53 research outputs found
Timeliness and clinical impact of hospital-initiated medication reviews
No full textLink to a related website: https://eprints.qut.edu.au/45023/1/Timeliness_and_Clinical_Impact_of_Hospital-initiated_Medication_Reviews.pdf, Open Access via UnpaywallBackground: Medication-related problems often occur in the immediate post-discharge period. To reduce medication misadventure the Commonwealth Government funds home medicines reviews (HMRs). HMRs are initiated when general practitioners refer consenting patients to their community pharmacists, who then engage accredited pharmacists to review patients’ medicines in their homes. Aim: To determine if hospital-initiated medication reviews (HIMRs) can be implemented in a more timely manner than HMRs; and to assess the impact of a bespoke referral form with comorbidity-specific questions on the quality of reports. Method: Eligible medical inpatients at risk of medication misadventure were referred by the hospital liaison pharmacist to participating accredited pharmacists post-discharge from hospital. Social, demographic and laboratory data were collected from medical records and during interviews with consenting patients. Issues raised in the HIMR reports were categorised: intervention/action, information given or recommendation, and assigned a rank of clinical significance. Results: HIMRs were conducted within 11.6 ± 6.6 days postdischarge. 36 HIMR reports were evaluated and 1442 issues identified – information given (n = 1204), recommendations made (n = 88) and actions taken (n = 150). The majority of issues raised (89%) had a minor clinical impact. The bespoke referral form prompted approximately half of the issues raised. Conclusion: HIMRs can be facilitated in a more timely manner than post-discharge HMRs. There was an associated positive clinical impact of issues raised in the HIMR reports.Suzanna Lövgren, Robyn A Clark, Manya Angley, Anne P Ponniah, Desmond Colley and Sepehr Shakibhttp://search.informit.com.au/documentSummary;dn=676308992591782;res=IELHE
Consumers' views of pharmacogenetics: A qualitative study
No full textBACKGROUND: Adverse drug reactions are recognized as a significant public health issue. Pharmacogenetics (PGx) provides a potential means of preventing some adverse drug reactions by predicting the optimal medication dose for an individual; however, PGx is rarely used in clinical practice. Thus far, there have been few studies investigating consumers’ perceptions of the barriers to the implementation of PGx in clinical practice. OBJECTIVES: This study explored the views of the general public regarding their current use of medications, and their experiences of side effects and opinions on PGx. METHODS: Members of the general public who suffered a chronic medical condition and/or had an immediate family member with a chronic medical condition were recruited to form 5 separate focus groups (n ¼ 35). Three separate age ranges were used in the focus groups. A questioning route was developed and used in focus groups to determine participants’ experiences with medication use and opinions on PGx (referred to as ‘‘Personalized Medicine’’). Focus group discussions were transcribed by 2 separate investigators, and qualitative analysis, based on the framework approach, was applied to the data. Data were independently coded to identify key themes then compared both within and between focus groups. RESULTS: A common theme was a desire to have a holistic approach to disease diagnosis and medication selection. A wide range of views were expressed by the focus group participants. Concerns were raised regarding the current level of side effects experienced with medications. Storage and privacy of genetic information, and the costs involved, were also seen as potential barriers to implementation of PGx. CONCLUSIONS: PGx testing was seen as a potential positive contribution, but only if other factors were considered during the prescribing process. As participants desired a high level of information and effective communication from their health-care professionals, PGx education of clinicians and pharmacists will be essential to satisfy consumers’ requirements.Catherine A. Haddy, Helena M. Ward, Manya T. Angley, Ross A. McKinno
Prescribing Antipsychotics for Young People and Monitoring Physical Health and Adverse Effects
No full textMonitoring physical health and adverse effects in children and adolescents prescribed antipsychotics
