A non-randomised controlled pilot study of clinical pharmacist collaborative intervention for community dwelling patients with COPD.

UK, home-based patients with COPD receive specialist care from respiratory physicians, nurses, and general practitioners (GPs), but increasing complexity of therapeutic options and a GP/Nurse workforce crisis suggests merit in testing the role of home visits by a clinical pharmacist. We conducted a non-randomised intervention study with a contemporaneous comparator group, in Glasgow (Scotland). A clinical pharmacist (working closely with a consultant respiratory physician) visited patients with COPD living at home, assessing respiratory and other co-morbid conditions, and medicines then, with patient approval, agreed treatment modifications with a consultant physician. Comparator group-patients were drawn from another hospital out-patient clinic. Main outcomes were exacerbations during 4-months of follow-up and respiratory hospitalisations (number and duration) after 1 year. In the intervention group, 86 patients received a median of three home visits; 87 received usual care (UC). At baseline, patients in the intervention group were similar to those in UC in terms of respiratory hospitalisations although slightly younger, more likely to receive specific maintenance antibiotics/Prednisolone and to have had exacerbations. Sixty-two (72.1%) of the intervention group received dose changes; 45 (52.3%) had medicines stopped/started and 21 (24.4%) received an expedited review at the specialist respiratory consultant clinic; 46 (53.5%) were referred to other healthcare services. Over one-third were referred for bone scans and 11% received additional investigations. At follow-up, 54 (63.5%) of intervention group participants had an exacerbation compared with 75 (86.2%) in the UC group (p = 0.001); fewer had respiratory hospitalisations (39 (45.3%) vs. 66 (76.7%); p < 0.001). Hospitalisations were shorter in the intervention group. Pharmacist-consultant care for community dwelling patients with COPD, changed clinical management and improved outcomes. A randomised controlled trial would establish causality.

Detecting contaminated birthdates using generalized additive models.

BACKGROUND: Erroneous patient birthdates are common in health databases. Detection of these errors usually involves manual verification, which can be resource intensive and impractical. By identifying a frequent manifestation of birthdate errors, this paper presents a principled and statistically driven procedure to identify erroneous patient birthdates. RESULTS: Generalized additive models (GAM) enabled explicit incorporation of known demographic trends and birth patterns. With false positive rates controlled, the method identified birthdate contamination with high accuracy. In the health data set used, of the 58 actual incorrect birthdates manually identified by the domain expert, the GAM-based method identified 51, with 8 false positives (resulting in a positive predictive value of 86.0% (51/59) and a false negative rate of 12.0% (7/58)). These results outperformed linear time-series models. CONCLUSIONS: The GAM-based method is an effective approach to identify systemic birthdate errors, a common data quality issue in both clinical and administrative databases, with high accuracy.

Meperidine: a continuing problem.

Letter to the Editor regarding meperidine prescriptions in Queensland, Australia, 1999 to 2010.