scholarly journals The Prescription of Drug Ontology 2.0 (PDRO): More Than the Sum of Its Parts

2021 ◽  
Vol 18 (22) ◽  
pp. 12025
Author(s):  
Jean-François Ethier ◽  
François Goyer ◽  
Paul Fabry ◽  
Adrien Barton
Keyword(s):  
Information Integration ◽  
Drug Product ◽  
Medical Outcomes ◽  
Term Care ◽  
Multiple Systems ◽  
Inappropriate Use ◽  
Knowledge Models ◽  
Lack Of Information ◽  
Geographical Scale

While drugs and related products have profoundly changed the lives of people around the world, ongoing challenges remain, including inappropriate use of a drug product. Inappropriate uses can be explained in part by ambiguous or incomplete information, for example, missing reasons for treatments, ambiguous information on how to take a medication, or lack of information on medication-related events outside the health care system. In order to fully assess the situation, data from multiple systems (electronic medical records, pharmacy and radiology information systems, laboratory management systems, etc.) from multiple organizations (outpatient clinics, hospitals, long-term care facilities, laboratories, pharmacies, registries, governments) on a large geographical scale is needed. Formal knowledge models like ontologies can help address such an information integration challenge. Existing approaches like the Observational Medical Outcomes Partnership are discussed and contrasted with the use of ontologies and systems using them for data integration. The PRescription Drug Ontology 2.0 (PDRO 2.0) is then presented and entities that are paramount in addressing this problematic are described. Finally, the benefits of using PDRO are discussed through a series of exemplar situation.

scholarly journals PERCEPTIONS OF LONG-TERM CARE RESIDENTS AND THEIR FAMILY MEMBERS ABOUT USING THE CONVERSATION STARTER KIT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S157-S157
Author(s):  
Sharon Kaasalainen ◽  
Tamara Sussman
Keyword(s):  
Long Term Care ◽  
Family Members ◽  
Term Care ◽  
Disease Trajectory ◽  
Lack Of Information ◽  
Difficult Conversations ◽  
Advance Care ◽  
Future Work ◽  
To Receive

Abstract The need for a palliative approach in long term care (LTC) is widely recognized. However, advance care planning (ACP) is still rare. The purpose of this study was to explore the perceptions of LTC residents and their families about using an ACP tool called The Conversation Starter Kit (CSK). This study utilized a mixed methods approach. Data was collected in four LTC homes in Ontario, Canada from 31 residents and family members during an interview after they had completed the CSK. Data was analyzed using thematic analysis and descriptive statistics. All participants read all sections but only 73% completed all sections of the toolkit. Participants spent an average of 36 minutes discussing it with their family members and/or LTC staff. Participants reported: a better understanding of ACP after using the tool (80%), that the tool helped clarify the available resources and/or choices (53%), and that they felt less apprehensive about ACP after using the tool (60%). Qualitative findings revealed many strengths (e.g., usefulness, ability to start difficult conversations, content and clarification), and weaknesses of the tool (e.g., redundant information, difficulty understanding the content and lack of information regarding medically assisted dying). Family members noted that the toolkit would have been helpful to receive earlier on in their family members’ disease trajectory, perhaps before being admitted into LTC. These study findings support the CSK for residents and family members to have ACP discussions in LTC. Future work is needed to evaluate the effectiveness of the tool with a larger sample.

scholarly journals The Impact of the Long-term Care Homes Act and Public Reporting on Physical Restraint and Potentially Inappropriate Antipsychotic Use in Ontario’s Long-term Care Homes

2019 ◽  
Author(s):  
Kevin Walker ◽  
Sara Shearkhani ◽  
Yu Qing Bai ◽  
Katherine S McGilton ◽  
Whitney B Berta ◽  
...  
Keyword(s):  
Long Term Care ◽  
Physical Restraint ◽  
Public Reporting ◽  
Care Homes ◽  
Term Care ◽  
Early Adopters ◽  
Inappropriate Use ◽  
Restraint Use ◽  
The Impact

