This webinar slide-set illustrates the stepwise process of engaging Scalable Architecture for Federated Translational Inquiries Network (SAFTINet) practice stakeholders in
selecting and adapting a measure of patient-reported medication adherence.
For more information on SAFTINet, please see http://www.ucdenver.edu/academics/colleges/medicalschool/programs/outcomes/COHO/saftinet/Pages/default.aspx
This document summarizes a study on the predictive characteristics of users of alternative medicine. The study found that 6.6% of patients surveyed had visited an alternative practitioner in the previous year. These patients tended to be of middle age, have chronic conditions, have a lower quality of life, greater anxiety and depression, and were heavier users of primary and secondary healthcare. Three factors - self-care and visiting specialists, changing primary doctors, and younger age - explained 66.2% of the variance in alternative medicine use. The conclusions indicate that seeking alternative medicine seems driven by patient characteristics but was not due to dissatisfaction with their primary doctor.
Knowledge and Perceptions Related to Hypertension, Lifestyle Behavior Modific...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
The document discusses issues related to measuring and modeling medication adherence using claims data. It covers calculating adherence measures like MPR and PDC, defining adherence thresholds, handling primary non-compliance, and addressing endogeneity and selection bias when modeling adherence as an independent variable to estimate its impact on outcomes. Regression adjustment, propensity score matching, and instrumental variables are some methods discussed to address biases in observational studies of adherence.
The document discusses various methods for measuring outcomes in pharmacoepidemiology studies. It describes:
1) Common outcome measures including functional status, symptom status, patient satisfaction, economic measures, and quality of life studies.
2) How therapeutic outcomes can be classified as cure, improvement, no change, or deterioration and as success or failure.
3) How drug use is also measured using monetary units, number of prescriptions, units dispensed, defined daily doses, and medication adherence.
4) How risk is expressed using attributable risk, relative risk, time-risk relationships, and odds ratios to quantify the probability of outcomes in exposed versus unexposed groups.
This document provides an introduction to pharmacoepidemiology. It defines pharmacoepidemiology as the study of drug use and effects in large populations. It discusses study designs used in pharmacoepidemiology including randomized trials, cohort studies, case-control studies, and case reports. Reasons for performing pharmacoepidemiology studies include fulfilling regulatory and legal obligations, assessing drug safety, and generating or testing hypotheses. Sources of data include spontaneous adverse event reporting, prescription databases, and electronic health records. The document also briefly discusses molecular pharmacoepidemiology, bioethics, pharmacoeconomics, and measuring quality of life outcomes.
Medication errors are a significant problem in healthcare that can harm patients. They occur commonly at various stages of the medication process including prescribing, transcribing, preparing, dispensing, and administering medications. Several studies over decades have found high rates of medication errors and preventable adverse drug events in hospitals. James Reason developed a widely used model for classifying errors as either active failures by frontline staff or latent failures due to upstream organizational or management issues. Understanding the causes of errors through models like Reason's can help pharmacists and other healthcare providers develop effective strategies to improve medication safety.
This document summarizes a study on the predictive characteristics of users of alternative medicine. The study found that 6.6% of patients surveyed had visited an alternative practitioner in the previous year. These patients tended to be of middle age, have chronic conditions, have a lower quality of life, greater anxiety and depression, and were heavier users of primary and secondary healthcare. Three factors - self-care and visiting specialists, changing primary doctors, and younger age - explained 66.2% of the variance in alternative medicine use. The conclusions indicate that seeking alternative medicine seems driven by patient characteristics but was not due to dissatisfaction with their primary doctor.
Knowledge and Perceptions Related to Hypertension, Lifestyle Behavior Modific...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
The document discusses issues related to measuring and modeling medication adherence using claims data. It covers calculating adherence measures like MPR and PDC, defining adherence thresholds, handling primary non-compliance, and addressing endogeneity and selection bias when modeling adherence as an independent variable to estimate its impact on outcomes. Regression adjustment, propensity score matching, and instrumental variables are some methods discussed to address biases in observational studies of adherence.
