Interventions to prevent or reduce rationing or missed nursing care: A scoping review.

AIMS: To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions. BACKGROUND: Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes. DESIGN: Scoping review. DATA SOURCES: We searched for eligible studies, published between 1980-2019, in six electronic databases. REVIEW METHODS: Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based. RESULTS: The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care. CONCLUSIONS: The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions. IMPACT: Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.

Psychometric properties of the Culig's questionnaire.

BACKGROUND: Perseverance in applying the therapy is an important determinant of its success, but evaluation of perseverance is extremely complex, and therefore, alternative method of processing the results by the Culig's questionnaire of perseverance is presented. SUBJECTS AND METHOD: Psychometric properties of the questionnaire on a sample of 225 examinees have been calculated and the factor structure of indicators that make up the scale is presented. RESULTS: Psychometric properties calculated in an alternative way are significantly better than the original, especially when it comes to reliability and representativeness of the questionnaire. CONCLUSION: This method of data analysis raises the possibility of multivariate data processing on the Culig's questionnaire, which is important for further research.

Pharmacist Competences and Impact of Pharmacist Intervention on Medication Adherence: an Observational Study.

BACKGROUND: The aim of this study is to determine the results of pharmacist interventions on patient's adherence to drugs in community settings. SUBJECTS AND METHODS: The study was designed using a standard EQ-SDQ questionnaire and a Culig questionnaire about the adherence to drug. General Level Framework (GLF) was used as a tool for competence assessment among community pharmacists. Participants were pharmacists that issued the medication on repeat prescription in the pharmacy. They interviewed the patient at the first visit to the pharmacy and the next time when the patient came to refill the prescription. The survey was conducted during a two-month period in the Atlantic Pharma pharmacy chain. A total of 152 patients were included at the first visit and 87 patients at the second visit. RESULTS: About two thirds of patients (65.5%) identified themselves as adherent during the first survey, and this number increased slightly during the second interview (by 3.5%), but not statistically significant (p=0.75). A total number of drugs prescribed during the first and second survey was 252 and 253 respectively. The percentage of the advices given to the patients increased during the second survey, but not statistically significant (p=0.62). CONCLUSION: It is definitely important to check that a patient understands current disease and what are doubts and difficulties in taking a therapy. The reasons for possible nonadherence are different: fears, worsening of the clinical state or other negative treatment outcomes. Enough time should always be left to clarify anything that is unclear and to listen. Application of GLF program for improving pharmacist competences resulted in slightly increased patient adherence to medication. For further development of competences, pharmacist intervention should include some other contents, i.e. tailoring the dosage scheme, counselling about drug-drug and drug-food interactions. The pharmacist counseling should be reimbursed by the Croatian Health Insurance Fund.

Comparison of two Different Methods (Patient Questionnaire and Medication Possession Ratio - MPR) for Measuring the Chronic Patient's Behavior.

BACKGROUND: Medication adherence is the extent to which patients take medications as prescribed by their health care providers. There are a number of approaches to study medication-taking behavior. The aim was to compare two most common methods for measuring adherence: Patient Adherence Questionnaire and Medication Possession Ratio (MPR). They belong to the indirect methods. METHODS: In this article four adherence studies were analysed and the results were compared, two wherein the patient questionnaire was applied and other two with medication possession ratio applied. RESULTS: The obtained results reveal that more than half of respondents (58.9%) experienced constant nonadherence behavior according to the prescribed therapy. The main reason of nonadherence is oblivion, suggesting that it is necessary to pay more attention to this problem. CONCLUSIONS: Nonadherence with therapy has negative consequences on the health of the individual, and an adverse impact on the community health and wealth. Patients should be informed of the importance of regularly taking prescribed therapy. The main problem of long-term therapy is significantly decreased of adherence to medication in a very short time. It is important to stress that almost all the interventions effective for improving patient adherence in long-term care are complex and should be repeated after a while.

From Morisky to Hill-bone; self-reports scales for measuring adherence to medication.

