Roles of the non-medical prescribing leads within organisations across a Strategic Health Authority: perceived functions and factors supporting the role

Objectives Extending the roles of nurses, pharmacists and allied health professionals to include prescribing has been identified as one way of improving service provision. In the UK, over 50 000 non-medical healthcare professionals are now qualified to prescribe. Implementation of non-medical prescribing ( NMP) is crucial to realise the potential return on investment. The UK Department of Health recommends a NMP lead to be responsible for the implementation of NMP within organisations. The aim of this study was to explore the role of NMP leads in organisations across one Strategic Health Authority (SHA) and to inform future planning with regards to the criteria for those adopting this role, the scope of the role and factors enabling the successful execution of the role. Methods Thirty-nine NMP leads across one SHA were approached. Semi-structured telephone interviews were conducted. Issues explored included the perceived role of the NMP lead, safety and clinical governance procedures and facilitators to the role. Transcribed audiotapes were coded and analysed using thematic analytical techniques. Key findings In total, 27/39 (69.2%) NMP leads were interviewed. The findings highlight the key role that the NMP lead plays with regards to the support and development of NMP within National Health Service trusts. Processes used to appoint NMP leads lacked clarity and varied between trusts. Only two NMP leads had designated or protected time for their role. Strategic influence, operational management and clinical governance were identified as key functions. Factors that supported the role included organisational support, level of influence and dedicated time. Conclusion The NMP lead plays a significant role in the development and implementation of NMP. Clear national guidance is needed with regards to the functions of this role, the necessary attributes for individuals recruited into this post and the time that should be designated to it. This is important as prescribing is extended to include other groups of non-medical healthcare professionals.

Safety Assessment of Potentially Inappropriate Medications (PIM) use in Older People and the Factors Associated with Hospital Admission

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Inappropriate management conditions, especially for the regressed class, are related to sperm quality in Prochilodus lineatus

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Rating of perceived exertion as a tool for prescribing and self regulating interval training: a pilot study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prescribing and regulating exercise with RPE after heart transplant: a pilot study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Medicamentos inadequados para idosos na estratégia da saúde da família

The ageing process can change the pharmacodynamics and pharmacokinetics parameters. Therefore, some medications are considered potentially inappropriate (PIM) for the elderly people, since they can increase the likelihood of occurrence of adverse drug events. The objectives are to estimate the frequency of use of PIM in the elderly people, with potentially hazardous drug interactions (PHDI) and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. A cross-sectional study was performed in a Health Family Strategy (region of Araraquara, SP), between January and February/2012. The medical records of patients aged ≥60 years, that use at least one drug, were consulted for identification of PIM, according to the Beers criteria. The MPI identified were classified considering the Anatomical Therapeutic Chemical Classification System (ATC) and the essentiality of the drug (safety, effectiveness, quality and cost parameters) The inclusion criteria were met by 358 elderly, being that 93 of them (26%) had taken at least one PIM. Of the 114 different drugs prescribed for elderly, ten were classified as PIM, of which four of them act on the central nervous system, four on cardiovascular system and two on the digestive tract. Seven MPI are essential medicines, belonging to national list of essential drugs (RENAME-2010). Fourteen drug interactions were identified, of which two are PHDI (fluoxetine/amitriptyline and digoxin/hydrochlorothiazide).After the PI, there was no change in medical prescriptions of patients with PIM use or with DI. Medical prescriptions of elderly attended in the Health Family Strategy show pharmacotherapeutic safety problems, of which may be responsible for health hazardous for this age group. Although the intervention carried out by letter had been ineffective for the adherence of doctors in prescribing safe alternatives, wide dissemination of the lists that contain PIM and PHDI is need, as well as the inclusion of safer equivalents in RENAME, in order to contribute for rational use of drugs.