The document discusses various methods for measuring outcomes in pharmacoepidemiology studies. It describes:
1) Common outcome measures including functional status, symptom status, patient satisfaction, economic measures, and quality of life studies.
2) How therapeutic outcomes can be classified as cure, improvement, no change, or deterioration and as success or failure.
3) How drug use is also measured using monetary units, number of prescriptions, units dispensed, defined daily doses, and medication adherence.
4) How risk is expressed using attributable risk, relative risk, time-risk relationships, and odds ratios to quantify the probability of outcomes in exposed versus unexposed groups.
This document provides an introduction to pharmacoepidemiology. It defines pharmacoepidemiology as the study of drug use and effects in large populations. It discusses study designs used in pharmacoepidemiology including randomized trials, cohort studies, case-control studies, and case reports. Reasons for performing pharmacoepidemiology studies include fulfilling regulatory and legal obligations, assessing drug safety, and generating or testing hypotheses. Sources of data include spontaneous adverse event reporting, prescription databases, and electronic health records. The document also briefly discusses molecular pharmacoepidemiology, bioethics, pharmacoeconomics, and measuring quality of life outcomes.
Medication errors are a significant problem in healthcare that can harm patients. They occur commonly at various stages of the medication process including prescribing, transcribing, preparing, dispensing, and administering medications. Several studies over decades have found high rates of medication errors and preventable adverse drug events in hospitals. James Reason developed a widely used model for classifying errors as either active failures by frontline staff or latent failures due to upstream organizational or management issues. Understanding the causes of errors through models like Reason's can help pharmacists and other healthcare providers develop effective strategies to improve medication safety.
THE IMPACT OF CLINICAL PHARMACIST IN DETECTION OFIslam Shallal
This study analyzed medical records from 80 patients at an internal medicine department in Zagazig, Egypt to identify drug-related problems. The study found that 66.2% of patients experienced drug-drug interactions, with the most common being moderate in severity and fair reliability. Errors included high doses, inappropriate frequencies, and wrong or duplicate drugs. The study recommends including clinical pharmacists in prescribing and monitoring to reduce errors and establish treatment guidelines.
The document outlines several strategies to reduce medication errors, including increasing awareness of high-risk populations like pediatrics and geriatrics, avoiding abbreviations, recognizing look-alike and sound-alike medications, focusing on high-alert medications, reporting errors to improve processes, controlling the environment, and educating patients. It emphasizes the importance of a culture of safety, team approach, best practices, and technical support strategies to continuously improve patient safety.
Medication errors that occur during hospital admission can lead to preventable adverse drug events. This study uses a model to assess the costs and health effects of interventions aimed at reducing medication errors during admission reconciliation. The model estimates that all five interventions identified by a literature review are highly cost-effective compared to current practice. A pharmacist-led reconciliation intervention has the highest expected cost-effectiveness. The study concludes that medication reconciliation interventions provide a cost-effective use of healthcare resources to improve patient safety.
This document provides an overview of case-control surveillance studies. It discusses that case-control studies are retrospective and aim to determine if an exposure is associated with an outcome. The document outlines how cases and controls are selected and defined, and how odds ratios are used to interpret the association between an exposure and disease. It also discusses potential sources of bias and confounding, and notes some key advantages and disadvantages of the case-control study design.
