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Biomedical subjects

Yea-Huei Kao Yang

Publications and source records attributed to Yea-Huei Kao Yang.

7 recordsLinked to original sources
PubMed2006

Effects of a national medication education program in Taiwan to change the public's perceptions of the roles and functions of pharmacists.

OBJECTIVE: To evaluate the effect of a national medication education program on public's perceptions of the roles and functions of pharmacists in Taiwan. METHODS: This was a single group, pre- and post-comparison study. The subjects were 955 community residents enrolled in the Community Education Program on Medication Use (CEPMU) between September 2003 and January 2004 in Taiwan. The program was a pharmacist-facilitated national education program implemented at 31 community universities nationwide. The education program consisted of 14 lectures that were delivered over a 4-month period. A questionnaire was administered before and after the program to survey the subjects on their usual drug-information sources, their evaluation of the credibility of the drug-information sources, and their perceptions of the roles and functions of pharmacists in Taiwan. Paired t-test was used to analyze the difference between pre- and post-tests with a significant level set at 0.05 a priori. RESULTS: At the end of the program, the subjects were more likely to request drug information from healthcare professionals as compared to the baseline (p < 0.05). They also had more confidence in the information provided by the community pharmacists (p < 0.05) and had a better understanding of the roles and functions of pharmacists (p < 0.05). CONCLUSIONS: The national medication education program facilitated by pharmacists helps to direct the subjects to pharmacists or other healthcare givers for drug information. It also improves their perceptions of the roles and functions of pharmacists in Taiwan. PRACTICE IMPLICATIONS: Pharmacists' proactive participation in health education helped society to appreciate the roles and functions of pharmacists as knowledge workers in terms of drug information providers and safeguards of drug use.

Adult↗
PubMed2006

Appeals system and its outcomes in national health insurance in Taiwan.

BACKGROUND: Prior authorization has been used extensively as one of the mechanisms to control costs and ensure quality of care by the National Health Insurance (NHI) plan in Taiwan. An appeals system, the Dispute Mediation Committee (DMC), independent of the NHI, is available for interested parties to dispute denials of prior authorization. Currently, medications for Alzheimer's disease constitute the largest category of appeals. OBJECTIVE: To describe the appeals system and analyze outcomes of cases of medications for Alzheimer's disease submitted to the Bureau of NHI (BNHI) for prior authorization and to the DMC for appeals. METHODS: Prescriptions of donepezil and rivastigmine submitted for prior authorization from 2000 through 2002 were analyzed. Cases denied prior authorization and later submitted as appeals to the DMC were summarized with descriptive and bivariate methods. RESULTS: A total of 12,237 cases of donepezil and 6975 cases of rivastigmine were submitted to the BNHI for prior authorization; among them, 72.6% of donepezil and 66.5% of rivastigmine cases received authorization. Among the thousands of cases denied prior authorization, 124 appealed to the DMC for dispute resolution. The result of the majority of the appeals (111 [89.5%]) was to uphold the BNHI denial decision. Most of the appeals were denied because of the lack of appropriate exclusion of other possible causes of dementia. CONCLUSIONS: Most appeals were again denied after expert review. Better education concerning utilization guidelines and a platform for insurer, insuree, and physician to dialog are needed to improve the effectiveness and efficiency of the appeals system.

Adult↗
PubMed2005

Effects of a national health education program on the medication knowledge of the public in Taiwan.

BACKGROUND: The inappropriate use of medication and inadequate medication knowledge among the general population has long been a concern in Taiwan. One reason for the deficiencies might be the lack of an active role of pharmacists in educating the public. To rectify the situation, in 2002, the Bureau of Pharmaceutical Affairs, Department of Health of Taiwan, began to sponsor a national effort, titled Community Education Program on Medication Use, to involve the expertise of pharmacists in public education. OBJECTIVE: To evaluate the effects of this education program by analyzing the changes in knowledge of drug therapy among the participating public. METHODS: This was a single-group pre- and post-comparison study. Between September 2003 and January 2004, a total of 955 community residents enrolled in the pharmacist-facilitated education program offered at 31 community universities. The medication knowledge of the participants was evaluated before and after the program. Demographic variables that might affect the education outcomes of the program were also examined. RESULTS: Medication knowledge at baseline was positively correlated with education level and negatively correlated with age. Females were more aware of drug-related information than were males. The participants showed a significant improvement in medication knowledge (p < 0.001) at the end of the program. The baseline knowledge score was the most important determinant of the improvement of the posttest score. CONCLUSIONS: A national education program facilitated by pharmacists can improve the medication knowledge of the participants. Pharmacists should be encouraged to play a proactive role in large-scale health education programs.

Adolescent↗
PubMed2005

Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients.

