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Winter J, Cruise B, Peters BR, Islur A. Pain Medication Prescribing Patterns in Augmentation Mammoplasty. Plast Surg (Oakv) 2023; 31:270-274. [PMID: 37654542 PMCID: PMC10467444 DOI: 10.1177/22925503211034828] [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: 05/12/2021] [Accepted: 06/22/2021] [Indexed: 09/02/2023] Open
Abstract
Background The rate of opioid prescribing after low-risk surgical procedures has increased over the past decade, and surgeons are responsible for prescribing approximately one-third of all opioid medications. There is additional supporting evidence that patients only consume about half of the opioids prescribed to them after outpatient plastic surgery. Currently, there is no literature to provide surgeons with reference ranges for how much opioid medication will adequately provide analgesia for patients after undergoing bilateral breast augmentation (BBA) surgery. Objective To quantify the amount of opioid medication required to adequately control pain for patients after undergoing BBA and use these data to provide recommendations on opioid prescribing practices. Methods Cross-sectional prospective data were obtained through a take-home medication and pain tracking questionnaire for 56 patients after they underwent either subpectoral or subglandular BBA. Patients documented their pain scores on a 0 to 10 analogue scale and documented the type and amount of pain medication they took for a 7-day period. Results Our study demonstrated that patients in the subglandular BBA group required an average of either 25 ± 1.2 Tylenol #3 or 19.3 ± 2.3 Tramacet tablets, and the subpectoral group required 27.7 ± 1.7 Tylenol #3 or 25.6 ± 0.9 Tramacet tablets over a 7-day period. There was no statistically significant difference between the 2 surgical groups. Conclusion We propose a reference range of medication required on average for patients undergoing BBA to obtain adequate pain control in the initial postoperative period that falls within the most recent Canadian guidelines for safe opioid prescribing practices.
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Affiliation(s)
- Jessica Winter
- Section of Plastic Surgery, Department of Surgery, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Braden Cruise
- Undergraduate Medical Education, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Blair R. Peters
- Section of Plastic Surgery, Department of Surgery, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Avi Islur
- Section of Plastic Surgery, Department of Surgery, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- First Gland Cosmetic Clinic, Manitoba, Winnipeg, Manitoba, Canada
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Robinson A, Elarbi M, Todd A, Husband A. A qualitative exploration of the barriers and facilitators affecting ethnic minority patient groups when accessing medicine review services: Perspectives of healthcare professionals. Health Expect 2021; 25:628-638. [PMID: 34951087 PMCID: PMC8957739 DOI: 10.1111/hex.13410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/14/2021] [Revised: 10/29/2021] [Accepted: 12/07/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Healthcare inequalities and ethnicity are closely related. Evidence has demonstrated that patients from ethnic minority groups are more likely to report a long‐term illness than their white counterparts; yet, in some cases, minority groups have reported poorer adherence to prescribed medicines and may be less likely to access medicine services. Knowledge of the barriers and facilitators that impact ethnic minority access to medicine services is required to ensure that services are fit for purpose to meet and support the needs of all. Methods Semistructured interviews with healthcare professionals were conducted between October and December 2020, using telephone and video call‐based software. Perspectives on barriers and facilitators were discussed. Interviews were audio‐recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Newcastle University Faculty of Medical Sciences Ethics Committee. Results Eighteen healthcare professionals were interviewed across primary, secondary and tertiary care settings; their roles spanned medicine, pharmacy and dentistry. Three themes were developed from the data regarding the perceived barriers and facilitators affecting access to medicine services for ethnic minority patients. These centred around patient expectations of health services; appreciating cultural stigma and acceptance of certain health conditions; and individually addressing communication and language needs. Conclusion This study provides much‐needed evidence relating to the barriers and facilitators impacting minority ethnic communities when seeking medicine support. The results of this study have important implications for the delivery of person‐centred care. Involving patients and practitioners in coproduction approaches could enable the design and delivery of culturally sensitive and accessible medicine services. Patient or Public Contribution The Patient and Public Involvement and Engagement (PPIE) group at Newcastle University had extensive input in the design and concept of this study before the research was undertaken. Throughout the work, a patient champion (Harpreet Guraya) had input in the project by ensuring that the study was conducted, and the findings were reported, with cultural sensitivity.
