An assessment of home remedy use by African Americans.

This analysis represents the first national look at family and individual use of home remedies by African Americans. The purpose is to examine home remedy usage by African-American individuals and their families and assess the relationship between sociodemographic characteristics and home remedy usage for African-American families and African-American individuals. Using logistic regression, a secondary analysis of the National Survey on Black Americans (NSBA) data (N = 2107) was conducted to examine factors associated with home remedy use. Multivariate analysis indicated that parent's education, importance of religion, living with a grandparent, and living in a rural area were associated with families' use of home remedies. Age, gender, living with a grandparent, education, and geographic region were associated with individual home remedy use. The results of this research may provide insight to health care practitioners in their challenge of appropriately integrating self-care practices (i.e., home remedy use) and the use of the formal health care system among the patients that utilize both "scientific" and "folk" medical systems. When possible, treatment plans should be adapted to consider patients' demographics, health beliefs, and self-care practices. Health care providers should encourage patient and family involvement and dialogue regarding therapeutic approaches. As more information becomes available, health care practitioners will be better able to ascertain the possible health consequences of concurrent usage of home remedies and prescription drug therapies.

Recent advances in geriatrics: drug-related problems in the elderly.

OBJECTIVE: To review recent articles examining drug-related problems in the elderly and comment on their potential impact on geriatric pharmacy practice. DATA SOURCES: Six articles published in 1997 and 1998. DATA SYNTHESIS: One study estimated that the cost of drug-related morbidity and mortality with the services of consultant pharmacists was $4 billion, compared with $7.6 billion without the services of consultant pharmacists. A study of ambulatory elderly patients with polypharmacy documented that 35% reported experiencing at least one adverse drug event within the previous year. Another study of ambulatory elderly found that in those with discontinued medications, adverse drug withdrawal events were uncommon. Two studies, one from Canada and one from the US, describe the development, by consensus, of explicit criteria for defining and identifying inappropriate drug use in the elderly (i.e., drugs to avoid, drugs with dose limits, drug-drug and drug-disease interactions). Finally, a modified Delphi survey of an expert panel reached consensus on 18 potential risk factors for drug-related factors in long-term care facility residents. CONCLUSIONS: Drug-related problems are considerable for elderly patients. Data from published studies should provide some guidance for today's practitioners as well as direction regarding future research.

Safety issues in the pharmacologic management of chronic pain in the elderly.

Chronic pain is commonly encountered in elderly patients. About 20-50% of community-dwelling elderly experience it, and 45-80% of nursing home residents may be affected. Selection of pharmacologic therapy for the management of chronic pain must take into consideration the increased potential for adverse effects in this population. Major classes of drugs used to treat chronic pain (nonsteroidal antiinflammatory drugs, opioids, antidepressants) have adverse effects that occur more frequently in elderly than in younger patients. Given the often prolonged duration of therapy, optimal management requires minimizing the risk of adverse reactions.

Design and results of a group counter-detailing DUR educational program.

PURPOSE: The study objectives were to (1) design, (2) implement and (3) evaluate a multi-step educational program as an integral component of a healthcare system's activities to improve medication use quality and control drug costs. Design and implementation of the educational program were based upon established principles of changing prescriber behavior. Two classes of oral medications, antihistamines and antibiotics, were targeted. METHODS: A before-after nonequivalent comparison group design with 2 comparison groups was used for evaluation. Medication claims data from the same time period one year previously were used as historical controls. Prescribing rates, net savings and prescribers' attitudes were assessed. RESULTS: Prescribing trends in the treatment group but not comparison groups generally reflected changes consistent with the educational message. A net savings of $84 was achieved in the antihistamine program. A net loss of ($2722) was seen in the antibiotic program. Over 75 percent of prescribers agreed or strongly agreed that the educational program was an appropriate mechanism to optimize medication use. Level of exposure and practice years affected perceived knowledge gains. CONCLUSION: The group counter-detailing DUR educational program was effective in improving prescribing rates. Prescribing rate changes and economic impacts differed by therapeutic category. The entire program was well accepted among prescribers including physicians and nurse practitioners.