STUDY OBJECTIVE: To determine whether the Beers criteria can predict adverse drug reactions (ADRs) in first-visit elderly outpatients. DESIGN: Prospective cohort study. SETTING: Outpatient clinics of a tertiary care and academic medical center in southern Taiwan. PATIENTS: Eight hundred eighty-two patients aged 65 years or older who were prescribed drugs at their first visit to either the medical center's outpatient internal medicine clinic or family medicine clinic between March 1, 2001, and July 31, 2001. INTERVENTION: Telephone survey conducted 1 week after clinic visit. MEASUREMENTS AND MAIN RESULTS: Potentially inappropriate drugs were assessed by the updated Beers criteria. Adverse drug reactions were detected by telephone survey and evaluated by the Naranjo criteria 1 week after drug administration. Of the 550 respondents, 64 (11.6%) had potentially inappropriate drugs prescribed and 126 (22.9%) had ADRs. Multiple logistic regression analysis revealed associations between ADRs and potentially inappropriate drug prescribing (relative risk [RR] 15.3, 95% confidence interval [CI] 4.0-58.8), number of prescribed drugs (RR 1.3, 95% CI 1.1-1.5), history of ADRs (RR 2.1, 95% CI 1.3-3.4), and noncompliance with prescribed drugs (RR 2.0, 95% CI 1.1-3.7). In patients who had potentially inappropriate drugs prescribed, the number of prescribed drugs was not significantly associated with ADRs (RR 0.8, 95% CI 0.6-1.1). In patients who did not have potentially inappropriate drugs prescribed, more prescribed drugs increased the risk of ADRs (RR 1.3, 95% CI 1.1-1.5). CONCLUSION: A positive association exists between potentially inappropriate drug prescribing, as defined by the Beers criteria, and ADRs in first-visit elderly outpatients. Clinicians should be alert to the possibility of ADRs if a patient takes more than five drugs, has a history of ADRs, or exhibits poor compliance with prescribed drugs.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Probable codeine phosphate-induced seizures.

OBJECTIVE: To report a case of seizure activity associated with oral codeine phosphate administered for analgesia in an elderly woman with end-stage renal disease. CASE SUMMARY: A 73-year-old Taiwanese woman with end-stage renal disease received oral codeine phosphate 30 mg 4 times daily for her back and rib pain without adjustment of her dosage regimen. Seven days after starting codeine therapy, the woman became stuporous and developed tonic-clonic seizures. After phenytoin initiation, codeine discontinuation, and naloxone administration, the seizures did not recur. DISCUSSION: Codeine is a frequently used opioid analgesic, especially when pain control with acetaminophen or nonsteroidal antiinflammatory drugs fails. Although seizures associated with codeine have been reported, pertinent data are very limited and the exact mechanism is unknown. An objective causality assessment indicated the seizure to be a probable drug-related event in this patient. CONCLUSIONS: Elderly patients with end-stage renal disease may be predisposed to seizures with higher doses of codeine phosphate. It is imperative to adjust the codeine dosage regimen based on patients' renal function to avoid the potential toxicity with overdose.

Aged↗
PubMed2004

Potentially inappropriate drug prescribing among first-visit elderly outpatients in Taiwan.

STUDY OBJECTIVE: To determine the prevalence and risk factors of potentially inappropriate drug prescribing among first-visit elderly outpatients. DESIGN: Cross-sectional survey. SETTING: An urban tertiary care and academic medical center in southern Taiwan. PATIENTS: Eight hundred eighty-two patients aged 65 years or older who were prescribed drugs at their first visit to either the medical center's outpatient internal medicine clinic or family medicine clinic between March 1, 2001, and July 31, 2001. MEASUREMENTS AND MAIN RESULTS: Potentially inappropriate drug prescribing was assessed according to updated Beers criteria. Ninety-seven potentially inappropriate drugs were identified in 93 (10.5%) patients. The most common classes were sedative-hypnotics (18.6%) and muscle relaxants (17.5%). Twenty (20.6%) of these inappropriate drugs had a high severity potential according to the Beers criteria. Patients prescribed potentially inappropriate drugs were more likely to be prescribed several drugs versus those who were not prescribed potentially inappropriate drugs (4.0+/-1.9 vs 2.8+/-1.4, p<0.001). Multiple logistic regression analysis revealed an interaction between age and the number of prescribed drugs on the risk of having potentially inappropriate drugs prescribed. In patients who were prescribed four agents or less, the risk was not associated with increasing age; in those who were prescribed five drugs or more, the risk was positively associated with increasing age. CONCLUSION: Potentially inappropriate drug prescribing among first-visit elderly outpatients was relatively low. Increasing patient age combined with increased number of drugs prescribed was associated with increased risk of having potentially inappropriate drugs prescribed.

Aged↗