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J J Gestal-Otero

Publications and source records attributed to J J Gestal-Otero.

At least 19 recordsLinked to original sources
PubMed2006

Influence of pharmacists' attitudes on adverse drug reaction reporting : a case-control study in Portugal.

INTRODUCTION: Pharmacists can play a fundamental role in adverse drug reaction (ADR) reporting, although the factors that affect underreporting among these professionals are unknown. The objectives of this study were to identify (i) professional or demographic characteristics; and (ii) attitudes associated with pharmacists' ADR reporting in northern Portugal. METHODS: We conducted a case-control study on a population of pharmacists employed in hospital and community pharmacies across Portugal's Northern Regional Health Authority catchment area in 2003. Cases (n=34) comprised pharmacists who had reported at least one ADR to the northern region's drug surveillance unit, and controls (n=280) were randomly sampled from pharmacists who had never reported an ADR. All were interviewed using a mail questionnaire. Most attitudes were based on Inman's 'seven deadly sins' and were measured using a continuous visual analogue scale. Answers were recorded in a range from 0 (total disagreement) to 10 (total agreement). Logistic regression was used to determine the ADR reporting adjusted odds ratio (OR) for a change in exposure corresponding to the interquartile range for each attitude. RESULTS: The response rate was 86.8%. Reporting probability proved higher among hospital versus community pharmacists (adjusted OR 20.0; 95 CI 3.3, 125.0; p<0.001). Attitudes to ADRs were strongly associated with reporting probability. Hence, an interquartile decrease in any of the following attitudes increased the probability of reporting by (i) 223% (95% CI 51, 595; p < 0.05) for "Really serious ADRs are well documented by the time a drug is marketed"; (ii) 240% (95% CI 89, 508; p=0.002) for "I would only report an ADR if I were sure that it was related to the use of a particular drug"; (iii) 316% (95% CI 44, 1104; p=0.010) for "It is only necessary to report serious or unexpected ADRs"; and (iv) 171% (95% CI 13, 549; p=0.020) for "I do not have time to think about the involvement of the drug or other causes in ADRs". CONCLUSIONS: ADR under-reporting is strongly associated with certain attitudes, possibly indicating that under-reporting could be minimised through educational interventions targeted at changing such attitudes. Pharmacists' ADR education must be improved and educational programmes should be focused on altering attitudes identified by the study as being associated with under-reporting. Our data also indicate that community pharmacists must be a priority target for this intervention.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

Do pharmacists' opinions affect their decision to dispense or recommend a visit to a doctor?

PURPOSE: To assess the relation between the pharmacists' opinions and the decision to dispense drugs without medical prescription and to recommend a visit to a doctor. METHODS: We carried out a cohort study on a sample of 166 pharmacists in North-West Spain. Pharmacists' opinions on prescription practice of the doctors, on pharmacists' qualification to dispense drugs without medical prescription, on their responsibility about dispensed drugs, on clients' qualification for self-medication, and pharmacists' perception of their work were collected through a personal interview. Dispensing and the recommendation to the patient to visit their doctor were measure in the follow-up. We constructed logistic regression models. RESULTS: The response rate to the first questionnaire was 98.8% and the participation rate in the follow-up was 60%. Pharmacists who considered that doctors prescribed excessively were less likely to dispense without medical prescription (OR = 0.48) and to send the client to the doctor more often (OR = 2.33). On the other hand, those who considered themselves to be capable to dispense without prescription do so frequently (OR = 1.24). A major appreciation of the pharmacist as a health educator was associated with a higher dispensing (OR = 3.81). Pharmacists who considered that customers' qualification for self-medication was good recommended, more frequently visiting a doctor (OR = 1.58). CONCLUSIONS: Our results show that the pharmacists' opinions are associated with their practice of counseling. Therefore, any program designed with the purpose of changing dispensing habits of the pharmacists should identify and take into account their opinions.

Adult↗
PubMed2002

Data collection methods for analyzing the quality of the dispensing in pharmacies.

