Treatment of patients with pulmonary embolism entirely in Hospital in the Home

BACKGROUND

Low molecular weight heparin (LMWH) has revolutionised the management of venous thromboembolism (VTE). An important feature of the use of LMWH is the ability to manage acute VTE in the home. This study examined the outcomes of patients with pulmonary embolism (PE) who were transferred to Hospital in the Home (HIH) within 24 hours of presentation for treatment with LMWH.

METHODS

The authors reviewed records of all patients with PE who presented to two major hospitals in Melbourne (Victoria) and who were transferred to HIH for treatment with LMWH within 24 hours of presentation. The main outcome measures were length of stay, unexpected staff callouts, unexpected returns to hospital, recurrent embolism, bleeding, and death.

RESULTS

Twenty-one patients were included in the study over 5 years, with a mean age of 56 years. Patients spent a mean of 9 hours in hospital before transfer and spent a mean of 6 nights in HIH. One patient required an unexpected staff callout. There were no unexpected returns to hospital. No patient deaths or instances of major bleeding were recorded. Three patients developed minor bleeding.

DISCUSSION

Despite the long study period, this is a small cohort of patients and no control group is offered. However, all eligible patients were included in the study. With appropriate risk assessment and medical model of HIH, it might be safe to treat low risk patients with PE in HIH for their entire hospital stay.

Discrepant illness perceptions, affect and expressed emotion in people with psychosis and their carers

BACKGROUND

Illness perception, a measure of illness representations developed from physical medicine, has recently been applied to psychosis. We investigated how illness perceptions relate to affect and expressed emotion (EE) in carer-patient dyads, particularly if their perceptions differed.

METHOD

We interviewed 82 carer-patient dyads, after a relapse of psychosis. Carers were assessed for illness perceptions, distress, self-esteem and EE; patients for illness perceptions, depression, anxiety and self-esteem, in a cross sectional study.

RESULTS

Carers were more pessimistic than patients about illness persistence and consequences, and carers with low mood were particularly pessimistic about persistence and controllability. Discrepant views about illness consequences were related to greater anxiety, depression, and lower self-esteem in patients, while discrepant views on controllability were associated with greater distress, depression, and lower self-esteem in carers. Illness perceptions did not relate directly to EE.

CONCLUSIONS

In this sample, meta-cognitive carer representations of illness in psychosis are related to negative affective reactions in carers, but not to EE. Resolving discrepant illness perceptions between carers and patients might provide a way of improving family reactions to the health threat of psychosis.

Medication costs: the role physicians play with their senior patients

OBJECTIVES

To determine how often primary care physicians discuss medication costs with their senior patients and what cost-reducing strategies they employ.

DESIGN

Cross-sectional, random-sample mail questionnaire.

SETTING

State of California.

PARTICIPANTS

Six hundred seventy-eight of 1,098 (62%) internal medicine and family practice physicians selected from the American Medical Association Masterfile.

MEASUREMENTS

Main outcomes included frequency of cost discussions with senior patients in the previous 30 days and choice of cost-reducing strategy when a senior expresses financial difficulty with medication costs.

RESULTS

Forty-three percent of physicians reported discussing medication cost with at least half of their senior patients in the previous 30 days. Patients initiated most of these discussions. Forty percent reported that, at least one time in the previous 30 days, they had not discussed cost but wished they had. The most common reason given was "I ran out of time" (36%). Physicians with high perceived knowledge of medication costs were more likely to discuss cost (odds ratio (OR)=3.49, 95% confidence interval (CI)=1.66-7.3) versus low perceived knowledge, but this trend was not seen in physicians who scored high on actual knowledge of medication costs (OR=0.78, 95% CI=0.43-1.43) versus low actual knowledge. The most common cost-reducing strategies were generic substitution (33%) and offering samples (25%).

CONCLUSION

The frequency of medication cost discussions between physicians and senior patients is low, and when it occurs, is often initiated by patients. Physicians' perception of their knowledge of medication costs may be an important factor in initiating cost discussions.

Postmortem interrogation and retrieval of implantable pacemakers and defibrillators: a survey of morticians and patients

INTRODUCTION

Recent recalls of pacemakers and defibrillators cast a spotlight on product reliability. Universal postmortem device analysis could yield valuable information, but little data exist on the rate and feasibility of device examinations following death. This study investigated how morticians manage pacemakers and defibrillators and surveyed morticians and device patients regarding routine postmortem device interrogation and explantation.

