scholarly journals MUSCLE ADVERSE EVENTS AMONG USERS OF SIMVASTATIN IN PRIMARY HEALTH CARE: COLLABORATIVE DRUG THERAPY MANAGEMENT

2018 ◽  
Vol 11 (1) ◽  
pp. 99
Author(s):  
Marcos Francisco Pereira Lobrigatte ◽  
Glauco de Mello Nogueira ◽  
Vinícius João Navarini ◽  
Márcia Terezinha Lonardoni Crozatti ◽  
Jorge Juarez Vieira Teixeira
Keyword(s):  
Health Care ◽  
Creatine Kinase ◽  
Primary Health Care ◽  
Drug Therapy ◽  
Adverse Events ◽  
Thyroid Stimulating Hormone ◽  
Therapy Management ◽  
Drug Therapy Management ◽  
Primary Health ◽  
One Year

Collaborative drug therapy management in primary health care involves communication among the physician, pharmacist and user of simvastatin and can result in safer results regarding patient wellbeing. The aim of the study was to investigate muscle adverse events and risk factors related to simvastatin. For patients who developed muscle adverse events, collaborative drug therapy management was performed in an attempt to resolve the symptoms. A non-randomized case study was conducted at the single basic health unit in the city of Peabiru, Parana, Brazil, for a period of one year. Patients were interviewed using a structured form. To confirm muscle adverse events, the patient was referred to a physician and submitted to the suspension and return to treatment. Thyroid-stimulating hormone, creatine kinase and alanine aminotransferase exams were performed. A sample of 148 users of simvastatin was selected. Eleven patients had some type of simvastatin-associated muscle adverse event (myopathy), among whom seven had muscle symptoms (myalgia) and four had elevated creatine kinase, but were asymptomatic (asymptomatic myopathy). Collaborative drug therapy management focused on simvastatin for five patients with myalgia led to improvements in the quality of life of two patients. EVENTOS ADVERSOS MUSCULARES ENTRE USUÁRIOS DE SINVASTATINA NA ATENÇÃO PRIMÁRIA EM SAÚDE: MANEJO COLABORATIVO DE TERAPIA MEDICAMENTOSA Resumo: O manejo colaborativo de tratamento medicamentoso em atenção primária envolve a comunicação entre o médico, farmacêutico e o usuário de sinvastatina e pode levar a resultados mais seguros, favorecendo o bem-estar do paciente. O objetivo do estudo foi investigar eventos adversos musculares e fatores de risco para tais eventos, relacionados à sinvastatina. Para os pacientes que desenvolveram eventos adversos musculares, o manejo colaborativo foi realizada de forma a resolver os sintomas. Um estudo de caso não randomizado foi realizado na única unidade básica de saúde na cidade de Peabiru, Paraná, Brasil, por um período de um ano. Os pacientes foram entrevistados por meio de um formulário estruturado. Para confirmar os eventos adversos musculares, o paciente era encaminhado ao médico, sendo submetido à suspensão e retorno da sinvastatina. Foram realizadas dosagens do hormônio tireoestimulante, creatina quinase e alanina aminotransferase. Uma amostra de 148 usuários de simvastatina foi selecionada. Do grupo estudado, 11 pacientes tiveram algum tipo de evento adverso muscular (miopatia) associada à sinvastatina, entre os quais sete tiveram sintomas musculares (mialgia) e quatro apresentaram elevação da creatina quinase, mas eram assintomáticos (miopatia assintomática). O manejo colaborativo de terapia medicamentosa focada na sinvastatina para cinco pacientes com mialgia levou a melhoria na qualidade de vida de dois pacientes. Palavras-chave: Evento adverso; Manejo da terapia medicamentosa; Doença muscular; Atenção primária em saúde; Sinvastatina.

Assessment of the Impact of Pharmacist-led Transitions of Care Services in a Primary Health Center

2019 ◽  
pp. 001857871988380
Author(s):  
Gaelle Njonkou ◽  
Kikelola Gbadamosi ◽  
Sheheryar Muhammad ◽  
Imran Chughtai ◽  
Giang Le ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Drug Therapy ◽  
Primary Health Center ◽  
Therapy Management ◽  
Care Services ◽  
Drug Therapy Management ◽  
Primary Health ◽  
Insured Patients ◽  
The Impact

