Reduced emergency room visits and improved medication adherence of an integrated oncology pharmaceutical care practice in China

2021 ◽  
pp. 107815522110272
Author(s):  
Huijie Qi ◽  
Lili Zhu ◽  
Lu Chen ◽  
Wenxin Zhang ◽  
Tianxiao Wang ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Medication Adherence ◽  
Emergency Room ◽  
Cancer Patients ◽  
Routine Care ◽  
Pharmacy Service ◽  
Care Group ◽  
Care Practice ◽  
Practice Model ◽  
Service Group

Objective We described our initial experience of a new integrated oncology phamaceutical care practice to enhance the quality of pharmacy service and patient care in Huashan hospital. Data sources: A retrospective study was performed from August 2019 to September 2020. Patients were described as integrated pharmacy service group and routine care group. Medication adherence of patients in integrated pharmacy service group was recorded by the online management system. Patient satisfaction and the cumulative incidence of emergency room (ER) and outpatient visit were evaluated between two groups. Data summary: In total, 323 patients received the integrating oncology pharmacy service. The percentage of the patients missing administration every day was reduced from 29.7% to 0.3% within a 40-day monitoring and intervention period. There was a significant difference on patient satisfaction with pharmacy service in two groups ( P < 0.05). Fewer patients in the integrated pharmacy service group visited clinic and ER compared with routine care group (33.1% vs. 59.2%; P < 0.05). Conclusions As a new practice model, the integrated program is adopted to provide patient care and ongoing monitoring for cancer patients. The practice model delivers high continuity of care for cancer patients and improves communication and collaboration between healthcare professionals and oncology patients. The practice also provides the potential of developing hospital pharmaceutical service and optimizing disease prevention and treatment strategies.

Role of Telemedicine in Inflammatory Bowel Disease: a Systematic Review and Meta-analysis of Randomized Clinical Trials (Preprint)

2021 ◽  
Author(s):  
Lanlan Pang ◽  
Heng-Yu Liu ◽  
Zhidong Liu ◽  
Jingyu Tan ◽  
Loungyuan Zhou ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Patient Satisfaction ◽  
Medication Adherence ◽  
Standard Care ◽  
Remission Rate ◽  
Meta Analysis ◽  
Care Group ◽  
Standard Care Group ◽  
Inflammatory Bowel ◽  
Clinic Visits

BACKGROUND Telemedicine plays an important role in the management of patients with inflammatory bowel disease (IBD), which is especially evident during the pandemic such as COVID-19. However, the exact effectiveness and efficiency of telemedicine in managing IBD is unclear. OBJECTIVE We aimed to compare the impact of telemedicine on management of IBD patients with the standard care. METHODS We systematically searched the PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus (search date April 22, 2020). Randomized controlled trials (RCTs) comparing telemedicine with standard care in IBD patients were included, while conference abstracts, letters, reviews, laboratory studies, or case reports were excluded. The IBD-specific quality of life (QoL), disease activity and remission rate of IBD patients were assessed as primary outcomes, and the number of clinic visits per patient, patient satisfaction, psychological outcome, and medication adherence were regarded as secondary outcomes. The Review Manage 5.3 and Stata 15.1 were used for the data analysis. RESULTS 17 RCTs (n=2571 participants) were included in this meta-analysis. The telemedicine group had higher IBD-specific QoL than the standard care group [standard mean difference (SMD) 0.18, 95% confidence interval (CI) 0.01 to 0.34，P=0.03)]. Furthermore, the number of clinic visits per patient in the telemedicine group was significantly lower than that in the standard care group (SMD -0.71, 95%CI -1.07 to -0.36, P<0.0001). Subgroup analysis showed that adolescents had a significantly higher IBD-specific QoL in telemedicine group than that in standard care group (SMD 0.42, 95%CI 0.15 to 0.69, I2=0%, P=0.002), while there was no significant differences between two groups among adults. There were no significant differences in disease activity, remission rate, patient satisfaction, depression, self-efficacy, generic QoL, and medication adherence outcomes between telemedicine and standard care group. CONCLUSIONS Telemedicine intervention showed a promising role in improving IBD-specific QoL among adolescents and decreased the number of clinic visits of IBD patients. Further researches are warranted to identify the ideal group of IBD patients who could benefit from telemedicine most.

scholarly journals Beneficial effects of auricular acupressure on preventing constipation in breast cancer patients undergoing chemotherapy: evidence from systematic review and meta-analysis

2018 ◽  
Vol 5 (3) ◽  
pp. 227-234 ◽  
Author(s):  
Su-Hua Zheng ◽  
Min Yan ◽  
Tiffany Field ◽  
Xiao Xu
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Methodological Quality ◽  
Routine Care ◽  
Care Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Breast Cancer Patients ◽  
Auricular Acupressure

