Perceptions of the influence of prescription medicine samples on prescribing by family physicians

Background: The provision of free prescription medicine samples is a common and traditional marketing strategy used by pharmaceutical companies, but concerns have been raised about their influence on physician prescribing behavior and patient safety. Objective: We sought to investigate the knowledge, attitudes, and behaviors of Australian family physicians regarding the use of sample prescription medications. Methods: Qualitative and quantitative techniques were used, including (1) mailed questionnaires to family physicians, (2) semistructured interviews with family physicians, and (3) sample cupboard inventories. Results: A number of issues about samples were identified by the questionnaires (208) and interviews (17 doctors), including insufficient labeling, poor record keeping, diversion of stock (personal use by doctors.. their families, practice staff and pharmaceutical representatives), and wasting of expired stock. Prescription medicine samples also influenced prescribing behavior. Australian doctors were less likely to provide samples to patients on financial grounds compared with a previous study in the United States on medical residents. Six sample cupboards were inventoried. Median wholesale value of sample cupboards was AUD $4959 (range $2395-$8709), with 6% of stock expired. Very little generic medicine was included in the sample cupboards. Conclusions: Better methods are needed to meet legislative requirements and to ensure quality use of medicines (and optimal public health) with respect to prescription medicine samples. Doctors and practice staff require training on the appropriate handling and storage of prescription medications. Alternative ways for distribution of sample medications need to be investigated.

Palliative care training: a survey of physicians in Australia and Europe

The purpose of this paper is to present data about the level and background characteristics of physicians' training in palliative care in Australia (AU), Belgium (BE), Denmark (DK), Italy (IT), the Netherlands (NL), Sweden (SE) and Switzerland (CH) (n=16,486). The response rate to an anonymous questionnaire differed between countries (39%-68%). In most countries approximately half of all responding physicians had any formal training in palliative care (median: 3-10 days). Exceptions were NL (78%) and IT (35%). The most common type of training was a postgraduate course. Physicians in nursing home medicine (only in NL), geriatrics, oncology (not in NL), and general practice had the most training. In all seven countries, physicians with such training discussed options for palliative care and options to forgo life-sustaining treatment more often with their patients than did physicians without. Irrespective of earlier palliative care training, 87%-98% of the physicians wanted extended training.

Immigrant dislocated identities:Rachid Nini’s Diario de un ilegal

This article describes the process through which the subjectivity of the illegal immigrant is deconstructed and later reconstructed, as revealed by the Moroccan journalist and intellectual Rachid Nini in his book Diario de un ilegal/Diary of an Illegal Immigrant (2002), an account of the author's perils as an illegal immigrant in Spain. The analysis focuses firstly on the narrative form that Nini employs to give an account of his story, and secondly on the spatial displacement to which the subject and his subjectivity are exposed, which leads to the obliteration of his identity. The abrupt changes that the subject faces in a new location are paramount and impel him to a constant quest for self-definition and of negotiation with the new Other. Thus, the privileges that Nini enjoyed while in Morocco, those of a male journalist, poet, translator and intellectual with a university degree, disappear altogether once his plane has landed on the Canary Islands. In this new location, the place of origin and/or race are now what define his identity; he is now simply a moro - a Moor - he is not considered as an individual but, as will be shown, as a member of a homogenizing category which resists definition. The article finishes by addressing how Nini, in his quest to destroy homogenizing stereotypes, employs other stereotypes as though this were the only escape from the schizophrenic state the illegal immigrant identity had been forced into.

Discovering the preferences of physicians with regards to rank-ordered medical documents

The practice of evidence-based medicine involves consulting documents from repositories such as Scopus, PubMed, or the Cochrane Library. The most common approach for presenting retrieved documents is in the form of a list, with the assumption that the higher a document is on a list, the more relevant it is. Despite this list-based presentation, it is seldom studied how physicians perceive the importance of the order of documents presented in a list. This paper describes an empirical study that elicited and modeled physicians' preferences with regard to list-based results. Preferences were analyzed using a GRIP method that relies on pairwise comparisons of selected subsets of possible rank-ordered lists composed of 3 documents. The results allow us to draw conclusions regarding physicians' attitudes towards the importance of having documents ranked correctly on a result list, versus the importance of retrieving relevant but misplaced documents. Our findings should help developers of clinical information retrieval applications when deciding how retrieved documents should be presented and how performance of the application should be assessed. © 2012 Springer-Verlag Berlin Heidelberg.