The document discusses various methods used for causality assessment of adverse drug reactions (ADRs), including algorithms. It outlines several algorithms such as the Karch & Lasagna, Begaud, Jones, Kramer, Naranjo, WHO-UMC, Thai, CIOMS/RUCAM, and ALDEN algorithms. Each algorithm has advantages and limitations. While the Naranjo algorithm is simple and brief, its dependability and validity are not confirmed for all populations. The WHO-UMC criteria are intended as a convenient tool for individual case reports but have limitations. Specific algorithms like CIOMS/RUCAM and ALDEN are used for certain ADRs. The best algorithm depends on the type of
Pharmacoepidemiology is the study of the use and effects of drugs in large populations. It combines the fields of clinical pharmacology and epidemiology. Recent data shows that adverse drug reactions cause 100,000 deaths and 1.5 million hospitalizations in the US each year, yet 20-70% may be preventable. Pharmacoepidemiology aims to detect adverse drug reactions early through observational studies in order to educate healthcare providers and the public about safer medication use. Key study types include case series, case-control studies, cohort studies, cross-sectional studies, and experimental studies. Drug utilization studies also fall under pharmacoepidemiology and evaluate factors related to prescribing, dispensing, administering, and taking
1. A patient was prescribed the wrong dose of phenytoin due to brand substitution and received 1025 mg instead of 270 mg, resulting in abnormal CT changes and prolonged drowsiness.
2. Dispensing and administration errors can occur from issues like confusing drug names, incorrect dosages, wrong drugs or routes of administration.
3. It is important for healthcare providers to have proper training, follow safe procedures, double check medications, and report any errors to prevent harm to patients.
complete description of causality assessment with the definition of basic terminologies.& relation with an adverse event and adverse drug reaction, causality terms & assessment criteria.
1) The study evaluated the potential severity of medication administration errors detected by a bar-code medication administration (BCMA) system in six hospitals.
2) The majority (91%) of errors reviewed were evaluated as having minor severity potential, while 9% were evaluated as moderate to severe.
3) "No order" errors, where there was no corresponding order entered, were significantly more likely to be evaluated as moderate or severe than other error types.
Role of hospital pharmacists in transitions of careRosalynn Pangan
Hospital pharmacists play a key role in medication reconciliation during care transitions to reduce medication errors. Medication reconciliation involves creating an accurate list of all medications a patient is taking and reconciling it with physician orders at various transition points like admission, transfer, and discharge. Studies show high rates of unintentional medication discrepancies during transitions that can harm patients if undetected. Pharmacists conducting medication reconciliation at transitions have been shown to identify and resolve many discrepancies, intercepting potential errors. Key elements for successful reconciliation include designating a single list shared by all providers, clearly defining roles, integrating the process into workflow, educating patients, and conducting reconciliation at various transition points in the care process.
Definition and scope of Pharmacoepidemiology ABUBAKRANSARI2
In these slides I shared the information of definition and scope of pharmacoepidemiology. Types of studies - cohort studies, cross-sectional studies etc.
This document provides an overview of drug utilization studies. It defines drug utilization research as the study of how drugs are used in populations with the goal of promoting rational and cost-effective drug use. The document outlines the objectives of drug utilization studies as describing drug use patterns, identifying irrational use, evaluating interventions to improve use, and quality control of drug use. It also discusses the types of information collected in these studies including drug-based, problem-based, patient-based, prescriber-based, and cost-based data. Finally, the document reviews the steps involved in conducting a drug utilization study from identifying the drugs and therapeutic areas to study design, data collection sources and methods, and establishing criteria to evaluate appropriate drug use.
The document summarizes the 2015 update of the American Geriatrics Society Beers Criteria, which provides a list of potentially inappropriate medications that should generally be avoided in older adults. Key points:
- The updated criteria include revisions to existing medications to avoid as well as new sections on medications requiring dose adjustments for kidney function and drug-drug interactions.
- A 13-member expert panel reviewed evidence and reached consensus on the criteria using a systematic, evidence-based process.
- The criteria are intended to improve medication safety for older adults by providing guidance to medical professionals, consumers, and health systems.
The document discusses medication errors and safe medication practices, including defining medication errors, causes of errors, and policies and procedures to prevent errors. Key policies include identifying patients, checking medications against orders, monitoring effects, documenting properly, and reporting any errors. The goal is to ensure the highest quality medications are safely administered as prescribed to prevent wrong drugs and adverse reactions.