METHODS AND RESULTS

Seventy-one morticians were surveyed on device interrogation and explantation practices. One hundred fifty patients presenting for routine device interrogation were interviewed regarding preferences for what should be done with devices postmortem and willingness to execute "device advance directives" authorizing analysis and retrieval. The average number of devices annually explanted per mortician was 7 +/- 10 (range = 1 to 50). The most common methods of disposal were placement in medical waste (44%) and donation for human reimplantation in developing nations (18%). Only 4% of morticians reported ever returning devices to manufacturers, but 87% agreed that routine explantation and return of devices to manufacturers would be feasible. Eighty-seven percent of device patients had no understanding of how their device would be handled after death. However, a majority (82%) indicated a willingness to have their device interrogated after death, and most (79%) were willing to have it returned to manufacturers. Willingness was not associated with age, sex, time since device implantation, or device type.

CONCLUSIONS

Implantable pacemakers and defibrillators are rarely analyzed after patients die. Systematic postmortem device retrieval appears feasible and acceptable to morticians and patients. Further efforts are needed to implement universal postmortem device evaluation.

Patient time costs associated with cancer care

BACKGROUND

Although costs of medical care for cancer have been investigated extensively, patient time costs associated with cancer care have rarely been estimated systematically. In this study, we estimated patient time costs associated with cancer care in patients aged 65 years and older in the United States.

METHODS

We identified 763,527 patients with breast, colorectal, corpus uteri, gastric, head and neck, lung, melanoma of the skin, ovary, prostate, renal, and urinary bladder cancers from linked Surveillance, Epidemiology, and End Results-Medicare files and 1,145,159 noncancer control subjects among Medicare enrollees who were matched by sex, age-group, and geographic location. Frequency of service use was calculated by category for patients and control subjects using Medicare claims data from 1995 to 2001. For each service category, time estimates were combined with service frequency and an hourly value of patient time. Net patient time costs were summed in the initial, continuing, and last-year-of-life phases of care for each tumor site. Net time cost estimates for the initial phase of care were applied to national estimates of numbers of new cancers in 2005 to obtain national time costs for the initial phase of care.

RESULTS

Net patient time costs during the initial phase of care ranged from 271 dollars (95% confidence interval [CI] = 213 dollars to 329 dollars) and 842 dollars (95% CI = 806 dollars to 878 dollars) for melanoma of the skin and prostate cancer, respectively, to 5348 dollars (95% CI = 4978 dollars to 5718 dollars) and 5605 dollars (95% CI = 5273 dollars to 5937 dollars) for gastric and ovarian cancers, respectively. Net patient time costs for care during the last year of life ranged from 1509 dollars (95% CI = 1343 dollars to 1675 dollars) for melanoma of the skin to 7799 dollars (95% CI = 7433 dollars to 8165 dollars), 7435 dollars (95% CI = 7207 dollars to 7663 dollars), and 7388 dollars (95% CI = 7018 dollars to 7758 dollars) for gastric, lung, and ovarian cancers, respectively. In 2005, patient time costs for the initial phase of care were 2.3 billion dollars.

CONCLUSIONS

Patient time costs for cancer care in the United States are substantial and vary by tumor site and phase of care, likely reflecting differences in stage at diagnosis and availability and intensity of treatment.

Perception par les sujets schizophrènes de la vie quotidienne : analyse de contenu du discours des patients sur les domaines d’une échelle de qualité de vie

INTRODUCTION

The validation of a questionnaire of subjective quality of life was used as pretext to question the way in which various fields of the everyday life were understood by schizophrenic subjects and nursing team members. Content analysis allowed the development of logico-semantic categories shared by the two populations and likely to give body to the subjacent social representations.

METHOD

Patients were asked to comment on the different items of the SQUALA. Patients' and nurses' answers for each item were grouped and the analysis was conducted on this corpus. For each item, the different points of view were summarised into categories of signification.

