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Paradissis C, Cottrell N, Coombes ID, Wang WYS, Barras MA. Unplanned rehospitalisation due to medication harm following an Acute Myocardial Infarction. Cardiology 2024:000538773. [PMID: 38615668 DOI: 10.1159/000538773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/28/2024] [Indexed: 04/16/2024]
Abstract
Introduction The contribution of medication harm to rehospitalisation and adverse patient outcomes after an acute myocardial infarction (AMI) needs exploration. Rehospitalisation is costly to both patients and the healthcare facility. Following an AMI, patients are at risk of medication harm as they are often older, have multiple comorbidities and polypharmacy. This study aimed to quantify and evaluate medication harm causing unplanned rehospitalisation after an AMI. Methods This was a retrospective cohort study of patients discharged from a quaternary hospital post-AMI. All rehospitalisations within 18 months were identified using medical record review and coding data. The primary outcome measure was medication harm rehospitalisation. Preventability, causality and severity assessments of medication harm were conducted. Results A total of 1564 patients experienced an AMI and 415 (26.5%) were rehospitalised. Eighty-nine patients (5.7% of total population; 6.0% of those discharged) experienced a total of 101 medication harm events. Those with medication harm were older (p=0.007) and had higher rates of heart failure (p=0.005), chronic kidney disease (CKD) (p=0.046), chronic obstructive pulmonary disease (COPD) (p=0.037) and a prior history of ischaemic heart disease (p=0.005). Gastrointestinal (GI) bleeding, acute kidney injury (AKI) and hypotension were the most common medication harm events. Forty percent of events were avoidable and 84% were classed as 'serious'. Furosemide, antiplatelets and angiotensin-converting enzyme inhibitors (ACEi) were the most commonly implicated medications. The median time to medication harm rehospitalisation was 79 days (interquartile range [IQR]: 16-200 days). Conclusion Medication harm causes unplanned rehospitalisation in 5.7% of all AMI patients (1 in 17 patients; 6.0% of those discharged). The majority of harm was serious and occurred within the first 200 days of discharge. This study highlights that measures to attenuate the risk of medication harm rehospitalisation are essential, including post-discharge medication management.
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Mattiazzi S, Cottrell N, Ng N, Beckman E. Behavioural outcomes of interprofessional education within clinical settings for health professional students: A systematic literature review. J Interprof Care 2024; 38:294-307. [PMID: 36744843 DOI: 10.1080/13561820.2023.2170994] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/03/2022] [Accepted: 01/07/2023] [Indexed: 02/07/2023]
Abstract
Interprofessional education facilitates collaborative practice, which promotes high-quality patient care and patient safety. Interprofessional education (IPE) experiences within clinical settings provide an opportunity for the development of interprofessional collaborative practice competence. The aim of this systematic review was to review the literature evaluating interprofessional education for health professional students within clinical settings and summarize the behavioral outcomes. Databases searched were PubMed, Embase, Scopus, Web of Science, Taylor & Francis Online, ERIC and PsycINFO. Full-text articles were independently screened by two reviewers and included if agreed. Outcomes were analyzed using Kirkpatrick's model modified for IPE. Studies with behavioral change outcomes were analyzed and synthesized using narrative methods. Included studies provided evidence that IPE experiences in clinical settings can enable students to develop and integrate interprofessional collaborative practice competencies, across diverse types of settings. Key tasks enabling students to achieve these learning outcomes included synchronous patient consultations, collaborative development of integrative health-care plans outside of patient consultations, and participation in socialization with health-care teams. There were limitations in the methodological design of the included studies, with limited use of comparator groups and validated tools, high usage of self-report data and serious risk of bias identified across all quantitative included studies. In conclusion, high-quality research designed to measure the construct of behavioral change is lacking. Such research could further investigate the key tasks in IPE experiences in clinical settings that are necessary for students to develop the range of required collaborative practice competencies and integrate these. This could provide clarification regarding if and how this could be achieved across different types of clinical placements.
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Affiliation(s)
- Sonya Mattiazzi
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Neil Cottrell
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Norman Ng
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Emma Beckman
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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3
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Costello J, Barras M, Foot H, Cottrell N. The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review. Explor Res Clin Soc Pharm 2023; 11:100305. [PMID: 37655116 PMCID: PMC10466898 DOI: 10.1016/j.rcsop.2023.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 09/02/2023] Open
Abstract
Background Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear. Aims To undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist. Methods Published studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes. Results Fifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported. Conclusions A post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.
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Affiliation(s)
- Jaclyn Costello
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Redcliffe Hospital, Metro North Health, Brisbane, QLD, Australia
| | - Michael Barras
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Holly Foot
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Neil Cottrell
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
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Percival M, McMurray A, Freeman C, Cottrell N. A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: Patient and general practitioner perceptions. Explor Res Clin Soc Pharm 2023; 9:100236. [PMID: 36923064 PMCID: PMC10009526 DOI: 10.1016/j.rcsop.2023.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: patient and general practitioner perceptions. Background Pharmacists working in general practice settings are slowly emerging in Australia, with comprehensive medication reviews forming a large part of their role in optimising pharmaceutical care. In Australia, pharmacists are entirely reliant on general practitioners (GPs) accepting and implementing their recommendations to manage drug related problems (DRPs). The next step is a model where the pharmacist takes on responsibility for implementing some of their recommendations. Aim To investigate patient and general practitioner perceptions of a collaborative model of care where the pharmacist has increased responsibility in assisting the general practitioner manage patients with chronic conditions. Method Semi-structured, phone and face-to-face interviews were conducted with a purposive sample of patients and GPs respectively. Data were transcribed by a professional transcription service, collated using NVivo 12 Plus and analysed using Braun and Clarke's thematic analysis. Provisional codes were generated and clustered into categories, from which themes were identified. Results Eighteen interviews were conducted (12 patients, 6 GPs). Four themes were identified from the patient interview data: pharmacist attributes; acknowledgement of the impact of the pharmacist, understanding of the GP-pharmacist collaborative model; relationships with and attitudes towards medicines and health care providers. Four themes were identified from the general practitioner interview data: pharmacist attributes; relationships with pharmacists; impressions on collaboration; impressions of the pharmacist's recommendations. Patients' and GPs' perceptions of the collaborative model of care overall were positive, acknowledging the advantages of a patient-centred, interdisciplinary approach and the potential benefits to patients. Conclusion The GP-pharmacist collaborative model was viewed favourably by patients and GPs, with some GPs articulating the value in the pharmacist's increased responsibility as they implemented some recommendations to manage DRPs.
