Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

2019 ◽  
Vol 40 (1) ◽  
pp. 77-86
Author(s):  
Kate N. Wang ◽  
J. Simon Bell ◽  
Julia F. M. Gilmartin-Thomas ◽  
Edwin C. K. Tan ◽  
Tina Cooper ◽  
...  
Keyword(s):  
Multinomial Logistic Regression ◽  
Aged Care ◽  
Inverse Probability ◽  
Falls Risk ◽  
Care Services ◽  
High Prevalence ◽  
Sedative Hypnotics ◽  
Considerable Morbidity ◽  
Inverse Probability Weighted ◽  
Explicit Criteria

Falls are associated with considerable morbidity and mortality in aged care services and falls risk increasing drugs (FRIDs) are often overlooked as a contributor to falls. This study aims to investigate the association between the risk of falling and use of FRIDs from aged care services. Inverse-probability-weighted multinomial logistic regression was used to estimate the association between falls risk and regular FRIDs in 383 residents from six Australian aged care services. Overall, residents at high and low falls risk had similar prevalence of FRIDs. Prevalence of antipsychotics and sedative-hypnotics was low. Residents at high falls risk had higher adjusted odds of using ≥2 psychotropic medications (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.17-2.61) and ≥2 medications that cause/worsen orthostatic hypotension (OR = 3.59, 95% CI = 2.27-5.69). High prevalence of FRIDs was mainly attributable to medications for which residents had clinical indications. Clinicians appeared to have largely avoided FRIDs that explicit criteria deem potentially inappropriate for high falls risk.

scholarly journals The potential role of local pharmacies to assess asthma control: an Italian cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Caminati ◽  
L. Cegolon ◽  
M. Bacchini ◽  
N. Segala ◽  
A. Dama ◽  
...  
Keyword(s):  
Asthma Control ◽  
Multinomial Logistic Regression ◽  
Asthma Severity ◽  
Cross Sectional Study ◽  
Disease Assessment ◽  
Community Pharmacies ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Services ◽  
Disease Community

Abstract Background Asthma control and monitoring still represents a challenge worldwide. Although the international guidelines suggest the interplay between secondary and primary care services as an effective strategy to control the disease, community pharmacies’ are seldom involved in asthma control assessment. The present cross-sectional study aimed at providing a picture of the relationship between asthma severity and control in community pharmacies within the health district of the city of Verona (Veneto Region, North-Eastern Italy). Methods A call for participation was launched through the Pharmacists’ Association of Verona. Patients referring to the participating pharmacies with an anti-asthmatic drug medical prescription and an asthma exemption code were asked to complete the Asthma Control Test (ACT) and a brief questionnaire collecting information on their age, sex, smoking status, aerobic physical exercise and usual asthma therapy, which also defined asthma severity. A multinomial logistic regression model was fitted to investigate the risk of uncontrolled as well as poorly controlled vs. controlled asthma (base). Results were expressed as relative risk ratios (RRR) with 95% confidence interval (95%CI). Results Fifty-seven community pharmacies accepted to participate and 584 asthmatic patients (54% females; mean-age: 51 ± 19 years) were consecutively recruited from 1st January to 30th June 2018 (6 months). Based upon ACT score 50.5% patients had a controlled asthma, 22.3% a poorly controlled and 27.2% uncontrolled. A variable proportion of patients with uncontrolled asthma were observed for every level of severity, although more frequently with mild persistent form of asthma. Most patients (92%) self-reported regular compliance with therapy. At multinomial regression analysis, patients under regular asthma treatment course (RRR = 0.33; 95%CI: 0.15; 0.77) were less likely to have an ACT< 16 compared to those not taking medications regularly. Conclusions Overall, our findings highlighted an unsatisfactory asthma control in the general population, independently of the severity level of the disease. Community pharmacies could be a useful frontline interface between patients and the health care services, supporting an effective asthma management plan, from disease assessment and monitoring treatment compliance to referral of patients to specialist medical consultancies.

scholarly journals Inverse probability weighted estimators of vaccine effects accommodating partial interference and censoring

Biometrics ◽  
2021 ◽  
Author(s):  
Sujatro Chakladar ◽  
Samuel P. Rosin ◽  
Michael G. Hudgens ◽  
M. Elizabeth Halloran ◽  
John D. Clemens ◽  
...  
Keyword(s):  
Inverse Probability ◽  
Partial Interference ◽  
Inverse Probability Weighted

We need a model of health and aged care services that adequately supports Australians with dementia

