scholarly journals Physicians’ Opinion Regarding Extended Access to Hormonal Contraception in Switzerland

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 184
Author(s):  
Tamara Yous ◽  
Samuel Allemann ◽  
Monika Lutters
Keyword(s):  
Patient Education ◽  
General Practitioners ◽  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
Future Research ◽  
Over The Counter ◽  
Web Based ◽  
Extended Access ◽  
Access Model

(1) Background: Access to hormonal contraceptives (HC) strongly differs between countries and varies from over the counter (OTC) to prescription-only availability. This study aimed to identify opinions among physicians in Switzerland regarding extended access to HC. (2) Methods: Web-based survey among physicians (gynecologists, general practitioners, and pediatricians) in Switzerland. (3) Results: Hundred sixty-three physicians, mainly gynecologists, participated in this survey and 147 (90%) were included for analysis. A total of 68% (n = 100) answered that prescription-only status could be extended under certain conditions but physicians were concerned about patients’ safety (97%, n = 142). Moreover, there was concern about insufficient patient education on HC (93%, n = 136) and that women may forego preventive examinations (80%, n = 118). Participants did not support OTC availability (93%, n = 136). Pharmacists prescribing (including initiation of HC) revealed controversial results, but a combined access model (initial prescription from physician and follow-up prescriptions by pharmacists) found acceptance in 70% (n = 103). (4) Conclusions: Participating physicians stated that prescription-only status for HC could be lifted under certain conditions but also some concerns, e.g., patients’ safety or neglection of preventive examinations, were raised. Future research should focus on specific conditions in which extended access to HC could be agreed on.

scholarly journals Extended Access to Hormonal Contraception in Pharmacies: A Survey among Swiss Pharmacists

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 210
Author(s):  
Tamara Yous ◽  
Samuel Allemann ◽  
Monika Lutters
Keyword(s):  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
Over The Counter ◽  
Web Based ◽  
Extended Access ◽  
Swiss Law ◽  
Dispensing Practices

Background: Worldwide the availability to Hormonal Contraceptives (HC) varies from over the counter (OTC) to prescription-only access. In various countries pharmacists are allowed to prescribe HC, although conditions may be different. In Switzerland, HC require a prescription from a physician, although Swiss law allows pharmacists to dispense prescription-only medications in justified exceptional cases without a valid physician’s prescription. This study aimed to identify current dispensing practices for HC in Swiss pharmacies, pharmacists’ knowledge about HC, and their opinion and interest about expanding access to HC. Methods: Web-based survey among Swiss pharmacists. Results: This survey was completed by 397 registered pharmacists and 331 (83%) were included for analysis. The survey showed that 21% of respondents regularly dispense HC without prescription and that a high number of participants are either very interested (57%, n = 189) or rather interested (33%, n = 110) in extended pharmacy access to HC. The majority did not or rather not support physician’s prescription-only status (77%, n = 256) or OTC availability (94%, n = 310). Furthermore, surveyed pharmacists are willing to train for contraception services (90%, n = 299). According to participants, resistance of physicians is the most relevant barrier to this service (88%, n = 292). Conclusion: Surveyed pharmacists are interested in extended access to HC.

Combined hormonal contraception and risk of venous thromboembolism within the first year following pregnancy

2014 ◽  
Vol 112 (07) ◽  
pp. 73-78 ◽  
Author(s):  
Thomas Bergholt ◽  
Anne Nielsen ◽  
Michael J. Paidas ◽  
Ellen Christine L. Løkkegaard ◽  
Jesper Petersen
Keyword(s):  
Venous Thromboembolism ◽  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
First Year ◽  
The Difference ◽  
Combined Hormonal Contraception ◽  
One Year ◽  
First Time ◽  
Combined Hormonal Contraceptives

