scholarly journals Prescribing patterns for medical treatment of suspected prostatic obstruction: A spatiotemporal statistical analysis of Scottish open access data

2020 ◽  
Author(s):  
Federico Andreis ◽  
Richard Bryant ◽  
Emanuele Giorgi ◽  
Andrea Williamson ◽  
Ashleigh Ward
Keyword(s):  
Statistical Analysis ◽  
Healthcare Services ◽  
Prescribing Patterns ◽  
Patient Specific ◽  
Ageing Population ◽  
Prescribing Practices ◽  
Outflow Obstruction ◽  
Prostate Hyperplasia ◽  
Bladder Outflow Obstruction ◽  
The Impact

AbstractBackgroundHealthcare services treating men with prostate conditions are increasingly burdened worldwide. One of the competing factors in this demand is increasing diagnosis and treatment of lower urinary tract symptoms in men, much of which is suspected bladder outflow obstruction secondary to benign prostate hyperplasia/enlargement. However, the impact of increases on services is largely hidden, and there is limited knowledge of potential differences in management based on geography.ObjectiveTo investigate potential variation in the prescribing of drugs for suspected bladder outflow obstruction in Scotland based on analysis of publicly available data, and identify trends that may help to inform future prescribing behaviour.Design, setting, and participantsWe linked the relevant publicly available prescribing and patient data to all general practices in Scotland between October 2015 and November 2019.Outcome measurements and statistical analysisWe analysed the numbers of daily doses of drugs prescribed for suspected bladder outflow obstruction per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements in prescribing.ResultsPrescriptions of drugs to treat suspected bladder outflow obstruction increased during the observation period in Scotland, consistent with an ageing population and increased diagnosis. Whilst some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice- and patient-specific characteristics such as socio-economic deprivation and rurality.ConclusionsVariations in spatiotemporal prescribing for suspected bladder outflow obstruction exist in Scotland, some of which are unexplained and require further investigation.

scholarly journals Prescribing patterns for medical treatment of suspected prostatic obstruction: a longitudinal register-based study of the Scottish Health and Social Care Open Data

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042606
Author(s):  
Federico Andreis ◽  
Richard Bryant ◽  
Emanuele Giorgi ◽  
Andrea E Williamson ◽  
Ashleigh Ward
Keyword(s):  
Average Rate ◽  
Rate Of Change ◽  
Prescribing Patterns ◽  
Patient Specific ◽  
Prescribing Practices ◽  
Outflow Obstruction ◽  
Prostate Hyperplasia ◽  
Bladder Outflow Obstruction ◽  
Health And Social Care ◽  
General Practices

BackgroundThe diagnosis of lower urinary tract symptoms related to suspected bladder outflow obstruction from benign prostate hyperplasia/enlargement in men is increasing. This is leading to high demand on healthcare services; however, there is limited knowledge of differences in pharmacotherapy prescribing for this condition based on geography.ObjectiveTo investigate potential variation in drug prescribing for suspected bladder outflow obstruction in Scotland, based on analysis of publicly available data, to identify trends and inform future prescribing.Study designA longitudinal register-based data study of prescribing and patient data publicly available from Scottish registries. All information is available as monthly aggregates at the level of single general practices.Setting and participants903 (97%) general practices in Scotland, over a 50-month period (October 2015 to November 2019).Outcome measurements and statistical analysisWe analysed numbers of daily doses of drugs for suspected bladder outflow obstruction prescribed per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements.ResultsPrescriptions for suspected bladder outflow obstruction medications increased during the observation period (overall average rate of change 1.24±0.28, ranging from 0.893 in Orkney to 1.95 in Lanarkshire). While some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice-specific and patient-specific characteristics such as deprivation and rurality.ConclusionsInequalities in prescribing for suspected bladder outflow obstruction medications exist in Scotland, partially ascribable to accepted sociodemographic and geographic factors.

Cardiovascular Risk After Sepsis: Understanding the Role of Statin Indications and the Impact of Clinical Inertia on Prescribing Patterns

2020 ◽  
Vol 25 (6) ◽  
pp. 541-547
Author(s):  
Vedant A. Gupta ◽  
Talal S. Alnabelsi ◽  
Sandipan Shringi ◽  
Steve W. Leung ◽  
Vincent L. Sorrell
Keyword(s):  
Cohort Analysis ◽  
Prescribing Patterns ◽  
Clinical Inertia ◽  
Major Adverse Cardiovascular Events ◽  
Prescribing Practices ◽  
Retrospective Cohort Analysis ◽  
The Mean ◽  
The Impact ◽  
Statin Use