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Affiliation(s)
- Anna Robinson
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Muna Elarbi
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Andy Husband
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, UK
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Shamsuddin A, Jeffries M, Sheikh A, Laing L, Salema NE, Avery AJ, Chuter A, Waring J, Keers RN. Strategies supporting sustainable prescribing safety improvement interventions in English primary care: a qualitative study. BJGP Open 2021:BJGPO. [PMID: 34226173 DOI: 10.3399/BJGPO.2021.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background While the use of prescribing safety indicators (PSI) can reduce potentially hazardous prescribing, there is a need to identify actionable strategies for the successful implementation and sustainable delivery of PSI-based interventions in general practice. Aim To identify strategies for the successful implementation and sustainable use of PSI-based interventions in routine primary care. Design & setting Qualitative study in primary care settings across England. Method Anchoring on a complex pharmacist-led IT-based intervention (PINCER) and clinical decision support (CDS) for prescribing and medicines management, a qualitative study was conducted using sequential, multiple methods. The methods comprised documentary analysis, semi-structured interviews, and online workshops to identify challenges and possible solutions to the longer-term sustainability of PINCER and CDS. Thematic analysis was used for the documentary analysis and stakeholder workshops, while template analysis was used for the semi-structured interviews. Findings across the three methods were synthesised using the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework. Results Forty-eight documents were analysed, and 27 interviews and two workshops involving 20 participants were undertaken. Five main issues were identified, which aligned with the adoption and maintenance dimensions of RE-AIM: fitting into current context (adoption); engaging hearts and minds (maintenance); building resilience (maintenance); achieving engagement with secondary care (maintenance); and emphasising complementarity (maintenance). Conclusion Extending ownership of prescribing safety beyond primary care-based pharmacists, and achieving greater alignment between general practice and hospital prescribing safety initiatives, is fundamental to achieve sustained impact of PSI-based interventions in primary care.
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Grill P, Marwick C, De Souza N, Burton JK, Hughes C, Guthrie B. The burden of psychotropic and anticholinergic medicines use in care homes: population-based analysis in 147 care homes. Age Ageing 2021; 50:183-189. [PMID: 32706851 DOI: 10.1093/ageing/afaa122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND older people living in care-homes are particularly vulnerable to adverse effects of psychotropic and anticholinergic drugs. METHODS anonymised dispensed prescription data from all 4,478 residents aged ≥ 60 years in 147 care-homes in two Scottish health boards were analysed. Psychotropic medicines examined were antipsychotics, antidepressants, hypnotic/anxiolytics, opioids and gabapentinoids. Anticholinergic burden was measured using the modified anticholinergic risk scale (mARS). Variation between care-homes and associations with individual and care-home characteristics were examined using multilevel logistic regression. RESULTS 63.5% of residents were prescribed at least one psychotropic drug, and 27.0% two or more, most commonly antidepressants (41.6%), opioids (20.3%), hypnotic/anxiolytics (16.9%) and antipsychotics (16.7%). 48.1% were prescribed an anticholinergic drug, and 12.1% had high anticholinergic burden (mARS ≥ 3). Variation between care-homes was high for antipsychotics (intra-cluster correlation coefficient [ICC] 8.2%) and hypnotics/anxiolytics (ICC = 7.3%), and moderate for antidepressants (ICC = 4.7%) and anticholinergics (ICC = 2.8%). Prescribing of all drugs was lower in the oldest old. People with dementia were more likely to be prescribed antipsychotics (adjusted OR = 1.45, 95%CI 1.23-1.71) but less likely to be prescribed anticholinergics (aOR = 0.61, 95%CI 0.51-0.74). Prescribing of antipsychotics was higher in Tayside (aOR = 1.52, 95%CI 1.20-1.92), whereas prescribing of antidepressants (particularly tricyclic-related) was lower (aOR = 0.66, 95%CI 0.56-0.79). There was no association with care-home regulator quality scores. CONCLUSION care-home residents have high psychotropic and anticholinergic burden, with considerable variation between care-homes that is not related to existing measures of quality of care. Research to better understand variation between care-homes and the interaction with local prescribing cultures is needed.
