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Quality Use (quality + use)
Selected AbstractsMedication accuracy and general practitioner referral lettersINTERNAL MEDICINE JOURNAL, Issue 2 2006S. L. Carney Abstract Prescriber medication communication is a Quality Use of Medicines barrier. Medication information in General Practice (GP) referral letters to a physician was evaluated. Accuracy of medications taken and drug dose was respectively 63% and 84%, an overall accuracy rate of 58%. Complementary/over-the-counter medication documentation occurred in 26% of the letters. To avoid medical mismanagement, physicians must validate all GP medication lists regardless of their apparent comprehensiveness. [source] The impact of pharmacy computerised clinical decision support on prescribing, clinical and patient outcomes: a systematic review of the literatureINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2010Jane Robertson Abstract Objectives Computerised clinical decision support systems (CDSSs) are being used increasingly to support evidence-based decision-making by health care professionals. This systematic review evaluated the impact of CDSSs targeting pharmacists on physician prescribing, clinical and patient outcomes. We compared the impact of CDSSs addressing safety concerns (drug interactions, contraindications, dose monitoring and adjustment) and those focusing on medicines use in line with guideline recommendations (hereafter referred to as Quality Use of Medicines, or QUM). We also examined the influence of clinical setting (institutional versus ambulatory care), system- or user-initiation of CDSS, prescribing versus clinical outcomes reported and use of multi-faceted versus single interventions on system effectiveness. Methods We searched Medline, Embase, CINAHL and PsycINFO (1990,2009) for methodologically adequate studies (experiments and strong quasi-experiments) comparing a CDSS with usual pharmacy care. Individual study results are reported as positive trends or statistically significant results in the direction of the intentions of the CDSS being tested. Studies are aggregated and compared as the proportions of studies showing the effectiveness of the CDSS on the majority (, 50%) of outcomes reported in the individual study. Key findings Of 21 eligible studies, 11 addressed safety and 10 QUM issues. CDSSs addressing safety issues were more effective than CDSSs focusing on QUM (10/11 versus 4/10 studies reporting statistically significant improvements in favour of CDSSs on , 50% of all outcomes reported; P= 0.01). A number of QUM studies noted the limited contact between pharmacists and physicians relating to QUM treatment recommendations. More studies demonstrated CDSS benefits on prescribing outcomes than clinical outcomes (10/10 versus 0/3 studies; P= 0.002). There were too few studies to assess the impact of system- versus user-initiated CDSS, the influence of setting or multi-faceted interventions on CDSS effectiveness. Conclusions Our study demonstrated greater effectiveness of safety-focused compared with QUM-focused CDSSs. Medicine safety issues are traditional areas of pharmacy activity. Without good communication between pharmacists and physicians, the full benefits of QUM-focused CDSSs may not be realised. Developments in pharmacy-based CDSSs need to consider these inter-professional relationships as well as computer-system enhancements. [source] The economic burden of depression and the cost-effectiveness of treatmentINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2003Philip S. Wang Abstract Cost-of-illness research has shown that depression is associated with an enormous economic burden, in the order of tens of billions of dollars each year in the US alone. The largest component of this economic burden derives from lost work productivity due to depression. A large body of literature indicates that the causes of the economic burden of depression, including impaired work performance, would respond both to improvement in depressive symptomatology and to standard treatments for depression. Despite this, the economic burden of depression persists, partly because of the widespread underuse and poor quality use of otherwise efficacious and tolerable depression treatments. Recent effectiveness studies conducted in primary care have shown that a variety of models, which enhance care of depression through aggressive outreach and improved quality of treatments, are highly effective in clinical terms and in some cases on work performance outcomes as well. Economic analyses accompanying these effectiveness studies have also shown that these quality improvement interventions are cost efficient. Unfortunately, widespread uptake of these enhanced treatment programmes for depression has not occurred in primary care due to barriers at the level of primary care physicians, healthcare systems, and purchasers of healthcare. Further research is needed to overcome these barriers to providing high-quality care for depression and to ultimately reduce the enormous adverse economic impact of depression disorders. Copyright © 2003 Whurr Publishers Ltd. [source] Pharmaceutical company influences on medication prescribing and their potential impact on quality use of medicinesJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 5 2008G. J. Kyle BPharm MClinPharm Summary Background:, Pharmaceuticals are big business, reporting strong market growth year after year. The ,gatekeepers' of this market are prescribers of medicines, who are the major target of pharmaceutical companies, utilizing direct and indirect influences. Methods:, This paper draws on previous research investigating pharmaceutical company prescribing influences to develop a qualitative model demonstrating the synergism between commercial influences on prescribing. The generic model was used to explore a realistic but hypothetical scenario to ascertain the applicability of the model. Results and Discussion:, A generic influence model was developed. The model was readily able to be adapted to reflect a realistic practice scenario. Conclusion:, Prescriber awareness of the linkages between various seemingly separate marketing techniques could potentially improve medicines usage in an evidence-based practice paradigm. [source] Prescription drug samples , does this marketing strategy counteract policies for quality use of medicines?JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 4 2003K. E. M. Groves BSc MSc PhD (Cand) Summary Prescription drug samples, as used by the pharmaceutical industry to market their products, are of current interest because of their influence on prescribing, and their potential impact on consumer safety. Very little research has been conducted into the use and misuse of prescription drug samples, and the influence of samples on health policies designed to improve the rational use of medicines. This is a topical issue in the prescription drug debate, with increasing costs and increasing concerns about optimizing use of medicines. This manuscript critically evaluates the research that has been conducted to date about prescription drug samples, discusses the issues raised in the context of traditional marketing theory, and suggests possible alternatives for the future. [source] Analysing the contribution of component cultivars and cultivar combinations to malting quality, yield and disease in complex mixturesJOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 12 2008Adrian C Newton Abstract BACKGROUND: Mixtures of cereal cultivars grown together generally enhance yield and reduce disease but end-users will not accept them for quality uses. Some combinations with very different quality may be problematic, others complementary. The common origin of Maris Otter for quality in winter barley may enable the benefits of complex mixtures to be exploited without quality compromises. RESULTS: Seven winter barley cultivar monocultures and all their equal proportion mixtures were trialled and data analysed by ANOVA, REML and principal component analyses to determine the contribution of particular varieties or combinations to crop performance. Agronomic yield was positively correlated with component number. Pipkin contributed negatively to thousand grain weight (TGW), but positively to several quality traits; Gleam negatively to the same quality traits but strongly positively to yield; and Melanie combined strong yield and TGW characteristics with neutral quality traits. Interactions in mixtures with Maris Otter, from which most of the cultivars are likely to derive some of their quality traits, were less apparent for quality than for yield. CONCLUSIONS: Complex mixtures gave yield benefits generally without compromising quality, and analysis methods were developed to identify the beneficial or negative effects of component cultivars on malting quality traits, thereby providing data for optimising mixtures design. Copyright © 2008 Society of Chemical Industry [source] | ||||||||||