RESULTS

The results are presented item by item. The most important points are the followings: perceived health, physical autonomy, mental well-being and safety are linked to social and relational aspect of patients' life. Abstract concepts could be questioned among schizophrenic patients. It was possible to establish coherent categories. The analysis of certain unclassifiable statements makes it possible to specify phenomenological aspects of the schizophrenic experience.

DISCUSSION

Methodological limitations of this study are essentially due to content analysis methodology (standardisation of answers, choice of categories) and to the characteristics of the populations selected.

Comparison of Urinary On-Site Immunoassay Screening and Gas Chromatography-Mass Spectrometry Results of 111 Patients With Suspected Poisoning Presenting at an Emergency Department

On-site tests based on immunoassay techniques are widely used for toxicologic screening analysis in patients with suspected poisoning. However, such assays usually have been validated using urine samples with known concentrations of the investigated substances. In the present investigation, on-site screening results were evaluated in a clinical setting. This was a retrospective study of patients with suspected poisoning from January to December 2003 in the emergency department of a tertiary urban hospital. Urine samples were analyzed using the Triage 8 panel and gas chromatography-mass spectrometry (GC-MS). A total of 111 patients were included (54 female, 57 male; average age 37.8 +/- 19.7 years). A total of 3.8% of the patients showed no symptoms, 45.2% minor, 24.0% moderate, and 26.9% serious symptoms. In 50 patients (45.0%), Triage 8 results corresponded well with GC-MS results. In 17 patients (15.3%), the Triage 8 results were confirmed by GC-MS, but additional substances were determined that could not be detected by the Triage 8 panel. A completely negative Triage 8 screening result was obtained in 23 patients (20.7%) who showed toxicologically relevant findings in GC-MS. In 21 patients (18.9%), Triage 8 results could not be confirmed by GC-MS. The analysis of the results in view of the patients' medical histories revealed that in 20 patients (18.0%), no relevant toxic substance could be detected. Additionally, 8 patients (7.2%) showed intoxication with alcohol, which could not be detected by the presently applied toxicologic screening investigations. On-site screening results in suspected poisoning were not very helpful in the present study because practically every second patient ingested substances that were not detectable by the Triage 8 device. In addition, every fifth result was not in line with GC-MS findings. On-site test findings should be interpreted very carefully, and in critical cases, a GC-MS screening should be performed.

[Egalitarian and individualistic perceptions of fairness in health care provision: results from a survey of patients and students]

OBJECTIVE

This study focuses on the following question: How are health care reform proposals accepted by different groups of insured persons? Two perceptions of justice or fairness are compared. The "egalitarian view" states that the financial burden should be distributed as equally as possible across all insured persons and that health care should be offered to all insured persons in the same way. The "individualistic view" states that health care should be provided according to the individual's willingness to pay for it, and also according to the individual health behaviour.

METHODS

In 2003, a standardised questionnaire was answered by a random sample of 343 persons (175 elderly patients and 168 students). The egalitarian view was assessed by four questions and the individualistic view by five questions. The questionnaire included vignettes. Based on this method it is possible to assess if an answer depends on the "frame" that is presented as an example (framing the question as: thinking of a poor or a wealthy person).

RESULTS

A bivariate analyses show that the egalitarian view is mostly present in the following groups of patients: higher age group, insured in a Statutory Sickness fund, high medication, many physician visits. Concerning students, this view is also associated with low physical activity. The individualistic view can be found mostly in the following groups of patients: male, insured in a private health insurance, higher educational level, employed, high physical activity, non-smoker. Concerning students, very similar associations can be seen. These results are largely confirmed by multivariate analyses. It can also be seen that the answers are strongly influenced by the vignettes.

DISCUSSION

The insured persons seem to approve or disapprove of health care reform proposals according to their personal characteristics. The overall acceptance of health care reforms will largely depend on the ability to integrate these different perspectives.

Use of low-molecular-weight heparin during dental extractions in a medicaid population

BACKGROUND

Evidence-based guidelines recommend against discontinuation of oral anticoagulation therapy during most dental procedures because severe bleeding complications are rare and there is an increased risk for thromboembolic events in patients for whom warfarin therapy is interrupted. Although interruption of oral anticoagulation and bridge therapy with low-molecular- weight heparin (LMWH) may be indicated for high-risk individuals undergoing certain procedures, the use of LMWH in tooth extractions is expensive and often unnecessary.