Bromocriptine Treatment for Inappropriate Lactation in Mares: A Case Report

Transient mammary gland development and lactation can occur eventually in weanling foals, yearlings, and adult mares without previous or recent history of pregnancy. The etiology of this condition has not been well documented, and there is limited information on the occurrence, frequency of episodes, composition, and treatment of galactorrhea secretion. This article reports a case of Brazilian Sport Horse mare, aged 10 years, with persistent lactation during 5 months. The treatment consisted of bromocriptine 0.04 mg/kg, b.i.d., orally, for 10 days, associated with hydrotherapy for 20 minutes, twice daily. After 20 days of the treatment onset, the mare was reevaluated, and a significant decrease in the volume of the udder and the amount of secretion produced was noted, and its aspect was clearer (serous) and consisted of more fluid compared with the one collected before treatment. No other clinical alterations or associated diseases were identified. Based on these findings, we suggest the diagnosis of idiopathic inappropriate lactation. Although there is no information about pharmacokinetics and description of the oral bromocriptine use in horses, being a therapeutic option for inappropriate lactation treatment in mares, it was effective at the recommended dosage. (C) 2012 Elsevier Inc. All rights reserved.

Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System?

[EN] Background This study aims to design an empirical test on the sensitivity of the prescribing doctors to the price afforded for the patient, and to apply it to the population data of primary care dispensations for cardiovascular disease and mental illness in the Spanish National Health System (NHS). Implications for drug policies are discussed. Methods We used population data of 17 therapeutic groups of cardiovascular and mental illness drugs aggregated by health areas to obtain 1424 observations ((8 cardiovascular groups * 70 areas) + (9 psychotropics groups * 96 areas)). All drugs are free for pensioners. For non-pensioner patients 10 of the 17 therapeutic groups have a reduced copayment (RC) status of only 10% of the price with a ceiling of €2.64 per pack, while the remaining 7 groups have a full copayment (FC) rate of 40%. Differences in the average price among dispensations for pensioners and non-pensioners were modelled with multilevel regression models to test the following hypothesis: 1) in FC drugs there is a significant positive difference between the average prices of drugs prescribed to pensioners and non-pensioners; 2) in RC drugs there is no significant price differential between pensioner and non-pensioner patients; 3) the price differential of FC drugs prescribed to pensioners and non-pensioners is greater the higher the price of the drugs. Results The average monthly price of dispensations to pensioners and non-pensioners does not differ for RC drugs, but for FC drugs pensioners get more expensive dispensations than non-pensioners (estimated difference of €9.74 by DDD and month). There is a positive and significant effect of the drug price on the differential price between pensioners and non-pensioners. For FC drugs, each additional euro of the drug price increases the differential by nearly half a euro (0.492). We did not find any significant differences in the intensity of the price effect among FC therapeutic groups. Conclusions Doctors working in the Spanish NHS seem to be sensitive to the price that can be afforded by patients when they fill in prescriptions, although alternative hypothesis could also explain the results found.

Public health impact of statin prescribing strategies based on JUPITER

To evaluate the public health impact of statin prescribing strategies based on the Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin Study (JUPITER).

Inappropriate interventions during the long-term follow-up of patients with an implantable defibrillator

QUESTIONS UNDER STUDY: In patients with an implantable defibrillator (ICD), inappropriate ICD interventions alter the quality of life, may cause hospitalisations and limit cost-effectiveness. The aim of the study was to determine the incidence and causes of inappropriate ICD interventions, and to identify patients at risk. METHODS: For this observational longitudinal study, consecutive patients undergoing ICD implantation at the University Hospital of Berne were included in a registry. All stored electrograms of episodes triggering ICD interventions were systematically reviewed and analysed to determine whether ICD interventions were appropriate or inappropriate. Inappropriate ICD interventions were classified according to their cause, and risk factors were sought. RESULTS: 214 consecutive patients were followed during a median time of 2.7 years (3.7 years IQR, 698 patient years). 81 inappropriate ICD interventions occurred in 58 patients (27%). Factors triggering inappropriate ICD interventions included atrial fibrillation and flutter (n = 35, 44%), sinus tachycardia (n = 26, 32%), lead fracture (n = 12), recurrent self-terminating ventricular tachycardia (n = 5), double-counting due to T-wave oversensing (n = 3). The only identifiable risk factor for inappropriate ICD interventions was sustained ventricular tachycardia as index arrhythmia. CONCLUSIONS: An important proportion of ICD patients suffer inappropriate ICD interventions that are most commonly due to supraventricular arrhythmias. Patients with ventricular tachycardia prior to ICD implantation are at higher risk of inappropriate ICD interventions. Interventions aiming at decreasing the risk of inappropriate ICD interventions should be considered in these patients.