Abstract Objective To evaluate the available evidence from randomized controlled trials (RCTs) of auricular acupressure (AA) therapy for preventing constipation in breast cancer patients undergoing chemotherapy. Methods The following databases were searched from their inception until August 2017: Ovid Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Allied and Alternative Medieine (AMED). We also searched four Chinese databases: Chinese BioMedical Database (CBM), China National Knowledge Infrastructure (CNKI), WANFANG Data, and Chinese VIP Database. Only the RCTs related to the effects of AA therapy on preventing constipation in breast cancer patients undergoing chemotherapy were included in this study. Quantitative syntheses of data from RCTs were conducted using RevMan 5.3 software. Study selection, data extraction, and validation were performed independently by two authors. Cochrane criteria for risk of bias were used to assess the methodological quality of the trials. Results Four RCTs met the inclusion criteria, and most were of low methodological quality. Study participants in the AA plus routine care group showed significantly greater improvements in the response rate (risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.14,1.42], P < 0.01) with low heterogeneity χ2 = 2.31, P = 0.31, l2 = 14%). In addition, when compared with routine care alone, one RCT suggested favorable statistically significant effects of AA plus routine care on Constipation Assessment Scale (CAS; mean difference [MD] = -5.07,95% CI [-6.86, -3.28], P < 0.01). Furthermore, when compared with routine care alone, one RCT suggested positive statistically significant effects of AA plus routine care on Patient Assessment of Constipation-Quality of Life (PAC-QOL; MD = -1.26,95% CI [-1.59, -0.93], P < 0.01). Conclusions Overall, as a potential safety therapy, only weak evidence can support the hypothesis that AA can effectively prevent constipation in breast cancer patients undergoing chemotherapy.

scholarly journals A Comparative Study between Day Care and Routine Care Inguinal Hernia Mesh Repair

2021 ◽  
Vol 8 (6) ◽  
pp. 140-147
Author(s):  
Ashwani Kumar ◽  
Devadatta Poddar ◽  
C Raja Bhanu Kiran
Keyword(s):  
Patient Satisfaction ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Day Care ◽  
Tertiary Care ◽  
Routine Care ◽  
Care Group ◽  
Hernia Surgery ◽  
Day Care Surgery ◽  
Care Surgery

Inguinal hernia is one of the oldest diseases known to mankind. If not treated on time, patient may land up with complications. The basic principle of hernia surgery is tension free repair. There are no guidelines regarding an ideal surgery or anaesthesia to be used for inguinal hernia repair. Around 10-12% patient visiting outpatient clinic suffer from inguinal hernia and occupy a significant space in the operative list. Day care surgery in which the patient is discharged within 24 hours of surgery is gradually becoming the norm. A lot of centres are performing exclusive day care surgery with a good patient acceptance, thus reducing the burden on the hospital. In this study conducted on 68 patients in a public tertiary care centre, we have compared day care versus routine care inguinal hernia surgery with 34 patients in each group. Lichtenstein hernia repair was done for all patients. The procedure was done under local anaesthesia for the day care surgery group whereas local/spinal/general anaesthesia was used for routine care group. Patients were admitted and discharged on the same day in day care group while patients in routine care group were admitted and discharged as per and norms of in-patient care. The feasibility of the procedure, recovery time, readmission for surgery related complications, and patient satisfaction was compared among the two groups. We concluded that day care surgery is a feasible option, with early recovery, short stay, early ambulation, minimal complications, and significant patient satisfaction. Day care procedures have an edge over routine care public tertiary care hospitals. Keywords: Inguinal hernia, day care surgery, Lichtenstein repair.

PCN208 Association of Quality of Life with Oncology Medication Adherence in Cancer Patients on the Service of a Specialty Pharmacy

2021 ◽  
Vol 24 ◽  
pp. S58
Author(s):  
R. Burruss ◽  
V. Arikian ◽  
K. Oleru ◽  
T. Traurig ◽  
M. Stranz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medication Adherence ◽  
Cancer Patients ◽  
Specialty Pharmacy

scholarly journals Consent for the discontinuation of life-prolonging treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

2020 ◽  
Author(s):  
YuJin Chung ◽  
JinHo Beom ◽  
JiEun Lee ◽  
Incheol Park ◽  
Junho Cho
Keyword(s):  
Emergency Room ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Life Extension ◽  
Medical Decision ◽  
Patient Consent ◽  
Before And After ◽  
The Law