Antihistamines: the old and the new.

Several pharmacologic agents provide antihistamine effects by acting at the H1 histamine receptor site. The classic agents are relatively nonselective, resulting in a wide range of effects, both therapeutic and undesirable. The newer agents preferentially block peripheral H1 receptor sites and, consequently, have fewer side effects, including sedation. Antihistamines are useful in the treatment of allergic conditions, Parkinson's disease, insomnia and some forms of nausea, and provide symptomatic relief of cough and other conditions associated with respiratory tract infections. Certain agents may play a role in the treatment of asthma and anorexia. Selection of a specific agent should be based on cost and the minimization of side effects. The classic antihistamines provide an inexpensive and highly effective means of treating histamine-mediated symptoms. The bothersome central nervous system side effects can be alleviated by taking the drugs at bedtime; their prolonged tissue half-life allows dosing once or twice a day for 24-hour clinical relief. The newer, more expensive nonsedating antihistamines are acceptable alternatives for patients who are incapable of tolerating the effects of classic agents.

Pharmacist participation in cardiopulmonary resuscitation.

Pharmacist participation in cardiopulmonary resuscitation (CPR), including the basic life support (BLS) activities of artificial respiration and chest compressions, was studied. A questionnaire was mailed in September 1991 to the 197 graduates (1986-90) of a Michigan college of pharmacy requiring BLS training for graduation. Another questionnaire was mailed in April 1992 to the 181 pharmacy directors at all general acute-care hospitals in Michigan. The "graduate" survey covered practice setting, current status of BLS certification, use of BLS, and attitudes toward BLS training. The "director" survey covered the characteristics of the institution and its pharmacists, pharmacist involvement in CPR, and departmental BLS-training requirements. The response rates for the graduate and director surveys were 81% (160 questionnaires) and 76% (138), respectively. Only 66 (41%) of the graduates were currently certified in BLS, and only 77 (48%) had completed a BLS course since graduation. More than half (84, or 53%) indicated they had never been involved in any CPR activity. Activities most likely to be reported were drug preparation, dosage calculation, documentation, and drug information; very few pharmacists had given artificial respiration or chest compressions. Forty-six (33%) of the directors indicated that pharmacists routinely were members of the CPR team. Most (59%) of these 46 hospitals did not require BLS training for pharmacists. Hospital size significantly affected whether pharmacists were included on the CPR team. Hospitals with decentralized pharmacists were more likely than hospitals with centralized pharmacists to have pharmacist involvement on the CPR team. Both study groups expressed ambivalence about the value of BLS training for their current pharmacy practice situations.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic hemodialysis patients. Part I: Characterization and drug-related problems.

OBJECTIVE: To describe medication use in hemodialysis patients and to characterize the potential drug-related problems that may occur in this population. DESIGN: All patients being dialyzed during the study period who were responsible for taking their own medications and who were able to provide an accurate medication history were included in this study. A pharmacist administered a structured medication history and drug therapy review protocol known as the Focused Drug Therapy Review Program to identify potential drug-related problems. This process was modified for a hemodialysis population. SETTING: Outpatient hemodialysis unit at a university-affiliated hospital. RESULTS: Thirty patients with endstage renal disease requiring hemodialysis were enrolled in the study. On average, 10 prescription and 2 prescribed nonprescription medications were used per patient. The incidence of potential adverse effects and medication allergies or intolerances averaged 5.5 and 2.2 per patient, respectively. Twenty patients (67 percent) reported missing an average of 3.4 (range 1-11) doses of medication per month. A total of 216 potential drug-related problems (encompassing both prescribing choices and patient behaviors) were identified by the pharmacist; the categories of drug selection and medication compliance contained the greatest number of potential problems (24 and 23 percent, respectively). CONCLUSIONS: Hemodialysis patients use a large number of medications, which increases the risk for adverse reactions and other drug-related problems. The types of potential drug-related problems identified are amenable to pharmacist input. Thus, such patients should be targeted for clinical pharmacy intervention.

Chronic hemodialysis patients. Part II: Reducing drug-related problems through application of the focused drug therapy review program.