Background: The impact of pharmacist-led transition of care services with collaborative drug therapy management has shown to improve patients’ outcomes and decrease health costs. Compelling statistics show higher readmission rates for under-insured patients compared with insured patients at primary health care clinics. Methods: This is a single center, prospective, cohort study designed to examine team-based collaborative drug therapy management and its effect on therapeutic outcomes of under-insured patients with target chronic diseases managed in a primary health center. Targeted chronic diseases included dyslipidemia, diabetes, hypertension, anticoagulation disorders, chronic obstructive pulmonary disease, and heart failure. The primary outcome measures included percentage of time in therapeutic international normalized ratio (INR) and percentage of patients at targeted goals of blood pressure, lipids, and hemoglobin A1c (HbA1c). Secondary outcomes included reduced emergency department visits, number of patient encounters, hospital readmissions within 30 days of discharge, and disease exacerbation rates. Results: Patients were at INR goal 58% of the time compared with 52% at baseline ( P = .66). There was a 9% improvement in mean HbA1c in the intervention group when compared with baseline (9.6% vs 10.9%, P = .03). With pharmacist intervention, 73.8% of the patients had their blood pressure at goal compared with 50% at baseline ( P = .14). A limited number of patients were readmitted for different reasons, including uncontrolled disease states. Conclusions: The pharmacist-physician collaborative drug therapy management led to improved blood pressure control, average HbA1c, and time in therapeutic INR range. A decrease in health care utilization was also identified.

Development of the perceptions of preventable adverse events assessment tool (PPAEAT): measurement properties and patients’ mental health status

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Franziska Maria Keller ◽  
Christina Derksen ◽  
Lukas Kötting ◽  
Martina Schmiedhofer ◽  
Sonia Lippke
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Patient Safety ◽  
Primary Health Care ◽  
Adverse Events ◽  
Health Care Professionals ◽  
Discriminant Validity ◽  
Assessment Tool ◽  
Primary Health ◽  
Item Scale

Abstract Background Patient-centered care and patient involvement have been increasingly recognized as crucial elements of patient safety. However, patient safety has rarely been evaluated from the patient perspective with a quantitative approach aiming at making patient safety and preventable adverse events measurable. Objectives The objectives of this study were to develop and evaluate the psychometric properties of a questionnaire assessing patient safety by perceived triggers of preventable adverse events among patients in primary health-care settings while considering mental health. Methods Two hundred and ten participants were recruited through various digital and print channels and asked to complete an online survey between November 2019 and April 2020. Exploratory factor analysis was performed to identify domains of triggers of preventable adverse events affecting patient safety. Furthermore, a multi-trait scaling analysis was performed to evaluate internal reliability as well as item-scale convergent–discriminant validity. A multivariate analysis of covariance evaluated whether individuals below and above the symptom threshold for depression and generalized anxiety perceive triggers of preventable adverse events differently. Results The five factors determined were information and communication with patients, time constraints of health-care professionals, diagnosis and treatment, hygiene and communication among health-care professionals, and knowledge and operational procedures. The questionnaire demonstrated a good total and subscale internal consistency (α = 0.90, range = 0.75–0.88), good item-scale convergent validity with significant correlations between 0.57 and 0.78 (P < 0.05; P < 0.01) for all items with their associated subscales, and satisfactory item-scale discriminant validity between 0.14 and 0.55 (P > 0.05) with no significant correlations between the items and their competing subscales. The questionnaire further revealed to be a generic measure irrespective of patients’ mental health status. Patients older than 50 years of age perceived a significantly greater threat to their own safety compared to patients below that age. Conclusion The developed Perceptions of Preventable Adverse Events Assessment Tool (PPAEAT) exhibits good psychometric properties, which supports its use in future research and primary health-care practice. Further validation of the PPAEAT in different settings, languages and larger samples is needed. The results of this study need to be considered when assessing patient safety in the context of health-care research.

scholarly journals Pain drawings, interpreter support and clinical findings among immigrant patients on sick leave in Swedish primary health care

2019 ◽  
Vol 20 ◽  
Author(s):  
Monica Löfvander
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Sick Leave ◽  
Formal Education ◽  
Clinical Findings ◽  
Psychosocial Stressors ◽  
Foreign Born ◽  
Pain Drawing ◽  
Primary Health ◽  
One Year