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Affiliation(s)
- Paula Grill
- Undergraduate Medical Student, School of Medicine, University of Dundee, Dundee, UK
| | - Charis Marwick
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Nicosha De Souza
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Jennifer Kirsty Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Carmel Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Bruce Guthrie
- Usher Institute, School of Medicine, University of Edinburgh, Edinburgh, UK
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MacRae C, Henderson DA, Mercer SW, Burton J, De Souza N, Grill P, Marwick C, Guthrie B. Excessive polypharmacy and potentially inappropriate prescribing in 147 care homes: a cross-sectional study. BJGP Open 2021; 5:BJGPO. [PMID: 34620596 DOI: 10.3399/BJGPO.2021.0167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Care home residents often have multiple cognitive and physical impairments, and are at high risk of adverse drug events (ADEs). AIM To describe excessive polypharmacy and potentially inappropriate prescribing predisposing care home residents to ADEs. DESIGN & SETTING A cross-sectional analysis of all dispensed prescriptions for 147 care home residents in Tayside and Fife, Scotland. METHOD Prevalence of excessive polypharmacy was examined using multilevel logistic regression, by modelling associations between individual and care home predictors with excessive polypharmacy (≥10 drugs). Prescribing of drugs known to increase the risk of eight clinically important ADE categories was examined. Drugs prescribed within each ADE category, for each resident, were counted. RESULTS In total, 32.3% (n = 1444/4468) of residents had excessive polypharmacy, which was more common in residents aged 70-74 years (adjusted odds ratio [aOR] 1.86, 95% confidence interval [CI] = 1.04 to 3.34) and 80-84 years (aOR 1.75, 95% CI = 1.01 to 3.02), living in a residential care home (aOR 1.50, 95% CI = 1.19 to 1.88), and located in Fife (aOR 1.37, 95% CI = 1.09 to 1.71). Excessive polypharmacy was less common in residents with dementia (aOR 0.73, 95% CI = 0.64 to 0.84), and 8.9% (95% CI = 5.9% to 11.6%) of the variation was attributable to care home predictors. Potentially inappropriate prescribing of ≥2 drugs was seen across all ADE categories, with highest prevalence seen in drugs predisposing to constipation (35.8%), sedation (27.7%), and renal injury (18.0%). CONCLUSION Excessive polypharmacy is common in care home residents and is associated with both individual and care home predictors. Potentially inappropriate prescribing of drugs that predisposed residents to all included ADE categories is common. Research is needed to support and evaluate safe care home prescribing practices.
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Rattanachotphanit T, Waleekhachonloet O. Effect of a Rational Drug Use Policy on the prescribing safety in outpatient settings in Thailand. Int J Pharm Pract 2020; 28:608-616. [PMID: 32813302 DOI: 10.1111/ijpp.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/23/2019] [Revised: 07/01/2020] [Accepted: 07/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In Thailand, the 'Rational Drug Use (RDU) policy' has been implemented in the Ministry of Public Health (MOPH) hospitals since October 2016. This study aimed to explore the effects of the RDU policy on prescribing safety indicators for elderly patients and those with common chronic diseases. METHOD Electronic outpatient databases were obtained from 15 MOPH hospitals. The selected indicators were the (1) glibenclamide prescribing in patients with diabetes mellitus who were elderly or had renal impairment; (2) duplicate prescribing of renin angiotensin system (RAS) blockers in patients with hypertension; (3) non-steroidal anti-inflammatory drugs (NSAIDs) prescribing in patients with chronic kidney disease stages 3-5; and (4) long-acting benzodiazepines prescribing in patients ≥65 years. The policy effects in terms of changes in prescribing trends were estimated using interrupted time-series analysis based on quarterly (Q) data. The postpolicy trends (2016, Q4-2017, Q4) were compared with the prepolicy trend (2014, Q1-2016, Q3). KEY FINDINGS The unsafe prescribing of glibenclamide in patients with diabetes mellitus was 19.2% in Q1, 2014 and decreased significantly due to the RDU policy to 11.0% in Q4, 2017 (-4.23 percentage points quarterly, P < 0.001). The unsafe prescribing of RAS blockers and long-acting benzodiazepines was relatively low in Q1, 2014 (1.0% and 1.1%, respectively) and did not decrease further after the RDU policy. The unsafe prescribing of NSAIDs was 4.2% in Q1, 2014, increased abruptly one quarter after the policy and decreased afterwards. CONCLUSION The RDU policy seemed to be a contributing factor that decreased the unsafe prescribing of glibenclamide, while the policy effect was minimal for the other indicators.