OBJECTIVE

The purpose of this review was to identify and characterize procedural use of LMWH for dental extractions with respect to current consensus recommendations.

METHODS

The Idaho Medicaid pharmacy and medical claims database was queried to identify patients with a tooth extraction procedure between February 1, 1998, and January 31, 2005. Patients on warfarin therapy for 2 months before tooth extraction were identified as were claims for LMWH within 30 days before the procedure or 5 days after. Patient profiles were reviewed to determine number of extractions, rate of LMWH use, indication for anticoagulation, and associated drug costs.

RESULTS

Of 55,260 Medicaid patients who had a tooth extraction, 518 (0.9%) had received warfarin for at least 2 consecutive months before the tooth extraction procedure. Of these, 31 patients (6%) received LMWH therapy at the time of extraction for a total of 35 procedures. All procedures selected for review carried a low bleeding risk, with an average of 1.3 teeth extracted per procedure. The indications for anticoagulation included 16 procedures (45.7%) involving patients with a history of a thromboembolic event more than 90 days before the procedure, 10 procedures (28.5%) involving patients with a prosthetic valve, 4 procedures (11.4%) involving anticoagulated patients with atrial fibrillation, and 5 procedures (14.2%) involving patients with a history of thromboembolism fewer than 3 months before the procedure. LMWH costs for these 35 extractions totaled $22,294, or an average of $637 per procedure or $474 per extracted tooth. Enoxaparin was used in all but 1 of the procedures, with an average 5-day supply (average 8 enoxaparin units) dispensed per procedure. The costs associated with the required additional drug monitoring, e.g., INR monitoring, were not included in this analysis.

CONCLUSION

Although the overall number of dental procedures in anticoagulated patients using LMWH was small in our review, this inappropriate use resulted in avoidable costs to this Medicaid program.

Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population

In the world today, there are roughly 25 million cancer survivors. Although the increasing numbers of survivors testifies to the success of early detection and treatment, there is a downside. Cancer survivors are at increased risk for second cancers, other forms of comorbidity (e.g., cardiovascular disease, diabetes, osteoporosis), and functional decline. Lifestyle factors, such as a healthy diet, regular exercise, and smoking cessation may prevent these conditions and improve survivors' quality of life. Data also are accumulating to suggest that healthful lifestyle practices and successful weight management may prevent progressive or recurrent disease. Previous surveys conducted among both adult and pediatric cancer survivors indicate that most survivors have high levels of interest in diet and exercise interventions. Additionally, survivors who smoke report high levels of interest in interventions aimed at smoking cessation. Many factors, such as intervention timing and duration and channels of delivery, must be carefully considered in developing interventions that best meet the needs of this vulnerable population. Total transparency also is necessary in reporting the results of trials to ensure the inclusion of information regarding proportional accrual, attrition, and study sample sociodemographic characteristics to move toward the development of interventions most likely to gain broad-scale acceptance and adherence. Home-based interventions that rely on telephone counseling, mailed materials, or computer-assisted approaches offer promising means of reaching the geographically dispersed population of cancer survivors. More research is necessary to develop interventions that can reach and effectively promote long-term behavior change in this ever-increasing population.

Computerised assessment of quality of life in oncology patients and carers

OBJECTIVES

To examine the feasibility of a computerised assessment and to compare resulting quality of life scores among oncology carers and patients.

METHODS

Six hundred and twenty-two subjects (carers n = 234, patients n = 388) attending an oncology or haematology clinic completed the WHO-Quality of Life-BREF (WHOQOL-BREF) and demographics on a personal computer. Age- and gender-standardised scores for carers and patients were compared to community norms. Carers were compared with patients using six three-way ANOVAs.

RESULTS

In total, 60.3% (234/388) of the patients had an accompanying carer attempt the survey and 93.6% (219 of 234) completed all items. The four domains of the WHOQOL-BREF had acceptable internal consistency (Cronbach alpha coefficients). Carers had lower quality of life on three domains (physical, psychological and environmental), and patients on two domains (physical and psychological), compared with the general community. Carers had higher overall satisfaction with their health than patients (standardised difference of 0.52 units-moderate effect).

