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Journal of the American Geriatrics... Dec 2014To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to...
OBJECTIVES
To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to determine the potential clinical relevance thereof.
DESIGN
Qualitative study with semistructured face-to-face interviews.
SETTING
A community pharmacy and a geriatric outpatient ward.
PARTICIPANTS
Community-dwelling people aged 70 and older (N = 59).
MEASUREMENTS
Participants were interviewed at home. Two researchers coded the reported problems and management strategies independently according to a coding scheme. An expert panel classified the potential clinical relevance of every identified practical problem and associated management strategy using a 3-point scale.
RESULTS
Two hundred eleven practical problems and 184 management strategies were identified. Ninety-five percent of the participants experienced one or more practical problems with the use of their medicines: problems reading and understanding the instructions for use, handling the outer packaging, handling the immediate packaging, completing preparation before use, and taking the medicine. For 10 participants, at least one of their problems, in combination with the applied management strategy, had potential clinical consequences and 11 cases (5% of the problems) had the potential to cause moderate or severe clinical deterioration.
CONCLUSION
Older people experience a number of practical problems using their medicines, and their strategies to manage these problems are sometimes suboptimal. These problems can lead to incorrect medication use with clinically relevant consequences. The findings pose a challenge for healthcare professionals, drug developers, and regulators to diminish these problems.
Topics: Aged; Aged, 80 and over; Disease Management; Drug Labeling; Drug Packaging; Female; Humans; Interviews as Topic; Male; Pharmaceutical Preparations; Qualitative Research
PubMed: 25516030
DOI: 10.1111/jgs.13126 -
Journal of Investigational Allergology... 2020The European Medicines Agency (EMA) defines excipients as the constituents of a pharmaceutical form apart from the active substance. Delayed hypersensitivity reactions... (Review)
Review
The European Medicines Agency (EMA) defines excipients as the constituents of a pharmaceutical form apart from the active substance. Delayed hypersensitivity reactions (DHRs) caused by excipients contained in the formulation of medications have been described. However, there are no data on the prevalence of DHRs due to drug excipients. Clinical manifestations of allergy to excipients can range from skin disorders to life-threatening systemic reactions. The aim of this study was to perform a literature review on allergy to pharmaceutical excipients and to record the DHRs described with various types of medications, specifically due to the excipients contained in their formulations. The cases reported were sorted alphabetically by type of medication and excipient, in order to obtain a list of the excipients most frequently involved for each type of medication.
Topics: Disease Management; Disease Susceptibility; Drug Compounding; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Excipients; Humans; Hypersensitivity, Delayed; Pharmaceutical Preparations
PubMed: 32376520
DOI: 10.18176/jiaci.0562 -
Lippincott's Case Management : Managing... 2006
Topics: Case Management; Communication; Continuity of Patient Care; Disease Management; Forecasting; Health Services Research; Humans; Information Management; Managed Care Programs; Operations Research; Organizational Policy; Personnel Staffing and Scheduling; Surveys and Questionnaires; United States; Utilization Review
PubMed: 16444123
DOI: 10.1097/00129234-200601000-00010 -
Journal of Managed Care Pharmacy : JMCP Jan 2014Accountable care organizations (ACOs) have the potential to lower costs and improve quality through incentives and coordinated care. However, the design brings with it...
BACKGROUND
Accountable care organizations (ACOs) have the potential to lower costs and improve quality through incentives and coordinated care. However, the design brings with it many new challenges. One such challenge is the optimal use of pharmaceuticals. Most ACOs have not yet focused on this integral facet of care, even though medications are a critical component to achieving the lower costs and improved quality that are anticipated with this new model.
OBJECTIVE
To evaluate whether ACOs are prepared to maximize the value of medications for achieving quality benchmarks and cost offsets.
METHODS
During the fall of 2012, an electronic readiness self-assessment was developed using a portion of the questions and question methodology from the National Survey of Accountable Care Organizations, along with original questions developed by the authors. The assessment was tested and subsequently revised based on feedback from pilot testing with 5 ACO representatives. The revised assessment was distributed via e-mail to a convenience sample (n=175) of ACO members of the American Medical Group Association, Brookings-Dartmouth ACO Learning Network, and Premier Healthcare Alliance.