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Affiliation(s)
- Matthew Percival
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia.,Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215, Australia
| | - Anne McMurray
- School of Nursing and Midwifery, Griffith University - Gold Coast Campus, Parklands Dr, Southport, Gold Coast, QLD 4222, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD 4556, Australia
| | - Christopher Freeman
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
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5
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Percival M, Freeman C, Cottrell N. Feasibility of a collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: a preliminary study. Int J Clin Pharm 2022; 45:502-508. [PMID: 36342565 DOI: 10.1007/s11096-022-01488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pharmacists working in general practices provide medication reviews with recommendations to general practitioners (GPs) to optimise medications. We describe a model where the pharmacist is empowered with increased responsibility to implement agreed recommendations through collaborative prescribing. AIM To assess a collaborative pharmacist prescribing model incorporating increased pharmacist responsibility, for patients with chronic diseases in general practice. METHOD This was a pre-test-post-test quasi experimental pilot study using a pharmacist embedded in three Australian general practices. A pharmaceutical care plan was developed with patients and their GP to identify drug related problems (DRPs). The pharmacist discussed recommendations to manage DRPs with the GP and implemented recommendations agreed by the GP and patient over the six-month study period. Outcome measures included acceptance and implementation rate of recommendations made by the pharmacist. RESULTS The pharmacist made 135 recommendations to optimise medicine use of which 126 (93.3%) were accepted by the GP. There were 105 (83.3%) implemented by the end of the study of which the pharmacist implemented 62 (49.3%). CONCLUSION Compared to other Australian studies using a general practice pharmacist model, this study suggested increased pharmacist responsibility through collaborative prescribing led to high acceptance and implementation rates of recommendations to manage DRPs.
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Affiliation(s)
- Matthew Percival
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD, 4102, Australia.
- Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.
| | - Christopher Freeman
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD, 4102, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4072, Australia
- Metro North Health, Brisbane, QLD, 4029, Australia
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD, 4102, Australia
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6
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Wood A, Copley J, Hill A, Cottrell N. Interprofessional identity in clinicians: A scoping review. J Interprof Care 2022:1-12. [PMID: 35880786 DOI: 10.1080/13561820.2022.2086222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/19/2022] [Accepted: 05/26/2022] [Indexed: 10/16/2022]
Abstract
Interprofessional collaborative practice (IPCP) has been recognized as invaluable in delivering safe, high-quality patient care with finite resources. However, despite a decade of advances in interprofessional (IP) research, policy, and competency frameworks, IPCP does not always occur in practice. One reason may be the influence of a clinician's identity in an IP context. The purpose of this scoping review was to understand the nature of IP identity in healthcare clinicians. The PRISMA framework was used to support a comprehensive search strategy and screening of 1746 articles. Inclusion criteria included original research, theses, and reviews, a primary focus on IP identity or professional identity (PI) in an IP team, and a focus on health professionals, including students transitioning to practice. Ninety-five papers met the eligibility criteria, though once charted, just four of the 95 papers focused on IP identity in clinicians. Three further papers examined shared team identity, 25 papers referred to, but did not focus on IP identity, and the remaining 63 papers explored PI in an IP team. While limited studies on clinician IP identity restrict conclusive findings, patterns were identified to direct further research on the nature of IP identity in clinicians. These include values and beliefs, individual and personal factors, profession and professional experience, education, socialization, context, leadership, and the process of IP identity development. While identity is undeniably central to being a clinician, the values, beliefs, attributes, and experiences that contribute to clinician IP identity, how clinician IP identity develops, and factors that influence IP identity remain unclear. The results of this review highlight the value of further investigation of the nature of IP identity, the interplay between PI and IP identity, and identity in an IP context.
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Affiliation(s)
- Angela Wood
- The University of Queensland, Brisbane, Australia
- Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Jodie Copley
- The University of Queensland, Brisbane, Australia
| | - Anne Hill
- The University of Queensland, Brisbane, Australia
| | - Neil Cottrell
- The University of Queensland, Brisbane, Australia
- Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
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7
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Brown NJ, Doran E, Greenslade JH, Lukin B, Cottrell N, Jaramillo F, Coombes I, Donovan P, Cullen L. Retrospective study of the prevalence and characteristics of adverse drug events in adults who present to an Australian emergency department. Emerg Med Australas 2022; 34:547-554. [PMID: 34973155 DOI: 10.1111/1742-6723.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/17/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the burden, on the ED, of harm from unintentional adverse drug events (ADEs) in the community. METHODS A retrospective, observational study of 936 randomly selected presentations to a level 6 ED at a principal referral hospital in Brisbane, Australia, in November 2017. Clinical records were screened by a pharmacist, who identified suspected ADEs. All suspected ADEs and a random selection of presentations without ADEs were reviewed by an expert panel, which classified, by consensus: occurrence and type of ADE, contribution of ADE to presentation, severity of harm and preventability of presentation. Medication-related ED presentations (ADE-Ps) and potential ADEs were, respectively, defined as presentations directly attributable to an ADE, and medication events that occurred but did not cause the ED presentation. Descriptive data analysis was performed. RESULTS The median (interquartile range) age of patients was 40 (27-58) years, with 49.7% (95% confidence interval [CI] 46.5-52.9) being male. The prevalences of ADE-Ps and potential ADEs were 9.2% (95% CI 7.5-11.3) and 5.0% (95% CI 3.8-6.6), respectively. The severity of harm was classified as 'death or likely permanent harm' in 4.7% (95% CI 0.2-9.1) of ADE-Ps, 'temporary harm' (89.5%, 95% CI 83.1-96.0) and 'minimal or no harm' (5.8%, 95% CI 0.9-10.8). Most (79.1%, 95% CI 70.5-87.7) ADE-Ps were preventable. CONCLUSIONS There is a high burden on emergency care because of unintended medication harm in the community. Interventions to reduce such harm are likely to require a co-ordinated primary, acute and public healthcare response. The high proportion of presentations with potential ADEs indicates opportunity for harm mitigation in the ED.