CONCLUSION

A computerised system for assessing quality of life was feasible and found that carers and patients had significant impairments in quality of life. Clinicians and services interested in quality of life for carers and patients may use computerised assessments to identify those with poorer quality of life.

Adherence to clinical practice guidelines for 7 chronic conditions in long-term-care patients who received pharmacist disease management services versus traditional drug regimen review

BACKGROUND

Numerous studies have shown that adherence to published clinical practice guidelines (CPGs) reduces disease morbidity and mortality. However, few benchmarks exist that demonstrate the rate of adherence to CPGs in patients in long-term-care facilities (LTCFs).

OBJECTIVE

To evaluate CPG adherence in patients in LTCFs who received consultation from pharmacists who emphasize disease state management (DSM) compared with patients in other LTCFs who received traditional drug regimen review (DRR).

METHODS

A retrospective chart review was conducted in November 2005 for 107 patients who received DSM services in 2 LTCFs and 304 patients who received DRR services in 4 LTCFs for the service period ending September 30, 2005. Chart review was conducted on all patients included in the current census as of September 1, 2005; residents were excluded from the analysis if they were discharged or deceased between September 1, 2005, and the date of chart review. CPG adherence was evaluated for the following 7 conditions: diabetes, coronary artery disease (CAD), stroke, heart failure (HF), hypertension, hyperlipidemia, and osteoporosis. In addition, the 6 most recent pharmacist recommendations for each patient were classified according to disease state.

RESULTS

Adherence to CPGs was significantly better (all P <0.05) in patients receiving DSM services for the following performance measures for 4 of the 7 disease states: (1) diabetes: antiplatelet or warfarin use or contraindication for use (hypersensitivity or history of serious bleeding event), 89.7% for DSM services versus 71.0% for DRR services, and glycosylated hemoglobin (HbA1c) 0.05). The mean number of pharmacist recommendations per patient per month was greater in DSM facilities (0.76) compared with DRR facilities (0.23, P <0.001). Pharmacists who provided DSM consultant services were more likely to make a recommendation to improve DSM (51.6%) than were pharmacists in the comparison facilities who provided traditional DRR services (31.7%, P <0.001).

CONCLUSION

This self-evaluation of the provision of pharmacist consultant services that focus on disease management in addition to DRR found a higher rate of adherence to clinical practice guidelines for 4 of 7 common chronic disease states in long-term-care patients compared with patients who received only traditional DRR services.

Comparison of patient doses in interventional radiology procedures performed in two large hospitals in Greece

Purpose of the study was to determine patient doses in the most common interventional radiology (IR) procedures performed in two large Greek hospitals. A total of 164 patients who underwent 4 types of IR procedures were studied. Fluoroscopy time, total exposure time, number of frames, number of runs, radiation field size, and cumulative dose-area product (DAP) were recorded. The median DAP values for carotid arteriography and lower limb arteriography were 66 and 123 Gy cm2 for hospital 'A' and 21 and 49 Gy cm2 for hospital 'B'. For the cerebral arteriographies performed in hospital 'A', the median DAP was 116 Gy cm2, while for the hepatic embolizations performed in hospital 'B', it was 104 Gy cm2. The DAP values observed in hospital 'A' for carotid arteriography and lower limb arteriography were almost three times than those of hospital 'B'. From the data analysis, it is evident that dose optimization in hospital 'A' should be pursued through revision of the techniques used.

Local diagnostic reference levels for some common diagnostic X-ray examinations in Tehran county of Iran

Various researchers who have carried out national and international surveys have reported wide variations in patient dose arising from specific X-ray examinations. This study was carried out as a part of a comprehensive project to establish national diagnostic reference level (NDRL), for the first time, in Iran. Seven most common X-ray examinations in 11 projections were included. Thermo luminescence dosimeters (TLD-100) were used to measure entrance surface doses (ESDs). The study group consisted of 535 patients who were referred for X-ray examinations to 12 randomly selected public hospitals in Tehran County. Minimum, median, mean, maximum, first and third quartile values of ESDs are reported. Our results are evident that mean dose values of patients undertaking a specific examination are widely different in various hospitals. Wide dose differences may emerge from complex causes, but in general, low peak kilovoltage and high milli Amperes are associated with higher doses. The results of this work together with further data expected to emerge from the work in progress will provide a useful base to establish Iran's DRLs.