RESULTS
The self-assessment was completed by 46 ACO representatives (26% response rate). ACOs reported high readiness to manage medications in a few areas, such as transmitting prescriptions electronically (70%), being able to integrate medical and pharmacy data into a single database (54%), and having a formulary in place that encourages generic use when appropriate (50%). However, many areas have substantial room for improvement with few ACOs reporting high readiness. Some notable areas include being able to quantify the cost offsets and hence demonstrate the value of appropriate medication use (7%), notifying a physician when a prescription has been filled (9%), having protocols in place to avoid medication duplication and polypharmacy (17%), and having quality metrics in place for a broad diversity of conditions (22%).
CONCLUSIONS
Developing the capabilities to support, monitor, and ensure appropriate medication use will be critical to achieve optimal patient outcomes and ACO success. The ACOs surveyed have embarked upon an important journey towards this goal, but critical gaps remain before they can become fully accountable. While many of these organizations have begun adopting health information technologies that allow them to maximize the value of medications for achieving quality outcomes and cost offsets, a significant lag was identified in their inability to use these technologies to their full capacities. In order to provide further guidance, the authors have begun documenting case studies for public release that would provide ACOs with examples of how certain medication issues have been addressed by ACOs or relevant organizations. The authors hope that these case studies will help ACOs optimize the value of pharmaceuticals and achieve the "triple aim" of improving care, health, and cost.
Topics: Accountable Care Organizations; Costs and Cost Analysis; Cross-Sectional Studies; Delivery of Health Care; Disease Management; Humans; Medicare; Patient Protection and Affordable Care Act; Pharmaceutical Preparations; Pharmacy; United States
PubMed: 24372456
DOI: 10.18553/jmcp.2014.20.1.17 -
The Milbank Quarterly 1996Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to... (Review)
Review
Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of evidence-based, planned care; reorganization of practice systems and provider roles; improved patient self-management support; increased access to expertise; and greater availability of clinical information. The challenge is to organize these components into an integrated system of chronic illness care. Whether this can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care remains unanswered.
Topics: Chronic Disease; Continuity of Patient Care; Disease Management; Humans; Models, Organizational; Patient Education as Topic; Patient-Centered Care; Primary Health Care; Randomized Controlled Trials as Topic; United States
PubMed: 8941260
DOI: No ID Found -
The European Journal of General Practice Dec 2018According to the Wonca International Dictionary for General/Family Practice Quaternary Prevention is defined as: 'Action taken to identify patient at risk of...
BACKGROUND
According to the Wonca International Dictionary for General/Family Practice Quaternary Prevention is defined as: 'Action taken to identify patient at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.' The concept of quaternary prevention was initially proposed by Marc Jamoulle and the targets were mainly patients with illness but without a disease.
OBJECTIVES
The purpose of this opinion article is to open the debate around a new possible definition and a new conceptual model of quaternary prevention based on the belief that quaternary prevention should be present in physicians' minds for every intervention they suggest to a patient.
DISCUSSION
The debate around quaternary prevention is vital in the context of contemporary medicine and has expanded worldwide. The human being may suffer harm from medical interventions from conception, during their childhood, during their entire healthy lifetime as well as during a self-limited disease, a chronic disease, or a terminal disease. The current definition of quaternary prevention has limitations because it excludes patients and medical interventions where a quaternary prevention perspective would be needed and useful to protect patients from harm. In this context, a new definition and conceptual model of quaternary prevention is proposed.
CONCLUSION
In this new proposal, quaternary prevention is defined as an 'action taken to protect individuals (persons/patients) from medical interventions that are likely to cause more harm than good.'