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Affiliation(s)
- Nathan J Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Doran
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Jaimi H Greenslade
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bill Lukin
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Fabian Jaramillo
- Brisbane North PHN/Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.,Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Peter Donovan
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Clinical Pharmacology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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8
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Paradissis C, Cottrell N, Coombes I, Scott I, Wang W, Barras M. Patient harm from cardiovascular medications. Ther Adv Drug Saf 2021; 12:20420986211027451. [PMID: 34367546 PMCID: PMC8317255 DOI: 10.1177/20420986211027451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Medication harm can lead to hospital admission, prolonged hospital stay and poor patient outcomes. Reducing medication harm is a priority for healthcare organisations worldwide. Recent Australian studies demonstrate cardiovascular (CV) medications are a leading cause of harm. However, they appear to receive less recognition as ‘high risk’ medications compared with those classified by the medication safety acronym, ‘APINCH’ (antimicrobials, potassium, insulin, narcotics, chemotherapeutics, heparin). Our aim was to determine the scale and type of medication harm caused by CV medications in healthcare. Methods A narrative review of adult (>16 years) medication harm literature identified from PubMed and CINAHL databases was undertaken. Studies with the primary outcome of measuring the incidence of medication harm were included. Harm caused by CV medications was described and ranked against other medication classes at four key stages of a patient’s healthcare journey. Where specified, the implicated medications and type of harm were investigated. Results A total of 75 studies were identified, including seven systematic reviews and three meta-analyses, with most focussing on harm causing hospital admission. CV medications were responsible for approximately 20% of medication harm; however, this proportion increased to 50% in older populations. CV medications were consistently ranked in the top five medication categories causing harm and were often listed as the leading cause. Conclusion CV medications are a leading cause of medication harm, particularly in older adults, and should be the focus of harm mitigation strategies. A practical approach to generate awareness among health professionals is to incorporate ‘C’ (for CV medications) into the ‘APINCH’ acronym. Plain language summary
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Affiliation(s)
- Chariclia Paradissis
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Scott
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Wang
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Barras
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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9
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Abstract
Aspirin, an antiplatelet drug, is commonly used at low doses for numerous indications, including prophylaxis of cardiovascular, neurovascular, and venous thromboembolic events. Due to review articles suggesting that aspirin resistance may result in poorer outcomes, interest in assessing platelet function is increasing. Despite this, platelet function tests are rarely used as part of routine clinical practice and therefore, a basic understanding of these tests may be lacking. Although aspirin resistance can be categorized as clinical or laboratory resistance, determining laboratory resistance is the only way to determine resistance before treatment failure occurs. Therefore, knowledge of platelet assays to determine aspirin resistance is of importance. The following review aims to provide a framework for clinicians to understand the main principles of platelet function tests. This includes comparison of the most frequently used platelet assays to diagnose aspirin resistance, including the basic mechanism, methodology, reference ranges, inter-assay comparison, and their respective clinical considerations when using.
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Affiliation(s)
- Nameer Van Oosterom
- School of Pharmacy, University of Queensland, Brisbane, Australia.,Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Michael Barras
- School of Pharmacy, University of Queensland, Brisbane, Australia.,Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Neil Cottrell
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Robert Bird
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
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10
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Freeman CR, Scott IA, Hemming K, Connelly LB, Kirkpatrick CM, Coombes I, Whitty J, Martin J, Cottrell N, Sturman N, Russell GM, Williams I, Nicholson C, Kirsa S, Foot H. Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial. Med J Aust 2021; 214:212-217. [DOI: 10.5694/mja2.50942] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ian A Scott
- Princess Alexandra Hospital Brisbane QLD
- Transitional Research Institute University of Queensland Brisbane QLD
| | - Karla Hemming
- Institute of Applied Health Research University of Birmingham Edgbaston United Kingdom
| | - Luke B Connelly
- Centre for the Business and Economics of Health University of Queensland Brisbane QLD
| | | | - Ian Coombes
- University of Queensland Brisbane QLD
- Royal Brisbane and Women's Hospital Brisbane QLD
| | - Jennifer Whitty
- University of Queensland Brisbane QLD
- Norwich Medical School University of East Anglia Norwich United Kingdom
| | - James Martin
- Institute of Applied Health Research University of Birmingham Edgbaston United Kingdom
| | | | | | - Grant M Russell
- Monash University Melbourne VIC
- Southern Academic Primary Care Research Unit Monash University Melbourne VIC
| | | | - Caroline Nicholson
- University of Queensland Brisbane QLD
- Mater‐UQ Centre for Primary Healthcare Innovation Mater Health Services Brisbane QLD
| | - Sue Kirsa
- Centre for Medicine Use and Safety Monash University Melbourne VIC
- Monash Health Melbourne VIC
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Naumann FL, Nash R, Schumacher U, Taylor J, Cottrell N. Interprofessional education clinical placement program: a qualitative case study approach. J Interprof Care 2020; 35:899-906. [PMID: 33190512 DOI: 10.1080/13561820.2020.1832448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of health professional education programs is to produce competent graduates, with an ability to work collaboratively as effective healthcare team members. We explored the reflections of students and clinical facilitators, in response to participation in a structured interprofessional education (IPE) clinical placement program. In our qualitative study we used an exploratory case study design. In our analysis, we highlight the benefits of interprofessional practice. Key themes identified by students included: limited opportunities to engage in IPE across their course; lack of clarity around IPE; value of IPE for students, practitioners, and patient outcomes; and need for IPE opportunities to be integrated into placements. Key themes identified by the clinical facilitators included: being reminded of the value of IPE for students and patients; preparation for IPE placements need to be embedded in curricula; coordination and communication of IPE learning activities need to be clear for staff and students; and IPE should continue as part of the broader clinical education agenda. Our findings reinforce the notion that students and clinical facilitators value the importance of IPE for student learning within the clinical placement setting. The outcomes offer valuable insights for universities and hospital and health care contexts for setting up and implementing IPE activities, and we provide recommendations for improving ongoing IPE efforts within clinical placement setting.