Precipitants to psychiatric patient assaults: review of findings, 2004-2006, with implications for EMS and other health care providers

Violent psychiatric patients present a safety risk for Emergency Medical Services (EMS) personnel and other health care providers. Although there have been numerous studies of the demographic and clinical characteristics of assaultive patients, these studies have yielded limited information in predicting violence. Recent research has begun to examine possible specific precipitants to patient assaults. This paper reviews the published studies from 2004 to 2006. Psychosis, organic impairment, staff interactions, and limit setting were cited as frequently occurring precipitants. The implications of these findings and specific strategies to reduce these precipitant risks for EMS and other health care providers are presented.

Client Similarities and Differences in Two Childhood Anxiety Disorders Research Clinics

Some evidence suggests that research and service clinics differ on treatment-relevant dimensions, but no study has examined whether research clinics (RCs) themselves differ. We compared 2 samples of children and adolescents (ages 7 to 17 years) with anxiety disorders treated in 2 different university-based child anxiety RCs, one in Philadelphia (n = 184) and one in Miami (n = 64), on child symptom and diagnostic measures, family characteristics (e.g., income), and level of maternal depression. The samples were not significantly different on any youth symptom and diagnostic measures except 1 (parent-reported diagnoses); further, the 2 samples were statistically equivalent on 3 of 6 youth symptom measures. Although the Miami sample had significantly more parent-reported diagnoses than the Philadelphia sample, the effect size was small (Cohen's d = .44). Statistically significant differences between the samples in ethnic background and family income were observed, though the former was not significant after controlling for population differences. Findings are discussed in terms of the implications of homogeneity of RCs for treatments tested there.

Patients’ attitudes towards and experiences of generic drug substitution in Norway

OBJECTIVE

The aim of the study was to assess patients' attitudes towards and experiences of generic substitution 3 years after generic substitution of prescription medicines was permitted in Norway.

METHODS

Prescriptions from 2,128 consecutive patients in a Norwegian pharmacy were retrospectively reviewed to identify all patients (n=274) receiving eight or more different prescription drugs on the fifth level in the Anatomical Therapeutic Chemical (ATC) classification system during the last 6 months. An age-adjusted control group (n=269) of patients receiving three to seven different prescription drugs was randomly selected. Of the 543 patients, 386 were eligible for inclusion. Both groups received a mailed questionnaire addressing their experiences with and attitudes towards generic substitution.

RESULTS

The overall response rate was 73% (281/386) and the average age of the respondents was 66 years old. The study found that patients who reported to have received information from their physician or the pharmacy about generic substitution were more likely to have switched (P<0.001). About half (138/281) of the patients had experienced a generic switch, and a higher proportion of the polypharmacy patients had their medication substituted compared to the control patients (P<0.001). Altogether 50 (36%) of the patients who had experienced a switch, reported one or more negative experiences connected to the substitution, and 29 of these (21%) reported an overall negative experience after the change. The experiences of the patients were not related to age, gender, or number of medications or information about generics from either the pharmacy or the physician. About 41% of the patients would not switch if they had no personal economic incentives.

CONCLUSIONS

About 1/3 of the patients who had their medication substituted reported negative experiences. Generic drug substitution for a number of patients is not considered an equal alternative to branded drugs, and these patients may need additional information and support. The lack of correlation between patient experiences and age, gender, and medical regimen complexity is interesting and should be investigated further.

Drug-use practices in teaching hospitals of Khartoum State, Sudan

PURPOSE

The present study was carried out to investigate current prescribing and dispensing practices in the largest two teaching hospitals in Sudan and compare them with those of published studies in developing countries.

METHODS

A descriptive, quantitative and cross-sectional study was conducted among hospital outpatients. The sample was selected using systematic random sampling. In each hospital, prescribing indicators were investigated through collection of data on 100 patient encounters, determination of consultation time and dispensing time for 100 patients, and by interview of 100 patients for the evaluation of dispensing practices.

