Willingness of patients to use unused medication returned to the pharmacy by another patient: a cross-sectional survey

ObjectivesRedispensing by pharmacies of medication unused by another patient could contribute to optimal use of healthcare resources. This study aimed to assess patient willingness to use medication returned by another patient and patient characteristics associated with this willingness.DesignCross-sectional survey.SettingA total of 41 community and 5 outpatient pharmacies in the Netherlands.ParticipantsTotal of 2215 pharmacy visitors.Primary and secondary outcome measuresPatients completed a questionnaire regarding their willingness to use medication returned unused to the pharmacy by another patient, assuming quality was guaranteed. Secondary outcome measures included patient sociodemographic characteristics that were associated with patient willingness, analysed using logistic regression analysis and reported as ORs with 95% CIs.ResultsOf the 2215 patients (mean (SD) age 50.6(18.0) years; 61.4% female), 61.2% were willing to use medication returned unused to the pharmacy by another patient. Patients who were unwilling mostly found it risky. Men were more willing to use returned medication (OR 1.3 95% CI 1.1 to 1.6), as did patients with a high educational level (OR 1.8 95% CI 1.3 to 2.5), those who regularly use 1–3 medications (OR 1.3 95% CI 1.1 to 1.7), those who returned medication to the pharmacy for disposal (OR 1.5 95% CI 1.0 to 2.3) and those who ever had unused medication themselves (OR 1.3 95% CI 1.1 to 1.6)). Patients with non-Dutch cultural background were less willing to use returned medication (OR 0.395% CI 0.3 to 0.4)).ConclusionsWhen quality is guaranteed, a substantial proportion of patients are willing to use medication returned unused to the pharmacy by another patient. This suggests that implementation of redispensing may be supported by patients.

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Association between socioeconomic status and prevalence of non-communicable diseases risk factors and comorbidities in Bangladesh: findings from a nationwide cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2018-025538 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025538 ◽

Cited By ~ 8

Author(s):

Tuhin Biswas ◽

Nick Townsend ◽

Md Saimul Islam ◽

Md Rajibul Islam ◽

Rajat Das Gupta ◽

...

Keyword(s):

Risk Factors ◽

Socioeconomic Status ◽

Outcome Measures ◽

Adult Population ◽

Multivariable Analysis ◽

Communicable Diseases ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Non Communicable Diseases

ObjectivesThis study aimed to examine the prevalence and distribution in the comorbidity of non-communicable diseases (NCDs) among the adult population in Bangladesh by measures of socioeconomic status (SES).DesignThis was a cross-sectional study.SettingThis study used Bangladesh Demographic and Health Survey 2011 data.ParticipantsTotal 8763 individuals aged ≥35 years were included.Primary and secondary outcome measuresThe primary outcome measures were diabetes mellitus (DM), hypertension (HTN) and overweight/obesity. The study further assesses factors (in particular SES) associated with these comorbidities (DM, HTN and overweight/obesity).ResultsOf 8763 adults,12% had DM, 27% HTN and 22% were overweight/obese (body mass index ≥23 kg/m2). Just over 1% of the sample had all three conditions, 3% had both DM and HTN, 3% DM and overweight/obesity and 7% HTN and overweight/obesity. DM, HTN and overweight/obesity were more prevalent those who had higher education, were non-manual workers, were in the richer to richest SES and lived in urban settings. Individuals in higher SES groups were also more likely to suffer from comorbidities. In the multivariable analysis, it was found that individual belonging to the richest wealth quintile had the highest odds of having HTN (adjusted OR (AOR) 1.49, 95% CI 1.29 to 1.72), DM (AOR 1.63, 95% CI 1.25 to 2.14) and overweight/obesity (AOR 4.3, 95% CI 3.32 to 5.57).ConclusionsIn contrast to more affluent countries, individuals with NCDs risk factors and comorbidities are more common in higher SES individuals. Public health approaches must consider this social patterning in tackling NCDs in the country.