Abstract Background The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of nonsensical life-prolonging treatment, and its enactment raised big controversy in Korean society. However, there is no study on whether the actual life-prolonging treatment for patients has decreased after enforcing the law. This study aimed to compare the provision of patient consent before and after the enforcement of the law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of the law on cancer patients' clinical care. Methods This retrospective single cohort study included advanced cancer patients over 19 years of age who visited the emergency room at a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the average length of hospital stay. The consent rate for cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes. Results The average length of hospital stay decreased after the law was enforced, from 4 days to 2 days (p= 0.001). The rates of direct transfers to secondary and nursing hospitals increased from 8.2% to 21.2% (p=0.001) and from 1.0% to 9.7%, respectively (p<0.001). The rate of provision of consent for admission to the ICU decreased from 6.7% to 2.3% (p=0.032). For CPR and CRRT, the rate of provision of consent decreased from 1.0% to 0.0% and from 13.9% to 8.8%, respectively, but the differences were not significant (p=0.226 and p=0.109, respectively). Conclusion According to previous research, for patients wishing only conservative treatment, the reduction in hospital stays at tertiary hospitals ultimately reduces the physical, emotional, financial burdens and also improves the quality of end-of-life at home or in a hospice facility. In this context, this research ultimately show that the purpose of the LEMD law has been achieved. Further research in several hospitals including those patients who completed the consent after hospitalization is needed to generalize the clinical implication of the LEMD law.

scholarly journals Critical aspects of the management of stable coronary artery disease in primary care practice or how to increase the efficacy of evidence-based pharmacological therapy?

2020 ◽  
Vol 6 (3) ◽  
pp. 15-20
Author(s):  
Sergey K. Zyryanov ◽  
Sergey B. Fitilev ◽  
Alexander V. Vozzhaev ◽  
Irina I. Shkrebniova ◽  
Dmitry A. Klyuev
Keyword(s):  
Primary Care ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Medication Adherence ◽  
Stable Coronary Artery Disease ◽  
Density Lipoprotein ◽  
Pharmacological Therapy ◽  
Care Practice ◽  
Cross Sectional ◽  
Artery Disease

Introduction: The publication describes a fragment of the pharmacoepidemiologic study conducted to review the quality of management of patients with stable coronary artery disease (SCAD) in primary care over a 12-year period. The aim of the study was to justify the application of standard operating procedures (SOPs). Such determinants of pharmacotherapy as non-pharmacological modification of cardiovascular risk factors (RFs) and medication adherence were analyzed. Material and methods: A retrospective, cross-sectional, 3-stage (2006, 2011, 2018) study was conducted in a primary care setting of Moscow. As many as 3027, 1834, 805 patients with verified diagnosis of SCAD were included. Demographics, medical history, data on modifiable RFs and prescribed drug therapies were collected. At the third stage, medication adherence was measured, using the 8-item Morisky scale. Results and discussion: Over a 7-year period, better control of modifiable RFs in coronary patients was revealed. The target levels of blood pressure were reached in 58.3% (+20.7%; p &lt; 0.05) of the patients, total cholesterol – in 33.0% (+16.0%; p &lt; 0.05), and low-density lipoprotein cholesterol – in 23.3% (+12.2%; p &lt; 0.05). Two critical problems that determined still inadequate RFs control were identified. The attention of physicians to RFs and rates of non-pharmacological interventions remained low throughout the study. Information on lifestyle RFs was recorded in fewer than one-third of the subjects. The lipid profile was registered only in half of patients’ histories. Non-adherence to pharmacotherapy was identified in 51.3% of patients. Conclusion: Further increase in efficacy of pharmacotherapy might be provided by application of SOPs regarding the registration and correction of modifiable cardiovascular RFs, identification of non-adherent patients and promotion of medication adherence.

scholarly journals Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 53 ◽  
Author(s):  
Rosanna Nga Suet Ip ◽  
Justin Wade Tenney ◽  
Angus Chun Kwok Chu ◽  
Pauline Lai Ming Chu ◽  
Grace Wai Man Young
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Health Care Utilization ◽  
Usual Care Group ◽  
Medication Reconciliation ◽  
Intervention Group ◽  
Medical Rehabilitation ◽  
Care Group ◽  
Care Utilization ◽  
Utilization Rate

Patients undergoing rehabilitation experience numerous changes in medication regimens during care transitions, exposing these patients to an increased risk of drug-related problems (DRPs). A prospective, non-randomized, quasi-experimental study was conducted in medical rehabilitation wards to evaluate the impact of pharmacist-delivered interventions and counseling on 30-day unplanned health care utilization and medication adherence for selected rehabilitation patients. A pharmacist provided medication reconciliation and counseling before discharge. Phone follow-up was completed 30 days after discharge to assess for unplanned health care utilization rate and medication adherence. A total of 85 patients (n = 43 in prospective intervention group and n = 42 in historical usual care group) were included. Among the intervention group, 23 DRPs were identified in 14 (32.6%) patients, resulting in 51 interventions. The intervention group had a significantly lower unplanned health care utilization rate than the usual care group (25.6% vs. 47.6%, p = 0.035). The risk of unplanned health care utilization was reduced by over 60% (Odds ratio (OR) = 0.378; 95% CI = 0.15–0.94). Patients reporting medium to high medication adherence increased from 23.6% to 88.4% 30 days after counseling (p < 0.05). Pharmacist medication reconciliation and discharge counseling reduced unplanned health care utilization 30 days after discharge and improved medication adherence.

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