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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↗
PubMed2004

Medication adherence and associated hemoglobin A1c in type 2 diabetes.

BACKGROUND: Tight blood glucose control has been correlated with a reduction in diabetes complications. Adherence to antidiabetic medications is crucial to achieving blood glucose control. OBJECTIVE: To assess the relationship between good glucose control [glycosylated hemoglobin (HbA1c) levels] and adherence to prescribed treatment in patients on a stable medication regimen for type 2 diabetes. METHODS: The Morisky survey, a 4-item questionnaire that predicts patient medication-taking behavior, was used to assess adherence in 301 patients. The relationship of HbA1c to Morisky score was evaluated, controlling for other variables related to patient demographics and clinical characteristics. Data were analyzed using a general linear model on log (HbA1c). RESULTS: Unadjusted mean HbA1c values (capped at 14.0%) for patients with Morisky scores of 0 or 1, 2, 3, and 4 were 8.92%, 8.67%, 7.74%, and 7.60%, respectively. Of all patients, 13.0%, 14.0%, 24.3%, and 48.8% had scores of 0 or 1, 2, 3, and 4, respectively. Good adherence (Morisky score > or = 3) was associated with a 10% lower total HbA1c (p = 0.0003) adjusted for all other factors in the model. Duration of diabetes (5-10 y) and presence of diabetes complications were also significantly associated with HbA1c (p = 0.026 and 0.002, respectively). Adherence was poor in 27% of patients. CONCLUSIONS: This study found that patients with a higher score on the Morisky scale had a lower associated HbA1c measurement. The Morisky score may be an efficient tool for identifying patients with poor medication-taking behavior who can then be targeted for directed adherence counseling services.

Adolescent↗
PubMed2002

Relationship between fluid intelligence and ability to benefit from cognitive-behavioural therapy in older adults: a preliminary investigation.

OBJECTIVE: The aim of this study was to conduct a preliminary evaluation of the hypothesis that fluid intelligence in older adults is associated with the ability to benefit from cognitive-behavioural therapy (CBT), but unrelated to the ability to benefit from non-directive supportive counselling (SC). METHOD: A sample of 32 older adults who had completed a randomized controlled trial course of either CBT (N = 16) or SC (N = 16) for anxiety disorders took part in the study. The Raven's Coloured Progressive Matrices (RCPM) test was used to assess fluid intelligence. The Beck Anxiety Inventory change scores between pre-treatment and post-treatment were used as an index of ability to benefit from therapy. A measure of depressive symptomatology was also administered to control statistically for the effects of depression on intellectual functioning. RESULTS: The results for the SC group showed a significant and positive association between fluid intelligence scores and anxiety change scores, such that older adults with higher levels of fluid intelligence demonstrated the most benefit from this intervention. In contrast, there was no significant association between level of fluid intelligence and ability to benefit from therapy in the CBT group. CONCLUSION: CBT for anxiety disorders is suitable for older adults, irrespective of their fluid intelligence, while the nature of SC may render it more sensitive to level of fluid intelligence.

Aged↗
PubMed2006

[Non-pharmacological management of hypertension in Southern Brazil].

A cross-sectional population-based study was carried out among individuals aged 20 to 69 years in the urban area of Pelotas, Rio Grande do Sul, Brazil. The objective was to analyze characteristics of hypertensive patients in relation to management of arterial hypertension. Among the 1,968 interviewees, 380 were hypertensive (19.3%), and 44.1% of these always consulted the same physician. Of the entire sample, 85.5% were sedentary, 48.2% showed excessive fat consumption, and 47.4% smoked. Most physicians recommend the following: lowering salt consumption (98.4%), cessation of alcohol consumption (93.7%), for losing weight, diet and consumption of low-fat food (88.2%), smoking cessation (73.2%), and physical activity (68.9%). The clinical management was classified as inadequate in 284 individuals (74.7%). Increased probability of adequate management was found among: women, individuals > 50 years, upper and middle-class patients, non-smokers, and patients with diabetes mellitus. Some findings showed positive aspects, but differences according to socioeconomic status evidenced lack of equity in care.

Adult↗
PubMed1999

The return of thalidomide: can birth defects be prevented?