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Tang J, Toma M, Gray NM, Delvaux J, Guthrie B, Grant A, Duncan EM, Dreischulte T. Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP): a qualitative study of anticipated implementation factors informed by the Theoretical Domains Framework. BMJ Open 2020; 10:e033574. [PMID: 32114469 PMCID: PMC7050331 DOI: 10.1136/bmjopen-2019-033574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/30/2022] Open
Abstract
OBJECTIVES The quality and safety of drug therapy in primary care are global concerns. The Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP) intervention aims to improve prescribing safety via an informatics tool, which facilitates proactive management of drug therapy risks (DTRs) by health-board employed pharmacists with established roles in general practices. Study objectives were (1) to identify and prioritise factors that could influence P-DQIP implementation from the perspective of practice pharmacists and (2) to identify potentially effective, acceptable and feasible strategies to support P-DQIP implementation. DESIGN Semistructured face-to-face interviews using a Theoretical Domains Framework informed topic guide. The framework method was used for data analysis. Identified implementation factors were prioritised for intervention based on research team consensus. Candidate intervention functions, behavioural change techniques (BCTs) and policies targeting these were identified from the behavioural change wheel. The final intervention content and modes of delivery were agreed with local senior pharmacists. SETTING General practices from three Health and Social Care Partnerships in National Health Service (NHS) Tayside. PARTICIPANTS 14 NHS employed practice pharmacists. RESULTS Identified implementation factors were linked to thirteen theoretical domains (all except intentions) and six (skill, memory/attention/decision making, behavioural regulation, reinforcement, environmental context/resources, social influences) were prioritised. Three intervention functions (training, enablement and environmental restructuring) were relevant and were served by two policy categories (guidelines, communication/marketing) and eight BCTs (instructions on how to perform a behaviour, problem solving, action planning, prompt/cues, goal setting, self-monitoring, feedback and restructuring the social environment). Intervention components encompass an informatics tool, written educational material, a workshop for pharmacists, promotional activities and small financial incentives. CONCLUSIONS This study explored pharmacists' perceptions of implementation factors which could influence management of DTRs in general practices to inform implementation of P-DQIP, which will initially be implemented in one Scottish health board with parallel evaluation of effectiveness and implementation.
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Affiliation(s)
- Jason Tang
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
| | - Madalina Toma
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
| | - Nicola M Gray
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
| | - Joke Delvaux
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
- Physiotherapy Department, NHS Tayside, Dundee, Angus, UK
| | - Bruce Guthrie
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK
| | - Aileen Grant
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Eilidh M Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Tobias Dreischulte
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University, Munchen, Bayern, Germany
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Byrne CJ, Cahir C, Curran C, Bennett K. High-risk prescribing in an Irish primary care population: trends and variation. Br J Clin Pharmacol 2017; 83:2821-2830. [PMID: 28701029 DOI: 10.1111/bcp.13373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 04/26/2017] [Revised: 07/03/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022] Open
Abstract
AIMS The aims of the present study were to examine the prevalence of high-risk prescribing (HRP) in community-dwelling adults in Ireland from 2011-2015 using consensus-validated indicators, factors associated with HRP, and the variation in HRP between general practitioners (GPs) and in the dispensing of high-risk prescriptions between pharmacies. METHODS A repeated cross-sectional national pharmacy claims database study was conducted. Prescribing indicators were based on those developed in formal consensus studies and applicable to pharmacy claims data. Multilevel logistic regression was used to examine factors associated with HRP and dispensing. RESULTS There were significant reductions in the rates of most indicators over time (P < 0.001). A total of 66 022 of 300 906 patients at risk in 2011 [21.9%, 95% confidence interval (CI) 21.8, 22.1%], and 42 109 of 278 469 in 2015 (15.1%, 95% CI 15.0, 15.3%), received ≥1 high-risk prescription (P < 0.001). In 2015, indicators with the highest rates of HRP were prescription of a nonsteroidal anti-inflammatory drug (NSAID) without gastroprotection in those ≥75 years (37.2% of those on NSAIDs), coprescription of warfarin and an antiplatelet agent or high-risk antibiotic (19.5% and 16.2% of those on warfarin, respectively) and prescription of digoxin ≥250 μg day-1 in those ≥65 years (14.0% of those on digoxin). Any HRP increased significantly with age and number of chronic medications (P < 0.001). a) After controlling for patient variables, the variation in the rate of HRP between GPs was significant (P < 0.05); and b) after controlling for patient variables and the prescribing GP, the variation in the rate of dispensing of high-risk prescriptions between pharmacies was significant (P < 0.05). CONCLUSIONS HRP in Ireland has declined over time, although some indicators persist. The variation between GPs and pharmacies suggests the potential for improvement in safe medicines use in community care, particularly in vulnerable older populations.
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Affiliation(s)
- Catherine J Byrne
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel Curran
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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