Abstract Background We report on the impact of two system-level policy interventions (the Long-Term Care Homes Act [LTCHA] and Public Reporting) on publicly reported physical restraint use and non-publicly reported potentially inappropriate use of antipsychotics in Ontario, Canada. Methods We used interrupted time series analysis to model changes in the risk-adjusted use of restraints and antipsychotics before and after implementation of the interventions. Separate analyses were completed for early ([a] volunteered 2010/2011) and late ([b] volunteered March 2012; [c] mandated September 2012) adopting groups of Public Reporting. Outcomes were measured using Resident Assessment Instrument Minimum Data Set (RAI-MDS) data from January 1, 2008 to December 31, 2014. Results For early adopters, enactment of the LTCHA in 2010 was not associated with changes in physical restraint use, while Public Reporting was associated with an increase in the rate (slope) of decline in physical restraint use. By contrast, for the late-adopters of Public Reporting, the LTCHA was associated with significant decreases in physical restraint use over time, but there was no significant increase in the rate of decline associated with Public Reporting. As the LTCHA was enacted, potentially inappropriate use of antipsychotics underwent a rapid short-term increase in the early volunteer group, but, over the longer term, their use decreased for all three groups of homes. Conclusions Public Reporting had the largest impact on voluntary early adopters while legislation and regulations had a more substantive positive effect upon homes that delayed public reporting.

scholarly journals Antipsychotic Use in Dementia

2016 ◽  
Vol 62 (3) ◽  
pp. 170-181 ◽  
Author(s):  
Julia Kirkham ◽  
Chelsea Sherman ◽  
Clive Velkers ◽  
Colleen Maxwell ◽  
Sudeep Gill ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Clinical Care ◽  
Neuropsychiatric Symptoms ◽  
Mental Illnesses ◽  
Educational Outreach ◽  
Term Care ◽  
Inappropriate Use ◽  
Regulatory Changes ◽  
Current Controversy

Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.

One province, one healthcare system: A decade of healthcare transformation in Alberta

2018 ◽  
Vol 31 (5) ◽  
pp. 167-171 ◽  
Author(s):  
David Veitch
Keyword(s):  
Cost Savings ◽  
Stroke Care ◽  
Term Care ◽  
Inappropriate Use ◽  
System A ◽  
Health Authorities ◽  
Enhance Patient Safety ◽  
Integration Of Services ◽  
Regional Health Authorities

Nearly a decade has passed since Alberta folded nine regional health authorities and three government agencies into one province-wide health system: Alberta Health Services (AHS). Deemed a reckless experiment by some at the time, there is now mounting evidence province-wide integration of services across the healthcare continuum is an enabler of improved quality, safety, and financial sustainability. The article highlights specific examples of how AHS is strengthening partnerships, standardizing best practices, and driving innovation, making Alberta a national and international leader in areas such as stroke care and potentially inappropriate use of antipsychotics in long-term care. It also shows how province-wide integration is being leveraged to build workplace culture, enhance patient safety, and find operational efficiencies that result in cost savings and cost avoidance.

Reducing Inappropriate Use of Antipsychotics in Long Term Care Residents

2014 ◽  
Vol 15 (3) ◽  
pp. B22
Author(s):  
Sahebi Saiyed ◽  
Sahebi Saiyed ◽  
Phyllis Tawiah ◽  
Manuel Eskildsen
Keyword(s):  
Long Term Care ◽  
Term Care ◽  
Inappropriate Use

Public Health/State Government Service as an Alternate Practice of Pharmacy

1996 ◽  
Vol 9 (4) ◽  
pp. 268-275 ◽  
Author(s):  
Ronald W. Gottrich
Keyword(s):  
Public Health ◽  
State Government ◽  
Drug Product ◽  
Pharmacy Practice ◽  
Pharmacy Education ◽  
Health State ◽  
Term Care ◽  
Product Selection ◽  
Alternate Forms

Public health and governmental service are discussed as alternate forms of the practice of pharmacy. The author discusses his employment with the Illinois Department of Public Health in the areas of drug product selection, drug, medical device, and cosmetic establishment inspections, and long-term care. Aspects of the author's former employment as consultant pharmacist for the state Medicaid program are related. Events leading to the author's selection of the field of public health pharmacy practice are described. The benefits of a pharmacy education in this field, rewards and frustrations of government employment, and the future prospects for public health pharmacy are highlighted.