Introduction: Patients with sepsis have high rates of major adverse cardiovascular events (MACE) in the literature, but the stratification of those at risk has been limited. Statin indicated groups provides clear criteria for therapy, but the risk of MACE after sepsis based on these groups has never been assessed. Materials and Methods: This was a retrospective cohort analysis conducted on adult patients admitted from January 1, 2013, to December 31, 2013, with suspected or confirmed sepsis and data available on statin use. Patients’ past medical history; statin use prior, during, or at time of discharge; and occurrence of MACE were recorded from electronic health records. Result: A total of 321 patients were screened and 265 were found to have data available on statin use. The mean age of the patients was 59 ± 15 years and 47% were female. Overall, 9% were observed to have a MACE at 1 year, with significantly higher rates in those in a statin indicated group (12.2%). On admission, 174 patients were not taking a statin out of whom 52% were in a statin indicated group. Among those in a statin indicated group who survived to hospital discharge, only 10% not on a statin on admission received a statin on discharge, whereas 89% on a statin on admission received a statin on discharge. Conclusion: There is a high risk of MACE after sepsis especially among those in statin indicated groups with significant clinical inertia in prescribing practices.

scholarly journals Physicians' Perspective on Prescribing Patterns and Knowledge on Antimicrobial Use and Resistance in Penang, Malaysia: A Qualitative Study

2020 ◽  
Vol 8 ◽  
Author(s):  
Ali Akhtar ◽  
Amer Hayat Khan ◽  
Hadzliana Zainal ◽  
Mohamed Azmi Ahmad Hassali ◽  
Irfhan Ali ◽  
...  
Keyword(s):  
Health Care ◽  
Antimicrobial Resistance ◽  
Qualitative Study ◽  
Health Care System ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
Antimicrobial Use ◽  
Prescribing Practices ◽  
The Impact ◽  
Care System

Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system.Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis.Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance.Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.

Integrating Social and Health Services for People, Communities, Homes, and Places

2021 ◽  
pp. 21-66
Author(s):  
Maddalena Illario ◽  
Vincenzo De Luca ◽  
Regina Roller-Wirnsberger
Keyword(s):  
Older Adults ◽  
Technological Innovation ◽  
Circular Economy ◽  
Fear Of Falling ◽  
Healthcare Services ◽  
Ageing Population ◽  
Ageing Society ◽  
Regional Policies ◽  
Framework Approach ◽  
The Impact

The challenge of an ageing population requires a paradigmatic shift in the way we provide social and healthcare services, demanding the need to prioritize the functionality and independence of older adults. The risk and subsequent fear of falling is one of the most high-risk states for older adults, as it generates a destabilizing effect on their health that is often hard to recover. It is essential to thoroughly address their risk factors and mitigators. This discussion needs to be made in light of a person-centered perspective that goes beyond fragilities to capitalize on the strengths of the older adults. The chapter provides examples of how to connect assessment, interventions, and monitoring to a coherent framework approach that mitigates the risks and the impact of falls on an ageing society. The authors explore how technological innovation, urban planning, and regional policies that are culturally relevant can be incorporated in creating a circular economy while meeting the needs of an aging population and preventing falls and cognitive decline.

Telehealth acceptability and opioid prescribing patterns of providers of painful chronic diseases during the COVID-19 pandemic: A survey of sickle cell providers

2021 ◽  
Vol 17 (6) ◽  
pp. 489-497
Author(s):  
Martha O. Kenney, MD ◽  
Benjamin Becerra, DrPH; MBA, MPH, MS ◽  
Sean Alexander Beatty, BA ◽  
Wally R. Smith, MD
Keyword(s):  
Chronic Diseases ◽  
Sickle Cell ◽  
Online Survey ◽  
Management Practices ◽  
Risk Mitigation ◽  
The United States ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
The Impact

Objective: The coronavirus disease 2019 (COVID-19) has led to a rapid transition to telehealth services. It is unclear how subspecialists managing painful chronic diseases—such as sickle cell disease (SCD), an inherited hemoglobinopathy with significant disparities in access and outcomes—have viewed the transition to telehealth or altered their pain management practices. This study elicits the views of sickle cell providers regarding their transition to telehealth and their opioid prescribing patterns during the COVID-19 pandemic.Design: An anonymous online survey was sent to eligible sickle cell providers.Setting: Comprehensive sickle cell centers and/or clinics across the United States. Participants: Physicians and advanced practice providers providing care to SCD patients.Main outcome measures: Respondents answered questions regarding their (1) views of telehealth compared to in-person encounters and (2) opioid prescribing practices during the early months of the pandemic.Results: Of the 130 eligible participants, 53 respondents from 35 different sickle cell centers completed at least 90 percent of the survey. Respondents reported a significant increase in telehealth encounters for routine and acute appointments (mean difference and standard deviation: 57.6 ± 31.9 percent, p 0.001 and 24.4 ± 34.1 percent, p 0.001, respectively) since COVID-19. The overwhelming majority of respondents reported no changes in their opioid prescribing patterns since COVID-19, despite increased telehealth use. Only a minority coprescribed naloxone as a risk mitigation strategy.Conclusion: The rapid uptake of telehealth has not suppressed ambulatory providers’ prescribing of opioids for SCD. Studies assessing the impact of the COVID-19 pandemic and telehealth on opioid prescribing practices in other painful chronic diseases are needed to ensure health equity for vulnerable pain patients.