OBJECTIVE: To test the value and measure the impact of a model of pharmacy practice called the Focused Drug Therapy Review Program (FDTRP) in patients with endstage renal disease on hemodialysis. DESIGN: A modified version of FDTRP, adapted for a hemodialysis population, was assessed for its impact on prescriber behavior. The impact was measured by examining the percentage of pharmacist therapeutic recommendations accepted and implemented by the prescriber. SETTING: Thirty patients at a university hospital-based outpatient hemodialysis unit participated in the study. Twenty-four patients completed the study through the implementation evaluation. RESULTS: The pharmacist generated 114 therapeutic recommendations and 85 informative comments regarding drug therapy. The prescriber accepted 76 percent and implemented 70 percent of the therapeutic recommendations. The prescriber considered the informative comments to be helpful, even if the information was known previously. CONCLUSIONS: The FDTRP has been shown to be useful in the care of chronic hemodialysis patients. In addition, the pharmacist was able to provide clinically important recommendations in a closely monitored patient population.

Consumer vinegar test for determining calcium disintegration.

A consumer test and standardized methods were compared for measuring the disintegration of calcium tablets, and the disintegration results were compared with results of dissolution testing to determine the ability of the consumer test of disintegration to predict bioavailability of calcium. Disintegration of 17 calcium supplement products, in tablet form, was studied in Simulated Gastric Fluid Test Solution, USP, without pepsin (GF), in distilled water, and in white distilled vinegar. For disintegration testing with GF and with distilled water, six tablets of each product were placed in an apparatus and immersed in the solution at 37 degrees C for 60 minutes. Six tablets of each product were tested in 200 mL of vinegar at room temperature for 30 minutes. Disintegration was determined by visual observation. Seven products were tested for dissolution in GF or water. Three samples of each product were tested at intervals over 120 minutes for calcium content. Results of testing with an ion-selective electrode were converted to milligrams and compared with the calcium content of the tablets (as claimed on the package label). The mean disintegration times of various calcium products in vinegar ranged from 1.8 to greater than 30 minutes. The mean time in distilled water and GF ranged from 1.6 to greater than 60 minutes and from 1.0 to greater than 60 minutes, respectively. Results were in agreement in 87% to 93% of cases between the consumer vinegar test and the standardized disintegration test methods, a significant correlation. No correlation was found between disintegration time and the extent of dissolution. The disintegration and dissolution of commercially available calcium tablets was highly variable.(ABSTRACT TRUNCATED AT 250 WORDS)

A systematic approach to educating elderly patients about their medications.

The purpose of this study was to evaluate a pharmacist-initiated, total package, patient education program based on the concepts described in the PRECEDE model. This program was directed towards 94 therapeutically complex elderly patients and consisted of a medication history, therapeutic evaluation, patient education needs assessment, patient education session, and a patient feedback/satisfaction telephone interview. Pharmacists identified on average 5.6 medication-related problems and provided an average of 6.2 recommendations. Problems commonly identified involved inadequate drug knowledge (25.5%), noncompliance (22.7%), and inappropriate drug use (17.4%). Typical recommendations included altering drug use (35.9%), improving compliance behavior (18.1%), and improving communication with health professionals (18.1%). Patient satisfaction with the education session was overwhelmingly positive. Based on the findings of this study, it is apparent that a patient education program based on the PRECEDE model can be used successfully by pharmacists to prepare education plans that would benefit the therapeutically complex elderly patient.

Ranitidine-induced chest pain.

A 45-year-old woman with no history of heart disease twice experienced chest pain after consuming a dose of ranitidine. The chest pain, which lasted about one hour, was substernal, left of midline, dull, and pounding. H2-receptors are present in cardiovascular tissues. Although several studies have not noted an effect of ranitidine on cardiac indices there have been case reports indicating a cardiac effect. There are no reports of chest pain associated with H2-blocker ingestion; however, both bradycardia and hypotension (reported effects) might cause chest pain. A discussion of the possible mechanisms is presented.

Relationship between drug use and urinary incontinence in elderly women.

