Bayesian Cohort and Cross-Sectional Analyses of the PINCER Trial: A Pharmacist-Led Intervention to Reduce Medication Errors in Primary Care

AbstractIntroductionThe Patient Dignity Question (PDQ) is a clinical tool developed with the aim of reinforcing the sense of personhood and dignity, enabling health care providers (HCPs) to see patients as people and not solely based on their illness.ObjectiveTo study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC).MethodA cross-sectional study using 20 palliative patients cared for in a PC unit. A post-PDQ satisfaction questionnaire was developed.ResultsTwenty participants were included, 75% were male; average age was 70 years old. Patients found the summary accurate, precise, and complete; all said that they would recommend the PDQ to others and want a copy of the summary placed on their family physician's medical chart. They felt the summary heightened their sense of dignity, considered it important that HCPs have access to the summary and indicated that this information could affect the way HCPs see and care for them. The PDQ-PT's took 7 min on average to answer, and 10 min to complete the summary.Significance of resultsThe PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. Future trials are now warranted.

Download Full-text

Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications

Journal of Primary Care & Community Health ◽

10.1177/21501327211035088 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110350

Author(s):

Pasitpon Vatcharavongvan ◽

Viwat Puttawanchai

Keyword(s):

Primary Care ◽

Primary Care Clinic ◽

Clinical Decision ◽

Cross Sectional Study ◽

Study Data ◽

Patient Specific ◽

Potentially Inappropriate Medications ◽

Cross Sectional ◽

Care Clinic ◽

Inappropriate Medications

Background Most older adults with comorbidities in primary care clinics use multiple medications and are at risk of potentially inappropriate medications (PIMs) prescription. Objective This study examined the prevalence of polypharmacy and PIMs using Thai criteria for PIMs. Methods This study was a retrospective cross-sectional study. Data were collected from electronic medical records in a primary care clinic in 2018. Samples were patients aged ≥65 years old with at least 1 prescription. Variables included age, gender, comorbidities, and medications. The list of risk drugs for Thai elderly version 2 was the criteria for PIMs. The prevalence of polypharmacy and PIMs were calculated, and multiple logistic regression was conducted to examine associations between variables and PIMs. Results Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively. Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI 2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively). Conclusion Prescriptions with PIMs were high in the primary care clinic. Describing unnecessary medications is crucial to prevent negative health outcomes from PIMs. Computer-based clinical decision support, pharmacy-led interventions, and patient-specific drug recommendations are promising interventions to reduce PIMs in a primary care setting.

Download Full-text

Medication Errors in Adolescents Using Asthma Controller Medications

Global Pediatric Health ◽

10.1177/2333794x20981341 ◽

2020 ◽

Vol 7 ◽

pp. 2333794X2098134

Author(s):

Henry Clark ◽

Delesha Carpenter ◽

Kathleen Walsh ◽

Scott A. Davis ◽

Nacire Garcia ◽

...

Keyword(s):

Medical Record ◽

Medication Errors ◽

Medication Use ◽

Persistent Asthma ◽

Cross Sectional Study ◽

Asthma Medication ◽

Sectional Study ◽

Cross Sectional ◽

Controller Medication ◽

Controller Medications

The purpose of this study was to describe the number and types of errors that adolescents and caregivers report making when using asthma controller medications. A total of 319 adolescents ages 11 to 17 with persistent asthma and their caregivers participated in this cross-sectional study. Adolescent and caregiver reports of asthma medication use were compared to the prescribed directions in the medical record. An error was defined as discrepancies between reported use and the prescribed directions. About 38% of adolescents reported 1 error in using asthma controller medications, 16% reported 2 errors, and 5% reported 3 or more errors. About 42% of caregivers reported 1 error in adolescents using asthma controller medications, 14% reported 2 errors, while 6% reported 3 or more errors. The type of error most frequently reported by both was not taking the medication at all. Providers should ask open-ended questions of adolescents with asthma during visits so they can detect and educate families on how to overcome errors in taking controller medication use.

Download Full-text

Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England

BMJ Open ◽

10.1136/bmjopen-2020-042551 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042551

Author(s):

Andrea L Hernan ◽

Sally J Giles ◽

Andrew Carson-Stevens ◽

Mark Morgan ◽

Penny Lewis ◽

...

Keyword(s):

Primary Care ◽

Primary Care Patient ◽

Care Patient ◽

System Level ◽

Service Improvement ◽

Cross Sectional ◽

Positive Effects ◽

Contributory Factors ◽

Safety Incident ◽

Patient Reported

BackgroundPatient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement.ObjectiveThe aim of this study was to characterise the nature of patient-reported safety incidents in primary care.DesignSecondary analysis of two cross sectional studies.ParticipantsAdult patients from Australian and English primary care settings.MeasuresPatients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented.ResultsA total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent.ConclusionsThe nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.

Download Full-text

Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care

Journal of Primary Care & Community Health ◽

10.1177/21501327211023726 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110237

Author(s):

Zouina Sarfraz ◽

Azza Sarfraz ◽

Alanna Barrios ◽

Radhika Garimella ◽

Asimina Dominari ◽

...

Keyword(s):

Primary Care ◽

Primary Infection ◽

Clinical Laboratory ◽

Point Of Care ◽

Case Reports ◽

Case Series ◽

Infectious Complications ◽

Care Physician ◽

Cross Sectional ◽

Infection Period

Background: Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care. Methods: Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords “COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication.” We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, while making healthcare considerations for primary care workers. Results: We identified 29 studies across 9 countries including 37.9% Chinese and 24.1% U.S. studies, comprising 655 patients (Mean Age = 45) with various ethnical backgrounds including Asian and European. Based on the WHO COVID-19 severity classification scale, initial disease severity was mild for 377 patients and severe for 52 patients. Treatments during primary infection included corticosteroids, oxygen support, and antivirals. The mean value (in days) for complication onset after acute recovery was 28 days. Complete blood counts and RT-PCR tests were the most common laboratory results described. In 22 of the studies, patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids. Conclusion: Post-recovery infectious complications are common in long-COVID-19 patients ranging from mild infections to life-threatening conditions. International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID-19 pneumonia, while focused patient care by the primary care physician is crucial to curb preventable adverse events. Recommendations for real-time and lab-quality diagnostic tests are warranted to establish point-of-care testing, detect early complications, and provide timely treatment.

Download Full-text