Evaluation of the Impact of Prior-to-Admission Sleep Aid Prescribing Practices on Sleep and Delirium in the Intensive Care Unit

2021 ◽  
pp. 106002802110426
Author(s):  
Melissa Chudow ◽  
Vittorio Paradiso ◽  
Nicole Silva ◽  
Jillian Collette
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Icu Admission ◽  
Icu Length Of Stay ◽  
The Impact ◽  
Time Point ◽  
Similar Incidence

Background: Sleep disruptions in the intensive care unit (ICU) may lead to complications such as delirium. There is limited evidence addressing how sleep aid use before and during ICU admission affects outcomes. Objective: The purpose of this study is to evaluate the impact of prior-to-admission sleep aid prescribing practices in the ICU on delirium and sleep outcomes. Methods: A retrospective review was conducted of adult patients admitted to any ICU from January to June 2018 receiving a sleep aid prior to admission. Patients were categorized based on sleep aid continuation, discontinuation, or alteration during the ICU admission. The primary end point was the incidence of delirium. Secondary end points included the incidence of sleep-wake cycle disturbances, delirium scores, and ICU length of stay. Results: A total of 291 patients were included with 109 in the continued group, 121 in the discontinued group, and 61 in the altered group. There was a similar incidence of delirium at 24 hours ( P = 0.71), 48 hours ( P = 0.60), 72 hours ( P = 0.25), and 5 days ( P = 0.48) after ICU admission. There was also no statistical difference in sleep-wake cycle disturbances or delirium scores at any time point. ICU length of stay was similar between the groups. Conclusion and Relevance: The incidence of delirium and sleep-wake cycle disturbances was not affected by differences in prior-to-admission sleep aid prescribing patterns during ICU admission.

scholarly journals 128 Getting Healthcare Students to be More Empathatic for Geriatric Patients: The Impact of Simulation Suit on Pharmacy Students

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv28-iv33
Author(s):  
Shaun Lee ◽  
Pei-Lee Teh
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Professionals ◽  
Intervention Group ◽  
Healthcare Services ◽  
Mental Illnesses ◽  
Controlled Study ◽  
Future Research ◽  
Ageing Population ◽  
The Impact

Abstract Introduction The world’s population worldwide is greying, and it is important that health care professionals such as pharmacists are able to gain proficiency in working with older adults who may be suffering from both physical and mental illnesses. One of the challenges for many schools that offer healthcare related courses is the need to support continued empathy towards this ageing population so that they can offer better healthcare services. Recently, ageing suits which are an immersive simulation suit designed to simulate the effects of ageing have been introduced to enable nursing students to experience what older adults face in health care situation. Method In this randomised controlled study, all year 1 students enrolled in the Bachelor of Pharmacy course (n=120) at our institution were assigned to either a polypharmacy only workshop or use an ageing suit together with polypharmacy workshop (intervention). The intervention group was tasked to perform a series of exercises, including walking a flight of stairs, picking up a coin as well as filling up a form. All participants completed the Jefferson Empathy Scale and semi-structured questionnaire. Results At the end of exercise, intervention group participants had a marginal improvement in their self-reported empathy levels, with an improvement of 1.7 +14.5 points compared to 1.2 + 9.4 points in control (p=0.81). Participants in the intervention reported changes in physical performance consistent with the expected changes associated with ageing. They also reported a change in attitude and were able to empathize better with older adults especially on issues related to patient communication. Conclusion As such, future research should also include and involve a wider range of students to ensure that they become health advocates for the health care needs of older adults. This will enable them to deliver better healthcare services to meet the needs of the older adults.

scholarly journals Shaping the Future of Digitally Enabled Health and Care

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 17
Author(s):  
Maureen Spargo ◽  
Nicola Goodfellow ◽  
Claire Scullin ◽  
Sonja Grigoleit ◽  
Andreas Andreou ◽  
...  
Keyword(s):  
Older People ◽  
Chronic Conditions ◽  
Sense Of Self ◽  
Healthcare Services ◽  
Self Management ◽  
Ageing Population ◽  
Self Sufficiency ◽  
Medicines Use ◽  
Active Lifestyles ◽  
The Impact