RESULTS

The present findings showed that 96% (95% CI: 92.0-98.1%) of patient encounters did not include one or more necessary elements. Strength of drug and the quantity to be dispensed were omitted in 57.5% (95% CI: 50.3-64.4%) and 91% (95% CI: 85.9-94.4%) of patient encounters, respectively. Other variables measured per patient encounter were mean (SD) number of drugs prescribed, 1.9 (0.9); percentage prescribed by generic name, 43.6 % (95% CI: 38.6-48.8%); percentage of patient encounters involving an antibiotic, 65.0% (95% CI: 57.9-71.5%); percentage of patient encounters with an injection prescribed, 10.5% (95% CI: 6.5-15.8%). The mean (SD) consultation and dispensing times were 4.5 (2.8) min and 46.3 (21.8) s, respectively. The percentages of dispensed drugs that were adequately labeled was 37.6% (95% CI: 33.1-41.8%), whilst adequate patient knowledge was demonstrated for 37.2% (95% CI: 32.3-42.0%) of drugs.

CONCLUSIONS

Cost-effective, multifaceted interventions are needed to improve current prescribing and dispensing practices at the teaching hospitals in Khartoum State, Sudan.

[Treatment adherence in schizophrenia. A comparison between patient's, relative's and psychiatrist's opinions]

INTRODUCTION

Patients with psychiatric illness typically have great difficulty following a medication regimen, but they also have the greatest potential for benefiting from adherence. Due to the lack of insight in schizophrenia, adherence to treatment is especially important. We try to analyze and compare the opinion on adherence and compliance of psychiatrists, patients with schizophrenia and relatives.

METHOD

A direct, anonymous survey specifically designed for the project was administered to psychiatrists, patients and relatives from all over Spain through different associations of patients and family legally constituted in Spain. Analysis was done separately for variables corresponding to the three groups.

RESULTS

The psychiatrists (n = 844) considered that 56.8 % of their evaluated patients (n = 7.439) were noncompliers in the past month, as opposed to 43.2% of these patients who were considered good compliers (3,215 patients). Ninety-five percent of the patients (n = 938) stated that they took their medication regularly, while 5 % answered no to this question. Eighty-two percent of relatives (n = 796) think that patients regularly take their medication, but 47% state that they sometimes forget to take it.

CONCLUSIONS

Treatment adherence should be evaluated in clinical trials and in research on treatment of diseases, particularly in chronic mental diseases such as schizophrenia. It seems clear that only programs aimed at detection and resolution of the problems involved in treatment adherence will be able to improve the mid- and long-term prognosis of patients with schizophrenic disorders.

Drug-related problems in patients with angina pectoris, type 2 diabetes and asthma--interviewing patients at home

OBJECTIVE OF THE STUDY

The objective of the overall study was to create a foundation for improving the quality of counselling practice in pharmacies. The research question addressed in this sub-study was to describe drug-related problems (DRPs) in terms of frequency as well as type in people with angina pectoris, type 2 diabetes and asthma, as the problems were identified through medication reviews and home interviews.

SETTING AND METHOD

During their pharmacy internships, fourth-year pharmacy students collected data for the study in 1999, 2000 and 2001 by carrying out medication reviews, conducting home interviews and registering DRPs for 414 patients. Data were collected from the following patient groups in the years indicated: in 1999, 123 angina pectoris patients; in 2000, 192 type 2 diabetes patients, and in 2001, 99 asthma patients. The interviews dealt with the patient's drug-related experiences, knowledge, perceptions, problems and actions. The DRPs were registered according to the so-called PI-Doc system.

RESULTS

A medication review was supplemented by qualitative interviews with the three patient groups, which revealed a relatively high number of DRPs compared to other studies. An average of 2.8 DRPs were identified per angina pectoris patient; 4.1 DRPs per type 2 diabetes patient and 4.0 DRPs per asthma patient. "Inappropriate use of medicines by the patient" and "Other problems" (such as limited knowledge of the illness, inappropriate lifestyle, fear of medication, lack of information, etc.) were the two most common DRP sub-categories identified in all three patient groups.

CONCLUSION

The study provided a profile of a pharmacy-based population of 414 patients visiting the pharmacy, all of whom are at high risk of experiencing drug-related problems. Pharmacy staff needs to take this high rate of DRPs in people with angina pectoris, asthma and type 2 diabetes into account when dispensing medicines to and advising patients from the three groups, especially when explaining how to use medicines appropriately.