Patients' perceived benefit from and satisfaction with asthma-related pharmacy services

OBJECTIVE

To determine whether patients targeted to receive intervention from an asthma management program reported receiving more services and had greater perceived benefit and satisfaction with those services compared with asthma patients not targeted by the program.

DESIGN

Mailed survey.

SETTING

Community pharmacy.

PATIENTS

471 community-based patients receiving asthma medications from 44 intervention pharmacies and 1,164 patients from 46 usual care (control) pharmacies.

MAIN OUTCOME MEASURES

Five-point agreement scale measuring asthma services received, perceived value of the services, and satisfaction.

RESULTS

Usable surveys were received from 39.0% of intervention patients and 42.4% of controls. There were no statistically significant differences between groups in the frequency of provision of listed services. Approximately 60% of respondents from both groups received written materials on asthma medications and 54% received inhaler counseling; both were rated high for perceived benefit. Fewer than 20% reported being counseled about asthma triggers. Fewer than 5% reported pharmacists talking to physicians on their behalf. General satisfaction with pharmacy services was high (78.2% agree or strongly agree), but not statistically different between groups. More than 65% believed that pharmacists spend enough time counseling patients. Several comments indicated that patients did not expect or ask for information because they were unaware that services were available and/or they had already been counseled by their physician. Responses to the statement "my asthma is better controlled because of help given to me by the pharmacist" were equivocal and not different between groups.

CONCLUSION

Overall, there were few differences between groups. General satisfaction with pharmacy services is high, but patients' perceived benefit and satisfaction with cognitive services is lower. Increased public awareness of pharmacists' capabilities and a more proactive approach to providing cognitive services is needed.

Clustering of Candida infections in the neonatal intensive care unit: concurrent emergence of multiple strains simulating intermittent outbreaks

BACKGROUND

Clusters of Candida albicans and Candida parapsilosis infections were noted intermittently in our neonatal intensive care unit (NICU). We attempted to determine whether these clusters represented single strain outbreaks or coincidental emergence of unrelated strains.

METHODS

A retrospective examination of the frequency of candidemia during a 9-year period, two point prevalence studies of colonization and assessment of strain relatedness of individual infant isolates during and in between clusters during a 2-year period with karyotyping and restriction endonuclease analysis of genomic DNA (REAG).

RESULTS

C. albicans and C. parapsilosis infections emerged in a scattered pattern (1 to 2 cases every few months) with intermittent clustering of 3 cases/month. The colonization rate was 50% 5 weeks after an apparent cluster, equally distributed between C. albicans and C. parapsilosis, and 17.6% (exclusively with C. parapsilosis) 4 months after absence of invasive disease. Utilizing REAG or karyotyping singly we noted 12 and 16 DNA banding patterns, respectively, among 23 infant isolates. Few patterns were observed repeatedly over 2- to 20-month periods, implying recurrent emergence of the same strains. Combining karyotyping with REAG revealed a different epidemiologic pattern. It identified 20 distinct composites with identical composites in 3 infant pairs. All infants with identical composites were in the NICU concurrently. The frequency of strain relatedness was comparable among clustered cases (16.7%), scattered cases (7.7%) and simultaneously colonized infants (16.7%).

CONCLUSIONS

These findings illustrate that Candida infections clustered periodically in our NICU but that these clusters were often caused by unrelated strains with infrequent cross-infection during and between clusters. With suboptimal typing this pattern of emergence can be mistaken for same strain outbreaks.

Pediatric psychologists' perceptions of their work settings

Describes the results of a survey of pediatric psychologists' perceptions of their work settings. Respondents (n = 261) described heterogeneous work settings, professional activities, expectations for workload and administrative arrangements. Clinical activities were prominent, accounting for nearly half the respondents' time. Respondents generally reported high levels of overall satisfaction with their work environments. Highest ranked sources of satisfaction included professional autonomy, patient care, and relationships with colleagues. Highest ranked sources of dissatisfaction included lack of time for research, salary, and patient care workload. Pediatric psychologists in private practice reported higher work satisfaction than those in other settings. Findings have implications for the work-related functioning of pediatric psychologists that should be addressed in research and professional activity.

Personality development, problem solving, and behavior problems among preschool children with early histories of nonorganic failure-to-thrive: a controlled study

Using a prospective study design, 48 preschool children with early histories of nonorganic failure-to-thrive (NOFT) and 47 physically healthy children of comparable age, sex, birth order, and family demographics were compared on measures of problem solving and personality development (ego control and ego resiliency). In responding to structured measures, NOFT children demonstrated deficits in behavioral organization, ego control, and ego resiliency compared with controls. Parents also identified higher levels of behavioral symptoms in children with early histories of NOFT compared with controls. However, home observational measures of ego control and ego resiliency did not differentiate the two groups. Deficiencies in problem solving and personality development and increased levels of behavioral symptoms in preschool children with early histories of NOFT may affect their future socioemotional development and learning.

Influences on the home environment of preschool children with early histories of nonorganic failure-to-thrive

The home environments of 58 children with early histories of nonorganic failure-to-thrive (NOFTT) who received time-limited outreach intervention after hospitalization were assessed from 12 to 36 months of age. The type of outreach intervention did not affect the quality of home environment as assessed by the Home Observation for Measurement of the Environment inventory (HOME). We tested the efficacy of three sets of variables: characteristics of NOFTT (age of onset and duration), nutritional status (weight for height) at time of diagnosis, and family characteristics (maternal IQ and income) in predicting HOME scores at 36 months. Family characteristics (income and maternal IQ) were the only variables to predict HOME scores. HOME scores were less stable than in the standardization sample. A subgroup of NOFTT children (n = 7) whose HOME scores decreased over the 2-year follow-up period were more likely to have subsequent siblings than children whose HOME scores improved over the same time period (n = 11). Findings suggest the need to identify and provide preventive intervention for NOFTT children whose home environments are vulnerable to deterioration following diagnosis.