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Affiliation(s)
- F L Naumann
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
| | - R Nash
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
| | - U Schumacher
- Metro North Hospital and Health Service, Queensland Health, Brisbane, Australia
| | - J Taylor
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - N Cottrell
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
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12
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Falconer N, Barras M, Abdel-Hafez A, Radburn S, Cottrell N. Development and validation of the Adverse Inpatient Medication Event model (AIME). Br J Clin Pharmacol 2020; 87:1512-1524. [PMID: 32986855 DOI: 10.1111/bcp.14560] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/14/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022] Open
Abstract
AIMS Medication harm has negative clinical and economic consequences, contributing to hospitalisation, morbidity and mortality. The incidence ranges from 4 to 14%, of which up to 50% of events may be preventable. A predictive model for identifying high-risk inpatients can guide a timely and systematic approach to prioritisation. The aim of this study is to develop and internally validate a risk prediction model for prioritisation of hospitalised patients at risk of medication harm. METHODS A retrospective cohort study was conducted in general medical and geriatric specialties at an Australian hospital over six months. Medication harm was identified using International Classification of Disease (ICD-10) codes and the hospital's incident database. Sixty-eight variables, including medications and laboratory results, were extracted from the hospital's databases. Multivariable logistic regression was used to develop the final risk model. Performance was evaluated using area under the receiver operative characteristic curve (AuROC) and clinical utility was determined using decision curve analysis. RESULTS The study cohort included 1982 patients with median age 74 years, of which 136 (7%) experienced at least one adverse medication event(s). The model included: length of stay, hospital re-admission within 12 months, venous or arterial thrombosis and/or embolism, ≥ 8 medications, serum sodium < 126 mmol/L, INR > 3, anti-psychotic, antiarrhythmic and immunosuppressant medications, and history of medication allergy. Validation gave an AuROC of 0.70 (95% CI: 0.65-0.74). Decision curve analysis identified that the AIME may be clinically useful to help guide decision making in practice. CONCLUSION We have developed a predictive model with reasonable performance. Future steps include external validation and impact evaluation.
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Affiliation(s)
- Nazanin Falconer
- School of Pharmacy, The University of Queensland, Brisbane, Australia.,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia.,Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Michael Barras
- School of Pharmacy, The University of Queensland, Brisbane, Australia.,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Ahmad Abdel-Hafez
- Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Sam Radburn
- Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, Australia.,Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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van Oosterom N, Barras M, Bird R, Nusem I, Cottrell N. A Narrative Review of Aspirin Resistance in VTE Prophylaxis for Orthopaedic Surgery. Drugs 2020; 80:1889-1899. [DOI: 10.1007/s40265-020-01413-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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14
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Foot H, La Caze A, Baker P, Cottrell N. Better understanding the influence and complexity of beliefs on medication adherence in asthma. Patient Educ Couns 2019; 102:564-570. [PMID: 30413309 DOI: 10.1016/j.pec.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/04/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim was to better understand how beliefs influence medication adherence in asthma. METHODS All participants were prescribed an inhaled corticosteroid for a diagnosis of asthma. Each participant completed a survey consisting of: Beliefs about Medicines Questionnaire (BMQ), Brief-Illness Perception Questionnaire (B-IPQ) and Multi-dimensional Health Locus of Control Scale (MHLCS). Adherence to inhaled corticosteroids was elicited using the Medication Adherence Report Scale (MARS). Multiple linear regression with interaction effects was used to identify significant predictors of medication adherence and interactions between beliefs. RESULTS A total of 198 participants completed the survey. The mean(±SD) MARS score was 19.2(±4.5). A multivariable model (adjusted R2 = 0.39) predicted adherence using: age, asthma hospitalisation, timeline (B-IPQ) subscale, necessity and concern (BMQ) subscales, doctor (MHLCS) subscale and the two interaction effects (concerns [BMQ] moderated by chance [MHLCS] and treatment control [B-IPQ] moderated by understanding [B-IPQ]). CONCLUSION The findings of this study contribute to a better understanding of the role of beliefs in medication adherence in asthma. Certain beliefs meaningfully interrelate and change the relationship they have with medication adherence. PRACTICE IMPLICATIONS If these beliefs are causally related to medication adherence and can be intervened upon, the findings are useful for providing targets to personalise adherence support.
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Affiliation(s)
- Holly Foot
- School of Pharmacy, The University of Queensland, Brisbane, Australia.
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Peter Baker
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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Steel L, Faint A, Barras M, Cottrell N, Parnell M, Macey B, Yip H. NOAC's It's Time to Extenuate Patient Knowledge Gaps. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Falconer N, Barras M, Cottrell N. How hospital pharmacists prioritise patients at high-risk for medication harm. Res Social Adm Pharm 2018; 15:1266-1273. [PMID: 30466812 DOI: 10.1016/j.sapharm.2018.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Medication harm is experienced by up to 30% of hospitalised patients, of which 7% experience severe harm. Pharmacist review can mitigate this harm. However, in increasingly busy hospitals, with high patient throughput, and scarce resources, there is a need to prioritise patients. Current methods are cumbersome, include many risk factors and are not evaluated in the clinical setting. OBJECTIVES To determine key criteria used by hospital pharmacists and investigate perspectives related to patient prioritisation for potential medication harm in the hospital setting. METHODS This study used two methods; focus groups and a cross-sectional survey of Australian hospital pharmacists. Focus groups were used to identify criteria and perspectives related to prioritisation and were analysed thematically. Criteria from focus groups, and a systematic review, were used to design the survey. The survey was distributed via the Society of Hospital Pharmacists of Australia. The top 10 prioritisation criteria, and associated sub-criteria selected by over 50% of respondents were ranked. Combination of criteria used most frequently on a day-to-day basis were identified. RESULTS Twenty clinical pharmacists participated in four, one-hour, audio recorded focus groups. Using inductive thematic analysis of transcripts three themes were identified; 1) prioritisation criteria, 2) barriers to, and 3) facilitators of patient prioritisation, with five sub-themes and 26 codes. Pharmacists identified a number of barriers such as a lack of relevant handover information. Organisational demands, such as patient discharge and medications supply also influenced priority and could act as barriers to a pharmacist enacting their prioritisation plan. A total of 231 pharmacists completed the survey. High priority criteria included, renal impairment, use of high-risk medications and therapeutic drug monitoring. CONCLUSION Pharmacists described prioritisation as a multifactorial process with a focus on high-risk medications and renal impairment. These findings will inform the development of a predictive risk score for patient prioritisation.