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Lifestyle, socioeconomic status and healthcare seeking among women with gynaecological cancer alarm symptoms: a combined questionnaire-based and register-based population study

BMJ Open ◽

10.1136/bmjopen-2018-021815 ◽

2018 ◽

Vol 8 (7) ◽

pp. e021815 ◽

Cited By ~ 3

Author(s):

Kirubakaran Balasubramaniam ◽

Sandra Elnegaard ◽

Sanne Rasmussen ◽

Peter Fentz Haastrup ◽

René dePont Christensen ◽

...

Keyword(s):

Socioeconomic Status ◽

Educational Level ◽

Lifestyle Factors ◽

Gynaecological Cancer ◽

High Educational Level ◽

Postmenopausal Bleeding ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Recent Onset ◽

High Educational

ObjectivesTo determine the proportion of contacts to general practitioner (GP) with recent onset gynaecological cancer alarm symptoms (pelvic pain, postmenopausal bleeding, bleeding during intercourse or pain during intercourse) and to analyse the associations between lifestyle factors, socioeconomic status and GP contact for these symptoms.DesignCross-sectional survey combined with data from national registers.SettingThe general Danish population.ParticipantsA total of 25 866 non-pregnant women ≥20 years completed the survey. Women reporting at least one of four gynaecological alarm symptoms within the preceding 6 months form the study base (n=2957).ResultsThe proportion of women reporting GP contact ranged from 21.1% (pain during intercourse) to 32.6% (postmenopausal bleeding). Women aged 60+ years had higher odds of reporting GP contact for at least one of the four gynaecological cancer alarm symptoms compared with those aged 20–39 years (OR 2.56, 95% CI 1.69 to 3.89), and immigrants had higher odds of reporting GP contact for at least one of the symptoms (OR 1.56, 95% CI 1.13 to 2.15) compared with ethnic Danish individuals. Among those reporting postmenopausal bleeding and/or bleeding during intercourse, women in the age group 60+ years had higher odds of reporting GP contact compared with those aged 20–39 years (OR 2.79, 95% CI 1.33 to 5.87). A high educational level (>12 years) was positively associated with reporting GP contact for postmenopausal bleeding and/or bleeding during intercourse compared with a low educational level (<10 years) (OR 2.23, 95% CI 1.19 to 4.19). No associations were found with lifestyle factors.ConclusionsFew women contacted their GP with recent onset gynaecological cancer alarm symptoms. Higher age, being immigrant and higher educational level increased the odds of GP contact. Future studies should explore the reasons for these findings as this may aid in prompting early diagnosis and thereby improve the prognosis of gynaecological cancer.

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Influence of political and medical leaders on parental perception of vaccination: a cross-sectional survey in Australia

BMJ Open ◽

10.1136/bmjopen-2018-025866 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025866 ◽

Cited By ~ 3

Author(s):

Elissa J Zhang ◽

Abrar Ahmad Chughtai ◽

Anita Heywood ◽

Chandini Raina MacIntyre

Keyword(s):

Outcome Measures ◽

Parental Attitudes ◽

Total Sample ◽

Cross Sectional Study ◽

Vaccine Hesitancy ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Market Research Company ◽