Thalidomide, the drug that caused a worldwide epidemic of serious birth defects in the late 1950s and early 1960s, was recently approved by the US Food and Drug Administration (FDA) for use in treating the skin disease erythema nodosum leprosum, a complication of leprosy. The drug has also shown promise in the treatment of other serious diseases. If thalidomide is eventually approved for use in the US and other countries for treatment of diseases more prevalent than erythema nodosum leprosum, or if use of the drug for non-approved indications becomes widespread, hundreds of thousands of women with childbearing ability could be treated. If this should happen, can we prevent another epidemic of birth defects? In an effort to prevent fetal exposures to thalidomide, the FDA mandated a comprehensive programme to regulate prescription, dispensing and use of the drug. The programme is designed to require registration of all participating prescribers, pharmacies and patients. It also requires use of effective methods of contraception and periodic pregnancy testing of all patients with childbearing ability during treatment. Prescribers are directed to counsel both female and male patients on the risks, benefits and proper use of the drug, as well as on the proper use of contraceptives during treatment. The patient is required to sign an informed consent form before beginning treatment. Prescription and dispensing of thalidomide will be tightly controlled. Athalidomide registry will monitor prescription. dispensing and use of the drug, and will investigate all reported fetal exposures. This mandatory, but untested, programme promises to be effective at preventing fetal exposures to thalidomide, provided that patients, prescribers and pharmacists comply with all of its provisions. However, even if the programme proves to be successful in the US, there is concern that thalidomide may eventually be widely used in countries that may not require such stringent controls. In Brazil, where thalidomide is commercially available for treatment of leprosy patients, 33 cases of thalidomide embryopathy have already been reported in the literature. Even in countries that may tightly regulate the distribution and use of thalidomide, some patients may obtain the drug through black market sources. Should these events occur, many cases of thalidomide-induced birth defects could appear. Therefore, there is a need to develop nonteratogenic analogues of thalidomide that can provide effective treatment for erythema nodosum leprosum and other serious conditions without increasing the potential for another epidemic of thalidomide-related birth defects.

Adult↗
PubMedDate not supplied

Adherence to mental health treatment in a primary care clinic.

BACKGROUND: Patient nonadherence is common for the standard mental health treatments in primary care: antidepressants and referrals to specialty mental health treatment. This is one of few studies to prospectively identify predictors of nonadherence. METHODS: We observed 95 veterans attending an internal medicine clinic prescribed antidepressant medication or referred to mental health treatment. We collected information on sociodemographic factors, health beliefs, preferences about treatment, past experiences, and treatment knowledge. RESULTS: At 1 month, medication adherence was greater when patients experienced previous pharmacy trouble and traveled for less than 30 minutes to reach the clinic. Appointment attendance improved when patients were ready for treatment, perceived benefits, and saw their physician as collaborative. At 6 months, medication adherence was greater when patients reported a preference for medicine treatment, traveled for less than 30 minutes, and perceived greater benefits. Fewer negative effects from previous mental health treatment improved adherence to appointments. In multivariate analyses examining adherence to all treatments, greater readiness for treatment predicted 1-month adherence, whereas being unmarried and seeing the physician as more collaborative improved 6-month adherence. CONCLUSIONS: Adherence to antidepressant medications and to mental health referrals should be examined separately. A brief initial assessment for nonadherence risk factors may identify persons for targeted adherence promoting interventions.

Adult↗
PubMed2004

Molecular markers and prostate cancer prognosis.

Prostate cancer is the most common malignancy among American men and is the second-leading cause of cancer-related mortality. Although radical prostatectomy and radiation therapy offer hope for cure for the majority of men with localized tumors, we continue to lack the tools to definitively determine which cancers need to be treated, which cancers will recur after treatment, and which cancers will behave aggressively when they have metastasized. Recent breakthroughs in molecular biology have led to the identification of a number of potential biomarkers for prostate cancer, many of which have been suggested to have prognostic significance. Eventually, combinations of these markers will hopefully enable us to more rationally facilitate counseling and direct management for men with prostate cancer.

