scholarly journals The Characteristics of Care Provided to Population(s) in Precarious Situations in 2015. A Preliminary Study on the Universal Health Cover in France

2020 ◽  
Vol 17 (9) ◽  
pp. 3305
Author(s):  
François Birault ◽  
Stéphanie Mignot ◽  
Nicole Caunes ◽  
Philippe Boutin ◽  
Emilie Bouquet ◽  
...  
Keyword(s):  
Primary Care ◽  
Bacterial Pneumonia ◽  
Defined Daily Dose ◽  
Patient Relationship ◽  
Cutaneous Infections ◽  
Daily Dose ◽  
Preliminary Study ◽  
Free Healthcare ◽  
Universal Health

Background: The French Universal Health Cover (CMU) aims to compensate for inequalities between precarious and non-precarious populations, enabling the former to access to free healthcare. These measures rely on the principle that precarious populations’ health improves if healthcare is free. We designed a study to examine whether CMU fails to compensate for inequalities in reimbursed drugs prescriptions in precarious populations. Material and method: This retrospective pharmaco-epidemiological study compared the Defined Daily Dose relative to different reimbursed drugs prescribed by general practitioners (GPs) to precarious and non-precarious patients in France in 2015. Data were analysed using Mann–Whitney tests. Findings: 6 out of 20 molecules were significantly under-reimbursed in precarious populations. 2 were over-reimbursed. The 12 remaining molecules did not differ between groups. Interpretation: The under-reimbursement of atorvastatin, rosuvastatin, tamsulosine and timolol reflects well-documented epidemiological differences between these populations. In contrast, the equal reimbursement of amoxicillin, pyostacine, ivermectin, salbutamol and tiopropium is likely an effect of lack of compensation for inequalities. Precarious patients are more affected by diseases that these molecules target (e.g., chronic bronchitis, bacterial pneumonia, cutaneous infections). This could also be the case for the equal and under-reimbursement of insulin glargine and metformin (targeting diabetes), respectively, although this has to be considered with caution. In conclusion, the French free healthcare cover does not fail to compensate for all but only for some selective inequalities in access to reimbursed drugs prescriptions. These results are discussed with respect to the interaction of the doctor–patient relationship and the holistic nature of primary care, potentially triggering burnout and empathy decrease and negatively impacting the quality of care in precarious populations.

scholarly journals IMPACT OF ANTIMICROBIAL STEWARDSHIP PROGRAM ON THE USE OF ANTIBIOTICS IN PNEUMONIA PATIENTS AT TEACHING HOSPITAL IN SURAKARTA INDONESIA

2021 ◽  
pp. 20-23
Author(s):  
HIDAYAH KARUNIAWATI ◽  
TRI YULIANTI ◽  
DEWI KUROTA AINI ◽  
FINISHIA ISNA NURWIENDA
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Study Data ◽  
Defined Daily Dose ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Daily Dose ◽  
The Impact ◽  
Method Show

Objective: Antibiotic resistance is a serious problem worldwide. One cause of antibacterial resistance is the inappropriate use of antibiotics. Thestudy of antibiotic use in hospitals found that 30–80% were not based on indications. Antimicrobial Stewardship Programs (ASP) was developed tocontrol antimicrobial resistance. This study aims to evaluate the impact of ASP in pneumonia patients qualitatively and quantitatively pre-post ASPapplied.Methods: This research is a non-experimental study. Data were taken from the medical records of pneumonia patients and analyzed qualitativelyusing the Gyssens method and quantitatively using the Defined Daily Dose (DDD) method. Sampling was conducted through purposive sampling andresults were described descriptively.Results: During the study period, 96 samples were obtained with 48 data pre-ASP and 48 data post-ASP. The results of the qualitative analysis usingthe Gyssens method show an increase in the prudent use of antibiotics from 31.25% to 62.5% pre-post ASP, respectively. Quantitative evaluationshows a decrease of antibiotic use pre-post ASP from 90.84 DDD/100 patients-days to 61.42 DDD/100 patients-days.Conclusion: The ASP can improve the quality of antibiotic use in pneumonia patients quantitatively and qualitatively.

