scholarly journals Patient views of therapeutic interchange of ACE inhibitors in Australian primary care: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044806
Author(s):  
Tessa Marshall ◽  
Hok Lim ◽  
Phyllis Lau
Keyword(s):  
Primary Care ◽  
Ace Inhibitors ◽  
Health Professionals ◽  
Ace Inhibitor ◽  
Exploratory Research ◽  
Structured Interviews ◽  
Patient Views ◽  
Therapeutic Interchange ◽  
The Cost ◽  
Medication Changes

ObjectivesIn Australia, therapeutic interchange of angiotensin-converting enzyme (ACE) inhibitors could generate savings for patients and the Pharmaceutical Benefits Scheme (PBS). The PBS subsidises nine drugs in the ACE inhibitor class. These drugs are therapeutically equivalent, but the price varies between each drug. Patients are key players in successful therapeutic interchange programmes, but little is known about their views. This study aims to explore patient views of therapeutic interchange of ACE inhibitors in Australian primary care.DesignQualitative exploratory research study using semi-structured interviews, asking participants about therapeutic interchange and their attitude towards hypothetically switching ACE inhibitors. Data were analysed thematically.SettingAustralian primary care.ParticipantsFourteen adults in Australia currently taking an ACE inhibitor, recruited via general practices and pharmacies, social media and professional networks.FindingsFive key themes were identified: participants’ limited understanding of medication; the expectation that a new drug would be ‘the same’; the view that choice, convenience and fear of change outweigh the cost; altruism; and trust in health professionals, particularly participants’ own general practitioner (GP).ConclusionsPatients’ limited understanding of medication changes poses a barrier to therapeutic interchange. Clinicians should explore patients’ understanding and expectations of therapeutic interchange. Counselling from trusted health professionals, particularly GPs, could ameliorate concerns. Policymakers implementing therapeutic interchange programmes should ensure a trusted GP directs medication changes.

Cost-Effectiveness of Erythromycin Versus Mupirocin for the Treatment of Impetigo in Children

PEDIATRICS ◽  
1992 ◽  
Vol 89 (2) ◽  
pp. 210-214 ◽  
Author(s):  
Teresa Duryea Rice ◽  
Anne K. Duggan ◽  
Catherine DeAngelis
Keyword(s):  
Cost Effectiveness ◽  
Side Effects ◽  
Drug Regimen ◽  
School Age Children ◽  
Controlled Clinical Trial ◽  
Structured Interviews ◽  
Working Parents ◽  
The Cost ◽  
To Receive ◽  
Medication Changes

A new topical antibiotic, mupirocin, has been found to be as effective as erythromycin for the treatment of impetigo, but concerns about its expense have been raised. This controlled clinical trial sought to compare the cost-effectiveness of erythromycin (E) and mupirocin (M). Ninety-three children, aged 3 months to 16 years, were randomly assigned to receive 10 days of oral erythromycin (n = 46) or topical mupirocin (n = 47). Costs and effects were measured through structured interviews. Cost per case differed significantly by group (E = $56.85; M = $62.30; P < .05) due chiefly to extra visits and medication changes needed by those treated with mupirocin. Erythromycin and mupirocin were equally effective. The likelihood of side effects (E = 43%, M = 22%) approached significance (P < .07); those treated with erythromycin were willing to pay more for a different medicine to avoid the side effects experienced (P < .05). Working parents and school-age children were more likely to alter their daily activities when the patient was taking erythromycin (P < .04). Compliance and parental satisfaction did not differ by treatment group; however, parents of children treated with erythromycin were more likely to prefer the alternate drug regimen. It is concluded that the type of medication prescribed can be based on parental preference because the increased cost of mupirocin is offset by increased side effects and number of schooldays and workdays lost with erythromycin.

scholarly journals Pregnancy protection and pregnancies in women prescribed ACE inhibitors or ARBs: a cross-sectional study in primary care

2020 ◽  
Vol 70 (700) ◽  
pp. e778-e784
Author(s):  
Elizabeth Lovegrove ◽  
John Robson ◽  
Patricia McGettigan
Keyword(s):  
Primary Care ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Angiotensin Receptor Blockers ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Women Of Childbearing Age ◽  
Sectional Study ◽  
Childbearing Age ◽  
Cross Sectional