OBJECTIVE: To review and discuss the advantages and limitations of the different data collection methods for analyzing the dispensing quality in community pharmacies. METHODS: A bibliographic search was carried out in MEDLINE (1980-2000). Articles with Medical Subject Heading (Mesh) "pharmacies" written in English and Spanish that evaluated the quality of dispensing (structure, process or outcome) were selected. RESULTS: Various data collection methods were observed. To analyze the quality of the structure, questionnaires and pharmacist interviews were used. To analyze the quality of the process, self-completed records, external observers and simulated clients were used. For analyzing the quality of the outcome, questionnaires, client interviews, and biologic samples were collected. CONCLUSIONS: The analysis of quality of structure can be useful as a first approach, however, this method may lack sensitivity. On the other hand, the analysis of outcome may be excessively complex and difficult to use, except for experimental or observational studies with large resources. Therefore, an analysis of the quality of the process is the best option. Methods utilizing external observers and simulated clients may best conjugate both internal and external validity.

Community Pharmacy Services↗
PubMed2001

Effectiveness of educational interventions on the improvement of drug prescription in primary care: a critical literature review.

This paper is a critical review of studies of educational programmes designed to improve prescription practices in ambulatory care. Scientific articles were selected from the following bibliographical indices: MEDLINE, IME, ICYT and ERIC. The searches covered the time period between 1988 and 1997. The search criteria included: primary-care, educat*, prescription* and other related keywords. The inclusion criteria were studies describing educational strategies aimed at general practitioners working in ambulatory settings. The study outcome was change in prescribing behaviour of physicians through prescribing indicators. The following data were extracted: study design, target drugs, type of intervention, follow-up period of the prescription trends, type of data analysis, type of statistical analysis and reported results. We found 3233 articles that met the search criteria. Of these, 51 met the inclusion criteria and 43 studied the efficacy/effectiveness of one or various interventions as compared to no intervention. Among seven studies evaluating active strategies, four reported positive results (57%), as opposed to three of the eight studies assessing passive strategies (38%). Among the 28 studies that tested reinforced active strategies, 16 reported positive results for all variables (57%). Eight studies were classified as a high degree of evidence (16%). We concluded that the results of our review suggest that the more personalized, the more effective the strategies are. We observe that combining active and passive strategies results in a decrease of the failure rate. Finally, better studies are still needed to enhance the efficacy and efficiency of prescribing practices.

Ambulatory Care↗
PubMed2001

Physicians' attitudes towards voluntary reporting of adverse drug events.

At the time a new drug is placed on the market, information on its therapeutic effect and toxicity is limited. Because of its simplicity and widespread use, the voluntary reporting by clinical physicians is the main method for detecting rare or unexpected adverse drug events (ADEs). However, the usefulness of this method may be compromised if the reporting rate is low. We present the results of a questionnaire-based case-control study carried out among 692 physicians from Galicia (north-west region of Spain), in which we assessed their attitudes and opinions towards ADEs. In general, the Galician physicians think it is difficult to link a given ADE with a drug (P < 0.05) and have very heterogeneous opinions on the fact that very severe ADEs are known before the drug is commercialized. They globally disagree with the proposal that ADE reporting should be renumerated and the fact that ADE reporting can be risky for the physician. Some of the beliefs concerning ADEs are incorrect. It is crucial to improve the training of the physicians through active educational strategies based on personal contact.

Adult↗
PubMed2001

A cohort study of stress and the common cold.