Public Health/Government Service as an Alternate Practice of Pharmacy

1989 ◽  
Vol 2 (2) ◽  
pp. 77-82 ◽  
Author(s):  
Ronald W. Gottrich
Keyword(s):  
Public Health ◽  
Drug Product ◽  
Pharmacy Practice ◽  
Pharmacy Education ◽  
Medicaid Program ◽  
Term Care ◽  
Product Selection ◽  
Alternate Forms ◽  
Selection Of

Public health and governmental service are discussed as alternate forms of the practice of pharmacy. The author discusses his employment with the Illinois Department of Public Health in the areas of drug product selection, drug, medical device, and cosmetic establishment inspections, and long-term care. Aspects of the author's employment as consultant pharmacist for the state Medicaid program are related. Events leading to the author's selection of the field of public health pharmacy practice are described. The benefits of a pharmacy education in this field, rewards and frustrations of government employment, and the future prospects for public health pharmacy are highlighted.

scholarly journals Using the Conversation Starter Kit in Canada to Promote Resident Care Planning Discussions in Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 247-247
Author(s):  
Sharon Kaasalainen ◽  
Tamara Sussman
Keyword(s):  
Long Term Care ◽  
Family Members ◽  
Care Planning ◽  
Term Care ◽  
Disease Trajectory ◽  
Lack Of Information ◽  
Difficult Conversations ◽  
Advance Care ◽  
To Receive

Abstract Advance care planning (ACP) is still rare in Canadian long-term care (LTC) homes. Residents and their families view ACP as uncomfortable and difficult to implement, leading them to avoid these discussions. The purpose of this study was to explore the perceptions of LTC residents and their families about using an ACP tool called The Conversation Starter Kit. This study utilized a mixed methods approach. Data was collected in four LTC homes in Ontario, Canada from 78 residents and family members. Data was analyzed using thematic analysis and descriptive statistics. All participants read all sections but only 73% completed all sections of the toolkit. Participants spent an average of 52.3 minutes completing the toolkit and 36.4 minutes discussing it with their family members and/or LTC staff. Participants reported: a better understanding of ACP after using the tool (80%), that the tool helped clarify the available resources and/or choices (53%), and that they felt less apprehensive about ACP after using the tool (60%). Qualitative findings revealed many strengths (e.g., usefulness, ability to start difficult conversations, content and clarification), and weaknesses of the tool (e.g., redundant information, difficulty understanding the content and lack of information regarding medically assisted dying). Family members noted that the toolkit would have been helpful to receive earlier on in their family members’ disease trajectory, perhaps before being admitted into LTC. These study findings support the feasibility and acceptability of the tool to engage residents and family members in/; ACP discussions in LTC.

scholarly journals Study Protocol and Baseline Comparisons for a Pan-Canadian Initiative to Reduce Inappropriate Use of Antipsychotics in Long-Term Care Homes

SAGE Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 215824401983594 ◽  
Author(s):  
John P. Hirdes ◽  
Jennifer Major ◽  
Selma Didic ◽  
Christine Quinn ◽  
Cynthia Sinclair ◽  
...  
Keyword(s):  
Study Protocol ◽  
Long Term Care ◽  
Small Scale ◽  
Term Care ◽  
Clinical Indicators ◽  
Inappropriate Use ◽  
Study Results ◽  
Facility Level ◽  
Discharge Patterns

Antipsychotic use in the absence of symptoms or diagnoses related to psychosis is generally regarded as an inappropriate approach to care of older adults in nursing homes. The Canadian Foundation for Healthcare Improvement (CFHI) launched a pan-Canadian intervention study to reduce antipsychotic use in long-term care based on promising pilot study results from the Winnipeg Regional Health Authority (WRHA). Data from the Continuing Care Report System (CCRS) managed by the Canadian Institute for Health Information (CIHI) were used to compare the characteristics of residents in intervention homes with control homes not in the study. The sample was comprised of 5,434 residents in 49 intervention homes compared with 123,781 residents in 1,193 control homes. Resident-level comparisons included demographic, diagnostic, and clinical indicators. Facility-level comparisons included nine risk-adjusted quality indicators. The main differences of note were in geographic representation (Ontario homes were underrepresented), access to rehabilitation, and discharge patterns (both of which were related to Ontario practice patterns). There were few substantial differences in quality indicator performance between homes by study participation prior to the onset of the intervention. The study protocol used in this pan-Canadian intervention was based on a successful, small-scale pilot undertaken in one province. Sites that participated in the intervention did not differ in substantively meaningful ways from control homes. Therefore, subsequent study findings after the intervention are unlikely to be attributable to differences between homes that existed prior to the study onset.

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