There are a number of approaches to studying medication-taking behavior. Self-report measures have the benefits of being cheap, easy to administer, non-intrusive, and able to provide information on attitudes and beliefs about medication. Potential limitations to self-report are that the ability to understand the items, and willingness to disclose information, can affect response accuracy and, thus, questionnaire validity. A computerized systematic search of the PubMed databases identified articles on scales for medication adherence measuring using the MeSH terms medication adherence, compliance, and persistence combined with the terms questionnaire self-report. Adherence scales have identified mostly in the last few years (2005-2012). One of the main sources has been article (Lavsa et. al) which evaluated literature describing medication adherence surveys/scales to gauge patient behaviors at the point of care. Articles were included if they evaluated or reviewed self-reported adherence medication scale applicable to chronic diseases and with a good coefficient of internal consistency reliability (Cronbach's alpha (alpha)). Articles that contained data about self-report medication adherence scales use were included. A total of about one hundred articles were identified. Of those articles, 20% (20 of 100) were included in the review because of their relevance to the article topic. This article describes various self-report scales by which to monitor medication adherence, their advantages and disadvantages, and discusses the effectiveness of their application at different chronic diseases. There are many self-report scales for measuring medication adherence and their derivatives (or subscales). Due to the different nature of the diseases, there is no gold-standard scale for measuring medication adherence. It can be nevertheless concluded that the nearest to gold-standard is the Medication Adherence Questionnaire (MAQ) scale by Morisky et.al. but we found better internal consistency reliability in some other scales.

Patient self-reported adherence for the most common chronic medication therapy.

AIMS: The aims of this study was to determine adherence to chronic disease medication measured by self-reported questionnaire. METHODS: The survey was conducted at 106 Zagreb pharmacies, and the questionnaire was filled out by the study subjects. RESULTS: A total 1,357 diagnoses were reported by survey respondents (i.e., an average of 2.1 diagnoses per respondent). The most common diagnoses were diseases of the circulatory system (n = 500; 36.8%). The great majority of study subjects reported forgetfulness ('I just forgot') as the main reason for skipping drug doses. CONCLUSIONS: Among the many reasons people give for not adhering to drug treatment, forgetfulness was the most common. Common barriers to adherence are under the patient's control, so that attention to them is a necessary and important step in improving adherence. The existence of more than one cause of risk considerably increases the non-adherence risk of a patient.

Pharmacy claims data as a tool to measure adherence.

Medication possession ratio (MPR) was introduced as a uniform methodology for estimating medication adherence from pharmacy claims data, but it does not provide accurate information on the continuity of medication usage and the measurement of medication persistency and identification of eventual gaps in medication supply. The combination of an MPR and a persistency metric could provide timely information on the dynamics of patient medication adherence.

Determining the difference in medication compliance between the general patient population and patients receiving antihypertensive therapy: a case study.

This study addressed the issue of medication compliance in general, compliance with antihypertensive therapy, and the relationship between these two groups. In addition to determining the reasons for noncompliance with therapy prescription, the aim of this study was to also establish whether it was considered feasible by the patients to comply with their physician's instructions and whether the patients believed that the prescribed therapy was beneficial to their health. Hypertensive patients were compared to the total study population according to age groups. The study was designed as a cross-sectional survey with the use of a 33-item self-administered questionnaire. The study included 635 individuals who were collecting or buying drugs for the treatment of chronic diseases, with special reference to subjects taking antihypertensive agents (n = 361). More than half (n = 361; 56.9%) of the 635 study subjects were on therapy for arterial hypertension and possibly for some other diseases. The great majority of study subjects reported forgetfulness as the main reason for skipping drug doses. Comparison between the total study population and the subjects treated for arterial hypertension according to age groups (compliant, noncompliant and all together) yielded no statistically significant difference. We concluded that there was no difference in medication compliance between the general patient population and patients receiving antihypertensive therapy and there was no correlation between medication compliance and age.

The effects of benzodiazepines in pregnancy.

OBJECTIVES: The objectives of the study were to assess the prevalence of anxiolytic use in pregnancy, the rate of congenital malformations in neonates at in utero exposure to these agents, and the possible association of congenital malformations with the use of these drugs in pregnancy. METHOD: The study was conducted as cross-sectional study. The study was performed at university departments of gynecology and obstetrics in four Zagreb hospitals and included 893 pregnant women. Main outcome measures were pathological defects and congenital malformations. RESULTS: The main anatomic group N drugs (nervous system) was predominated by the use of the benzodiazepine anxiolytic diazepam (FDA group D), which increased with gestational age. Diazepam was used by 74 (8.3%), 127 (14.2%) and 212 (23.7%) women in the first, second and third trimester respectively. Diazepam ranked second among twenty most frequently prescribed drugs in pregnancy. It was taken by 303 (33.9%) pregnant women, while congenital cardiovascular malformations were recorded in three children and genitourinary malformations in three children too. CONCLUSIONS: The high utilization of diazepam in pregnancy that is not supported by professional guidelines is an issue of serious concern. In spite of some study limitations, its results pointed to inappropriate and even potentially harmful use of drugs in pregnant women from Zagreb, thus calling for upgrading the quality of therapy in this vulnerable period of life. In our opinion, other measures appear to be a more appropriate therapeutic modality than medicamentous therapy in many cases.