No full textBackground: The adverse effects and long-term health risks associated with antipsychotic use means that monitoring children and adolescents prescribed these medications is important. Aim: To implement an evidence-based chart and guideline to monitor physical health and adverse effects in children and adolescents prescribed antipsychotics in a range of practice settings; and to identify the barriers and benefits of implementation. Method: Using an action research approach a pilot trial was undertaken to implement a chart and guideline in a range of practice settings. Patient and health professional resource kits and an information compact disc were produced to facilitate implementation. Barriers identified during implementation were doctor/health professional, patient-related and environmental. Carer and doctor satisfaction questionnaires were administered to assess the implementation process and evaluate the quality and usefulness of the monitoring chart and guideline. Results: 10 doctors were recruited to participate in the implementation trial and 21 patients prescribed antipsychotics were enrolled. Monitoring data collected retrospectively from patients' case notes, such as weight/height measurements and haematological monitoring were congruent with the guideline in 41% and 29% of patients respectively. Carer and doctor satisfaction questionnaires indicated that the monitoring package was well received and raised awareness of potential adverse effects and the importance of monitoring. Conclusion: The monitoring package can bridge the evidence to practice gap regarding monitoring physical health and adverse effects in children and adolescents prescribed antipsychotics.Luke E Grzeskowiak, David P Ellis, Adam J Phillips, Manya T Angle
Alternatives to post-discharge home medication reviews for high-risk patients: Doctors' and pharmacists' views
No full textABSTRACTBackgroundWe examined health professionals' views of a novel post‐discharge medication review model for high‐risk patients with 2 referral pathways – general practitioners (GPs) referring for home medicines reviews (HMRs) or hospital doctors referring for hospital‐initiated medication reviews (HIMRs).AimTo identify positive and negative aspects of the model, barriers and facilitators to implementation and to make recommendations for a post‐discharge home medication review program.Method23 semi‐structured interviews were conducted with key stakeholders – hospital doctors, GPs, accredited pharmacists, hospital pharmacists and community pharmacists. Data were analysed thematically based on a conceptual framework.ResultsThere was consensus that the availability of flexible pathways to post‐discharge home medication reviews was vital for patient care. Participants highlighted it was crucial that the patient's GP and community pharmacist are kept informed if the HIMR pathway was chosen. Barriers to implementation were time constraints experienced by health professionals to organise and conduct the review within 7 days post‐discharge and lack of awareness of the HMR process. Facilitators to implementation included existing positive working relationships and familiarity and support for the HMR process. Suggestions for future implementation included incorporating the liaison pharmacist role into the usual responsibilities of clinical pharmacists and educating medical interns about the model.ConclusionConsensus among medical and pharmacy stakeholders was that streamlined and flexible pathways to post‐discharge medication reviews would enhance quality use of medicines along the continuum of care.Vaishali Padhye, Anne P Ponniah, Lisa K Spurling, Xin Jou Bong, Sepehr Shakib, Manya Angle
Integration of a consultant pharmacist into a general practice: development of a collaborative care model
No full textEscaping the Kmara Box: Reframing the Role of Civil Society in Georgia’s Rose Revolution
Get PDFThis article examines the role of civic groups in Georgia’s Rose Revolution using Larry Diamond’s framework of the democratic functions of civil society. The author argues that the contribution of civil society to the peaceful transfer of power in 2003 is best understood by expanding the analytical focus out from the Kmara youth movement to include a larger set of organisations. Rather than focusing on the Kmara youth movement as the primary civil society actor in 2003, the author contends that Kmara was, in fact, a product of the coordinated involvement of a cohort of NGOs. The article stresses the highly interconnected nature of Georgian civic leaders and organisations, particularly regarding networks with other NGOs, opposition politicians, and journalists from the Rustavi 2 television station
Clinical outcomes of a collaborative, home-based postdischarge warfarin management service
