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PubMed1999

Management and relationships in total purchasing pilots. Relevance for primary care groups.

Primary Care Groups (PCGs) represent a natural evolution of the various models--total purchasing, multifunds and locality commissioning--embraced by the term "primary care commissioning". They will involve large numbers of different professionals working together to commission improved health care for their populations. The total purchasing pilots (TPPs) were the subjects of an extensive evaluation which has highlighted the significance of developing and improving relationships between the key players as a prerequisite for the successful implementation of their strategy. Management arrangements were central to this success. Similar considerations will be of crucial importance for the PCGs which are considerably larger and more complex organisations than the TPPs.

Contract Services↗
PubMed1989

The use of non-prescription salbutamol inhalers by asthmatic patients in the Hunter Valley, New South Wales. Newcastle Retail Pharmacy Research Group.

Because of concern over the unsupervised use of bronchodilator aerosols, we studied the characteristics of a group of asthmatic subjects who purchased their salbutamol inhalers and a group of asthmatic subjects who obtained their inhalers by prescription. Community pharmacists distributed 360 questionnaires to consecutive patients who requested salbutamol inhalers; 320 questionnaires were returned (response rate, 89%). Of these, 240 respondents described themselves as asthmatic and stated that they obtained their inhalers exclusively or predominantly by either purchase (120 subjects) or prescription (120 subjects). Purchasers were younger than were users of prescribed inhalers and were more likely to be in current employment. The "purchase" group perceived less disability from chest disease than did the "prescription" group but were not different from the prescription group with respect to more-objective measures of disease severity, such as the occurrence of wheeze every day, nocturnal wakening with wheezing, and admissions to hospital with asthma. The purchasers had a low rate of consultation with family practitioners and specialists and reported a low use of prescription-only medications, particularly of inhaled corticosteroid agents. This study highlights the possible disadvantages of providing bronchodilator aerosols without prescription, and emphasizes an important counselling role for community pharmacists in the management of bronchial asthma.

Administration, Inhalation↗
PubMed1991

The effect of unilateral optic nerve section on retinal light damage in rats.

The effect of unilateral optic nerve section on the susceptibility of rat photoreceptors to damage by constant light was studied. Optic nerves of albino rats were cut intracranially by a ventral approach, so as not to interfere with structures in the orbit of the eye, with the brain or with the blood supply to the retina. Two separate experiments were performed on unilaterally optic nerve sectioned rats from two different sources. One group was purchased from a commercial supplier and the other group was born and raised in 3 lux cyclic light in our laboratory. For 1-4 weeks after surgery they were exposed to either 1000 lux for 24 hr or 80 lux for 48 hr. Light damage was quantified by measuring the outer nuclear layer area remaining in histological sections through the vertical meridian of the retina. It was found that retinas with optic nerves cut suffered substantially less damage from light than did those with intact optic nerves. Sham operated rats suffered the same amount of damage as did the optic nerve intact retinas of rats with one nerve cut. The extent of protection was greatest in the region previously shown to be most susceptible to damage. The protection afforded by optic nerve section could not be explained on the basis of behavior or rhodopsin photochemistry. The possible role of heat-shock proteins and a neuromodulator is discussed.

Animals↗
PubMed1991

Physicians promoting bicycle helmets for children: a randomized trial.

Head injury is the leading cause of death and serious morbidity in bicycle accidents. There is good evidence to recommend helmets, yet few children wear them. We evaluated helmet promotion in a randomized trial targeting children presenting to primary care settings for routine ambulatory care. The intervention consisted of physician counseling and take-home pamphlets. The study involved 339 families, 167 in the intervention group and 172 in the control group. In a follow-up telephone call, 2 to 3 weeks later, only 7.2% of the intervention group had purchased helmets, compared with 7.0% of the control group (chi 2 = 0.0056, P = .94). During the latter half of the study, bicycle safety received considerable media attention in Ottawa, and the provincial medical society sponsored a $5 discount campaign. Therefore both groups were subject to community "co-intervention." Nonetheless, we were surprised that physician counseling made no additional impact. Our results and the success of certain community programs suggest that physicians interested in helmet promotion would do better to participate in the design and implementation of multidisciplinary campaigns.

Adolescent↗
PubMed1999

Pressure ulcer prevention: a randomized controlled trial of 2 risk-directed strategies for patient surface assignment.

OBJECTIVE: To compare the clinical utility, in terms of incidence of pressure ulcer (PU) development, and economic impact of 2 programs of patient surface assignment for PU prevention. DESIGN: Randomized controlled clinical trial with economic evaluation. SETTING: 30-bed multidisciplinary intensive care unit (ICU), serving as the regional trauma center. PATIENTS: 144 consecutive eligible patients at risk for the development of PUs. INTERVENTION: PU risk was assessed on admission using the Skin Ulcer Risk Evaluation (SURE) Score, and patients were randomized to either the experimental (purchase) or control group (purchase/rent). Based on their SURE Score, patients were assigned a specialty surface if needed. Patients received head-to-toe skin assessments twice weekly, new PUs were documented, a new SURE Score was calculated, and specialty surfaces were upgraded or downgraded as necessary. OUTCOMES: The incidence of PUs by site and severity, and cost. ANALYSES: Multivariate logistic regression and decision modeling. RESULTS: No significant differences were detected between groups with respect to baseline population characteristics, nor in the development of PUs. Predictors of PU development were ICU length of stay and SURE Score. The experimental (purchase) group was the less costly strategy. Under baseline assumptions, surface costs per at-risk patient were $76 CDN and $171 CDN in the experimental and control groups, respectively. The savings of $95 CDN per at-risk patient translates into conservative annual savings of $47,500 CDN. CONCLUSIONS: Using an objective, risk-based method of patient surface assignment, the authors compared the clinical and economic outcomes of 2 programs of PU prevention. In a direct comparison of alternatives, the strategy that emphasized purchased rather than rented products proved to be the more economical. Finally, this approach illustrates how by prospectively capturing data on both the costs and consequences of competing alternatives, a more objective and informed decision-making process can result.

Aged↗