ABSTRACT
OBJECTIVE: Exploration of longer-term outcomes of an ongoing educational-outreach service for community doctors. DESIGN: Quasi-experimental, with parallel and historical comparisons. SETTING: Since 1992, a teaching-hospital-based service has been providing advice and information on drugs and therapeutic strategies to community medical practitioners. PARTICIPANTS: 210 doctors practising in a particular area of metropolitan Adelaide (79% general practitioners; 21% specialists). INTERVENTIONS: Two surgery visits during 1992 focused on better use of prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Subsequent visits on other topical therapeutic issues have occurred regularly. MAIN OUTCOME MEASURES: Doctor participation in the service; supply of prescription NSAIDs; hospital admissions for gastrointestinal (GI) effects of NSAID use. RESULTS: 89% of doctors practising within the service area received the first visit on NSAIDs and 86% received the second visit. More than 85% continue to receive the service. Relative to a comparison area, aggregate reductions of 9% and 28%, respectively, were observed in two different measures of NSAID use. During an 11-year observation period, a single change point in the number of hospital admissions for GI disorders occurred in the service area, coinciding with delivery of the NSAID program. In the five years since the visits commenced, a 70% reduction in admissions was observed. No notable changes in hospital admission rates occurred in the comparison area. CONCLUSIONS: A continuing education and support service for community medical practitioners which uses principally academic detailing methods in its contact with doctors has contributed to sustained changes in prescribed NSAID use over a five-year period. A focus on risk-minimisation in prescribing of NSAIDs appears to have contributed to reductions in hospitalisations for GI adverse events.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Community Medicine/education , Education, Medical, Continuing , Education, Pharmacy , Outcome Assessment, Health Care , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Cohort Studies , Decision Support Systems, Clinical , Drug Information Services , Drug Prescriptions , Drug Utilization , Education, Medical , Family Practice/education , Female , Follow-Up Studies , Gastrointestinal Diseases/chemically induced , Hospitals, Teaching , Humans , Male , Patient Admission , South Australia , SpecializationABSTRACT
A 67-year-old man developed concurrent severe agranulocytosis and elevation of hepatic transaminases as a result of treatment with clomipramine. Although such adverse drug reactions can be considered rare events, the potentially serious nature of these reactions vindicate the routine monitoring of blood picture, and liver function tests, after initiation of treatment with tricyclic antidepressants.
Subject(s)
Agranulocytosis/chemically induced , Chemical and Drug Induced Liver Injury/complications , Clomipramine/adverse effects , Clomipramine/therapeutic use , Depressive Disorder/drug therapy , Aged , Agranulocytosis/complications , Agranulocytosis/enzymology , Chemical and Drug Induced Liver Injury/diagnosis , Clomipramine/pharmacology , Humans , Liver/drug effects , Liver/enzymology , Liver Function Tests , Male , Transaminases/metabolismABSTRACT
Fifty patients were interviewed, on discharge from hospital, about their medications. Nine (18%) patients did not know, and a further four (8%) had inappropriate beliefs about why they were taking at least one of their discharge medications. Very few patients knew of significant side-effects which they might expect, or precautions which they should take, and over half did not know how long they were to continue taking their medicines. A small proportion was unable to read the bottle or open the container. Thus, even patients who, by virtue of an in-patient stay, have had a prolonged opportunity for education regarding their medicines have very little knowledge of their medicines upon discharge from hospital.