SummaryEstimating the risk of venous thromboembolism (VTE) associated with combined hormonal contraceptives following early terminated pregnancies or birth, a Danish nationwide retrospective cohort observing a one-year follow-up was defined using three unique registries. All Danish women with confirmed pregnancies aged 15–49 during the period of 1995–2009 were included. The main outcomes were relative and absolute risks of first time venous thromboembolism in users as well as non-users of combined hormonal contraceptives. In 985,569 person-years, 598 venous thromboembolisms were recorded. After early terminated pregnancies and births, respectively, 113 and 485 events occurred in 212,552 and 773,017 person-years. After early terminated pregnancies, the crude VTE incidence ratios were similar, and the numbers needed to harm were equal between groups that did or did not use combined hormonal contraceptives throughout the follow-up year. After childbirth, individuals that used combined hormonal contraceptives were more likely than non-users to experience VTE depicted by crude incidence ratios; however, the difference was only significant after 14 weeks. This implied that the numbers needed to harm were lower for those that used compared to those that did not use combined oral contraceptives in the initial 14 weeks postpartum. In conclusion, the use of combined hormonal contraceptives after early terminated pregnancies was not detrimental, but during the puerperal period, they should be used with caution.

scholarly journals Referring patients with chronic kidney disease back to primary care: a criteria-based analysis in outpatient renal clinics

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Carola van Dipten ◽  
Davy Gerda Hermina Antoin van Dam ◽  
Wilhelmus Joannes Carolus de Grauw ◽  
Marcus Antonius Gerard Jan ten Dam ◽  
Marcus Matheus Hendrik Hermans ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Practitioners ◽  
Estimated Glomerular Filtration Rate ◽  
Outpatient Clinics ◽  
Future Research ◽  
Care Facilities ◽  
Nephrology Care

Abstract Background The increased demand for nephrology care for patients with chronic kidney disease (CKD) necessitates a critical review of the need for secondary care facilities and the possibilities for referral back to primary care. This study aimed to evaluate the characteristics and numbers of patients who could potentially be referred back to primary care, using predefined criteria developed by nephrologists and general practitioners. Method We organised a consensus meeting with eight nephrologists and two general practitioners to define the back referral (BR) criteria, and performed a retrospective cohort study reviewing records from patients under nephrologist care in three hospitals. Results We reached a consensus about the BR criteria. Overall, 78 of the 300 patients (26%) in the outpatient clinics met the BR criteria. The characteristics of the patients who met the BR criteria were: 56.4% male, a median age of 70, an average of 3.0 outpatients visits per year, and a mean estimated glomerular filtration rate of 46 ml/min/1,73m2. Hypertension was present in 67.9% of this group, while 27.3% had diabetes and 16.9% had cancer. The patients who could be referred back represented all CKD stages except stage G5. The most common stage (16%) was G3bA2 (eGFR 30 ≤ 44 and ACR 3 ≤ 30). Conclusion A substantial proportion of patients were eligible for referral back to primary care. These patients often have a comorbidity, such as hypertension or diabetes. Future research should focus on generalisability of the BR criteria, the feasibility of actual implementation of the back referral, follow-up assessments of renal function and patient satisfaction.

scholarly journals The effectiveness of e-learning in patient education delivered to patients with rheumatoid arthritis: The WebRA study—protocol for a pragmatic randomised controlled trial

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Line Raunsbæk Knudsen ◽  
Kirsten Lomborg ◽  
Mwidimi Ndosi ◽  
Ellen-Margrethe Hauge ◽  
Annette de Thurah
Keyword(s):  
Rheumatoid Arthritis ◽  
Statistical Analysis ◽  
Patient Education ◽  
Controlled Trial ◽  
Self Management ◽  
Web Based ◽  
Face To Face ◽  
E Learning ◽  
Randomised Controlled