[Resistance of uropathogenic strains of Escherichia coli in pregnant women and other women in generative ages in comparison with antibiotics consumption in Zagreb]. / Rezistencija uropatogenih sojeva bakterije Escherichia coli kod trudnica i zena generativne dobi u usporedbi s potrosnjom anti- biotika u Zagrebu.

AIM: To compare resistance of uropathogenic strains of Escherichia coli (UPEC) to antibiotics in women in generative ages and pregnant women during two year period (2004 and 2008) in Zagreb, and comparison of resistance and the consumption of antibiotics. METHODS: The standard disk-diffusion method was used for sensitivity testing to 16 different antibiotics. Data on antibiotic utilization were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants using Anatomical-Therapeutic-Chemical/DDD methodology. Data on antibiotic consumption during pregnancy were collected using a questionnaire filled in by 893 women after delivery. RESULTS: During 2004 resistance of UPEC to antimicrobial drugs was not different in pregnant and in non-pregnant women, with the exception of amoxicillin and nitrofurantoin, with statistically higher resistance in pregnant women (p < 0.01). Four years later the statistically higher resistance to norfloxacin was observed in non-pregnant women (p < 0.01). Comparing the resistance in 2004 and 2008, in the both groups of women a statistically significant decrease of resistance to cefalexin and nitrofurantoin was detected (p < 0.01). Outpatient utilization of antimicrobial drugs in Zagreb increased significantly, from 32 to 39 DDD/1000 inhabitants per day. The most used antibiotic was co-amoxiclav, and its utilization increased from 9.6 to 12.2 DDD/1000/day. Amoxicillin and co-amoxiclav were used during pregnancy by 9.6% interviewed women. CONCLUSION: The observed significant decrease of resistance to cefalexin makes that antibiotic the drug of choice for treatment of urinary tract infections in women in generative ages, and together with coamoxiclav can be administered in pregnancy. Constant monitoring of urinary tract pathogens resistance to antimicrobial agents ensures the effectiveness of empirical therapy, whose versatile use is limited due the potentially harmful effects of antimicrobial drugs on fetus.

Efficiency of hypertonic and isotonic seawater solutions in chronic rhinosinusitis.

BACKGROUND: To compare the efficiency of isotonic and hypertonic seawater solutions used for nasal lavage and quality of life of the patients with chronic rhinosinusitis. METHODS: A random and controlled clinical study was performed. The study included 60 patients with history of chronic rhinosinusitis. At the beginning of the study, each subject was given a Patient Logbook, which needed to be filled out daily during the 15-day study period. There were three visits per each patient during the study. RESULTS: Results Patient Logbook notes showed significant statistical differences in all symptoms in the group of patients using hypertonic seawater solution. However, while the notes showed significant statistical differences in congestion and rhinorrhea, in the group of patients using isotonic seawater solution, other symptoms showed no major changes during the study period. CONCLUSIONS: Hypertonic seawater solution has been proven to be better than isotonic seawater solution in eliminating the symptoms of nasal congestion, rhinorrhea, cough, headache and waking up during the night.

Pregnancy and drugs for cardiovascular diseases.

OBJECTIVE: The course of pregnancy is associated with a number of changes in the female body. Literature data indicate that 1-3% of pregnant women develop some cardiac disorder. The aim of the study was to assess the prevalence of using cardiovascular agents in pregnancy, the rate of congenital malformations in neonates at in utero exposure to these agents, and the possible association of congenital malformations with the use of these drugs during pregnancy. METHODS AND RESULTS: One arm of the study (one-month study) was performed at four maternity hospitals in Zagreb, Croatia. The other arm of the study (one-year study) was performed at the University Department of Gynaecology and Obstetrics, Genetic Counselling Unit, and Department of Pathology and Histology in Novi Sad, Serbia. Only pregnant women using drugs for cardiovascular disorders during pregnancy were included in the study. Final analysis included data on 134 (32 from Zagreb and 102 from Novi Sad) pregnant women. Following delivery or abortion, the newborns and foetuses were thoroughly examined and followed-up for the occurrence of minor or major malformations. Malformations were found in 8 (6.0%) foetuses and newborns. CONCLUSION: For most cardiac disorders, the risk posed by the disease itself for both the mother and the foetus generally exceeds the postulated risk of medications used to treat the disease. If a pregnant woman requires such therapy, a respective agent with the best safety profile should definitely be prescribed.