People generally need more support as they grow older to maintain healthy and active lifestyles. Older people living with chronic conditions are particularly dependent on healthcare services. Yet, in an increasingly digital society, there is a danger that efforts to drive innovations in eHealth will neglect the needs of those who depend on healthcare the most—our ageing population. The SHAPES (Smart and Healthy Ageing through People Engaging in Supportive Systems) Innovation Action aims to create an open European digital platform that facilitates the provision of meaningful, holistic support to older people living independently. A pan-European pilot campaign will evaluate a catalogue of digital solutions hosted on the platform that have been specifically adapted for older people. ‘Medicines control and optimisation’ is one of seven themes being explored in the campaign and will investigate the impact of digital solutions that aim to optimise medicines use by way of fostering effective self-management, while facilitating timely intervention by clinicians based on remote monitoring and individualised risk assessments powered by artificial intelligence. If successful, the SHAPES Innovation Action will lead to a greater sense of self-sufficiency and empowerment in people living with chronic conditions as they grow older.

scholarly journals Evaluation of discharge prescribing after rescheduling of gabapentin as a controlled substance

2021 ◽  
Author(s):  
Melody J Robbins ◽  
Catherine Floroff ◽  
Amanda Ingemi ◽  
Marcus C Kaplan
Keyword(s):  
Health System ◽  
Chart Review ◽  
Primary Outcome ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Final Version ◽  
Before And After ◽  
Final Article ◽  
Controlled Substance ◽  
The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Gabapentin has increasingly been identified as a drug of abuse, especially when used concurrently with opioids. Rescheduling gabapentin as a schedule V controlled substance may strengthen monitoring and prescribing restrictions. The purpose of this study was to characterize the impact of rescheduling gabapentin from a nonscheduled to a schedule V substance in Virginia on discharge prescribing patterns in a health system. Methods This was a retrospective, pre-post, multicenter chart review conducted at 4 sites. Data from 3 months before gabapentin rescheduling (prerescheduling group) and 3 months after gabapentin rescheduling (postrescheduling group) were evaluated. The primary outcome was the percentage of newly prescribed gabapentin prescriptions upon discharge, which was compared between the pre- and postrescheduling groups. Results A similar percentage of gabapentin prescriptions were newly prescribed in the prerescheduling group as compared to the postrescheduling group (55.0% vs 50.0%, P = 0.479). Gabapentin prescribing characteristics did not differ between the groups for new gabapentin prescriptions (n = 55 in the prerescheduling group, n = 50 in the postrescheduling group). Concomitant discharge prescribing of benzodiazepines (5.5% vs 2.0%, P = 0.619) and opioids (45.5% vs 60.0%, P = 0.136) did not differ significantly between the postrescheduling group and prerescheduling group for new gabapentin prescriptions. However, fewer opioid prescriptions exceeded 90 daily morphine milligram equivalents (MME) in the postrescheduling group as compared to the prerescheduling group for new gabapentin prescriptions (36.0% vs 20.0%, P = 0.020). Conclusion Gabapentin prescribing practices did not differ before and after rescheduling of gabapentin as a controlled substance. There was a trend toward dosages with reduced daily MME for concomitant opioid prescriptions after rescheduling. However, additional investigation with larger studies over longer periods of time is needed to discover whether gabapentin rescheduling significantly changes prescribing practices.

Promoting equity through health services

2020 ◽  
pp. 23-32
Author(s):  
Bo Burström
Keyword(s):  
Primary Care ◽  
Policy Reform ◽  
Healthcare Services ◽  
Ageing Population ◽  
Freedom Of Choice ◽  
Disadvantaged Area ◽  
Health Policy Reform ◽  
Child Healthcare ◽  
The Impact ◽  
Proportionate Universalism

The provision of healthcare should be in relation to the need of care, but this is not always the case, as examples given in this chapter illustrate. The impact on equity in the utilization of care of need-based resource allocation versus recent market-oriented choice reforms and changes in reimbursement systems in primary care in Sweden are discussed. Examples are given of alternative ways of providing services in primary care in disadvantaged areas. Further, the chapter describes an applied example of the concept of proportionate universalism in child healthcare services, where extra postnatal home visits are provided in a disadvantaged area of Stockholm. Finally, the emerging needs of integrated care in an ageing population are contrasted against current health policy reform, which emphasizes freedom of choice of providers, and discussed.

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