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Affiliation(s)
- Nazanin Falconer
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, 4102, Australia.
| | - Michael Barras
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, 4102, Australia; Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, 4102, Australia.
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, 4102, Australia.
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Foot H, Scott IA, Russell GM, Cottrell N, Sturman N, Freeman CR. Ethics and site-specific governance approvals for multi-centre, inter-sector health care research. Med J Aust 2018; 209:175-176. [PMID: 29996745 DOI: 10.5694/mja17.01017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/16/2018] [Indexed: 11/17/2022]
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18
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Falconer N, Barras M, Cottrell N. Reply to Iuga and Genaidy ‘Comment on Falconer et al
. (2018) - the need for specific adverse drug reaction outcomes‘. Br J Clin Pharmacol 2018; 84:1857. [DOI: 10.1111/bcp.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nazanin Falconer
- School of Pharmacy, Pharmacy Australia Centre of Excellence; The University of Queensland; Brisbane QLD 4102 Australia
| | - Michael Barras
- School of Pharmacy, Pharmacy Australia Centre of Excellence; The University of Queensland; Brisbane QLD 4102 Australia
- Princess Alexandra Hospital; Metro South Health; 199 Ipswich Road, Woolloongabba Brisbane QLD 4102 Australia
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of Excellence; The University of Queensland; Brisbane QLD 4102 Australia
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Falconer N, Barras M, Cottrell N. Systematic review of predictive risk models for adverse drug events in hospitalized patients. Br J Clin Pharmacol 2018; 84:846-864. [PMID: 29337387 PMCID: PMC5903258 DOI: 10.1111/bcp.13514] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/21/2017] [Accepted: 01/03/2018] [Indexed: 12/23/2022] Open
Abstract
AIM An emerging approach to reducing hospital adverse drug events is the use of predictive risk scores. The aim of this systematic review was to critically appraise models developed for predicting adverse drug event risk in inpatients. METHODS Embase, PubMed, CINAHL and Scopus databases were used to identify studies of predictive risk models for hospitalized adult inpatients. Studies had to have used multivariable logistic regression for model development, resulting in a score or rule with two or more variables, to predict the likelihood of inpatient adverse drug events. The Checklist for the critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) was used to critically appraise eligible studies. RESULTS Eleven studies met the inclusion criteria and were included in the review. Ten described the development of a new model, whilst one study revalidated and updated an existing score. Studies used different definitions for outcome but were synonymous with or closely related to adverse drug events. Four studies undertook external validation, five internally validated and two studies did not validate their model. No studies evaluated impact of risk scores on patient outcomes. CONCLUSION Adverse drug event risk prediction is a complex endeavour but could help to improve patient safety and hospital resource management. Studies in this review had some limitations in their methods for model development, reporting and validation. Two studies, the BADRI and Trivalle's risk scores, used better model development and validation methods and reported reasonable performance, and so could be considered for further research.
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Affiliation(s)
- Nazanin Falconer
- School of Pharmacy, Pharmacy Australia Centre of ExcellenceThe University of QueenslandBrisbaneQLD4102Australia
| | - Michael Barras
- School of Pharmacy, Pharmacy Australia Centre of ExcellenceThe University of QueenslandBrisbaneQLD4102Australia
- Princess Alexandra HospitalMetro South Health199 Ipswich Road, WoolloongabbaBrisbaneQLD4102Australia
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of ExcellenceThe University of QueenslandBrisbaneQLD4102Australia
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Foot H, La Caze A, Cottrell N. Identifying the relationship between beliefs and medication adherence in asthma. Ann Allergy Asthma Immunol 2017; 119:284-285. [PMID: 28743425 DOI: 10.1016/j.anai.2017.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Holly Foot
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia.
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
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21
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Foot H, Freeman C, Hemming K, Scott I, Coombes ID, Williams ID, Connelly L, Whitty JA, Sturman N, Kirsa S, Nicholson C, Russell G, Kirkpatrick C, Cottrell N. Reducing Medical Admissions into Hospital through Optimising Medicines (REMAIN HOME) Study: protocol for a stepped-wedge, cluster-randomised trial. BMJ Open 2017; 7:e015301. [PMID: 28408545 PMCID: PMC5719661 DOI: 10.1136/bmjopen-2016-015301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION A model of general practitioner (GP) and pharmacist collaboration in primary care may be an effective strategy to reduce medication-related problems and provide better support to patients after discharge. The aim of this study is to investigate whether a model of structured pharmacist and GP care reduces hospital readmissions in high-risk patients. METHODS AND ANALYSIS This protocol details a stepped-wedge, cluster-randomised trial that will recruit participants over 9 months with a 12-month follow-up. There will be 14 clusters each representing a different general practice medical centre. A total of 2240 participants will be recruited from hospital who attend an enrolled medical centre, take five or more long-term medicines or whose reason for admission was related to heart failure or chronic obstructive pulmonary disease.The intervention is a multifaceted service, involving a pharmacist integrated into a medical centre to assist patients after hospitalisation. Participants will meet with the practice pharmacist and their GP after discharge to review and reconcile their medicines and discuss changes made in hospital. The pharmacist will follow-up with the participant and liaise with other health professionals involved in the participant's care. The control will be usual care, which usually involves a patient self-organising a visit to their GP after hospital discharge.The primary outcome is the rate of unplanned, all-cause hospital readmissions over 12 months, which will be analysed using a mixed effects Poisson regression model with a random effect for cluster and a fixed effect to account for any temporal trend. A cost analysis will be undertaken to compare the healthcare costs associated with the intervention to those of usual care. ETHICS AND DISSEMINATION The study has received ethical approval (HREC/16/QRBW/410). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders. TRIAL REGISTRATION NUMBER ACTRN12616001627448.
