Biomedical subjects

Bonnie L Svarstad

Publications and source records attributed to Bonnie L Svarstad.

6 recordsLinked to original sources

PubMed2002

Nurse-physician communication and quality of drug use in Swedish nursing homes.

The objective was to explore the impact of the quality of nurse-physician communication on the quality of psychotropic drug use in Swedish nursing homes, while controlling for resident mix and other nursing home characteristics. Data were collected from a sample of 36 Swedish nursing homes providing care for 1645 residents. Drug use data, along with residents' demographic characteristics, were obtained from residents' medication administration lists. Ward nurses reported other residents' characteristics (e.g. diagnosis and frequency of behavioral problems), and facility characteristics were obtained from head nurses. The quality of drug use was assessed and cross-sectional relationships among study variables were compared. Outcome measures included two drug use quality scores reflecting selection of drug and polymedicine. To assess behavioral problems, a list of the most commonly observed problems was created through a number of steps, including focus groups in the target population. Furthermore, a valid and reliable scale for assessing communication quality was developed. This measure was included in a survey administrated to nurses in the 36 facilities. There was a remarkable variation in the quality of drug use according to the two drug measures. As predicted, the quality of drug use was positively associated with the quality of nurse-physician communication and with regular multidisciplinary team discussions addressing drug therapy and negatively associated with prevalence of behavioral disturbances among residents. Facility size, level of staffing, resident's diagnostic mix, and demographic mix were unrelated to the two drug quality measures. Future efforts to improve the quality of drug use in long term facilities should consider ways of improving communication skills and communication routines among health care professionals.

Aged↗

PubMed2002

Using alternative methodologies for evaluating patient medication leaflets.

A variety of direct and indirect methods have been used to evaluate written medication information; however, no published research has validated assessment tools or presented direct consumer assessment of patient information leaflets (PILs) provided in US community pharmacy (CP). We report on two new instruments: the medication information design assessment scale (MIDAS), an indirect measure of design quality administered by the investigators, and the consumer information rating form (CIRF), a direct measure of comprehensibility, utility, and overall design quality applied by a consumer panel. These were used to assess two types of PILs: 36 CP-PILs obtained from community pharmacies and 3 Model-PILs incorporating recommended design characteristics. The validity of the MIDAS was demonstrated in two ways. First, as predicted, the Model-PILs were rated more positively by consumers. We also found a significant positive correlation between the number of design criteria incorporated in a CP-PIL (as measured by the MIDAS score) and the consumers rating of design quality (CIRF). In conclusion, we confirmed the importance of design characteristics in the production of written medication information and have also developed and validated two easy-to-use tools for the assessment of written medication information.

Drug Labeling↗

PubMed2002

Challenges to the use of nonpharmacologic interventions in nursing homes.

The Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987, stated that nursing homes should try nonpharmacologic interventions before resorting to pharmacologic agents when addressing problem behaviors among residents. Since that time, the use of pharmacologic agents has decreased, but there is little evidence to suggest that the use of nonpharmacologic interventions has increased. Psychosocial models describe problem behaviors as complex phenomena that require individualized strategies based on a resident's unique characteristics. Categories of intervention include social contact, behavior therapy, staff training, structured activities, environmental interventions, and a combination of therapies. This article discusses internal barriers to the use of nonpharmacologic interventions based on the Porras stream organization model: organizing arrangements, social factors, technology, and physical setting. Also, external barriers related to the regulatory, legal, and economic sectors are discussed. The authors offer recommendations for overcoming these barriers.

Aged↗

PubMed2002

Effects of residents' depression, sleep, and demand for medication on benzodiazepine use in nursing homes.