Abstract Aim: To evaluate the spread of pain and its correlates among immigrant patients on sick leave. Background: Backache, outspread pain and sick-leave questions are problematic to handle primary health care, especially in multicultural settings. Methods: Two hundred and thirty-five patients 20–45 years on paid sick leave (59% women, 93% foreign-born, mostly non-Europeans). Many had little formal education. One-third had professional interpreter support. The patients pointed out on their bodies where they felt pain. This information was transferred on a pain drawing [pain drawing fields (PDFs) 0–18] by a doctor. Major depression and psychosocial stressors were assessed using Diagnostic and Statistical Manual of Mental Disorders. Nociceptive locations for pain were established (pain-sites 0–18). Dependent variable was the number of PDFs. Independent variables were social data, sick leave, interpreter, depression, stress levels and number of pain sites. Calculations were done using descriptive methods and multi-variable linear regression in full models, by gender. Findings: Many patients had depression (51% women versus 32% men). A majority were exposed to psychosocial stressors. Women had more PDFs, in median 5 [inter-quartile ranges (IQR) 4–8] versus men 3 (IQR 2–5), and also more pain sites, in median 3 (IQR 2–5) versus men in median 2 (IQR 1–3). For men, the regression calculations revealed that numbers of PDFs associated only with increasing numbers of pain sites (B 0.871 P < 0.001). For women, this association was weaker (B 0.364, P < 0.001), with significant values also for age (B 0.103) and sick leave > one year (B 0.767, P = 0.010), and a negative predicting value for interpreter support (B −1.198, P < 0.043). To conclude, PDFs associated often with somatic findings but varied much among the women. This implies potential problems regarding cause, function and sick leave questions. However, support by professional interpreters may facilitate a shared understanding with immigrant women having long-standing pain.

scholarly journals The effect of problem-based learning after coronary heart disease – A randomised study in primary health care (COR-PRIM)

2019 ◽  
Author(s):  
Anita Kärner Köhler ◽  
Tiny Jaarsma ◽  
Pia Tingström ◽  
Staffan Nilsson
Keyword(s):  
Health Care ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Primary Health Care ◽  
Patient Information ◽  
Patient Empowerment ◽  
Problem Based Learning ◽  
Primary Health ◽  
One Year ◽  
Experimental Group

Abstract Background The hypothesis tested was that one year of problem-based learning (PBL) improves patients’ self-efficacy, and empowerment to change self-care significantly compared to one year of standardised home-sent patient information after an event of coronary heart disease (CHD). Methods We randomly assigned 157 patients (78% male; age 68±8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) to either PBL (experimental group; n = 79) or home-sent patient information group (controls; n = 78). The PBL intervention consisted of a patient education in primary health care by trained district nurses who tutored groups of 6-9 patients on 13 occasions over one year. Controls received home- sent patient information on 11 occasions during the study year. Results At the one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [-0.17 (SD 1.5) vs. 0.50 (SD 1.6), P=0.033 ], body weight [-0.83 (SD 4.45 vs. 1.14 kg (SD 4.85), P=0.026 ] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P=0.038 ] for the experimental group compared to controls. Conclusions The PBL and the home-sent patient information interventions had similar results regarding patient empowerment. However, PBL exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that the PBL intervention positively affected risk factors compared to the home-sent patient information intervention. Trial registration : NCT01462799 (August 2019, date last accessed) Keywords: Problem-based learning, Coronary Heart Disease, Primary Health Care, Patient empowerment, Risk factors, Self-care

Clinical Impact of a Comprehensive Medication Management Service in Primary Health Care

2019 ◽  
pp. 089719001986630
Author(s):  
Bruna Damázio Santos ◽  
Mariana Martins Gonzaga do Nascimento ◽  
Grazielli Cristina Batista de Oliveira ◽  
Yone de Almeida Nascimento ◽  
Juliana Vaz de Melo Mambrini ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Drug Therapy ◽  
Care Setting ◽  
Medication Management ◽  
Clinical Impact ◽  
Initial Assessment ◽  
Management Service ◽  
Primary Health ◽  
Multiple Variables

Objective:To evaluate the clinical impact of a comprehensive medication management (CMM) service in a Brazilian primary health-care setting.Methods:A quasi-experimental study has been carried out between July 2014 and November 2016 with patients who received the service in the primary care setting of a Brazilian city (n = 1057). Factors associated with drug therapy problems (DTP) detection in the initial assessment were evaluated by performing univariate and multivariate analyzes. To evaluate the impact of the CMM service, a linear regression model was constructed from the difference between the initial and final values of the clinical and laboratory parameters adjusted by multiple variables.Results:A total of 1642 DTPs was identified, the most prevalent one being “nonadherence” (31.9%) and the “need for additional drug therapy” (22.9%). The use of 5 or more medications and the presence of 3 or more diseases were positively associated with the identification of 3 or more DTPs during the initial assessment. Even after multiple adjustments, a statistically significant reduction has been observed in the values of glycated hemoglobin, systolic blood pressure, low-density cholesterol, and total cholesterol.Conclusion:The CMM service contributed to the resolution of DTP and showed positive clinical impact in primary health care in the studied setting.

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