Patients’ and physicians’ experiences of atrial fibrillation and anticoagulation therapy:a qualitative journey

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF) however it is often underutilized and sometimes refused by patients. This programme of work included a meta-synthesis and two inter-linking studies aiming to explore patients’ and physicians’ experiences of AF and OAC. Methods: A meta-synthesis of qualitative evidence was conducted which informed the empirical work. Semi-structured individual interviews were utilised. Study 1: Three AF patient sub-groups were interviewed; accepted (n=4), refused (n=4), or discontinued (n=3) warfarin. Study 2: Four physician sub-groups (n=4 each group) prescribing OAC to AF patients were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Data was analysed using interpretative phenomenological analysis. Results: Study 1: Three over-arching themes comprised patients’ experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients’ reflections. Patients commented on the relief and reassurance experienced during the consultation but they perceived the decision making process mostly led by the physician. Lack of education and take-home materials distributed during the initial consultation was highlighted. Patients who had experienced stroke themselves or were caregivers, were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Warfarin monitoring was challenging for patients, however some patients perceived it as beneficial as it served to enhance patient-physician relationship. Study 2: Two over-arching themes emerged from physicians’ experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians’ approach to the consultation style shifted through a continuum of compliance-adherence-concordance during the consultation. They aimed for concordance, however challenges such as time and the perceived patient trust in them as the expert, led to physicians adopting a paternalistic approach. Physicians also pointed out challenges associated with guideline adherence and the need to adopt a multi-disciplinary approach, where other health professionals could provide on-going education. Conclusion: This programme of work has illustrated the benefit of taking an in depth phenomenological approach to understanding the lived experience of the physician-patient consultation. Together with the meta-synthesis, this work has strengthened the evidence base and demonstrated that there is a need to target patients' and physicians' ability to communicate with each other in a comprehensible way.

Physicians' perceptions, attitudes and expectations regarding the role of hospital-based pharmacists in the West Bank, Palestine

Objective - To evaluate the perceptions, expectations and experiences of physicians with regard to hospital-based pharmacists in the West Bank, Palestine. Methods - A self-administered questionnaire was distributed to 250 physicians practising in four general hospitals in the West Bank, Palestine. The main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists. Key findings - One hundred and fifty seven questionnaires were completed and returned (response rate, 62.8%). The majority of respondents were most comfortable with pharmacists detecting and preventing prescription errors (76.4%; 95% confidence interval (CI) 69.5–81.2%) and patient education (57.9%; CI 51.2–63.4%) but they were not comfortable with pharmacists suggesting the use of prescription medications to patients (56.7%; CI 49.8–62.4%). Most physicians (62.4%; CI 56.8–69.1%) expected the pharmacist to educate their patients about the safe and appropriate use of their medication. However, approximately one-third (31.7%; CI 26.0–39.6%) did not expect pharmacists to be available for consultation during rounds. Physicians' experiences with pharmacists were less favourable; whereas 77% (CI 70.2–81.5%) of the physicians agreed that pharmacists were always a reliable source of information, only 11.5% (CI 6.2–16.4%) agreed that pharmacists appeared to be willing to take responsibility for solving any drug-related problems. Conclusion -The present study showed that hospital physicians are more likely to accept traditional pharmacy services than newer clinical services for hospital-based pharmacists in the West Bank, Palestine. Pharmacists should therefore interact more positively and more frequently with physicians. This will close the gap between the physicians' commonly held perceptions of what they expect pharmacists to do and what pharmacists can actually do, and gain support for an extended role of hospital-based pharmacists in future patient therapy management.

Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making:a multi-perspective IPA design

OBJECTIVE: To explore patients' and physicians' experiences of atrial fibrillation consultations and oral anticoagulation decision-making. DESIGN: Multi-perspective interpretative phenomenological analyses. METHODS: Participants included small homogeneous subgroups: AF patients who accepted (n=4), refused (n=4), or discontinued (n=3) warfarin, and four physician subgroups (n=4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective IPA analyses to attend to individuals within subgroups and making comparisons within and between groups. RESULTS: Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision, and Negotiating systemic factors. CONCLUSIONS: This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care, and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.

Encouraging majority support for immigrant access to health services:multiple categorization and social identity complexity as antecedents of health equality

Health disparities between groups remain even after accounting for established causes such as structural and economic factors. The present research tested, for the first time, whether multiple social categorization processes can explain enhanced support for immigrant health (measured by respondents’ behavioral intention to support immigrants’ vaccination against A H1N1 disease by cutting regional public funds). Moreover, the mediating role of individualization and the moderating role of social identity complexity were tested. Findings showed that multiple versus single categorization of immigrants lead to support their right to health and confirmed the moderated mediation hypothesis. The potential in developing this sort of social cognitive intervention to address health disparities is discussed.

The effect of group counseling on the self-esteem, attendance, and counselor utilization of immigrant Hispanic secondary limited English proficient students

As the population of the United States becomes more diverse and the immigrant Hispanic, limited English proficient (LEP) school age population continues to grow, understanding and addressing the needs of these students becomes a pressing question. The purpose of this study was to investigate the effects of group counseling, by a bilingual counselor, on the self-esteem, attendance and counselor utilization of Hispanic LEP high school students. The design for this study was a quasi-experimental design. The experimental and control groups consisted of one class from each of the four levels of English for Speakers of Other Languages (ESOL), I-IV. The counseling intervention, the independent variable, was delivered by a bilingual counselor once a week, for fifteen weeks.^ A total of 112 immigrant Hispanic LEP students selected from the total ESOL student population participated in the study. The experimental and control groups were administered the Culture Free Self Esteem Inventory (CFSEI) Form AD as a pretest and posttest. The Background Information Questionnaire (BIQ) was utilized to gather information on counselor utilization and demographic data. Attendance data were obtained from the students' computer records. At the conclusion of the study the differences between the experimental and control groups on the three dependent variables were compared.^ Statistical analyses of the data were done using SPSS statistical software. A multivariate analysis of variance (MANOVA) was utilized to determine if there were significant differences in the self-esteem scores, attendance and counselor utilization. Correlational analyses was utilized to determine if there was a relationship between English language proficiency and self-esteem and between acculturation level and self-esteem.^ The study results indicate that there were no significant differences in the self-esteem scores and attendance of the subjects in the experimental group at the completion of the group counseling treatment. Counselor utilization was statistically significant for the targeted population. A relationship was found between English language proficiency level and self-esteem scores for students in ESOL levels II, III and IV. No significant correlation was found between acculturation and self-esteem.^ Research on the dropout rates of LEP coupled with the results of this study show that students at the intermediate and advanced levels of ESOL (III and IV) exhibit more positive self-esteem and achieve higher graduation rates that levels I and II. LEP students at levels I and II, once they became familiar with the role and function of school counselors through group counseling, utilized their services. ^

Influences on immigrant students' perceptions of the chances of making it in the United States

This study examined immigrant minority students' perceptions of race relations and of the chances for social mobility in the United States (U.S.) using cohort samples of West Indian (N = 173) and Haitian (N = 191) students. The Students' responses collected during the 6th and 7th, 8th and 9th grades were analyzed to determine whether perceptions of racial mistrust, teacher derogation and social mobility varied depending on the student's length of stay in the U.S. or self-concept. Quantitative methodology was applied to data extrapolated from a larger epidemiological longitudinal study consisting of 7,386 middle school students in Miami (Vega and Gil, 1998). ^ Results show that West Indian and Haitian students' perceptions of racial mistrust, teacher derogation and social mobility were associated more with student's self-concept than length of stay. Students with more favorable self-concepts reported greater optimism toward social mobility than those with less favorable self-concepts. Results also indicate that in the context of parental education and SES that racial mistrust is the strongest predictor of these students' level of optimism towards social mobility. ^