Before And After

ObjectivesThe aim of this survey was to investigate parental vaccination attitudes and responses to vaccine-related media messages from political and medical leaders.DesignThis was a cross-sectional study using a semiquantitative questionnaire. Data were analysed using descriptive statistics, X2tests and logistic regression.SettingData were collected from a web-based questionnaire distributed in Australia by a market research company in May of 2017.Participants411 participants with at least one child under 5 were included in this study. The sample was designed to be representative of Australia in terms of gender and state of residence.Primary and secondary outcome measuresThe primary outcome measures were parental attitudes towards childhood immunisation before and after viewing vaccine-related messages from political and medical leaders, including Donald Trump (USA), Pauline Hanson (Australia) and Michael Gannon (Australia). Parents were classified as having ‘susceptible’ (not fixed) or ‘fixed’ (positive or negative) views towards vaccination based on a series of questions.ResultsParents with fixed vaccination views constituted 23.8% (n=98) of the total sample; 21.7% (n=89) were pro-vaccination and 2.2% (n=9) were anti-vaccination. The remaining 76.2% of participants were classified as having susceptible views towards vaccination. Susceptible parents were more likely to report a change in their willingness to vaccinate after watching vaccine-related messages compared with fixed-view parents, regardless of whether the messaging was positive or negative (Trump OR 2.54, 95% CI (1.29 to 5.00); Hanson OR 2.64, 95% CI (1.26 to 5.52); Gannon OR 2.64, 95% CI (1.26 to 5.52)). Susceptible parents were more likely than fixed-view parents to report increased vaccine hesitancy after viewing negative vaccine messages (Trump OR 2.14, 95% CI (1.11 to 4.14), Hanson OR 2.34, 95% CI (1.21 to 4.50)).ConclusionsThe findings suggest that most parents including the vaccinating majorty are susceptible to vaccine messaging from political and medical leaders. Categorising parents as ‘fixed-view’ or ‘susceptible’ can be a useful strategy for designing and implementing future vaccine promotion interventions.

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Caregiver burden and associated factors among primary caregivers of patients with ALS in home care: a cross-sectional survey study

BMJ Open ◽

10.1136/bmjopen-2021-050185 ◽

2021 ◽

Vol 11 (9) ◽

pp. e050185

Author(s):

Shan Tang ◽

Li Li ◽

Hongxia Xue ◽

Shuyan Cao ◽

Chao Li ◽

...

Keyword(s):

Logistic Regression ◽

Outcome Measures ◽

Caregiver Burden ◽

Primary Caregivers ◽

Survey Study ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Disease Knowledge ◽

Factors Influencing

ObjectivesThis study aims to understand the caregiver burden experienced by the primary caregivers of patients with amyotrophic lateral sclerosis (ALS), and to explore the factors influencing caregiver burden.DesignA cross-sectional survey design was used.SettingThis study was conducted with ALS inpatients and follow-up outpatients at the neurology department of a tertiary general hospital in Taiyuan, Shanxi, China and their caregivers.ParticipantsPatients with ALS and their caregivers (N=120 pairs) participated in a face-to-face interview.Primary and secondary outcome measuresPrimary outcome measures included the Zarit Burden Interview scores and personal/role burden scores. There were no secondary outcomes.ResultsMultiple linear and logistic regression analyses were performed to examine the factors influencing burden in ALS patient’s caregivers. Multiple linear regression showed that caregivers with higher Anxiety Index (AI) experienced greater personal (β=0.089, p<0.001), role (β=0.065, p<0.001) and overall (β=0.200, p<0.001) burden. Logistic regression analysis showed that AI (p=0.025; OR 1.351, 95% CI 1.038 to 1.759) and disease knowledge level (p=0.033; OR 0.305, 95% CI 0.107 to 0.593) are the influencing factors of ALS load classification.ConclusionsHigher AI scores were associated with greater caregiver burden. Caregiver burden of caregivers who had no knowledge of the patient’s disease was 0.305 times that of those who had good knowledge. The level of disease knowledge and AI score can serve as key predictors of caregiver burden in ALS.

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Evaluating the Experiences of New and Existing Teledermatology Patients post-Covid19 Implementation (Preprint)

10.2196/preprints.25999 ◽

2020 ◽

Author(s):

Judy Hamad ◽

Amy Fox ◽

Maria Suzanne Kammire ◽

Alison Nancy Hollis ◽

Saif Khairat

Keyword(s):

Patient Satisfaction ◽

Patient Experience ◽

Medical Center ◽

Cross Sectional Study ◽

Rapid Expansion ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Significant Difference ◽

