ABSTRACT
WHAT IS KNOWN AND OBJECTIVE: Polypharmacy, medication errors and adverse events are common in older people receiving home nursing medication management support. Access to clinical pharmacists is limited. In Australia, few home nursing clients receive a general practitioner (GP)-initiated pharmacist-led Home Medicines Review, despite their eligibility and community nurses' (CN) efforts to facilitate this. An integrated home nursing clinical pharmacy service, in which CNs directly referred clients to a pharmacist, was therefore developed and piloted. The aim was to explore the number and type of medication-related problems (MRPs) and medication treatment authorization (medication order) discrepancies identified and addressed by clinical pharmacists. METHODS: Two part-time clinical pharmacists were employed. They reviewed and reconciled clients' medications, educated clients/carers about their medicines, provided advice and support to CNs and worked with clients' GPs and other prescribers to optimize medication regimens and revise/update nurses' medication treatment authorizations. Evaluation involved review of clients' medicines data, including treatment authorizations and pharmacist medication review reports. RESULTS AND DISCUSSION: Eighty-four clients (median 86 years, 6 health conditions, 13 medications) were reviewed. The pharmacists identified 334 MRPs (median 4 per client) and 307 medication discrepancies in treatment authorizations (median 2 per client). The pharmacists made 282 recommendations to prescribers to address MRPs; 148 (52.5%) recommendations were acted on, resulting in 190 medication changes for 60 (71.4%) clients (median 2 per client). The pharmacists prepared, or assisted GPs to update, treatment authorizations for 68 (81%) clients. WHAT IS NEW AND CONCLUSION: Integrating pharmacists into a home nursing service identified and addressed MRPs and medication treatment authorization discrepancies, hence contributing to enhanced medication safety.
Subject(s)
Medication Therapy Management/organization & administration , Pharmaceutical Services/organization & administration , Pharmacists/organization & administration , Aged , Aged, 80 and over , Australia , Female , General Practitioners/organization & administration , Home Nursing/organization & administration , Humans , Male , Medication Errors/prevention & control , Medication Reconciliation/organization & administration , Middle Aged , Professional Role , Prospective Studies , Referral and ConsultationABSTRACT
INTRODUCTION: The Asthma 3+ Visit Plan is a Commonwealth primary care initiative to improve care for patients with moderate or severe asthma through visits to general practitioners (GP). AIMS: To assess the use of, and barriers to, completing the Asthma 3+ Visit Plan in recurrent emergency department attendees; asthma knowledge, symptoms and quality of life were assessed before and after undertaking the plan. METHODS: The design was a predominantly qualitative study. Consenting individuals who presented for emergency treatment for asthma were interviewed before and after completing the Asthma 3+ Visit Plan with their GP. Asthma knowledge, symptom control, quality of life and demographic information were collected and participants underwent in-depth interviews for qualitative analysis. The setting was a tertiary teaching hospital and two suburban hospitals. The participants were 20 recurrent emergency attendees with asthma. RESULTS: Individuals who completed the Asthma 3+ Visit Plan had significant improvements in asthma-related quality of life and asthma knowledge. Qualitative interviews revealed that recurrent emergency attendees for asthma viewed the Asthma 3+ Visit Plan favourably. A good relationship with the GP appeared integral to the success of the Asthma 3+ Visit Plan and patient recall was an important factor in plan completion. Cost was also a barrier to patients completing the plan. CONCLUSION: Our findings support the Asthma 3+ Visit Plan as a discharge strategy for recurrent emergency attendees with asthma.
Subject(s)
Asthma/prevention & control , Asthma/therapy , Family Practice/organization & administration , Health Planning/organization & administration , Adolescent , Adult , Australia , Emergency Service, Hospital , Emergency Treatment/methods , Female , Follow-Up Studies , Health Care Surveys , Humans , Male , Middle Aged , Office Visits , Patient Compliance , Patient Education as Topic/methods , Patient Selection , Respiratory Function Tests , Risk Assessment , Sampling Studies , Secondary Prevention , Severity of Illness IndexABSTRACT
BACKGROUND: Major epidemiological studies in asthma use the question: "How many attacks of asthma have you had in the last 12 months?" We set out to study what constitutes an asthma attack from the perspective of people with asthma. We also examined concordance between qualitative responses and standard quantitative measures of this question. METHODS: Individuals aged 18 to 70 years who sought care for asthma at Emergency Departments in an Australian central city, a suburban and a regional hospital were recruited. Sixty two (43 women and 19 men) participants were interviewed in depth. All interviews were taped, transcribed and thematically analyzed. Demographic data and responses to respiratory health data were also collected. FINDINGS: Widely varying responses to the question, "How many attacks of asthma have you had in the last 12 months?" were found in the quantitative data set. Comparison of quantitative and qualitative data sets showed good agreement between these two responses (intraclass correlation 0.66). People defined asthma attacks as "major" and "minor," as determined by the degree of personal control they were able to exercise. A strongly unifying description of a severe attack was that it was "out of control." Patient's recognized that upper respiratory tract infections commonly triggered major attacks. INTERPRETATION: A commonly asked question about the number of asthma attacks in the past year needs refinement in order to enhance validity. Asthma action plans should use the words "out of control" when defining a severe attack of asthma.
Subject(s)
Asthma/diagnosis , Asthma/epidemiology , Hospitalization/statistics & numerical data , Adolescent , Adult , Age Distribution , Aged , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Cohort Studies , Emergency Service, Hospital , Female , Hospitals, Teaching , Humans , Incidence , Male , Middle Aged , Patient Participation , Recurrence , Reproducibility of Results , Respiratory Function Tests , Risk Assessment , Rural Population , Severity of Illness Index , Sex Distribution , Surveys and Questionnaires , Urban Population , Victoria/epidemiologyABSTRACT
BACKGROUND: Asthma treatment guidelines currently recommend a 'therapeutic partnership' to achieve best care. It is frequently assumed that individuals presenting to emergency departments with asthma do not have a good doctor-patient relationship. We asked what is the nature of patients' relationships with their doctors in those presenting to hospital emergency departments for asthma care. METHODS: A qualitative study of all consenting individuals aged 18-70 years who presented to a hospital emergency department over 2 months was carried out. Sixty-two participants (19 male) engaged in in-depth interviews which were taped, transcribed and underwent thematic analysis. Questionnaire data were also collected and asthma severity determined. RESULTS: Nearly all patients (61/62) had a doctor whom they saw for their asthma. Patients made thoughtful choices on where they sought care according to their needs. Our findings identified that perceptions of doctors' competence, listening to patients and time constraints were important influences on doctor-patient relationships. Participants had strong expectations that their personal disease experience would be acknowledged by their doctors. CONCLUSION: This group of patients had doctors who cared for their asthma. The acceptability of medical care was determined as much by patient choice as by the quality of the doctor-patient relationship.