The common cold is one of the major causes of work absenteeism. Former studies, based on artificial inoculation of rhinovirus, implicated psychological stress in the occurrence of this syndrome, either by increasing susceptibility to the virus or by causing the subject to overrate the perception of the symptoms. Nevertheless, few studies on the effect of stress on the naturally acquired common cold have been conducted. We carried out a 1-year prospective cohort study among the faculty and staff of a Spanish university (N = 1,149). By means of standardized questionnaires, validated in a random sample of the population, we assessed the relation between the occurrence of common cold episodes and exposure to four dimensions of stress: stressful life events, negative affect, positive affect, and perceived stress. All four aspects of stress were related to the occurrence of the common cold. Subjects with a high (fourth quartile) index of negative affect showed an incidence rate ratio of 3.7 (95% confidence interval = 2.2-6.2). The incidence rate ratios for the fourth quartile were 2.5 (95% confidence interval = 1.5-4.1) and 1.9 (95% confidence interval = 1.1-3.2) for perceived stress and stressful events, respectively. A high index of positive affect was associated with an incidence rate ratio of 0.6 (95% confidence interval = 0.3-1.0). These findings suggest that psychological stress is a risk factor for the common cold.

Absenteeism↗
PubMed2001

One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial.

OBJECTIVES: The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in primary care. METHODS: A pragmatic controlled trial was designed; the study population included general and family practitioners in Galicia (northwestern Spain) divided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational intervention included explicit recommendations for selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data analysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of prescribed units of the NSAID total. RESULTS: One-to-one education obtained an average prescribing behavior improvement of 6.5% (P < 0.001) in the 9 months after intervention. In the education group, the average improvement was 2.4% (P < 0.05) for the same period. Statistically significant differences were observed between the group intervention and one-to-one groups. The reminder increased significantly the effectiveness of the one-to-one intervention. CONCLUSIONS: A single, short educational session to primary care doctors can improve their prescribing standards during long periods of > or = 9 months. Of the 2 strategies followed in the trial, one-to-one education has shown to be the most effective. Results also show that the effectiveness of these interventions increases when presented together with written material.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Influence of physician's education, drug information and medical-care settings on the quality of drugs prescribed.

OBJECTIVE: To identify factors associated with low prescription quality in primary care. METHODS: We carried out a cross-sectional study on a sample of 405 primary care physicians in Galicia (Northwest Spain). The following independent variables were collected through a mail questionnaire survey: physician's education and speciality, physician's perception of the quality of available drug information sources, type of practice and number of patients. We constructed multiple regression models using as dependent variables four indicators of the quality of drugs prescribed. RESULTS: The response rate was 75.2%. The quality of drugs prescribed was found to be associated with regulated physician training (P = 0.001), perceived credibility of information sources (P = 0.013) and environmental characteristics of the practice (reform model and number of patients' cards). CONCLUSION: Study results suggest that in order to improve the quality of drugs prescribed, physician education and training must be improved and the role of pharmaceutical companies in physician training should be limited, emphasising more objective sources of information, such as therapeutic guidelines. Our results also underline the need to complete the reform of our primary care system and promote better relationships among physicians and between physicians and patients.

Cross-Sectional Studies↗
PubMed2000

Sociodemographic factors related to self-medication in Spain.

To identify the sociodemographic factors associated to self-medication (i.e. use of non-prescription medicines) and undesirable self-medication, a cross-sectional study was carried out using a sample (n = 20,311) representative of the population of adults of 16 years of age and older in Spain. Multivariate Cox's regression was used. The prevalence of self-medication in the sample was 12.7% during the two weeks preceding the interview. Self-medication is more prevalent among women, persons who live alone, and persons who live in large cities. For persons who reported acute disorders, self-medication prevalence was higher among those with higher educational levels. The prevalence of undesirable self-medication in the sample was 2.5% during the two weeks previous to the interview. Undesirable self-medication is twice as common among persons older than 40 years, as compared to persons younger than 27 years. Undesirable self-medication prevalence is 53.0% higher among those who live alone as compared to those who live with their partner (95% confidence interval (CI): 15.2-103.2) and 36.8% higher among students as compared to full-time workers (95% CI: 1.9-83.5). People over 40 years of age, people living alone, and students should be the priority target populations for public health education programs aimed at improving the quality of self-medication behavior.

Adolescent↗
PubMed1999

Influence of physicians' attitudes on reporting adverse drug events: a case-control study.