Topics: Concept Formation; General Practice; Humans; Medicalization; Medically Unexplained Symptoms; Physician-Patient Relations
PubMed: 29384397
DOI: 10.1080/13814788.2017.1422177 -
Journal of Managed Care Pharmacy : JMCP 2004
Topics: Disease Management; Drug Costs; Histamine H1 Antagonists; Humans; Managed Care Programs; Nonprescription Drugs; Rhinitis, Allergic, Seasonal; United States
PubMed: 15228380
DOI: 10.18553/jmcp.2004.10.3.267a -
The Annals of Pharmacotherapy Feb 2011Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that...
BACKGROUND
Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors.
OBJECTIVE
To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR).
METHODS
Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted.
RESULTS
Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time.
CONCLUSIONS
BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes must be continually analyzed and restructured to yield the intended full benefits of BCMA technology.
Topics: Adult; Electronic Data Processing; Humans; Medical Order Entry Systems; Medication Errors; Medication Systems, Hospital; Pharmaceutical Preparations
PubMed: 21285409
DOI: 10.1345/aph.1P262 -
The American Journal of Managed Care Apr 2002To investigate how health plans manage chronic diseases.
OBJECTIVE
To investigate how health plans manage chronic diseases.
STUDY DESIGN
Health plan medical directors were surveyed regarding the disease management (DM) practices of their plans.
METHODS
We took a stratified random sample of 65 plans, all members of the American Association of Health Plans. Forty-five plans responded. Results were weighted to be representative of the industry (including nonmember plans). Medical directors were asked to consider that they had a DM program only if 2 things were true: (1) A majority of a plan's enrollees could not be ineligible for a DM program for non-clinical reasons (eg, geographic location); and (2) a DM program had to have at least 6 of the 8 components of a DM program as defined by the Disease Management Association of America.
RESULTS
The 3 diseases most likely to be the focus of DM programs were diabetes, asthma, and congestive heart failure. For each of these diseases, at least one quarter of Americans were enrolled in plans offering a DM program. Medical directors perceived their DM programs to be highly effective in reducing mortality and morbidity and in improving the functional status of patients, and perceived them to be effective in lowering cost. The greatest challenge in implementing DM programs involves information technology. These results yield insights into the future of treatment of chronic disease in the United States.
CONCLUSION
Health plans have made a significant investment in programs to improve care for chronic illness. The almost universality of DM programs highlight the need for scholarly evaluations of their effectiveness and cost effectiveness.
Topics: Asthma; Chronic Disease; Decision Making, Organizational; Diabetes Mellitus; Disease Management; Health Care Surveys; Heart Failure; Humans; Insurance, Health; Managed Care Programs; Medical Informatics; United States
PubMed: 11950130
DOI: No ID Found -
Emerging Topics in Life Sciences Sep 2020Precision medicine can be defined as personalized medicine enhanced by technology. In the past, medicine has, in some cases, been personalized. For example, some drugs... (Review)
Review
Precision medicine can be defined as personalized medicine enhanced by technology. In the past, medicine has, in some cases, been personalized. For example, some drugs are dosed on an individualized basis based on age, body-mass index, comorbidities and other clinical parameters. However, overall, medicine has largely followed the 'one-size-fits-all' paradigm as exemplified in the treatment of essential hypertension or type 2 diabetes mellitus. What has changed in the past few years is that technologies such as high throughput sequencing, mass spectrometry, microfluidics, and imaging can help conduct a multitude of complex measurements on clinical samples. Aided by analytics, these technologies have been providing an increasingly detailed picture of molecular and cellular alterations underlying numerous diseases and have revealed tremendous variability between individuals and patients at the molecular and cellular level. These findings have motivated a more personalized or 'precision' approach to medicine, in which molecular and cellular markers help tailor patient management to each individual. Here we provide an overview of the key factors driving adoption of precision medicine and highlight current research that may soon make precision medicine more predictive.
Topics: Biomarkers; Diabetes Mellitus, Type 2; Disease Management; Forecasting; Genetic Predisposition to Disease; Genomics; Humans; Hypertension; Molecular Targeted Therapy; Pharmaceutical Preparations; Precision Medicine
PubMed: 32856697
DOI: 10.1042/ETLS20190197