Trends in antipsychotic prescribing practices in an urban community mental health clinic

OBJECTIVE

Availability of new psychotropic agents, and formulations, as well as expanded indications for previously available agents, has had an impact on prescribing patterns in community psychiatric practice. This study tracked changes in patient diagnostic profiles and compared antipsychotic prescribing patterns for patients managed by a continuing care team over a 2.25-year period.

METHOD

Data pertaining to patient diagnoses and psychotropic medications was obtained from sequential cross-sectional file review and the pharmacy database. Data were collected in late 2004 (n = 224) and early 2007 (n = 294).

RESULTS

The majority of patients suffered from DSM-IV schizophrenia, schizoaffective and related disorders (68% in 2004, 71% in 2007). Second generation antipsychotic (SGA) medications (79% in 2004, 99% in 2007 of all antipsychotics) were the most widely used agents. Use of quetiapine as a proportion of all oral SGAs increased (8% to 17%) as did that of long-acting risperidone (<1% to 17% of all antipsychotics) paralleled by a decline in long-acting first generation antipsychotic agents (15% to <1%). Significant changes in the prescription of non-benzodiazepine hypnotics and mood stabilizers were also noted.

CONCLUSIONS

Statistically significant changes in prescribing patterns of antipsychotics during the study period were noted. Likely causes are discussed.

An intervention study to enhance medication compliance in community-dwelling elderly individuals

OBJECTIVE

To determine whether daily videotelephone or regular telephone reminders would increase the proportion of prescribed cardiac medications taken in a sample of elderly individuals who have congestive heart failure (CHF).

METHODS

The authors recruited community-dwelling individuals age 65 and older who had the primary or secondary diagnosis of CHF into a randomized controlled trial of reminder calls designed to enhance medication compliance. There were three arms: a control group that received usual care; a group that received regular daily telephone call reminders; and a group that received daily videotelephone call reminders. Compliance was defined as the percent of therapeutic coverage as recorded by Medication Event Monitoring System (MEMS) caps. Subjects were recruited from 2 sources: a large urban home health care agency and a large urban ambulatory clinic of a major teaching hospital. Baseline and post-intervention MOS 36-Item Short-Form Health Survey (SF-36) scores and Minnesota Living with Heart Failure (MLHF) scores were obtained.

RESULTS

There was a significant time effect during the course of the study from baseline to post-intervention (F[2,34] = 4.08, p < .05). Over time the elderly individuals who were called, either by telephone or videotelephone, showed enhanced medication compliance relative to the control group. There was a trend, but no significant difference between the two intervention groups. Both SF-36 and MLHF scores improved from baseline to post-intervention for all groups. There was no significant change in the SF-36 scores for the sample, but there was a significant change for the MLHF scores (p < .001). The control group had a significant fall off in the medication compliance rate during the course of the study, dropping from 81% to 57%.

CONCLUSIONS

Telephone interventions are effective in enhancing medication compliance and may prove more cost effective than clinic visits or preparation of pre-poured pill boxes in the home. Technologic advances which enable clinicians to monitor and enhance patient medication compliance may reduce costly and distressing hospitalization for elderly individuals with CHF.

From computer technology to information technology. Findings from a national study of nursing education

A research survey was conducted on a stratified random sample of National League for Nursing accredited diploma, associate, baccalaureate, and master programs to determine the status of computer and information technology in nursing education. Fifty-five percent (n = 190) of the 347 selected schools responded. Compared with national statistics, all programs (diploma, associate, and higher degree) were proportionately represented. Findings indicated that schools have almost universal access to computers and educational software. However, further data analysis indicated that a majority of schools lacked a coordinated plan for technology implementation and were underfinanced for technology and related personnel. In addition, less than one third of the schools addressed nursing informatics (the information of nursing) in the curriculum and only 19 schools indicated that nursing informatics was offered as a separate course. Successful strategies for the implementation of computer and information technology are presented based on the findings.

Setting standards for nursing data sets in information systems

The American Nurses Association (ANA) has established the Nursing Information and Data Set Evaluation Center (NIDSEC). The purpose of this Center is to develop and disseminate standards pertaining to information systems that support the documentation of nursing practice, and to evaluate voluntarily submitted information systems against these standards. The need for an evaluation center arises out of a long history of calls for standards pertaining to nursing data and to information systems. Standards have been developed to evaluate the completeness, accuracy and appropriateness of four dimensions of nursing data sets and the systems that contain them 1) nomenclature, 2) clinical content, 3) clinical data repository, and 4) general system characteristics. Once the standards and scoring mechanisms were established, they were tested for reliability and validity. A Content Validity Index (CVI) of 0.875 was established for the scoring tool.

The information age: the status of technology in nursing education programs in the United States

The purpose of this research was to determine the status of technology in nursing education in the United States. The research design was a comparative descriptive survey of a stratified random sample of National League for Nursing accredited diploma, associate, baccalaureate and master programs. The instrument for data collection was developed by a panel of six experts in the area of educational technology. The survey, mailed to 347 randomly selected schools, identified four primary areas of investigation: 1) technology inventory, 2) technology applications and content, including education and clinical areas, 3) implementation plan, and 4) decision making including funding and staffing resources. Findings indicated there was a significant difference in available electronic resources among baccalaureate, associate and diploma programs. A majority of schools utilize computer applications to enhance teaching, but a very small percentage of schools addressed informatics in the curriculum. The project was funded by a grant from the Helene Fuld Health Trust Fund.