BACKGROUND: Voluntary physician reporting of adverse drug events (ADEs) in among their patients remains the single most important source of information on serious and rare ADEs. Yet, substantial under-reporting exists and the factors producing its causes are unclear. OBJECTIVES: The objectives of the study are to: (1) identify the practitioner's demographic and professional characteristics associated with ADE reporting; and (2) identify knowledge, attitudes, and opinions associated with ADE reporting. DESIGN: Case-control study. SUBJECTS: Physicians within the National Health Service in Galicia (Northwestern Spain). The 194 case doctors are those who reported at least one ADE to the regional drug surveillance center between 1991 and their enrollment in the study. The 498 controls were randomly selected among the remaining physicians. All were interviewed using a mail questionnaire. MAIN OUTCOME MEASURES: We used logistic regression to determine the ADE reporting odds ratio. RESULTS: The response rate was 63.7%. The probability of reporting ADEs increases with increasing volume of prescriptions and decreases with increasing patient load. The following attitudes are associated with a smaller probability of reporting: (1) belief that really serious adverse drug events are well documented by the time a drug is marketed; (2) belief that it is nearly impossible to determine if a drug is responsible for a particular adverse event; (3) only reporting an adverse drug reaction if one is sure that it is related to the use of a particular drug; and (4) belief that the one case an individual physician might see cannot contribute to medical knowledge. CONCLUSIONS: Some physician attitudes regarding ADEs are associated with underreporting.

Adult↗
PubMed1997

An algorithm for the design of epidemiologic studies applied to drug surveillance.

Spontaneous reporting of adverse drug reactions (ADRs), although commonly used, is of limited efficacy for the establishment of causation, and must be complemented by more rigorous epidemiologic studies. This article presents a decision algorithm that could be used as a tool in the selection of the most appropriate study design to investigate the causal relationship between a given ADR and a drug. It is based on the incidence of the ADR, on the objective of the study--determination of all the adverse effects of a given drug, or all the drugs increasing the risk of occurrence of a given adverse event--and on the funds available to the researcher.

Algorithms↗
PubMed1996

The epidemiology of lung cancer: review of risk factors and Spanish data.

Lung cancer is the main form of cancer among men both in Spain and in the rest of europe. However, Spanish incidence rates are among the lowest of the European registries, especially for women. In this country, lung cancer mortality increased much more rapidly for men than for women between the fifties and the eighties. This increase was larger for lung cancer than for any other site. The trend of incidence, in Spain as well as in the greatest part of the world, is entirely explained by tobacco consumption, which remains the major risk factor for lung cancer. Occupational radon and asbestos exposures are other important but less extended determinants of lung cancer. Genetic factors could also play a role in the occurrence of the disease. On the other side, a high consumption of fruit and vegetables is protective, but, so far, no single dietary component has been found to be preventive. In this article, we review the major risk factors of lung cancer with an emphasis on Spanish and European data.

Adult↗
PubMed1995

Detection of Brucella antibodies in eluted dried blood: a validation study.

In order to develop a rapid method for the diagnosis of human brucellosis, results of the ELISA test performed on dried whole blood spotted on filter paper were compared with those of the same test carried out on the serum of the same 160 subjects. Four patterns of elution were tested, combining incubation at 4 degrees C with different exposure times in an ultrasound bath. The best correlation (r = 0.79) for the IgG test, was obtained by using a 12-h incubation period plus a 20-min ultrasonic exposure; the same incubation period without ultrasound produced the best correlation for the IgM test (r = 0.81).

Antibodies, Bacterial↗
PubMed1987

The influence of habitat on the prevalence of mental handicap.

The influence of habitat on the frequency and characteristics of mental handicap in Galicia (NW Spain) has been studied by means of a survey of registered mentally handicapped people. Higher prevalence is observed in rural, inland, mountainous, isolated and socioeconomically and culturally depressed areas with low population density, high migration rates and a high degree of endogamy. In these areas the prevalence of severe deficiency among the mentally handicapped is also higher due to CNS infections, cranial traumatisms and goitre and to the infrequent use of birth control methods. The expectation of rehabilitation in these areas is nil, though in some cases occupational adaptation is possible.

Humans↗