[Cross-sectional study of drug use in pregnancy]. / Presjecno istrazivanje (cross-sectional study) uporabe lijekova u trudnoci.

The aim of the paper is to investigate the impact of drugs utilization during pregnancy in the City of Zagreb. This one-month cross-sectional study was conducted in all four Zagreb maternity hospitals using a questionnaire administered to 893 pregnant women. The women used a mean of 2.6 drugs. The vitamin-mineral complex was the leading medicament used by the women during the study period (62.9%) and during pregnancy period. The leading drugs taken between hospital admission and delivery were metoclopramide (10.1%) and diazepam (6.0%). Utilization of diazepam is high during the entire pregnancy. According to FDA risk classification during pregnancy, most drugs are in B class (88%), and in A class (77%). Percent of FDA C class is 16%. In the FDA classes with fetal risk, D class has 47.5%, and X class, with only one woman using drug from this class has a 0.1% of total utilization. In spite of some limitations of the study, the results pointed to the uneconomical, potentially harmful drug use during pregnancy and puerperium, obviously calling for therapy quality upgrading in this vulnerable period of life.

Risk of pneumonia recurrence in patients previously hospitalized for pneumonia--a retrospective study (1998-2000).

Although elderly hospitalized patients, irrespective of the cause of hospitalization, are known to be at a high risk of subsequent development of pneumonia, some studies suggest the risk to be even higher in those hospitalized for pneumonia than in those hospitalized for other diseases. The aim of this retrospective study was to determine the association of hospitalization for pneumonia and some other diseases with subsequent pneumonia morbidity and mortality. The risk of recurrent pneumonia in patients hospitalized for pneumonia was investigated. Rehospitalization of pneumonia patients previously hospitalized for the same disease was followed-up and compared with rehospitalization of patients hospitalized for other diseases during the same study period. The study included patients aged overl8, initially hospitalized in 1998 for pneumonia (J12-J18), or for some particular gastrointestinal (K20-K31) and urogenital diseases (N10-N12, N30-N39). All rehospitalizations for pneumonia in nine Zagreb hospitals were followed-up during a 3-year study period (1998-2000). Out of 975 patients followed-up for rehospitalization, 227 (23.3%) had initially been hospitalized for pneumonia, and 748 (76.7%) for other diagnoses. During the 3-year period, 30 patients were rehospitalized for pneumonia, out of which number 22 had initially been hospitalized for pneumonia, yielding a statistically significant difference between the two study groups (chi2 = 34.780, p < 0.001). The mortality directly caused by pneumonia was also significantly higher in the group of patients with the initial diagnosis of pneumonia than in the group of patients with other diagnoses (chi2 = 15.82, p < 0.001).

Morbidity and mortality in the city of Zagreb, Croatia--health needs and demands.

The aim of the study was to assess health indicators in the city of Zagreb in order to evaluate the population health status and health needs. A descriptive method was used to analyze data from regular health statistics. In the population of Zagreb, the life expectancy at birth is longer than the European average but shorter than that recorded in Austria and Slovenia. The standardized mortalitay rates of tracheal, bronchial and lung cancer, and of malignant diseases in the Zagreb population exceed the European average, whereas those of ischemic heart disease, cerebrovascular disease, uterine cervix carcinoma and breast cancer are lower than the European average. Circulatory diseases and neoplasms, the two most important groups of death causes, showed a constant rise during the 30-year period (1971-2001). The highest index of primary health care utilization (98.8%) was recorded for the > or = 65 age group, with a mean of 7.5 primary health care visits per capita. The prevalence of hypertensive disorders and of intervertebral disk diseases and other dorsopathies was significantly higher in the oldest population group (chi2 = 27.3 and chi2 = 13.43, respectively, p < 0.05 both). Considering the predominance of chronic widespread diseases that substantially influence the patient's quality of life, public health actions should primarily be focused on preserving personal autonomy of the old and sick man for as long as possible. As the standardized mortality rates of ischemic heart disease, cerebrovascular diseases, tracheal, bronchial and lung cancer, and malignant diseases exceed those reported from some neighboring countries, the highest priority and needs are now related to coping with unhealthy behavior of the population such as smoking, physical inactivity, and dietary issues that should be modified and controlled through implementation of preventive programs, along with appropriate organization and management of public health services.