Clinical and haematological predictors of antibiotic prescribing for acute cough in adults in Swiss practices - an observational study.

BackgroundAcute cough is a common problem in general practice and is often caused by a self-limiting, viral infection. Nonetheless, antibiotics are often prescribed in this situation, which may lead to unnecessary side effects and, even worse, the development of antibiotic resistant microorganisms worldwide. This study assessed the role of point-of-care C-reactive protein (CRP) testing and other predictors of antibiotic prescription in patients who present with acute cough in general practice.MethodsPatient characteristics, symptoms, signs, and laboratory and X-ray findings from 348 patients presenting to 39 general practitioners with acute cough, as well as the GPs themselves, were recorded by fourth-year medical students during their three-week clerkships in general practice. Patient and clinician characteristics of those prescribed and not-prescribed antibiotics were compared using a mixed-effects model.ResultsOf 315 patients included in the study, 22% were prescribed antibiotics. The two groups of patients, those prescribed antibiotics and those treated symptomatically, differed significantly in age, demand for antibiotics, days of cough, rhinitis, lung auscultation, haemoglobin level, white blood cell count, CRP level and the GP¿s license to self-dispense antibiotics. After regression analysis, only the CRP level, the white blood cell count and the duration of the symptoms were statistically significant predictors of antibiotic prescription.ConclusionsThe antibiotic prescription rate of 22% in adult patients with acute cough in the Swiss primary care setting is low compared to other countries. GPs appear to use point-of-care CRP testing in addition to the duration of clinical symptoms to help them decide whether or not to prescribe antibiotics.

Appropriateness and long-term discontinuation rate of biological therapies in ulcerative colitis

BACKGROUND Anti-TNFα agents are commonly used for ulcerative colitis (UC) therapy in the event of non-response to conventional strategies or as colon-salvaging therapy. The objectives were to assess the appropriateness of biological therapies for UC patients and to study treatment discontinuation over time, according to appropriateness of treatment, as a measure of outcome. METHODS We selected adult ulcerative colitis patients from the Swiss IBD cohort who had been treated with anti-TNFα agents. Appropriateness of the first-line anti-TNFα treatment was assessed using detailed criteria developed during the European Panel on the Appropriateness of Therapy for UC. Treatment discontinuation as an outcome was assessed for categories of appropriateness. RESULTS Appropriateness of the first-line biological treatment was determined in 186 UC patients. For 64% of them, this treatment was considered appropriate. During follow-up, 37% of all patients discontinued biological treatment, 17% specifically because of failure. Time-to-failure of treatment was significantly different among patients on an appropriate biological treatment compared to those for whom the treatment was considered not appropriate (p=0.0007). Discontinuation rate after 2years was 26% compared to 54% between those two groups. Patients on inappropriate biological treatment were more likely to have severe disease, concomitant steroids and/or immunomodulators. They were also consistently more likely to suffer a failure of efficacy and to stop therapy during follow-up. CONCLUSION Appropriateness of first-line anti-TNFα therapy results in a greater likelihood of continuing with the therapy. In situations where biological treatment is uncertain or inappropriate, physicians should consider other options instead of prescribing anti-TNFα agents.