Evaluation of ambulatory antibiotic use in Hungary using drug-specific quality indicators

2013 ◽  
Vol 154 (24) ◽  
pp. 947-956 ◽  
Author(s):  
Mária Matuz ◽  
Ria Benkő ◽  
Edit Hajdú ◽  
Réka Viola ◽  
Gyöngyvér Soós
Keyword(s):  
Quality Indicators ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Consumption Patterns ◽  
Defined Daily Dose ◽  
Beta Lactams ◽  
Daily Dose ◽  
Constant Quantity ◽  
Rational Use Of Antibiotics

Introduction: Rational use of antibiotics is an important tool in combating antibiotic resistance. Aim: The aim of the authors was to evaluate the quality of ambulatory antibiotic use in Hungary. Method: Crude antibiotic sales data for the period between 1996 and 2010 were converted into DDD (Defined Daily Dose) per 1000 inhabitants and per year. The recently developed and validated drug-specific quality indicators were used to evaluate antibiotic use. Results: Beside constant quantity (18.0±1.8 DDD/1000 inhabitants/day), the authors detected major changes in the composition of antibiotic use. Ratios of the consumption of broad to narrow spectrum beta-lactams and macrolides increased eight-fold (1996: 2.2 vs. 2010: 15.8) and consumption of fluoroquinolones tripled. Out of the ten surveyed drug-specific quality indicators, Hungary belonged to the European elite in case of three, while considering the remaining seven, Hungary ranked among the weak or weakest European countries. Conclusion: In quantity Hungary an ambulatory antibiotic use resembles to Scandinavian countries while it mimics antibiotic consumption patterns of southern countries. Orv. Hetil., 2013, 154, 947–956.

scholarly journals The Quality of Primary Care in a Country with Universal Health Care Coverage

2011 ◽  
Vol 26 (7) ◽  
pp. 724-730 ◽  
Author(s):  
Tinh-Hai Collet ◽  
Sophie Salamin ◽  
Lukas Zimmerli ◽  
Eve A. Kerr ◽  
Carole Clair ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Universal Health Care ◽  
Health Care Coverage ◽  
Quality Of Primary Care ◽  
Universal Health Care Coverage ◽  
Universal Health

Opening Minds through Art: A preliminary study evaluating the effects of a creative-expression program on persons living with dementia and their primary care partners

Dementia ◽  
2021 ◽  
pp. 147130122199729
Author(s):  
Kate Levenberg ◽  
Daniel R George ◽  
Elizabeth Lokon
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Emotional Support ◽  
Perceived Quality ◽  
Art Making ◽  
Perceived Quality Of Life ◽  
Care Partners ◽  
Preliminary Study ◽  
Anxiety Depression

For people living with dementia and their care partners, a decline in the ability to effectively communicate can cause significant distress. However, in recent decades, the arts have emerged as an effective care modality in fostering communication and expression for those with declining verbal skills and memory loss. Opening Minds through Art (OMA) is a national initiative that empowers people living with dementia by facilitating creative expression and social engagement through art-making in partnership with trained college student volunteers. Research has demonstrated that participation in the program benefits quality of life for those living with dementia and also improves student attitudes toward dementia. To date, however, no research has involved primary care partners. We implemented an OMA program at three residential care homes in State College, Pennsylvania, with residents cocreating artwork alongside primary care partners (i.e., a family member or primary medical personnel) over the course of four art-making sessions. We evaluated the effects of participation on quality of life and care partner burnout through pre–post use of “emotional thermometers” (measuring levels of distress, anxiety, depression, anger, and perceived quality of life), the National Institute of Health NIH emotional support scale, and the NIH caregiver assessment (care partner burnout). For people living with dementia, participation significantly increased perceived quality of life while decreasing distress, anxiety, depression, and anger ( p < .01; n = 12) after each class; however, the intervention did not significantly impact perceived emotional support. For care partners, participation significantly lowered post-intervention measures of burnout and self-rated stress ( p < .01; n = 9). This preliminary study suggests that a structured art-based activity appears to positively impact acute mood for patients and, importantly, decrease care partner burnout. Future research can bring more robust methods to bear in determining how to use OMA and other arts interventions to optimize social support for people living with dementia and their care partners.