BackgroundThe teratogenic risks of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are well documented, but prescribing these in younger women in primary care is becoming increasingly frequent.AimTo record how frequently women of childbearing age, who are prescribed an ACE inhibitor or ARB, receive preconception advice and/or are prescribed contraception, and how many pregnancies, terminations, and miscarriages occur in this population. Additionally, to ascertain whether patterns in the above differ across age groups.Design and settingCross-sectional study conducted among patients from 141 general practices in East London.MethodWomen aged 15–45 years who were issued a prescription for an ACE inhibitor or ARB between 1 October 2018 and 1 January 2019 inclusive were included. An electronic search strategy was designed to extract pseudonymised data concerning preconception and contraception advice, contraception, and pregnancies from the electronic clinical system; this was applied to the selected cohort on 1 January 2019. Data were analysed in 5-year age groups.ResultsOf 302 939 women aged 15–45 years, 2651 (0.9%) were prescribed an ACE inhibitor or an ARB in a 3-month period. Of these, 2159 (81.4%) had no advice and no contraception prescription recorded, 35 (1.3%) had preconception advice recorded, and 230 (8.7%) had contraception advice recorded. A total of 100 pregnancies and 21 terminations/miscarriages were recorded in the 12 months preceding the index date (1 January 2019).ConclusionThis study found that the recording of pre-pregnancy advice and contraception in women of childbearing age who were prescribed an ACE inhibitor or an ARB was suboptimal; this may place women and their babies at risk of exposure to teratogens during pregnancy. The findings indicate that there is a need for improved safety strategies based in primary care.

scholarly journals How to engage French professionals to undertake social responsibility at a local level?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Gautier ◽  
Y Bourgueil
Keyword(s):  
Primary Care ◽  
Access To Care ◽  
Health Professionals ◽  
Local Level ◽  
Radical Change ◽  
Team Work ◽  
Professional Commitment ◽  
Fee For Service ◽  
Structured Interviews ◽  
Integration Of Care

Abstract Background In France, primary care is organised according to the principles of private practice: independent providers, payment by fee for service, freedom of settlement... Successive reforms have introduced more regulation i.e. gatekeeping role for GPs, better recognition of professional groups, new forms of payment and promotion of team work and multi-professional practices. Today, the concept of Health Territorial and Professional Communities (HTPC) is becoming a key element of health care reform encouraging primary care professionals to meet with specialists and social workers at a larger level than practice. HTPC should address issues such as access to services, coordination of care and promoting of preventive actions toward populations. This implies change in the roles, skills, methods and resources needed on both professional and regulatory sides. This study explores levers of the professional commitment in the HTPC and resources necessary for it. Methods We conducted a qualitative multiple case study in three French regions. Data was collected from thirty semi-structured interviews with key national informants, regional regulators and health professionals themselves. Results Professional commitment emerges at a local level on a territory defined by the collaboration practices and habits following a bottom-up process. The integration of care relies on the size of the HTPC which allows them to know each other and to work together to improve access to care and patient’s disease management. In order to achieve that, professionals claim to have access to administrative health data and to be able to analyze it. They need to develop news skills in management and group animation. The function and training of coordination professionals appear to be essential. Conclusions The professional commitment in HTPC relies on professional empowerment toward collective activities. This requires autonomy, skills and new roles both for professionals and regulatory authorities. Key messages French government relies on professionals’ investment at the territorial level by implementing HTPC to guarantee access to care and respond to population needs in primary care. HTPC implementation implies radical change for the professionals to undertake social and populational responsibility for which public health professionals should help to meet the challenge.

Clinical Judgment and the Influence of Screening on Decision Making

2009 ◽  
Author(s):  
Howard N. Garb
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Judgment ◽  
Structured Interviews ◽  
Primary Care Settings ◽  
Broad Array ◽  
Clinically Depressed

How do clinicians arrive at diagnostic decisions? In most cases the decision is not made following formal criteria, but by intuition. In addition, routine interviews are often narrow and the feedback gleaned from patients is inadequate. Yet it is not clear if screening helps or hinders clinical judgment. It might be that only clinicians who have low confidence and interviewing and diagnostic skills are open to the use of and actually helped by diagnostic tools. To provide a theoretical framework for understanding why it is difficult for physicians to detect depression in primary care settings, a broad array of research in the mental health fields can be described. For example, more than 1,000 studies have been conducted on clinical judgment in the area of mental health practice, and the results from these studies can be used to illuminate the challenges physicians face in judging whether a patient is clinically depressed and can benefit from treatment. In this chapter, results on clinical judgment will be described. A second topic will also be briefly discussed. Results from research on clinical judgment would seem to indicate that screening should be of value. Yet, as noted in Chapter 7, stand-alone screening programs have added little or nothing to outcomes. Reasons for this unexpected result will be explored. Three topics will be discussed: (1) narrowness of interviews, (2) nature of patient feedback, and (3) the cognitive processes of clinicians. Depression goes undetected because in many cases physicians do not ask patients if they have symptoms of a depressive mood disorder.3 To place this in context, it can be noted that mental health professionals also often do not ask patients about important symptoms and behaviors. Failure to inquire about depression in primary care settings can be viewed in the broader context of failure to inquire about important symptoms and events in mental health settings. Research on clinical judgment has demonstrated that lack of comprehensiveness is often a problem for interviews made in clinical practice. For example, in one study,4 mental health professionals saw patients in routine clinical practice, and afterwards research investigators conducted semi-structured interviews with the patients. Remarkably, the mental health professionals had evaluated only about 50% of the symptoms that were recorded using the semi-structured interviews.