Abstract Background Patient education is integral to the treatment and care of patients with rheumatoid arthritis. Change is taking place in the organisation of healthcare systems because of a demographic shift towards ageing populations, an increasing use of technology and advancements in digital technologies, allowing for new interventions. This study will aim to evaluate the effectiveness of a newly developed e-learning patient education programme based on self-management that targets patients with rheumatoid arthritis. Methods A pragmatic multi-centre randomised controlled trial is planned. We intend to recruit approximately 200 patients with a new diagnosis (< 3 months) of rheumatoid arthritis. Participants will be randomised 1:1 to web-based patient education delivered through an e-learning programme at home or standard face-to-face patient education provided at the hospital. The primary outcome is self-efficacy. Secondary outcomes are improved knowledge of rheumatoid arthritis, adherence to medication, health literacy level and quality of life. Outcomes will be measured at baseline and follow-up occurring 1, 3, 6 and 12 months after enrolment. Furthermore, data on healthcare utilisation and utilisation of the e-learning programme will be assessed at the 12-month follow-up. Statistical analysis, including differences between groups, will be evaluated using the chi-square and Kruskal–Wallis tests. Statistical analysis will follow the intention-to-treat principle, and analysis of variance will be used to evaluate the within- and between-groups differences testing the hypothesis of the ‘superiority’ of web-based patient education over standard face-to-face education provided at the hospital. Per protocol analysis will be used to assess the impact of missing data. Enrolment started in February 2021 and will end in June 2022. Discussion The study is expected to contribute to the evidence on the effectiveness of web-based patient education within rheumatic diseases. If the e-learning programme is effective, it will be incorporated into existing services to improve the self-management of patients with rheumatoid arthritis. Further, this mode of providing patient education may impact the organisation of health care for both rheumatic diseases and other chronic diseases by offering different modes of delivering patient education based on the needs and preferences of patients. Trial registration: ClinicalTrials.gov identifier NCT04669340. Registered on November 27, 2020. https://www.clinicaltrials.gov/ct2/show/NCT04669340?term=e-learning&cond=Rheumatoid+Arthritis&draw=2&rank=1. See Additional file 1 for detailed information on the dataset according to the World Health Organization Trial Registration Data Set.

scholarly journals Gap between desired and self-determined roles of general practitioners: a multicentre questionnaire study in Japan

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Takashi Chinen ◽  
Yusuke Sasabuchi ◽  
Kazuhiko Kotani ◽  
Hironori Yamaguchi
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Cancer Care ◽  
Primary Care Physicians ◽  
Survivorship Care ◽  
Web Based ◽  
Care Continuum ◽  
Cancer Care Continuum ◽  
Cancer Specialists

Abstract Background Primary care physicians have diverse responsibilities. To collaborate with cancer specialists efficiently, they should prioritise roles desired by other collaborators rather than roles based on their own beliefs. No previous studies have reported the priority of roles such clinic-based general practitioners are expected to fulfil across the cancer care continuum. This study clarified the desired roles of clinic-based general practitioners to maximise person-centred cancer care. Methods A web-based multicentre questionnaire in Japan was distributed to physicians in 2019. Physician roles within the cancer care continuum were divided into 12 categories, including prevention, diagnosis, surgery, follow-up with cancer survivors, chemotherapy, and palliative care. Responses were evaluated by the proportion of three high-priority items to determine the expected roles of clinic-based general practitioners according to responding physicians in similarly designated roles. Results Seventy-eight departments (25% of those recruited) from 49 institutions returned questionnaires. Results revealed that some physicians had lower expectations for clinic-based general practitioners to diagnose cancer, and instead expected them to provide palliative care. However, some physicians expected clinic-based general practitioners to be involved in some treatment and survivorship care, though the clinic-based general practitioners did not report the same priority. Conclusion Clinic-based general practitioners prioritised involvement in prevention, diagnoses, and palliative care across the cancer continuum, although lower expectations were placed on them than they thought. Some additional expectations of their involvement in cancer treatment and survivorship care were unanticipated by them. These gaps represent issues that should be addressed.

scholarly journals Discontinuation of hormonal contraception in Oman: prevalence and reasons