2021 ◽  
Vol 214 (2) ◽  
pp. 66
Author(s):  
◽  
Lee‐Fay Low ◽  
Kate Laver ◽  
Katherine Lawler ◽  
Kate Swaffer ◽  
...  
Keyword(s):  
Aged Care ◽  
Care Services

INCIDENCE OF ABDOMINAL TUBERCULOSIS IN PATIENTS PRESENTING WITH PAIN ABDOMEN

2021 ◽  
pp. 13-15
Author(s):  
Pankaj Prasad Verma ◽  
Manjar Ali ◽  
Sanjay Singh ◽  
Vinay Pratap
Keyword(s):  
Health Care Services ◽  
Abdominal Tuberculosis ◽  
Morbidity And Mortality ◽  
Medical Sciences ◽  
Major Health Problem ◽  
Major Health ◽  
Care Services ◽  
Abdominal Symptoms ◽  
Pain Abdomen ◽  
Considerable Morbidity

Tuberculosis is a major health problem worldwide and in India continues to be responsible for considerable morbidity and mortality despite tremendous effort made in diagnosis, prophylaxis and therapy. The disease may involve any system of body but abdomen is one of the commonest site of involvement after lungs. This study is carrying to nd out Incidence of Abdominal Tuberculosis in patients of pain abdomen presenting as acute/chronic cases. The present study was carried out in the Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi, from April 2018 to September 2019. The total number of cases selected disease remains early detection. A continual awareness on the part of the clinician of the possibility of abdominal Tuberculosis in many patients with obscure abdominal symptoms should avoid errors and aid in the detection of a condition, which if treated early, not only produces remarkable remission and relief on the part of for this study was 1800. According to the presentation, the patients were clinically divided into 2 broad groups: those who were admitted as acute emergencies and those who came with a chronic presentation. From these two groups 100 cases were fall in our inclusion criteria. Of these 100 patients, most were in their third or fourth decades of life, and females were approx two times more commonly affected as their male counterparts, maintaining an approximate ratio of 1.86:1. Thus we had a 5.55 % incidence of abdominal Tuberculosis in this series. The development of cheap and efcient procedures for early diagnosis remains one of the practical problems to battle this disease, because the only way to decrease morbidity and mortality of this the patients but also takes unnecessary burden off the health care services.

MO847PREVALENCE OF FATIGUE REPORTED BY PATIENTS ON HEMODIALYSIS THERAPY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Mauricio Sanabria ◽  
Cesar Mauricio Doria ◽  
Edward Martinez ◽  
Carlos Simon ◽  
Jasmin Vesga ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Chronic Hemodialysis ◽  
Multicenter Cohort Study ◽  
Care Services ◽  
Protein Energy ◽  
Confounding Variables ◽  
Patient Reported ◽  
High Prevalence ◽  
One Year

Abstract Background and Aims Fatigue is a symptom with a high prevalence in patients on hemodialysis therapy due to uremic toxins, anemia, associated comorbidity, and hemodialysis treatment per se. Our objective is to evaluate the prevalence of fatigue reported by patients and their association with the nutritional status. Method This was a prospective observational, multicenter cohort study. Prevalent patients on HD therapy for at least 90 days, older than 18, at the Baxter Renal Care Services were included between September 1, 2017, to November 30, 2017 with one-year follow-up. Socio-demographic and clinical characteristics of all patients were summarized descriptively, the nutritional status was evaluated by protein Energy waste (PEW). Patient reported fatigue was measured with high flux membrane and medium cut-off membrane (Theranova). A generalized linear binomial multivariable model was conducted to assess the effect of PEW on fatigue symptom controlling for some confounding variables. Results We found that the fatigue reported by the patients has a prevalence of 55% [95% CI: 52.2 to 57.7] in our population, there are no statistical differences due to the use of different types of membranes p= 0.911, and neither did we find that the nutritional status is an independent factor that explains this symptom. If we find that women and diabetics have a higher risk of fatigue; RR=1.17 [95% CI: 1.06 to 1.29] and RR= 1.19 [95% CI: 1.00 to 1.42] respectively. Conclusion The fatigue is a prevalent symptom in the chronic hemodialysis population; being a woman and the diagnosis of diabetes are risk factors associated with this outcome. PEW and the type of dialysis membrane used were not associated with this symptom. Studies evaluating the recovery time from post-dialysis symptoms and its relationship with the type of membrane are necessary.

scholarly journals Case Study for Stroke: National Stroke Data Linkage Program

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Monique F Kilkenny ◽  
Joosup Kim ◽  
Lachlan Dalli ◽  
Amminadab Eliakundu ◽  
Muideen Olaiya
Keyword(s):  
Linked Data ◽  
Data Linkage ◽  
Stroke Care ◽  
Aged Care ◽  
Public Hospitals ◽  
Economic Evaluations ◽  
Care Services ◽  
Linkage Program ◽  
The Impact