Willingness To Use

BACKGROUND With the rapid shift to remodel office-based dermatology into virtual clinics during the coronavirus disease-19 (Covid-19) pandemic teledermatology received an upsurge of utilization. OBJECTIVE To assess the patient experience with teledermatology among new versus existing clinic patients in the context of the rapid practice shift to teledermatology during the Covid-19 pandemic. METHODS We report a cross-sectional study of 184 teledermatology patients seen during Covid-19 at a major Southeastern medical center from May 13th to June 5th 2020. The primary outcome was patient satisfaction levels among new and existing patients. The secondary outcome was future willingness to use teledermatology. RESULTS Of 288 teledermatology patients seen during the study period, 184 (64%) completed the survey. Patients reported high overall satisfaction with teledermatology (Figure 1), with 159 (86%) participants reporting positive overall satisfaction and experience with teledermatology. New patients had significantly higher overall satisfaction with teledermatology than follow-up patients (mean Likert 4.70 for new, 4.43 for existing; p=0.03). Overall, satisfaction with teledermatology did not significantly differ by age, race/ethnicity, education level, residence, or insurance status (p>0.05). There was no significant difference in overall satisfaction by prior telehealth experience (p=0.53), video versus telephone visit type (p=0.17), or platform type (0.22). Prior telehealth experience was associated with a higher odds of willingness to use telehealth in the future (OR 2.39, 95% CI 1.31-4.35, p=0.004). CONCLUSIONS This cross-sectional survey-based study reports that the rapid expansion of teledermatology was met with high levels of patient satisfaction during the Covid-19 pandemic. Further studies are needed to identify ideal disease-specific scheduling algorithms to ensure the visit modality suits the dermatologic condition being addressed. As teledermatology experiences wider adoption with the Covid-19 pandemic, it is essential to examine patient experience and satisfaction with teledermatology.

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Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in Sohag—Egypt, 2019

BMJ Open ◽

10.1136/bmjopen-2020-047757 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047757

Author(s):

Heba AlSawahli ◽

Caleb D Mpyet ◽

Gamal Ezzelarab ◽

Ibrahim Hassanin ◽

Mohammad Shalaby ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Rapid Assessment ◽

Good Control ◽

Population Based ◽

Secondary Outcome ◽

Public Health Approach ◽

Eye Care ◽

Cross Sectional Survey ◽

Prevalence Survey ◽

Cross Sectional

ObjectivesTo determine the prevalence of diabetes mellitus (DM), prevalence of diabetic retinopathy (DR) and sight-threatening conditions among persons with DM aged 50 years and older in Sohag governorate in Upper Egypt.DesignPopulation-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.SettingsSohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.Participants4078 people aged 50 years and older in 68 clusters were enrolled, of which 4033 participants had their random blood sugar checked and 843 examined for features of DR.Primary and secondary outcomesThe prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.ResultsThe prevalence of DM was 20.9% (95% CI 19.3% to 22.5%). The prevalence in females (23.8%; 95% CI 21.4% to 26.3%) was significantly higher than in males (18.9%; 95% CI 17.1% to 20.7%) (p=0.0001). Only 38.8% of persons diagnosed with diabetes had good control of DM. The prevalence of DR in the sample was 17.9% (95% CI 14.7% to 21.1%). The prevalence in females was higher (18.9%; 95% CI 14.0% to 23.8%) than in males (17.1%; 95% CI 13.0% to 21.2%). Up to 85.3% of study participants have never had eye examination. Sight-threatening DR (R4 and/or M2) was detected in 5.2% (95% CI 3.4% to 7.0%) with only 2.3% having had laser treatment.ConclusionThe prevalence of uncontrolled DM in Sohag governorate in Egypt is higher than the national prevalence. There is a high prevalence of sight-threatening retinopathy and/or maculopathy with few people having access to diabetic eye care. A public health approach is needed for health promotion, early detection and management of DR.