2021 ◽  
Author(s):  
Fatma Al-Ghashri ◽  
Habiba Al-Harthi ◽  
Maryam Al Shukri ◽  
Asma Al Shidhani
Keyword(s):  
Breast Feeding ◽  
Hormonal Contraception ◽  
Unmet Need ◽  
Hormonal Contraceptives ◽  
Future Research ◽  
First Year ◽  
Discontinuation Rate ◽  
Contraceptive Methods ◽  
Related Factors ◽  
Number Of Children

Background: Discontinuation of hormonal contraceptives is an important contributor to unmet need of contraception. Aims: To determine the discontinuation rate and the reasons for discontinuation of hormonal contraception among Omani women. Methods: This was a 2-stage sampling, multicentre, retrospective cohort study conducted in 2018 at primary health care centres in Muscat Region, Oman. It included newly registered users of hormonal contraceptives in birth spacing clinics from January to December 2016 and the course of care over the following 12 months. A telephone interview was conducted to complement some of the missing data. The contraceptive methods available were combined oral contraceptives, progesterone only pills and injectable depot medroxyprogesterone acetate. Results: We included 404 women and 87.8% were breast-feeding. By the end of the first year, (268; 66.3%) women discontinued their contraceptive method. More than half (55.2% 148/268) of the discontinuation was attributed to adverse effects and the most prevalent was menstrual abnormality (102/268; 38.1%). Only 5.6% (15/268) discontinued contraception because they desired pregnancy. Partners and logistics of availability and access played a minimal role in discontinuation. Age and number of children did not influence the discontinuation rate. Conclusion: This study improves our knowledge about the rate of discontinuation of hormonal contraception and its related factors in Oman, which can be used for population-specific counselling. Future research should study the contraception behaviour of breast-feeding women to assess when and why they discontinue their contraceptive methods.

scholarly journals Web-based training and supervision for LGBT-affirmative mental health practice: A randomized controlled trial

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Lelutiu-Weinberger ◽  
J E Pacjankis
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Clinical Skills ◽  
Controlled Trial ◽  
Future Research ◽  
Provider Attitudes ◽  
Web Based ◽  
The Impact ◽  
Lgbt Individuals

Abstract Background Lesbian, gay, bisexual, and transgender (LGBT) individuals in most countries remain stigmatized, requiring culturally sensitive mental health care to foster coping and resilience. This trial tested the efficacy of an LGBT-affirmative mental health training for psychologists and psychiatrists in Romania, where such resources are scarce. The trial compared in-person and web-based training modalities. Methods Participants were randomized to a 2-day training either in-person (n = 56) or via web by viewing the live-streamed training (n = 54), and assessed pre- and 5-, 10- and 15-months post-training, with optional monthly web-based supervision (n = 47) after the first follow-up. Generalized linear mixed models were conducted to assess for change across time. Results The sample (M age=34.98) was mostly female (88%) and heterosexual (84%). Trainees, regardless of in-person or web-based attendance, reported significant decreases from baseline to 15-month follow-up in explicitly (b = 0.21, 95% CI 0.06 − 0.37, p &lt; 0.01) and implicitly (b = 0.26, 95% CI 0.10 − 0.41, p &lt; 0.001) assessed homonegativity, and significant increases in LGBT-affirmative clinical skills (b = -1.19, 95% CI -1.41− -1.00, p &lt; 0.001), beliefs (b = -0.17, 95% CI -0.31 − -0.03, p &lt; 0.05) and behavior (b = -1.17, 95% CI -1.72 − -0.61, p &lt; 0.05). Conclusions Training in LGBT-affirmative mental health can change provider attitudes and practice in high-stigma countries. The fact that web-based trainings were equally efficacious as in-person trainings suggests that such education can have widespread reach. As LGBT individuals represent one of the highest-risk global populations for mental health problems driven by stigma, findings hold strong public health potential. Future research should assess the impact of such trainings across high-need settings and include patient outcomes.