scholarly journals Connecting primary care patients to community-based physical activity: a qualitative study of health professional and patient views

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101100
Author(s):  
Sharon Ann Carstairs ◽  
Rayna H Rogowsky ◽  
Kathryn B Cunningham ◽  
Frank Sullivan ◽  
Gozde Ozakinci
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Community Based ◽  
Healthcare Settings ◽  
Primary Care Patients ◽  
Exercise Programmes

BackgroundInconclusive evidence supporting referrals from health professionals to gym-based exercise programmes has raised concern for the roll-out of such schemes, and highlights the importance of developing links between healthcare settings and community-based opportunities to improve physical activity (PA) levels.AimThis study aimed to identify methods, and explore barriers and facilitators, of connecting primary care patients with PA opportunities from the perspectives of both health professionals (HPs) and patients, using the example of jogscotland.Design & settingAn exploratory study utilising semi-structured interviews with primary care patients (n = 14) and HPs (n = 14) from one UK NHS board was conducted.MethodPatient and HP transcripts were analysed separately using thematic analysis. Potential methods of connection were identified. The Capability, Opportunity, Motivation, behavioural (COM-B) model and theoretical domains framework (TDF) were employed to facilitate identification of barriers and facilitators for connecting primary care to community jogscotland groups.ResultsThree methods of connecting patients to community-based groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators for patient connection fell into five TDF domains for HPs and two COM-B model components for patients.ConclusionFor patients, HPs raising the topic of PA can help to justify, facilitate, and motivate action to change. The workload associated with connecting patients with community-based opportunities is central to implementation by HPs. Integrative resource solutions and social support for patients can provide a greater variety of PA options and the vital information and support for connecting with local opportunities, such as jogscotland.

EFFECTS OF TECHNOLOGY TRANSFER ON THE SOCIAL STRUCTURE: AN EMPIRICAL STUDY OF A MALAYSIAN MANUFACTURING COMPANY. PRELIMINARY RESEARCH REPORT OF AUTOCLAVE PILOT SURVEY

2016 ◽  
Vol 78 (5-10) ◽  
Author(s):  
Noor Ashikin Said ◽  
Eric Olmedo ◽  
Che Zulhaimee Abdullah ◽  
Razman Shah Rajab
Keyword(s):  
Methodological Approach ◽  
Research Report ◽  
Exploratory Research ◽  
Structured Interviews ◽  
High Turnover ◽  
Training Tool ◽  
Research Technology ◽  
Long Time ◽  
To Come ◽  
The Cost

Worldwide employee turnover in 2014 had hit the average of 18.5% (voluntary and involuntarily) (Radford 2014). Without exception, Malaysia‟s aerospace manufacturing industries have dealt with the same issue of high turnover rate for a long time. The human resource management of Composite Research Technology Malaysia (CTRM) has stepped out as the pioneer to be involved in an experiment to mitigate this issue. Therefore, there is a need to come out with a virtualized training tool that can help in cutting the cost and the duration of training new workers. An exploratory research has been conducted focusing on the linguistics aspect of the training tool. This report aimed to profile the technicians and to detect gaps between what is perceived and the actual reality on the floor, so that the technology could be transferred effectively. Semi-structured interviews, direct observation and focus group were used as the methodological approach to collect the data. The results indicate that their English competency is generally low. Malay language is used in all aspects of verbal communication. The glossary used for the instruction board is not comprehensible enough for the technicians and they have their own specific way of perceiving time at workplace.

Tailoring Communications for Primary Care Settings

1998 ◽  
Vol 37 (02) ◽  
pp. 171-178 ◽  
Author(s):  
B. Glassman ◽  
B. K. Rimer
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Contact Time ◽  
Behavioral Changes ◽  
Patient Specific ◽  
Specific Information ◽  
Medical Settings ◽  
Primary Care Settings ◽  
Professional Contact ◽  
Tailored Communications

AbstractIn more and more medical settings, physicians have less and less time to be effective communicators. To be effective, they need accurate, current information about their patients. Tailored health communications can facilitate positive patient-provider communications and foster behavioral changes conducive to health. Tailored communications (TCs) are produced for an individual based on information about that person. The focus of this report is on tailored print communications (TPCs). TPCs also enhance the process of evaluation, because they require a database and the collection of patient-specific information. We present a Tailoring Model for Primary Care that describes the steps involved in creating TPCs. We also provide examples from three ongoing studies in which TPCs are being used in order to illustrate the kinds of variables used for tailoring the products that are developed and how evaluation is conducted. TPCs offer opportunities to expand the reach of health professionals and to give personalized, individualized massages in an era of shrinking professional contact time.

Experiences in physical activity promotion in health care settings for primary prevention in the UK

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Controlled Trial ◽  
Full Range ◽  
Tertiary Care ◽  
Physical Activity Promotion ◽  
Community Based ◽  
Activity Promotion ◽  
Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

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