OBJECTIVE: This study sought to identify risk factors associated with the prescription and use of benzodiazepines in nursing homes and to assess the prevalence and determinants of demand for benzodiazepines among nursing home residents. METHODS: Data were available for 2,060 residents who had participated in a previous study of use of medications in 18 randomly selected nursing homes in Wisconsin between 1986 and 1989. Data sources included nursing home and pharmacy records; nurses' assessments of residents' behavior, pain, sleep, and demand for medication; and researchers' observations of resident requests for medication. Measures of benzodiazepine use included benzodiazepine prescriptions, prevalence and extent of as-needed drug use, and chronic use as defined by Health Care Financing Administration guidelines. RESULTS: A quarter of the residents received prescriptions for benzodiazepines. Of these, 71 percent received prescriptions to aid sleep or to be taken at bedtime; 32 percent used benzodiazepines for a longer period than recommended; and 26 percent requested medication. Logistic regression analysis showed that residents with depression, pain, or sleep problems were more likely to have received benzodiazepines and to have requested medication. Chronic use was significantly higher among residents with depression, sleep problems, or multiple benzodiazepine regimens and among those who requested medication. Demand and sleep problems also were associated with higher rates of any as-needed use and with higher numbers of as-needed doses used. CONCLUSIONS: Efforts to improve benzodiazepine use in nursing homes must address the need for better assessment and management of depression, sleep, pain, and residents' demand for these medications.

Aged↗

PubMedDate not supplied

Effects of pharmacist monitoring on patient satisfaction with antidepressant medication therapy.

OBJECTIVE: To examine the effects of pharmacist monitoring on patient satisfaction with and adherence to antidepressant medication therapy. DESIGN: In this prospective field study, we interviewed patients starting an antidepressant after a new prescription was dispensed and again 2 months later. The first interview assessed patients' characteristics, antidepressant medication history, knowledge of antidepresant medications and their use, and beliefs about antidepressant medications. The second interview focused on pharmacist monitoring behavior and satisfaction with the antidepressant medication. SETTING AND PARTICIPANTS: From 23 community pharmacies, we enrolled 100 patients, 59 of whom were taking an antidepressant for the first time. MAIN OUTCOME MEASURES: Patient satisfaction with and reported adherence to their antidepressant medication regimen. RESULTS: Pharmacist monitoring of patients' antidepressant medication use varied. More than 70% of patients reported that pharmacists asked about medication concerns; 53% and 54% of patients, respectively, said pharmacists encouraged their questions and listened to their concerns; and 32% found pharmacists helpful in solving problems related to the antidepressant. Fifty-seven percent of patients reported feeling better a lot of the time since taking the antidepressant, 40% said the antidepressant did not bother them, and 83% reported missing doses, adding doses, or stopping the antidepressant during the study period. Initial beliefs about antidepressants were a strong predictor of patient outcomes. Pharmacist monitoring was predictive of satisfaction and adherence for individuals taking an antidepressant for the first time. CONCLUSION: Pharmacists can play a critical role in monitoring medication concerns at the beginning of use, allowing for problem solving, reinforcement, and greater patient satisfaction with and adherence to medication therapy. Obstacles to effective pharmacist monitoring and follow-up need to be identified and addressed in future improvement efforts.

Adult↗

PubMedDate not supplied

Evaluation of written prescription information provided in community pharmacies: a study in eight states.

OBJECTIVES: To develop three tools for assessing the quality of written information provided with new prescriptions in community pharmacies and to identify pharmacy, pharmacist, and patient characteristics associated with the dissemination and quality of that information. DESIGN: Observational study. Regression techniques were used to analyze the influence of pharmacy, pharmacist, and shopper (acting as patient) characteristics on outcome measures. PARTICIPANTS: Trained shoppers (acting as patients) visited 306 randomly selected pharmacies in 8 states. Each shopper presented three prescriptions, answered questions according to a standard scenario, accepted the information offered, and paid for the prescriptions. MAIN OUTCOME MEASURES: Percentage of shoppers receiving any written information; quality of written information as judged by an expert panel using explicit criteria. RESULTS: Shoppers received an information leaflet with 87% of the 918 prescriptions dispensed. Although most leaflets provided unbiased information, leaflet length and quality of information varied greatly. A majority of leaflets did not include adequate information about contraindications, precautions, and how to avoid harm. Shoppers were more likely to receive leaflets in chain pharmacies and pharmacies with more staff. Information quality also was higher in chain pharmacies. Shopper and pharmacist demographic characteristics were unrelated to the level or quality of written information after controlling for other factors. CONCLUSION: The provision of patient leaflets is becoming a routine practice in the states studied. However, most leaflets do not meet quality criteria. It is important for pharmacists to become familiar with criteria for evaluating these leaflets and to take necessary action to improve their quality.

Adult↗