IntroductionStroke is a leading cause of death and disability. Since 2012, our innovative national data linkage program, has enabled the successful linkage of data from the Australian Stroke Clinical Registry (AuSCR) with national and state-based datasets to investigate the continuum of stroke care and associated outcomes. Objectives and ApproachUsing stroke as a case study, in this symposium we will describe the use of linked data to undertake clinical and economic evaluations and contribute new knowledge for policy and practice. We have undertaken a range of iterative and innovative projects linking the AuSCR (used now in >80 public hospitals across Australia with follow-up survey of patients between 90-180 days) with various administrative datasets. Linkages with the National Death Index, inpatient admissions and emergency presentations, Pharmaceutical Benefits Scheme (PBS), Medicare Benefits Schedule (MBS), Aged Care services; Ambulance Victoria, Australian Rehabilitation Outcomes Centre and general practice network datasets (POLAR) have been achieved. ResultsThe symposium will provide case studies and results from four data linkage projects involving the AuSCR: 1) Stroke123 (NHMRC: #1034415), a study to investigate the impact of quality of acute care on admission/emergency presentations and survival; 2) PRECISE (NHMRC:#1141848), a study to evaluate models of primary care involving linkages with PBS/MBS, aged care services and admissions/emergency data; 3) AMBULANCE: a study to investigate how pre-hospital care affects acute stroke care involving linkages with the ambulance and admissions/emergency datasets; and 4) POLAR: a study to understand the long-term management of stroke involving linkages with primary health data. Conclusion / ImplicationsThe National Stroke Data Linkage Program has been visionary and remains highly contemporary in the field of linked data. A unique feature of this program is the active participation of clinicians and policy-makers to ensure the evidence generated have direct benefits for accelerating change in practice and informing policy.

Senior staff perspectives of a quality indicator program in public sector residential aged care services: a qualitative cross-sectional study in Victoria, Australia

2016 ◽  
Vol 40 (1) ◽  
pp. 54 ◽  
Author(s):  
Liam M. Chadwick ◽  
Aleece MacPhail ◽  
Joseph E. Ibrahim ◽  
Linda McAuliffe ◽  
Susan Koch ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Public Sector ◽  
Data Collection ◽  
Aged Care ◽  
Residential Aged Care ◽  
Successful Implementation ◽  
Front Line ◽  
Cross Sectional ◽  
Executive Staff ◽  
Care Services

Objective The aims of the present study were to describe the views of senior clinical and executive staff employed in public sector residential aged care services (RACS) about the benefits and limitations of using quality indicators (QIs) for improving care, and to identify any barriers or enablers to implementing the QI program. Methods A cross-sectional qualitative study using semistructured interviews and direct observation of key informants involved in the QI program was performed across 20 public sector RACS in Victoria, Australia. Participants included senior clinical, executive and front-line staff at the RACS. The main outcome measures were perceived benefits and the enablers or barriers to the implementation of a QI program. Results Most senior clinical and executive staff respondents reported substantive benefits to using the QIs and the QI program. A limited number of staff believed that the QI program failed to improve the quality of care and that the resource requirements outweighed the benefits of the program, resulting in disaffected staff. Conclusions The QIs and QI program acted as a foundation for improving standards of care when used at the front line or point of care. Senior executive engagement in the QI program was vital to successful implementation. What is known about this topic? QIs measure the structures, processes or outcomes of care and identify issues that need further investigation or improvement. QIs are increasingly being adopted throughout the world. In Australia, the public sector RACS QIs project was implemented in 2006. It is yet to be formally evaluated. What does this paper add? Perceived benefits and limitations of the QI program were identified, together with barriers to successful implementation of the program and recommendations for future improvements. QI data were reported to improve quality culture and assist with identifying clinical areas for improvement. However, the QI program was associated with significantly increased workload and some stakeholders questioned its usefulness. The QI program studied could be improved through better access to education and training for those responsible for data collection and results dissemination to appropriate training and resources; and revision of the QI definitions and reporting methods. What are the implications for clinicians? QI data are useful for identifying opportunities for quality improvement. Despite data limitations, public sector RACS can use data for internal benchmarking, staff education and targeting of quality improvement interventions. At the policy level, revising the QI definitions and simplifying data collection and reporting would improve and strengthen the program. At the clinician and executive level, there is also a strong preference for QI data that allow comparison and benchmarking between facilities.

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