scholarly journals Antibiotic usage at a private hospital in Central Java: results of implementing the Indonesian Regulation on the Prospective Antimicrobial System (Regulasi Antimikroba Sistem Prospektif Indonesia [RASPRO])

2021 ◽  
Author(s):  
Ronald Irwanto Natadidjaja ◽  
Tarcisius Henry ◽  
Hadianti Adlani ◽  
Aziza Ariyani ◽  
Rika Bur
Keyword(s):  
Private Hospital ◽  
Descriptive Study ◽  
Antibiotic Consumption ◽  
Defined Daily Dose ◽  
Intravenous Antibiotic ◽  
Central Java ◽  
Stewardship Program ◽  
Daily Dose ◽  
Before And After ◽  
Preliminary Study

Methods: A pre–post-descriptive study was conducted in 2019 for 3 months at a private hospital in Central Java, Indonesia, to evaluate the implementation of the Regulation on Indonesian Antimicrobial Stewardship Program (ASP), namely, the Prospective Antimicrobial System/Regulasi Antimikroba Sistem Prospektif Indonesia (RASPRO). Outcomes were measured before and after the implementation of the RASPRO in the ward including: 1) intravenous antibiotic defined daily dose (DDD) per 100 patient-days, 2) antibiotic expenditure, and 3) antibiotic expenditure per inpatient. Result: The total antibiotic consumption was expressed in DDD/100 patient-days. For the levofloxacin category, the number increased intensely from 2.38 to 15.29; carbapenem escalated from 0.51 to 2.31, ceftriaxone from 32.10 to 38.03, and ampicillin sulbactam from 1.14 to 1.18. In contrast, cefuroxime significantly reduced from 17.25 to 1.38, cefotaxime decreased from 10.33 to 6.83, gentamicin decreased from 3.18 to 1.91, and amikacin decreased from 2.27 to 2.13. The overall cephalosporin usage decreased from 19.89 to 15.41. The total antibiotic expenditure had a decline of 20.28%, followed by 14.44% reduction on the percentage of antibiotic expenditure per inpatient. Conclusion: Our study describes the 3-month analysis of antimicrobial usage before and after the implementation of the RASPRO by evaluating several parameters. The antibiotic consumption expressed in DDD/100 patient-days for each antibiotic category has demonstrated that there are different impacts that may be debatable and calls for further evaluation. A decrease in the total antibiotic expenditure has also been reported. However, since our study is a preliminary study, it should be continued by further studies that involve longer study duration to observe further impacts of the program.

scholarly journals Implementing advance care planning in heart failure: A qualitative study of primary healthcare professionals

2021 ◽  
pp. BJGP.2020.0973
Author(s):  
Markus Schichtel ◽  
John Ian Macartney ◽  
Bee Wee ◽  
Anne-Marie Boylan
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Healthcare Professionals ◽  
Holistic Care ◽  
Care Planning ◽  
Patient Relationship ◽  
Primary Care Nurses ◽  
Advance Care ◽  
Disease Specific

Background: Advance care planning (ACP) can improve the quality of life of patients suffering from heart failure (HF). However, primary care healthcare professionals (HCPs) find ACP difficult to engage with and patient care remains suboptimal.Aim: To explore the views of primary care HCPs on how to improve their engagement with ACP in heart failure.Design and Setting: A qualitative interview study with GPs and primary care nurses in England.Method: Semi-structured interviews were conducted with a purposive sample of 24 primary HCPs. Data were analysed using reflexive thematic analysis.Results: Three main themes were constructed from the data: ACP as integral to holistic care in HF; potentially limiting factors to the doctor-patient relationship; approaches to improve professional performance. Many HCPs saw the benefits of ACP as synonymous with providing holistic care and improving patients’ quality of life. However, some feared that initiating ACP could irrevocably damage their doctor-patient relationship. Their own fear of death and dying, a lack of disease specific communication skills and uncertainty about the right timing were significant barriers to ACP. To optimise their engagement with ACP in HF, HCPs recommended better clinician-patient dialogue through question prompts, enhanced shared decision-making approaches, synchronising ACP across medical specialities, and disease specific training. Conclusion: GPs and primary care nurses are vital to deliver ACP for patients suffering from HF. HCPs highlighted important areas to improve their practice and the urgent need for investigations into better clinician-patient engagement with ACP.