No full textBACKGROUND: Warfarin remains a high-risk drug for adverse events, especially following discharge from the hospital. New approaches are needed to minimize the potential for adverse outcomes during this period. OBJECTIVE: To evaluate the clinical outcomes of a collaborative, home-based postdischarge warfarin management service adapted from the Australian Home Medicines Review (HMR) program. METHODS: In a prospective, nonrandomized controlled cohort study, patients discharged from the hospital and newly initiated on or continuing warfarin therapy received either usual care (UC) or a postdischarge service (PDS) of 2 or 3 home visits by a trained, HMR-accredited pharmacist in their first 8 to 10 days postdischarge. The PDS involved point-of-care international normalized ratio (INR) monitoring, warfarin education, and an HMR, in collaboration with the patient's general practitioner and community pharmacist. The primary outcome measure was the combined incidence of major and minor hemorrhagic events in the 90 days postdischarge. Secondary outcome measures included the incidences of thrombotic events, combined hemorrhagic and thombotic events, unplanned and warfarin-related hospital readmissions, death, INR control, and persistence with therapy at 8 and 90 days postdischarge. RESULTS: The PDS (n = 129) was associated with statistically significantly decreased rates of combined major and minor hemorrhagic events to day 90 (5.3% vs 14.7%; p = 0.03) and day 8 (0.9% vs 7.2%; p = 0.01) compared with UC (n = 139). The rate of combined hemorrhagic and thrombotic events to day 90 also decreased (6.4% vs 19.0%; p = 0.008) and persistence with warfarin therapy improved (95.4% vs 83.6%; p = 0.004). No significant differences in readmission and death rates or INR control were demonstrated. CONCLUSIONS: This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence in patients taking warfarin following hospital discharge. Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care.Leanne Stafford, Gregory M. Peterson, Luke R. E. Bereznicki, Shane L. Jackson, Ella C. van Tienen, Manya T. Angley, Beata V. Bajorek, Andrew J. McLachlan, Judy R. Mullan, Gary M. H. Misan, Luigi Gaetan
Eliciting comprehensive medication histories in the emergency department: the role of the pharmacist.
No full textThe Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to hospital. Accurate medication histories are vital in optimising health outcomes and have been shown to reduce mortality rates. This study aimed to examine the accuracy of medication histories taken in the Emergency Department of the Royal Adelaide Hospital. Medication histories recorded by medical staff were compared to those elicited by a pharmacy researcher. The study, conducted over a six-week period, included 100 patients over the age of 70, who took five or more regular medications, had three or more clinical co-morbidities and/or had been discharged from hospital in three months prior to the study. Following patient interviews, the researcher contacted the patient¿s pharmacist and GP for confirmation and completion of the medication history. Out of the 1152 medications recorded as being used by the 100 patients, discrepancies were found for 966 medications (83.9%). There were 563 (48.9%) complete omissions of medications. The most common discrepancies were incomplete or omitted dosage and frequency information. Discrepancies were mostly medications that treated dermatological and ear, nose and throat disorders but approximately 29% were used to treat cardiovascular disorders. This study provides support for the presence of an Emergency Department pharmacist who can compile a comprehensive and accurate medication history to enhance medication management along the continuum of care. It is recommended that the patient¿s community pharmacy and GP be contacted for clarification and confirmation of the medication history
Feasibility and timeliness of alternatives to post-discharge home medicines reviews for high-risk patients
No full textBackground: The period 7 to 10 days following hospital discharge is associated with a significant risk of medication misadventure, especially in high-risk patients. Aim: To investigate whether post-discharge hospital-initiated medication reviews (HIMRs) are more timely than postdischarge home medicines reviews (HMRs). Method: An implementation study was conducted over 9 months (2008/2009) at 3 hospitals in South Australia. A risk stratification instrument was used to identify patients at 'high' risk of medication misadventure. Feasibility was assessed and time to conduct post-discharge medication reviews was determined for the HMR and HIMR pathways. Results: Of the 97 consenting patients, 92 were considered 'high' risk. HIMRs were organised for 59 patients and 52 patients completed the HIMR process. Of the 22 HMRs organised via the patient's general practitioner, 18 patients completed the HMR process. The time from request to conducting HIMRs and HMRs were statistically significantly different - HIMRs and HMRs took 6.5 plus or minus 4.7 days and 11 plus or minus 7.4 days, respectively (p = 0.02). Conclusion: This study has demonstrated the feasibility of alternative pathways to post-discharge medication reviews. HIMRs were conducted sooner than HMRs organised via existing community processes. Medication misadventure in high-risk patients can be reduced in a more timely manner if post-discharge medication reviews are organised via the HIMR pathway.Manya Angley, Anne P. Ponniah, Lisa K. Spurling, Louise Sheridan, Desmond Colley, Vivek B. Nooney, Xin, Jou Bong, Vaishali Padhye, Sepehr Shaki
- …