Adenocarcinoma↗
PubMedDate not supplied

A continuing education program for hospital and public health nurses to guide families of very low birth-weight infants in caregiving.

Nurses have a critical role in family development of competencies for giving care to very low birth-weight infants, However, current information-based methods of preparation may be inadequate for competency development. This article describes a continuing education program designed to strengthen nurses' support of families in developing caregiving competencies through processes of guided participation. Program effectiveness was explored with: (1) a survey of participant and non-participant nurse satisfaction with family work and with organizational resources and practices; (2) a description of relationship and caregiving competencies for mothers who had and had not received guided participation; and (3) a review of mothers' reports of their experience either with or without guided participation. Organizational arrangements and mechanisms for establishing guided participation practice within an agency, including ongoing reflective supervision sessions, peer collaboration, and documentation of competency development, are discussed.

Attitude of Health Personnel↗
PubMed2005

Prevalence of HCV and HCV/HIV co-infection among in-patients at the Kenyatta National Hospital.

OBJECTIVE: To determine the prevalence of HCV and HCV/HIV co-infection among medical in-patients at the Kenyatta National Hospital. DESIGN: Prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral and teaching hospital, in-patient department SUBJECTS: HIV/AIDS and HIV negative in-patients at KNH medical wards. RESULTS: Among 458 HIV/AIDS medical in-patients, the prevalence of HCV was 3.7% while in the 518 HIV negative patients, it was 4.4%. The prevalence of co-infection with HCV and HIV was 3.7%. The incidence of risk factors in persons with HCV and/or HIV infection(s) was low. CONCLUSION: This study found the prevalence of HCV infection among medical in-patients to be similar in HIV positive and HIV negative group of patients. The co-infection rates were low, as were the risk factors for transmission of these infections.

Adolescent↗
PubMed1995

Managed care organizations: an introduction--Part I of II.

Today, managed care organizations operate along a wide spectrum of healthcare delivery models. From staff model HMOs to EPOs, the common element remains the delivery of cost-effective healthcare services to the patient. Implicit in such a system is pharmaceutical care and its related services provided by a pharmacist. Just as the definition or specific delivery model for medical services in managed care has changed since the mid-1950s, pharmacy and pharmaceutical service is different today from our predecessors' practice. Contemporary pharmacist roles and responsibilities continue to change and expand beyond those which existed as little as 1 year ago. As has been accomplished in hospitals, MCO pharmacists are increasingly involved in determining and selecting the best course of rational drug therapy for selected patients' conditions in all managed care settings. This is manifested by drug formularies, drug review programs, clinical practice guidelines, coordinated care committee work, and direct patient counseling. In the next part, the different organizational and professional roles of a pharmacist will be explored.

Managed Care Programs↗
PubMedDate not supplied

Making a plan. Helping patients in end-of-life decision making.

Few medical legal issues are more complex or confusing than end-of-life decision-making. Many people form definite views about what they would or would not want based on the case of a friend or relative, only to discover when their turn comes that the medical facts are very different, and their preconceived views are inapplicable. Others simply change their minds.

Advance Directives↗
PubMed1999

[An investigation of small marker chromosome in eight Turner syndrome patients by fluorescence in situ hybridization and DNA analysis].

OBJECTIVE: To direct genetic counseling and identify the origin of small marker chromosome in patients with Turner syndrome stigmata. METHODS: The specific primer on the sex determining region on Y (SRY) and biotin labeled X- and Y-chromosome DNA probes were utilized in the analysis of sex chromosome-derived markers. The PCR product from the amplification was detected on agarose gel, and fluorescence in situ hybridization (FISH) was conducted to metaphase chromosome. RESULTS: In 8 patients who had a small marker chromosome, five markers were derived from the X chromosome and three from the Y chromosome. Two patients with a Y-derived marker were determined by Y-chromosome probe as well as by SRY sequences amplification. One patient with a Y-derived marker was only demonstrated by FISH. CONCLUSION: The findings of this study demonstrate successfully the value and necessity of FISH utilizing DNA probes combined with specific amplification on SRY gene in the identification of sex chromosome marker. Such identification is important not only for clinical care, but also for understanding phenotype-karyotype correlations.

DNA-Binding Proteins↗