scholarly journals General Practitioners� Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery (Preprint)

2017 ◽  
Author(s):  
Mirjana Subotic-Kerry ◽  
Catherine King ◽  
Kathleen O'Moore ◽  
Melinda Achilles ◽  
Bridianne O'Dea
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
General Practitioners ◽  
Health Care Professionals ◽  
Strong Support ◽  
Service Design ◽  
Web Based ◽  
Wide Range

BACKGROUND Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs’ views need to be measured. OBJECTIVE This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design. METHODS GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service. RESULTS A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service. CONCLUSIONS GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured.

scholarly journals Feedback in web-based questionnaires as incentive to increase compliance in studies on lifestyle factors

2011 ◽  
Vol 15 (6) ◽  
pp. 982-988 ◽  
Author(s):  
Olle Bälter ◽  
Elinor Fondell ◽  
Katarina Bälter
Keyword(s):  
Epidemiological Studies ◽  
Lifestyle Factors ◽  
Future Research ◽  
Upper Respiratory Tract ◽  
Group Level ◽  
Personalized Feedback ◽  
Web Based ◽  
Baseline Questionnaire ◽  
Tract Infections

AbstractObjectiveWe explored the use of feedback in interactive web-based questionnaires for collecting data on lifestyle factors in epidemiological studies.DesignHere we report from a cohort study on lifestyle factors and upper respiratory tract infections among 1805 men and women. We introduced interactivity in the form of personalized feedback and feedback on a group level regarding dietary intake, physical activity and incidence of infections in web-based questionnaires as incentives for the respondents to continue answering questions and stay in the study.SettingThe study was performed in Sweden.SubjectsAll participants were randomly selected from the population registry.ResultsPersonalized feedback was offered in the baseline questionnaire and feedback on a group level in the five follow-up questionnaires. In total, 88 % of the participants actively chose to get personalized feedback at least once in the baseline questionnaire. The follow-up questionnaires were sent by email and the overall compliance at each follow-up was 83–84 %, despite only one reminder. In total, 74 % completed all five follow-ups. However, the compliance was higher among those who chose feedback in the baseline questionnaire compared with those who did not choose feedback.ConclusionsThe results show that it is possible to use feedback in web questionnaires and that it has the potential to increase compliance. The majority of the participants actively chose to take part in the personalized feedback in the baseline questionnaire and future research should focus on improving the design of the feedback, which may ultimately result in even higher compliance in research studies.

A Pilot Study of Mobile Telephone Message Interventions with Suicide Attempters in China

Crisis ◽  
2010 ◽  
Vol 31 (2) ◽  
pp. 109-112 ◽  
Author(s):  
Hui Chen ◽  
Brian L. Mishara ◽  
Xiao Xian Liu
Keyword(s):  
Pilot Study ◽  
Effective Means ◽  
Text Message ◽  
Text Messages ◽  
Mobile Telephone ◽  
Future Research ◽  
Quick Method ◽  
Suicide Attempters ◽  
To Receive

Background: In China, where follow-up with hospitalized attempters is generally lacking, there is a great need for inexpensive and effective means of maintaining contact and decreasing recidivism. Aims: Our objective was to test whether mobile telephone message contacts after discharge would be feasible and acceptable to suicide attempters in China. Methods: Fifteen participants were recruited from suicide attempters seen in the Emergency Department in Wuhan, China, to participate in a pilot study to receive mobile telephone messages after discharge. All participants have access to a mobile telephone, and there is no charge for the user to receive text messages. Results: Most participants (12) considered the text message contacts an acceptable and useful form of help and would like to continue to receive them for a longer period of time. Conclusions: This suggests that, as a low-cost and quick method of intervention in areas where more intensive follow-up is not practical or available, telephone messages contacts are accessible, feasible, and acceptable to suicide attempters. We hope that this will inspire future research on regular and long-term message interventions to prevent recidivism in suicide attempters.

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