Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training.

Transforming the English NHS using information technology: the story so far

The use of information and communication technologies (ICT) for transforming the way publicservices are delivered, has been an area of investment and focus in many countries in recentyears. The UK government envisioned moving from e-Government to transformationalgovernment by 2008, and initiatives such as the National Programme for IT (NPfIT) wereunderway towards this end. NPfIT was the largest civil IT programme worldwide at an initialestimated cost of £12.4bn over a ten-year period. It was launched in 2002 by the UKgovernment as part of its policy to transform the English NHS and to implement standardised ITsolutions at a national level. However, this top down, government led approach came underincreasing scrutiny, and is now being reconfigured towards a more decentralised mode of operations. This paper looks into the implementation of NPfIT and analyses the reasons behindits failure, and what effect the new NHS reforms are likely to have on the health sector. Wedraw from past studies (Weill and Ross, 2005) to highlight the key areas of concern in ITgovernance, using the NPfIT as an illustration

Scenarios of technology adoption towards low-carbon cities

Technological change has often been presented as a readily accepted means by which long-term greenhouse gas (GHG) emission reductions can be achieved. Cities are the future centers of economic growth, with the global population becoming predominantly urban; hence, increases or reductions of GHG emissions are tied to their energy strategies. This research examines the likelihood of a developed world city (the Greater Toronto Area) achieving an 80% reduction in GHG emissions through policy-enabled technological change. Emissions are examined from 3 major sources: light duty passenger vehicles, residential buildings and commercial/institutional buildings. Logistic diffusion curves are applied for the adoption of alternative vehicle technologies, building retrofits and high performance new building construction. This research devises high, low and business-as-usual estimates of future technological adoption and finds that even aggressive scenarios are not sufficient to achieve an 80% reduction in GHG emissions by 2050. This further highlights the challenges faced in maintaining a relatively stable climate. Urban policy makers must consider that the longer the lag before this transition occurs, the greater the share of GHG emissions mitigation that must addressed through behavioural change in order to meet the 2050 target, which likely poses greater political challenges.

Effects of trade policy on technology adoption and investment

This paper studies the consequences of trade policy for the adoption of new technologies. It develops a dynamic international trade model with two sectors. Workers in manufacturing decide if new technologies are used, capital owners then choose investment. We analyze three different arrangements: free trade, tariffs, and quotas. In the model economy, free trade as well as tariffs guarantee that the most productive technology available will be used. In contrasL under a quota the most productive technology available will not be used at all times. Further, in the latter case investment and the capital stock are smaller than in the former one. Finally, there exists parameter values for which the computed difference in GDP is a factor of thirty.

Technology adoption and effects of transfers across locations

This paper develops a two-period model with heterogeneous agents to analyze the e¤ects of transfers across locations on convergence, growth and welfare. The model has two important features. First, locations are asymmetric as it is assumed that there are more specialized occupations in the more developed one. Second, the returns on the investment to acquire new technology depend positively on the level of each region’s knowledge and on the level of the world knowledge assumed to be available to all. In one hand, the poor region has a disadvantage as it has a lower stock of knowledge. On the other hand, it has the advantage of not having yet exploited a greater stock of useable knowledge available in the world. Hence, there are two possible cases. When the returns are greater in the poor region, we obtain the following results: (i) the rich location grows slower; (ii) the transfers to the poor location enhances the country’s growth rate; and (iii) there is a positive amount of transfers to the poor region that is welfare improving. When the returns are greater in the rich region, the …rst two results are reversed and transfers to the rich region are welfare improving. In both cases, the optimal amount of transfer increases with the level of income disparity across regions and is not dependent on the level of the country’s economic development (measured by its income per capita). Barriers to the adoption of new technology available in the world can constrain the convergence process as it harms in greater length the poor region. The results do not change whether migration is allowed or not.

Rural technology adoption and its impacts: direct planting system in Sao Paulo

Este trabalho investiga a adoção do Sistema de Plantio Direto (SPD) no Brasil, uma tecnologia rural bastante promovida devido aos benefícios, tanto privados como sociais, que alegadamente traz. O trabalho baseia-se em evidências recentes sobre os determinantes da adoção desta tecnologia para investigar seus impactos utilizando-se de um grande painel de microdados de unidades de produção agrícola no estado de São Paulo, Brasil. Nós exploramos variações em localizações geográficas e características de solos para construir instrumentos para a adoção e assim identificar os impactos dessa adoção na produção agrícola, nas alo- cações de terras e em outros indicadores da organização produtiva das fazendas. Embora as evidências de ganhos de produtividade permaneçam inconclusivas, nós encontramos impactos significativos da adoção de SPD na alocação de terras e nas decisões de produção.

Environmental regulation, technology adoption and structural transformation: evidence from Brazilian sugarcane industry

We estimate the effects of the adoption of mechanized agriculture led by a new environmental regulation on structural change of local labor markets within a large emerging country, Brazil. In 2002, the state of S\~{a}o Paulo passed a law outlying the timeline to end sugarcane pre-harvest burning in the state. The environmental law led to the fast adoption of mechanized harvest. We investigate if the labor intensity of sugarcane production decreases; and, if so, if it leads to structural changes in the labor market. We use satellite data containing the type of sugarcane harvesting -- manual or mechanic harvest -- paired with official labor market data.%, also geomorphometric data base for our instrumental variable correction. We find suggestive evidence that mechanization of the field led to an increase in utilization of formal workers and a reduction in formal labor intensity in the sugarcane sector. This is partially compensated by an increase in the share of workers in other agricultural crops and in the construction and services sector. Although we find a reduction in employment in the manufacturing sector, the demand generated by the new agro-industries affected positively the all sectors via an increase in workers' wage.

Information technology for development of small and medium-sized exporters in Latin America and East Asia

Includes bibliography

The technical skills of information technology workers in Argentina

Includes bibliography