Benzodiazepines and non-benzodiazepine hypnotics – impact of a cluster adopted protocol on primary care prescribing

2019 ◽  
Vol 64 (3) ◽  
pp. 97-102 ◽  
Author(s):  
Christopher J Weatherburn
Keyword(s):  
Primary Care ◽  
Information Service ◽  
Interrupted Time Series ◽  
Defined Daily Dose ◽  
Its Analysis ◽  
Daily Dose ◽  
General Practices ◽  
One Year ◽  
The Impact ◽  
Information Service Division

Background and Aims Reduction of benzodiazepines and non-benzodiazepine hypnotics (BZDs and Z-drugs) prescribing is a priority. Dundee, Scotland, has a total of 25 general practices, split into four clusters. The cluster with the highest recorded prescribing of BZDs and Z-drugs adopted a prescribing protocol that aimed to reduce such prescribing. This paper evaluates the impact of this protocol. Methods Quarterly prescribing data were obtained from Information Service Division, NHS Scotland from Q1 2015/16 to Q4 2017/18. Data were split into four clusters and standardised to Defined Daily Dose (DDDs) per 1000 registered patients. Interrupted time series (ITS) analysis was performed to assess prescribing one year after this protocol was introduced. Results There was a crude reduction in prescribing of BZDs and Z-drugs across all GP practice clusters, but this related to an ongoing downward trend in prescribing. Allowing for this, in the cluster that adopted the protocol, ITS revealed there was no significant reduction attributable to the intervention in prescribing of DDD equivalent doses (−0.4%, 95% CI: −7.2 to 7.6). Conclusions Introduction of a cluster-wide prescribing protocol did not provide significant reduction of prescribing. Although crude figures might suggest an improvement, ITS analysis revealed this not to be the case.

scholarly journals Antibiotic use in Albania between 2011 and 2012

2015 ◽  
Vol 9 (01) ◽  
pp. 094-098 ◽  
Author(s):  
Iris Hoxha ◽  
Admir Malaj ◽  
Ledjan Malaj
Keyword(s):  
Antibiotic Use ◽  
World Health ◽  
Measurement Unit ◽  
Defined Daily Dose ◽  
Anatomic Therapeutic Chemical ◽  
Daily Dose ◽  
Health Institutions ◽  
Health Organization ◽  
Official Data

Introduction: Health institutions in Albania have recently reported an increase in antibiotic misuse and microbial resistance. Until now, there have been no comprehensive studies that analyzed the overall use of antibiotics in Albania. The aim of this study was to analyze the overall antibiotic use in Albania between 2011 and 2012, using standardized methodology of measurement, based on World Health Organization guidelines. Methodology: Data from 2011 and 2012 on antibiotic use from ambulatory and hospital sector were examined. Antibiotics were divided based on anatomic therapeutic chemical classification. Defined daily dose (DDD) for each drug was assigned, and DDD per 1,000 inhabitants per day (DID) was used as a measurement unit. In cases of antibiotic combinations for which DDD were not available, unit doses were assigned. Results: In 2011–2012, total antibiotic use decreased from 24.25 to 20.66 DID. Penicillin’s were the most used antibiotic class, with 10.62 DID (2011) and 10.51 DID (2012). Tetracycline use decreased from 5.45 DID (2011) to 0.98 DID (2012). Macrolides increased from 1.36 to 1.88 DID, quinolones from 1.72 to 2.51 DID. The overall antibiotic use was significantly higher than the reimbursed antibiotic use – 3.17 DID (2011) and 2.79 DID (2012) – based on the official data for the same period. Conclusions: This study enables policymakers to further analyze the quality of antibiotic prescriptions and draw comparisons to other countries. The analyzed data suggest there are different factors influencing out-of-pocket use of antibiotics and wrongly prescribed antibiotics. Further studies are necessary to evaluate these factors.

Sign in / Sign up

Export Citation Format

Share Document