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Affiliation(s)
- Holly Foot
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Freeman
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Karla Hemming
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Ian Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Southern School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ian D Coombes
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
- Department of Pharmacy, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ian D Williams
- Brisbane South PHN, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Luke Connelly
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Queensland, Australia
- Poche Centre for Indigenous Health, University of Queensland, Brisbane, Queensland, Australia
| | - Jennifer A Whitty
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine and Health Sciences, University of East Anglia Norwich Medical School, Norwich, UK
| | - Nancy Sturman
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Sue Kirsa
- Department of Pharmacy, Monash Health, Clayton, Victoria, Australia
- Centre for Medicine Use and Safety, Monash University Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Caroline Nicholson
- Mater Misericordiae Health Services Brisbane Ltd, South Brisbane, Queensland, Australia
| | - Grant Russell
- School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia
| | - Carl Kirkpatrick
- Centre for Medicine Use and Safety, Monash University Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Neil Cottrell
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
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Mulvogue K, Roberts JA, Coombes I, Cottrell N, Kanagarajah S, Smith A. The effect of pharmacists on ward rounds measured by the STOPP/START tool in a specialized geriatric unit. J Clin Pharm Ther 2016; 42:178-184. [PMID: 27981600 DOI: 10.1111/jcpt.12489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The STOPP/START tool has been validated to assess elderly patients for potentially inappropriate prescribing. This study aimed to assess the effect of inclusion of a pharmacist on a physician-led ward round on potentially inappropriate prescribing in hospitalized elderly patients. METHODS This was an observational study of prescribing for patients using the STOPP/START tool at three points during hospital stay; admission to hospital, on transfer to the specialized geriatric unit and on discharge from hospital. Data were collected over 4 months pre- and post-introduction of a pharmacist to a physician-led ward round. Demographic and clinical data, including total number of medications and STOPP/START criteria met, were collected. The mean number of STOPP/START criteria at each time-point was compared for pre- and post-introduction of a pharmacist using a Mann-Whitney U-test. The mean number of criteria for each time-point within each group was compared using a paired Student's t-test. RESULTS AND DISCUSSION The demographic characteristics of the participants in the pre- and post-intervention groups were similar. The post-intervention group had numerically less STOPP/START criteria, mean 1·18 (1·37) compared to the pre-intervention group 1·50 (1·41), P = 0·07 at discharge. The pre-intervention group had no significant change in the criteria from admission 1·78 (1·57) to geriatric unit transfer 1·72 (1·54) (P = 0·37); however, there was a significant decrease from geriatric unit transfer 1·72 (1·54) to discharge 1·50 (1·41) (P = 0·02). The post-intervention group had a significant decrease from hospital admission 2·30 (1·91) to geriatric unit transfer 1·59 (1·60) (P < 0·01) and again to discharge 1·18 (1·37) (P < 0·01). WHAT IS NEW AND CONCLUSION Pharmacist participation on the ward round in a specialized geriatric unit resulted in a numerical improvement in prescribing quality as measured by the STOPP/START tool.
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Affiliation(s)
- K Mulvogue
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia
| | - J A Roberts
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia.,Burns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - I Coombes
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia
| | - N Cottrell
- Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia
| | - S Kanagarajah
- Geriatric Evaluation and Management Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - A Smith
- Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia.,School of Pharmacy, University of Otago, Dunedin, New Zealand
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Nguyen TMU, La Caze A, Cottrell N. Validated adherence scales used in a measurement-guided medication management approach to target and tailor a medication adherence intervention: a randomised controlled trial. BMJ Open 2016; 6:e013375. [PMID: 27903564 PMCID: PMC5168495 DOI: 10.1136/bmjopen-2016-013375] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine if a targeted and tailored intervention based on a discussion informed by validated adherence scales will improve medication adherence. DESIGN Prospective randomised trial. SETTING 2 community pharmacies in Brisbane, Australia. METHODS Patients recently initiated on a cardiovascular or oral hypoglycaemic medication within the past 4-12 weeks were recruited from two community pharmacies. Participants identified as non-adherent using the Medication Adherence Questionnaire (MAQ) were randomised into the intervention or control group. The intervention group received a tailored intervention based on a discussion informed by responses to the MAQ, Beliefs about Medicines Questionnaire-Specific and Brief Illness Perception Questionnaire. Adherence was measured using the MAQ at 3 and 6 months following the intervention. RESULTS A total of 408 patients were assessed for eligibility, from which 152 participants were enrolled into the study. 120 participants were identified as non-adherent using the MAQ and randomised to the 'intervention' or 'control' group. The mean MAQ score at baseline in the intervention and control were similar (1.58: 95% CI (1.38 to 1.78) and 1.60: 95% CI (1.43 to 1.77), respectively). There was a statistically significant improvement in adherence in the intervention group compared to control at 3 months (mean MAQ score 0.42: 95% CI (0.27 to 0.57) vs 1.58: 95% CI (1.42 to 1.75); p<0.001). The significant improvement in MAQ score in the intervention group compared to control was sustained at 6 months (0.48: 95% CI (0.31 to 0.65) vs 1.48: 95% CI (1.27 to 1.69); p<0.001). CONCLUSIONS An intervention that targeted non-adherent participants and tailored to participant-specific reasons for non-adherence was successful at improving medication adherence. TRIAL REGISTRATION NUMBER ACTRN12613000162718; Results.
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Affiliation(s)
- Thi-My-Uyen Nguyen
- Pharmacy Australia Centre of Excellence-School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Adam La Caze
- Pharmacy Australia Centre of Excellence-School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Neil Cottrell
- Pharmacy Australia Centre of Excellence-School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
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Foot H, La Caze A, Gujral G, Cottrell N. The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis. Patient Educ Couns 2016; 99:706-717. [PMID: 26613666 DOI: 10.1016/j.pec.2015.11.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This meta-analysis investigated whether beliefs in the necessity and concerns of medicine and the necessity-concerns differential are correlated with medication adherence on a population level and in different conditions. METHODS An electronic search of Web of Science, EMBASE, PubMed and CINAHL was conducted for manuscripts utilising the Beliefs about Medicines Questionnaire and comparing it to any measure of medication adherence. Studies were pooled using the random-effects model to produce a mean overall effect size correlation. Studies were stratified for condition, adherence measure, power and study design. RESULTS Ninety-four papers were included in the meta-analysis. The overall effect size(r) for necessity, concerns, and necessity-concerns differential was 0.17, -0.18 and 0.24 respectively and these were all significant (p<0.0001). Effect size for necessity was stronger in asthma and weaker in the cardiovascular group compared to the overall effect size. CONCLUSION Necessity and concerns beliefs and the necessity-concerns differential were correlated with medication adherence on a population level and across the majority of included conditions. The effect sizes were mostly small with a magnitude comparable to other predictors of adherence. PRACTICE IMPLICATIONS This meta-analysis suggests that necessity and concern beliefs about medicines are one important factor to consider when understanding reasons for non-adherence.