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Effect of ultraprocessed food intake on cardiometabolic risk is mediated by diet quality: a cross-sectional study

BMJ Nutrition, Prevention & Health ◽

10.1136/bmjnph-2020-000225 ◽

2021 ◽

pp. bmjnph-2020-000225

Author(s):

Jennifer Griffin ◽

Anwar Albaloul ◽

Alexandra Kopytek ◽

Paul Elliott ◽

Gary Frost

Keyword(s):

Food Intake ◽

Energy Intake ◽

Food Consumption ◽

Outcome Measures ◽

Diet Quality ◽

Cardiometabolic Risk ◽

Saturated Fat ◽

Secondary Outcome ◽

Cross Sectional ◽

Occupational Cohort

ObjectiveTo examine the effect of the consumption of ultraprocessed food on diet quality, and cardiometabolic risk (CMR) in an occupational cohort.DesignCross-sectional.SettingOccupational cohort.Participants53 163 British police force employees enrolled (2004–2012) into the Airwave Health Monitoring Study. A total of 28 forces across the UK agreed to participate. 9009 participants with available 7-day diet record data and complete co-variate data are reported in this study.Main outcome measuresA CMR and Dietary Approaches to Stop Hypertension score were treated as continuous variables and used to generate measures of cardiometabolic health and diet quality. Secondary outcome measures include percentage of energy from fat, saturated fat, carbohydrate, protein and non-milk extrinsic sugars (NMES) and fibre grams per 1000 kcal of energy intake.ResultsIn this cohort, 58.3%±11.6 of total energy intake was derived from ultraprocessed (NOVA 4) foods. Ultraprocessed food intake was negatively correlated with diet quality (r=−0.32, p<0.001), fibre (r=−0.20, p<0.001) and protein (r = −0.40, p<0.001) and positively correlated with fat (r=0.18, p<0.001), saturated fat (r=0.14, p<0.001) and nmes (r=0.10, p<0.001) intake . Multivariable analysis suggests a positive association between ultraprocessed food (NOVA 4) consumption and CMR. However, this main effect was no longer observed after adjustment for diet quality (p=0.209). Findings from mediation analysis indicate that the effect of ultraprocessed food (NOVA 4) intake on CMR is mediated by diet quality (p<0.001).ConclusionsUltraprocessed food consumption is associated with a deterioration in diet quality and positively associated with CMR, although this association is mediated by and dependent on the quality of the diet. The negative impact of ultraprocessed food consumption on diet quality needs to be addressed and controlled studies are needed to fully comprehend whether the relationship between ultraprocessed food consumption and health is independent to its relationship with poor diet quality.

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Government management capacities and the containment of COVID-19: a repeated cross-sectional study across Chinese cities

BMJ Open ◽

10.1136/bmjopen-2020-041516 ◽

2021 ◽

Vol 11 (4) ◽

pp. e041516

Author(s):

Wenchao Li ◽

Jing Li ◽

Junjian Yi

Keyword(s):

Outcome Measures ◽

Cross Sectional Study ◽

Control Measures ◽

Secondary Outcome ◽

Cross Sectional ◽

Travel Restrictions ◽

Government Management ◽

The Government ◽

Laws And Policies ◽

Novel Coronavirus

ObjectivesBetter understanding of the dynamics of the COVID-19 (2019 novel coronavirus disease) pandemic to curb its spread is now a global imperative. While travel restrictions and control measures have been shown to limit the spread of the disease, the effectiveness of the enforcement of those measures should depend on the strength of the government. Whether, and how, the government plays a role in fighting the disease, however, has not been investigated. Here, we show that government management capacities are critical to the containment of the disease.SettingWe conducted a statistical analysis based on cross-city comparisons within China. China has undergone almost the entire cycle of the anticoronavirus campaign, which allows us to trace the full dynamics of the outbreak, with homogeneity in standards for statistics recording.Primary and secondary outcome measuresOutcome measures include city-specific COVID-19 case incidence and recoveries in China.ResultsThe containment of COVID-19 depends on the effectiveness of the enforcement of control measures, which in turn depends on the local government’s management capacities. Specifically, government efficiency, capacity for law enforcement, and the transparency of laws and policies significantly reduce COVID-19 prevalence and increase the likelihood of recoveries. The organisation size of the government, which is not closely related to its capacity for management, has a limited role.