Two hundred older women with urinary incontinence were studied to observe the influence of their prescription and nonprescription drug use on symptoms of incontinence. Ninety percent of women reported using medication, with an average use of four drugs. Medications statistically associated with urinary incontinence symptomatology were prostaglandin inhibitors, diuretics, and estrogen therapy. Further studies are needed to clarify the relationship between medication usage and the presence and severity of urinary incontinence.

Urinary incontinence in the elderly: etiology and treatment.

Urinary incontinence is a common, though often hidden, medical problem among the elderly. Urinary continence requires integrity of the neural, muscular, and hormonal systems. Five distinct types of urinary incontinence can be distinguished based on patient symptoms. A variety of factors can impair continence, including aging, environmental barriers, and medications. Both pharmacological and nonpharmacological measures are useful in the treatment of incontinence.

An assessment of different components of patient medication knowledge.

Different components of drug knowledge (i.e., knowledge of the drug purpose, regimen, action if a dose is missed, and common side effects) were examined in 187 ambulatory cardiovascular patients in order to determine whether the components were similar enough to be considered interchangeable in representing drug knowledge. Patients and physicians were interviewed in a family practice setting and their responses compared for each cardiovascular drug the patient was taking. Scores were highest for knowledge of the drug regimen and purpose, fewer patients were correct about the appropriate action if a dose were missed, and only a small number could accurately identify common side effects associated with their drug therapy. The comparison of patient responses to each of the knowledge measures indicated that there was little consistency in response across the various types of knowledge. The differences in the measures were supported further by regression equations that showed different relationships between a set of independent variables and knowledge of drug purpose and regimen, respectively. The study findings suggest that a partial explanation for inconsistencies of research about drug knowledge may be the way this concept is measured.

A systematic approach to identifying and reducing medication-related problems in family practice patients.

Because of the existence of multiple medical diseases and the concurrent use of multiple medications, many elderly patients present a therapeutically complex picture to clinicians. This pilot study evaluates a systematic approach to identifying and reducing medication-related problems in a population averaging five chronic medical problems and taking an average of eleven medications. The approach is unique in its use of an in-depth home medication history and a comprehensive review of therapy. In spite of close medical supervision, an average of ten potentially medication-related problems were identified among seventeen therapeutically complex patients. Recommendations to eliminate these problems were developed by pharmacists who reviewed the patient information. These recommendations were presented to the patient's physician who accepted 67% of the suggestions.

Potential medication-related problems in noninstitutionalized elderly.

The extent of potential medication-related problems was examined using a thorough review of drug therapy for 53 elderly patients who averaged five chronic illnesses and who used a mean of 11 drugs. An average of 11 specific potential medication-related problems was identified for each patient. These problems fell into three broad categories: drug toxicity, physician prescribing, and patient medication behaviors. The strongest predictor of the total number of potential problems was the number of prescription medications. The type of drug therapy review used in this study can help health professionals identify and prevent the types of medication-related problems occurring in multiple medication users.

Discontinuing antiepileptic therapy.

Prognosis for successful withdrawal of antiepileptics is excellent in selected patients. Studies indicate that therapy should be maintained for at least three seizure-free years before antiepileptics are discontinued. The decision to withdraw medication in an epileptic patient hinges on the likelihood of seizure recurrence and a critical assessment of the benefits of discontinuing therapy as compared with the possible consequences of a recurrent seizure.

The effectiveness of four education strategies in the elderly.

A study was designed for practitioners wishing to provide comprehensive educational services to the elderly. The effectiveness of four methods (i.e., oral instructions alone or in combination with written information, a medication reminder calendar, or a medication reminder package) of changing patient attitudes, drug knowledge, and compliance behavior was measured in 158 ambulatory cardiovascular patients using a randomized, controlled, single-blind design. The results indicate that drug knowledge will most likely be improved by a strategy that provides small amounts of specific information, thereby reducing the possibility of overwhelming the patient. Noncompliance behavior caused by forgetfulness can be best improved by combining a reminder aid with oral reinforcement. The high levels of motivation present in these patients indicate that improving patient attitudes toward medication taking may be unnecessary.