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Affiliation(s)
- Holly Foot
- School of Pharmacy, The University of Queensland, Brisbane, Australia.
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Gina Gujral
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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Affiliation(s)
- Lily Sim
- Royal Brisbane and Women's Hospital
- School of Pharmacy; The University of Queensland; Brisbane Queensland
| | - Michael Barras
- Royal Brisbane and Women's Hospital
- School of Pharmacy; The University of Queensland; Brisbane Queensland
| | - Neil Cottrell
- School of Pharmacy; The University of Queensland; Brisbane Queensland
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Affiliation(s)
- Christopher Freeman
- Charming Institute; Brisbane Australia
- School of Pharmacy; University of Queensland; Brisbane Australia
- School of Clinical Sciences; Queensland University of Technology; Brisbane Australia
| | - Neil Cottrell
- School of Pharmacy; University of Queensland; Brisbane Australia
| | | | | | - Lisa Nissen
- School of Clinical Sciences; Queensland University of Technology; Brisbane Australia
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Nguyen TMU, La Caze A, Cottrell N. What are validated self-report adherence scales really measuring?: a systematic review. Br J Clin Pharmacol 2014; 77:427-45. [PMID: 23803249 DOI: 10.1111/bcp.12194] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 06/12/2013] [Indexed: 12/13/2022] Open
Abstract
AIMS Medication non-adherence is a significant health problem. There are numerous methods for measuring adherence, but no single method performs well on all criteria. The purpose of this systematic review is to (i) identify self-report medication adherence scales that have been correlated with comparison measures of medication-taking behaviour, (ii) assess how these scales measure adherence and (iii) explore how these adherence scales have been validated. METHODS Cinahl and PubMed databases were used to search articles written in English on the development or validation of medication adherence scales dating to August 2012. The search terms used were medication adherence, medication non-adherence, medication compliance and names of each scale. Data such as barriers identified and validation comparison measures were extracted and compared. RESULTS Sixty articles were included in the review, which consisted of 43 adherence scales. Adherence scales include items that either elicit information regarding the patient's medication-taking behaviour and/or attempts to identify barriers to good medication-taking behaviour or beliefs associated with adherence. The validation strategies employed depended on whether the focus of the scale was to measure medication-taking behaviour or identify barriers or beliefs. CONCLUSIONS Supporting patients to be adherent requires information on their medication-taking behaviour, barriers to adherence and beliefs about medicines. Adherence scales have the potential to explore these aspects of adherence, but currently there has been a greater focus on measuring medication-taking behaviour. Selecting the 'right' adherence scale(s) requires consideration of what needs to be measured and how (and in whom) the scale has been validated.
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Affiliation(s)
- Thi-My-Uyen Nguyen
- Pharmacy Australia Centre of Excellence - School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, 4102, Australia
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Abstract
AIMS Medication non-adherence is a significant health problem. There are numerous methods for measuring adherence, but no single method performs well on all criteria. The purpose of this systematic review is to (i) identify self-report medication adherence scales that have been correlated with comparison measures of medication-taking behaviour, (ii) assess how these scales measure adherence and (iii) explore how these adherence scales have been validated. METHODS Cinahl and PubMed databases were used to search articles written in English on the development or validation of medication adherence scales dating to August 2012. The search terms used were medication adherence, medication non-adherence, medication compliance and names of each scale. Data such as barriers identified and validation comparison measures were extracted and compared. RESULTS Sixty articles were included in the review, which consisted of 43 adherence scales. Adherence scales include items that either elicit information regarding the patient's medication-taking behaviour and/or attempts to identify barriers to good medication-taking behaviour or beliefs associated with adherence. The validation strategies employed depended on whether the focus of the scale was to measure medication-taking behaviour or identify barriers or beliefs. CONCLUSIONS Supporting patients to be adherent requires information on their medication-taking behaviour, barriers to adherence and beliefs about medicines. Adherence scales have the potential to explore these aspects of adherence, but currently there has been a greater focus on measuring medication-taking behaviour. Selecting the 'right' adherence scale(s) requires consideration of what needs to be measured and how (and in whom) the scale has been validated.
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Affiliation(s)
- Thi-My-Uyen Nguyen
- Pharmacy Australia Centre of Excellence - School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, 4102, Australia
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Mellor R, Cottrell N, Moran M. “Just working in a team was a great experience…” – Student perspectives on the learning experiences of an interprofessional education program. J Interprof Care 2013; 27:292-7. [DOI: 10.3109/13561820.2013.769093] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cottrell N. Australian Clinical Pharmacy Award 2007. Journal of Pharmacy Practice and Research 2007. [DOI: 10.1002/j.2055-2335.2007.tb00774.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Neil Cottrell
- School of Pharmacy; The University of Queensland; St Lucia Queensland
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Abstract
The use of an NSAID by individuals with heart failure increases the likelihood of exacerbating the problem. Patients with heart failure were interviewed using a standardized questionnaire to determine their perceptions of the risks involved with the use of an NSAID. Of the 28 patients interviewed, 2 had been advised to avoid a particular medicine, but could not remember which medicine. The use of an analgesic that could exacerbate their heart failure was regarded as high risk (score >5 on a scale of 1-10) by 22 (79%) of the patients. In this small sample, most patients with heart failure were not aware of the risks of using NSAIDs. However, based on their responses, most patients would avoid the use of NSAIDs once educated about the adverse effects that these drugs might have on their heart failure.
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Affiliation(s)
- Neil Cottrell
- School of Pharmacy, The University of Queensland, St. Lucia, Brisbane, Queensland, Australia.
