Geriatric Care Issues: An American and an International Perspective.

As the global population ages, there is an opportunity to benefit from the increased longevity of a healthy older adult population. Healthy older individuals often contribute financially to younger generations by offering financial assistance, paying more in taxes than benefits received, and providing unpaid childcare and voluntary work. Governments must address the challenges of income insecurity, access to health care, social isolation, and neglect that currently face elderly adults in many countries. A reduction in disparities in these areas can lead to better health outcomes and allow societies to benefit from longer, healthier lives of their citizens.

Conducting medication safety research projects in a primary care physician practice-based research network.

OBJECTIVE: To describe a roadmap for developing a practice-based research network (PBRN) through the experience of conducting medication safety research projects in a primary care physician PBRN. SETTING: Southern Primary-care Urban Research Network (SPUR-Net) in Houston, Tex., from 2000 to 2007. PRACTICE DESCRIPTION: SPUR-Net is a partnership of six health care organizations in Houston and includes 32 clinics with 313 primary care clinicians (50% family physicians, 25% general internists, and 25% pediatricians) who provide care for approximately 1 million patient encounters annually. PRACTICE INNOVATION: The pharmacist principal investigator collaborates with physicians and researchers in primary care clinics to investigate medication safety practice in SPUR-Net. MAIN OUTCOME MEASURES: (1) A roadmap for PBRN research and (2) initiation of a research program focusing on medication safety through the PBRN. RESULTS: A roadmap with 10 steps for conducting practice-based research is recommended: (1) form collaborative partnership, (2) develop research infrastructure, (3) formulate research questions, (4) design study methods, (5) obtain funding support, (6) develop study instruments, (7) implement the study, (8) manage and analyze data, (9) disseminate results, and (10) translate research into practice. Four research projects focusing on medication safety were conducted in SPUR-Net from 2002 to 2007. Medication outcomes include improved medication use, increased awareness for medication counseling, decreased medication errors, and identification of best practices for medication reconciliation. CONCLUSION: Practice-based research conducted in primary care settings identifies, studies, and evaluates common problems encountered in busy clinic practice. With feedback from stakeholders, best practices and improved practice can be identified and "translated" back to practice. Grant funding for research projects helps sustain PBRNs. The implementation of medication safety research projects has helped primary care clinics, clinicians, and patients increase appropriate medication use and explore ways to further improve medication safety.

Stress perceptions in community clinic: a pilot survey of patients and physicians.

This pilot survey of 103 patients and 17 physicians in an urban family medicine clinic gathered information pertinent to the design of a feasible stress intervention for patients bothered by stress, but who did not have a psychiatric diagnosis. Among patients, 45% reported being excessively bothered by stress in the preceding month, with the chief stressors being job (70% reporting), financial worries (58%) and family concerns (50%). Patients reported a variety of problems perceived to be related to stress, such as headaches, insomnia, eating control, and gastrointestinal symptoms. Although about 80% reported using positive coping methods (e.g., talking, exercising, and relaxing), 42% reported using alcohol, and 10% used non-prescribed drugs to cope with stress. Only 37% of patients had sought help for stress from their physician. The wide variety of responses from the physicians reflected a lack of standardized approaches, inadequate training, and a reluctance to engage patients about their stress problems. About 42% of the physicians reported routinely asking patients about stress, and 77% felt that dealing with patient stress was a significant burden on their practice of medicine. Overall, the findings indicate that opportunities are being missed for helping patients to deal with stress constructively, and that a standardized stress self-management program might be one solution.

EM clustering analysis of diabetes patients basic diagnosis index.

Cluster analysis can group similar instances into same group and different instances into different groups. It assigns classes to samples without known the classes in advance. EM clustering algorithm can find number of distributions of generating data and build "mixture models". It identifies groups that are either overlapping or varying sizes and shapes. In this project, by using EM in Weka system, diabetes patient basic diagnosis index data have been analyzed for clustering.

Development of a Web-based diabetes patient management tool.

A Web-based programmed lipid management reminder system has been developed to evaluate physician compliance with the National Cholesterol Education Program's Third Report of the Adult Treatment Panel Guidelines in primary care clinics. The system builds a knowledge-based database from an EMR database first, then generates quarterly profiles of providers and sends the profiles with a reminder letter to each participated physicians by email every quarter to help primary care providers to improve the quality of their care.

Development of a Web-based quarterly profile of providers in ATP III study.

A Web-based programmed lipid management reminder system has been developed to evaluate physician compliance with the National Cholesterol Education Program's Third Report of the Adult Treatment Panel Guidelines in primary care clinics. The system builds a knowledge-based database from an EMR database first, then generates quarterly profiles of providers and sends the profiles with a reminder letter to each participated physicians by email every quarter to help primary care providers to improve the quality of their care.

Collaborative drug therapy management services and reimbursement in a family medicine clinic.

PURPOSE: The legislative and regulatory issues surrounding the reimbursement of pharmacists for cognitive services are reviewed and billing practices for a pharmacist-physician collaborative drug therapy management service (DTMS) in a family medicine clinic are examined. A case study is offered to illustrate the real-world application of these practices. SUMMARY: As regimens of prescription medications have become more complex and the potential for adverse drug reactions and interactions has increased, the need for individualized optimal drug therapy and drug-therapy experts has grown. Pharmacists, who are professionally trained to be an integral part of the medical team, are well prepared to ensure optimal drug therapy and medication safety for patients. Consequently, collaboration between physicians and pharmacists can lead to improved patient care and reduced medication errors. The following 10 steps are recommended for establishing a successful collaborative DTMS: (1) establish a working relationship with physician colleagues, (2) assess the needs of your patients, (3) draft collaborative DTMS protocols and agreements, (4) apply for credentialing status within your health organization, (5) consult the billing office staff at the clinic, (6) design a clinic-encounter form, (7) identify and train support personnel, (8) allocate resources, (9) advertise the DTMS, and (10) evaluate and improve your service. CONCLUSION: Establishing a DTMS presents many challenges and obstacles, but they should not lead to discouragement. Rather, pharmacists should be diligent and continue to explore ways in which they could provide optimal medication therapy to patients through appropriate channels that also facilitate reimbursement.

A wireless mobile health-related quality of life assessment.

Self-administered waiting room questionnaires are popular tools for gathering health information from patients, but they require optical scanning or manual data entry to obtain survey results. The application described here eliminates those extra steps by inputting the results into a remote database directly through wireless connection, and the assessment can be finished easily anywhere in the clinic through a mobile platform. A measure of health-related quality of life, the SF-8 Health Survey, was used in developing this application for using in the clinical setting. It has only eight questions measuring each of the eight domains of health in the longer SF-36 Health Survey.

Urea breath testing and analysis in the primary care office.

The 13C-urea breath test provides accurate, noninvasive diagnosis of active Helicobacter pylori infection and can document posttherapy cure. This study evaluated point-of-care testing with onsite sample analysis with the use of a desktop infrared spectrophotometer. Ambulatory patients (N=320) underwent 13C-urea breath testing, and breath samples were analyzed immediately by clinic staff with no prior breath testing experience. Duplicate samples were sent to a reference laboratory, and the results of both methods were compared. Point-of-care testing was simple, with an overall agreement of 99.1%. Accurate near-patient 13C-urea breath testing is now practical in the primary care setting even when done by inexperienced personnel.