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Validation of the German Life-Space Assessment (LSA-D): cross-sectional validation study in urban and rural community-dwelling older adults

BMJ Open ◽

10.1136/bmjopen-2021-049926 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049926

Author(s):

Sandra Angelika Mümken ◽

Paul Gellert ◽

Malte Stollwerck ◽

Julie Lorraine O'Sullivan ◽

Joern Kiselev

Keyword(s):

Older Adults ◽

Construct Validity ◽

Outcome Measures ◽

Total Sample ◽

Community Dwelling ◽

Secondary Outcome ◽

Life Space ◽

Cross Sectional ◽

The Past ◽

Community Dwelling Older Adults

ObjectivesTo develop a German version of the original University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA-D) for measurement of community mobility in older adults within the past 4 weeks and to evaluate its construct validity for urban and rural populations of older adults.DesignCross-sectional validation study.SettingTwo study centres in urban and rural German outpatient hospital settings.ParticipantsIn total, N=83 community-dwelling older adults were recruited (n=40 from urban and n=43 from rural areas; mean age was 78.5 years (SD=5.4); 49.4% men).Primary and secondary outcome measuresThe final version of the translated LSA-D was related to limitations in activities and instrumental activities of daily living (ADL/iADL) as primary outcome measure (primary hypothesis); and with sociodemographic factors, functional mobility, self-rated health, balance confidence and history of falls as secondary outcome measures to obtain construct validity. Further descriptive measurements of health included hand grip strength, screening of cognitive function, comorbidities and use of transportation. To assess construct validity, correlations between LSA-D and the primary and secondary outcome measures were examined for the total sample, and urban and rural subsamples using bivariate regression and multiple adjusted regression models. Descriptive analyses of LSA-D included different scoring methods for each region. All parameters were estimated using non-parametric bootstrapping procedure.ResultsIn the multiple adjusted model for the total sample, number of ADL/iADL limitations (β=−0.26; 95% CI=−0.42 to −0.08), Timed Up and Go Test (β=−0.37; 95% CI=−0.68 to −0.14), shared living arrangements (β=0.22; 95% CI=0.01 to 0.44) and history of falls in the past 6 months (β=−0.22; 95% CI=−0.41 to −0.05) showed significant associations with the LSA-D composite score, while living in urban area (β=−0.19; 95% CI=−0.42 to 0.03) and male gender (β=0.15; 95% CI=−0.04 to 0.35) were not significant.ConclusionThe LSA-D is a valid tool for measuring life-space mobility in German community-dwelling older adults within the past 4 weeks in ambulant urban and rural settings.Trial registration numberDRKS00019023.

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Evaluation of an Online System for Routine Outcome Monitoring: A Cross-Sectional Survey (Preprint)

10.2196/preprints.29243 ◽

2021 ◽

Author(s):

Deanna Wiebe ◽

Pria Nippak ◽

Julien Meyer ◽

Shannon Remers

Keyword(s):

Mental Health ◽

Outcome Measures ◽

Service Providers ◽

Routine Outcome Monitoring ◽

Completion Rates ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Online System ◽

Health Service Providers ◽

Outcome Monitoring

BACKGROUND The use of Routine Outcome Monitoring (ROM) in the treatment of mental health has emerged as a method of improving psychotherapy treatment outcomes. Despite this, very few clinicians regularly use ROM in clinical practice. Online ROM has been suggested as a solution to increase adoption. OBJECTIVE To identify the influence of moving ROM online on client completion rates of self-reported outcome measures and to identify implementation and utilization barriers to online ROM by assessing clinicians’ views on their experience utilizing the online system over previous paper-based methods. METHODS Client completion rates of self-reported outcome measures were compared pre and post implementation of an online system of ROM. In addition, a survey questionnaire was administered to 340 mental health service providers regarding their perception of benefits with an online system of ROM. RESULTS Client completion rates of self-reported measures increased from 15% to 54% after moving online. Fifty-eight% of service providers found the new system less time consuming than previous paper-based ROM and 64% found that it helped monitor clients. However, the perceived value of the system remains in doubt as only 23% found it helped them identify clients at risk for treatment failure, and only 18% found it strengthened the therapeutic alliance. CONCLUSIONS Although the current study suggests mixed results regarding service providers’ views on their experience using an online system for ROM, it has identified barriers and challenges that are actionable for improvement.

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