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Abstract
BACKGROUND Metformin is commonly prescribed to treat type 2 diabetes mellitus, however it is associated with the potentially lethal condition of lactic acidosis. Prescribing guidelines have been developed to minimize the risk of lactic acidosis development, although some suggest they are inappropriate and have created confusion amongst prescribers. The aim of this study was to investigate whether metformin dose was influenced by the presence of risk factors for lactic acidosis. METHODS The study was prospective, and retrieved information from patients admitted to hospital who were prescribed metformin at their time of admission. RESULTS Eighty-three patients were included in the study, 60 of whom had a least one risk factor for lactic acidosis. Of those 60 patients, 78.3% had a dose adjustment, with renal impairment, hepatic impairment, surgery and use of radiological contrast media--the risk factors most likely to result in a dose adjustment. When dose adjustments did occur, metformin was withheld on 88.7% of occasions. CONCLUSION Metformin dose was influenced by the presence of risk factors for lactic acidosis, although it was dependent upon the number and particular risk factor/s present.
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Affiliation(s)
- S Millican
- School of Pharmacy, University of Queensland, St Lucia, Brisbane, Australia
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Abstract
BACKGROUND/PURPOSE A reliable noninvasive intraoperative marker of caudal analgesia effectiveness remains elusive. Caudal analgesia causes sympathetic inhibition resulting in vasodilatation, increased blood flow, and a resultant increase in temperature in the affected dermatomes. The authors hypothesize that this change in temperature between the affected and unaffected dermatomes is measurable and may represent a noninvasive method of monitoring effectiveness of caudal analgesia. METHODS Children undergoing lower abdominal surgery participated in the caudal or noncaudal (control) analgesia arm of the study. After induction of general anesthesia, 0.25% bupivicaine (1 mL/kg) was infiltrated for a field block in control patients or a caudal block in the experimental group. Temperature was measured at the C4 and L2 dermatomes starting after induction and 5 minutes before the caudal or field block and every 5 minutes after. T(o) is defined as the difference between the C4 and L2. Delta T (DeltaT) is the temperature variation between T(o). A change in the DeltaT is defined by an increase in the L2 temperature. RESULTS Forty-six families enrolled (36 experimental, 10 control). The DeltaT for controls was 0.2+/-0.09 degrees C (SEM). Each child in the experimental group had 2 temperature measurements before the caudal with an average DeltaT of 0.3+/-0.07 degrees C (SEM), thus, were internal controls. A marked increase in DeltaT at 5 minutes 0.5+/-0.06 degrees C (SEM) and at 10 minutes 0.6+/-0.07 degrees C (SEM; P <.05) was noted in the experimental group. CONCLUSION A significant transient change in temperature is observed after caudal analgesia and maybe a noninvasive marker of effectiveness. Further study may clarify its clinical utility.
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Affiliation(s)
- P F Ehrlich
- Department of Surgery, Anesthesia, and Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia 26505, USA
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Green B, Duffull S, Cottrell N, D'Emden M. Myocardial infarction and type II diabetes--preferential treatment for high risk patients? J Clin Pharm Ther 2002; 27:371-6. [PMID: 12383139 DOI: 10.1046/j.1365-2710.2002.00436.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare variability of blood glucose concentration in patients with type II diabetes with (cases) and without (controls) myocardial infarction. A secondary objective was identification of predictive factors for higher blood glucose on discharge from hospital. DESIGN A retrospective matched case-control study. PARTICIPANTS Medical notes of 101 type II diabetic patients admitted with a myocardial infarction (MI) and 101 type II diabetic patients (controls) matched on gender and age with no MI were reviewed. Blood glucose concentrations over two consecutive 48-h periods were collected. Demographic data and therapy on admission/discharge were also collected. RESULTS Patient characteristics were comparable on recruitment excluding family history of cardiovascular disease (P=0.003), dyslipidaemia (P=0.004) and previous history of MI (P=0.007). Variability of blood glucose in cases was greater over the first 48 h compared with the second 48 h (P=0.03), and greater when compared with controls over the first 48 h (P=0.01). Cases with blood glucose on discharge >8.2 mmol / L (n=45) were less likely to have a history of previous MI (P=0.04), ischaemic heart disease (P=0.03) or hypertension (P=0.02). CONCLUSIONS Type II diabetics with an MI have higher and more variable blood glucose concentrations during the first 48 h of admission. Only cardiovascular 'high risk' patients had target blood glucose set on discharge. The desirability of all MI patients with diabetes, having standardized-glucose infusions to reduce variability of blood glucose, should be evaluated in a randomized controlled trial.
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Affiliation(s)
- B Green
- Department of Pharmacy, Royal Brisbane Hospital, Brisbane, Queensland, Australia.
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Sanders D, Hibbert D, Ackrill P, Clinkard S, Cooke J, Cottrell N. Do anaemia co-ordinators have to be nurses? EDTNA ERCA J 1999; 25:39-41. [PMID: 10531882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The role of the anaemia co-ordinator has developed subsequent to the introduction of erythropoietin therapy for renal anaemia, and posts have been established at an increasing number of hospitals in the UK. While co-ordinators have previously tended to come from a nursing background, the post at our hospital has been held jointly by a pharmacist and a clinical nurse specialist since July 1997. This paper presents an informal evaluation of our experience of joint working, and has drawn on diary entries to outline the components of the service provided. The main focus is on the boundary negotiated between pharmacist and nurse responsibilities and expertise, involving as it does areas of potential conflict and complementarity. Through a critical examination of the assumptions and expectations associated with 'generic' pharmacist and nurse roles, we begin to clarify the respective contributions which the disciplines make to anaemia management.
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Affiliation(s)
- D Sanders
- Nephrology Unit, Withington Hospital, Manchester, UK
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Cottrell N. Drug administration. The view from the pharmacy. Nurs Times 1990; 86:55-7. [PMID: 2235579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abajo FJ, Garijo B, Frias J, Scarpello JHB, Cottrell N. Points: Overuse of monitoring of blood concentrations of antiepileptic drugs. West J Med 1987. [DOI: 10.1136/bmj.294.6583.1355-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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