutions the minimum inhibitory concentration was exceeded for up to 5 h post irrigation, which is sufficient contact time to establish a total kill, thus indicating the possibility that a once daily irrigation may be appropriate in asymptomatic bacteriuria which utilizes either chlorhexidine or noxythiolin.
Publisher: Wiley
Date: 09-2004
Publisher: Wiley
Date: 03-2002
Publisher: Wiley
Date: 12-2014
DOI: 10.1002/JPPR.1027
Publisher: Springer Science and Business Media LLC
Date: 23-12-2007
DOI: 10.1007/S11096-006-9076-9
Abstract: To establish the range of medicine information sources used by consumers and their perception of the reliability of these, using the repertory grid technique. Consumers visiting three community pharmacies in Brisbane, Australia, were interviewed using the repertory grid technique. During the interview, consumers were asked to name up to three medicine information sources that they used for a supermarket medicine, an over-the-counter medicine and a prescription medicine. They were then presented with their named information sources in groups of three and asked to discriminate between these in terms of their perceived reliability of the information source. The descriptors used by the consumer to discriminate between the information sources are known as constructs and these were recorded. The consumer was then asked to rate each of their information sources against each generated construct. The range of information sources generated was determined along with the perceived reliability of these from the calculated median score of each information source when rated on each generated construct. A total of 110 consumers were interviewed and identified 648 information sources that they would use. The most frequent information sources cited by the 110 consumers were their doctor (83%), written information (90%) and the pharmacist (78%). There were a total of 299 constructs generated by 88 of the consumers and these were themed into 16 discrete categories. The most common generated constructs themes were "good knowledge" (15%), "training" (14%) and "trustworthiness" (13%). The consumer perception of their information sources were that the doctor and pharmacist have good knowledge (median score 1) and are trained (median score 1) and were perceived to be trustworthy (median score 3 and 2, respectively). The repertory grid technique was successful in identifying the information sources consumers accessed to find out about their medicines and in identifying the perception of these sources in terms of their reliability. The repertory grid technique offers a novel method for future research into consumer preferences for different treatment options.
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2018-022225
Abstract: National and international guidelines make recommendations for secondary prevention of stroke including the use of medications. A strategy which engages patients in a conversation to personalise evidence-based educational material (patient-centred educational exchange PCEE) may empower patients to better manage their medications. This protocol outlines a non-blinded randomised controlled trial. Consenting patients admitted with a diagnosis of stroke or transient ischaemic attack will be randomised 1:1 to receive either a PCEE composed of two sessions, one at the bedside before discharge and one by telephone at least 10 days after discharge from hospital in addition to usual care (intervention) or usual care alone (control). The primary aim of this study is to determine whether a PCEE improves adherence to antithrombotic, antihypertensive and lipid-lowering medications prescribed for secondary prevention of stroke over the 3 months after discharge, measured using prescription-refill data. Secondary aims include investigation of the impact of the PCEE on adherence over 12 months using prescription-refill data, self-reported medication taking behaviour, self-reported clinical outcomes (blood pressure, cholesterol, adverse medication events and readmission), quality of life, the cost utility of the intervention and changes in beliefs towards medicines and illness. Communication of the trial results will provide evidence to aid clinicians in conversations with patients about medication taking behaviour related to stroke prevention. The targeted audiences will be health practitioners and consumers interested in medication taking behaviour in chronic diseases and in particular those interested in secondary prevention of stroke. The trial has ethics approval from Metro South Human Research Ethics Committee (HREC/15/QPAH/531) and The University of Queensland Institutional Human Research Ethics (2015001612). ACTRN12615000888561 Pre-results.
Publisher: Wiley
Date: 09-2020
DOI: 10.1111/IMJ.14986
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-07-2019
DOI: 10.1002/HEP4.1398
Publisher: Informa UK Limited
Date: 02-2013
DOI: 10.2147/PPA.S40725
Publisher: BMJ
Date: 04-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-05-2022
DOI: 10.1002/HEP4.1999
Publisher: Hindawi Limited
Date: 16-12-2016
DOI: 10.1111/JCPT.12489
Abstract: The STOPP/START tool has been validated to assess elderly patients for potentially inappropriate prescribing. This study aimed to assess the effect of inclusion of a pharmacist on a physician-led ward round on potentially inappropriate prescribing in hospitalized elderly patients. This was an observational study of prescribing for patients using the STOPP/START tool at three points during hospital stay admission to hospital, on transfer to the specialized geriatric unit and on discharge from hospital. Data were collected over 4 months pre- and post-introduction of a pharmacist to a physician-led ward round. Demographic and clinical data, including total number of medications and STOPP/START criteria met, were collected. The mean number of STOPP/START criteria at each time-point was compared for pre- and post-introduction of a pharmacist using a Mann-Whitney U-test. The mean number of criteria for each time-point within each group was compared using a paired Student's t-test. The demographic characteristics of the participants in the pre- and post-intervention groups were similar. The post-intervention group had numerically less STOPP/START criteria, mean 1·18 (1·37) compared to the pre-intervention group 1·50 (1·41), P = 0·07 at discharge. The pre-intervention group had no significant change in the criteria from admission 1·78 (1·57) to geriatric unit transfer 1·72 (1·54) (P = 0·37) however, there was a significant decrease from geriatric unit transfer 1·72 (1·54) to discharge 1·50 (1·41) (P = 0·02). The post-intervention group had a significant decrease from hospital admission 2·30 (1·91) to geriatric unit transfer 1·59 (1·60) (P < 0·01) and again to discharge 1·18 (1·37) (P < 0·01). Pharmacist participation on the ward round in a specialized geriatric unit resulted in a numerical improvement in prescribing quality as measured by the STOPP/START tool.
Publisher: Hindawi Limited
Date: 10-2004
DOI: 10.1111/J.1365-2710.2004.00589.X
Abstract: Metformin is commonly prescribed to treat type 2 diabetes mellitus, however it is associated with the potentially lethal condition of lactic acidosis. Prescribing guidelines have been developed to minimize the risk of lactic acidosis development, although some suggest they are inappropriate and have created confusion amongst prescribers. The aim of this study was to investigate whether metformin dose was influenced by the presence of risk factors for lactic acidosis. The study was prospective, and retrieved information from patients admitted to hospital who were prescribed metformin at their time of admission. Eighty-three patients were included in the study, 60 of whom had a least one risk factor for lactic acidosis. Of those 60 patients, 78.3% had a dose adjustment, with renal impairment, hepatic impairment, surgery and use of radiological contrast media--the risk factors most likely to result in a dose adjustment. When dose adjustments did occur, metformin was withheld on 88.7% of occasions. Metformin dose was influenced by the presence of risk factors for lactic acidosis, although it was dependent upon the number and particular risk factor/s present.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Neil Cottrell.