A voluntary, Internet-based reporting system for neonatal healthcare providers recently revealed that a broad range of medical errors occur in the NICU.[3] The most frequent error categories reported were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). Errors in patient misidentification, for example, were a common cause of feeding a mother's expressed breast milk to the wrong baby.[3]
This document provides guidelines for preventing medication errors in pediatric patients. It discusses how medication errors are usually the result of failures in healthcare systems rather than individual practitioners. It recommends organizational systems like computerized prescriber order entry and automated dispensing devices to help prevent errors, provided they are programmed carefully with pediatric considerations in mind. Specific recommendations are provided for functions of computerized ordering, programming automated devices, and using technologies like bar coding appropriately in pediatric settings. The goal is to establish redundant systems that can help shape behavior and minimize medication errors in children.
This document discusses quality issues related to patient safety, specifically medication errors. It defines key terms like medical error, adverse event, and near miss. It then identifies systems and personnel issues that can contribute to medication errors, such as staffing levels, the physical environment, and a lack of adherence to policies and procedures. The document also outlines the nurse's role in preventing errors and systems that have been implemented, such as computerized order entry and barcoding. It provides an overview of a trigger tool for measuring adverse drug events and discusses the results of a previous study on using clinical decision support systems to change physician ordering behavior and reduce errors.
Sills MR. Medication Adherence PROM Measures Updates and Pilot Results. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection and Refinement by SAFTINet Stakeholders. 2 July 2012.
THE IMPACT OF CLINICAL PHARMACIST IN DETECTION OFIslam Shallal
This study analyzed medical records from 80 patients at an internal medicine department in Zagazig, Egypt to identify drug-related problems. The study found that 66.2% of patients experienced drug-drug interactions, with the most common being moderate in severity and fair reliability. Errors included high doses, inappropriate frequencies, and wrong or duplicate drugs. The study recommends including clinical pharmacists in prescribing and monitoring to reduce errors and establish treatment guidelines.
The document outlines several strategies to reduce medication errors, including increasing awareness of high-risk populations like pediatrics and geriatrics, avoiding abbreviations, recognizing look-alike and sound-alike medications, focusing on high-alert medications, reporting errors to improve processes, controlling the environment, and educating patients. It emphasizes the importance of a culture of safety, team approach, best practices, and technical support strategies to continuously improve patient safety.
Medication errors that occur during hospital admission can lead to preventable adverse drug events. This study uses a model to assess the costs and health effects of interventions aimed at reducing medication errors during admission reconciliation. The model estimates that all five interventions identified by a literature review are highly cost-effective compared to current practice. A pharmacist-led reconciliation intervention has the highest expected cost-effectiveness. The study concludes that medication reconciliation interventions provide a cost-effective use of healthcare resources to improve patient safety.
This document provides an overview of case-control surveillance studies. It discusses that case-control studies are retrospective and aim to determine if an exposure is associated with an outcome. The document outlines how cases and controls are selected and defined, and how odds ratios are used to interpret the association between an exposure and disease. It also discusses potential sources of bias and confounding, and notes some key advantages and disadvantages of the case-control study design.
The document discusses various methods used for causality assessment of adverse drug reactions (ADRs), including algorithms. It outlines several algorithms such as the Karch & Lasagna, Begaud, Jones, Kramer, Naranjo, WHO-UMC, Thai, CIOMS/RUCAM, and ALDEN algorithms. Each algorithm has advantages and limitations. While the Naranjo algorithm is simple and brief, its dependability and validity are not confirmed for all populations. The WHO-UMC criteria are intended as a convenient tool for individual case reports but have limitations. Specific algorithms like CIOMS/RUCAM and ALDEN are used for certain ADRs. The best algorithm depends on the type of
Pharmacoepidemiology is the study of the use and effects of drugs in large populations. It combines the fields of clinical pharmacology and epidemiology. Recent data shows that adverse drug reactions cause 100,000 deaths and 1.5 million hospitalizations in the US each year, yet 20-70% may be preventable. Pharmacoepidemiology aims to detect adverse drug reactions early through observational studies in order to educate healthcare providers and the public about safer medication use. Key study types include case series, case-control studies, cohort studies, cross-sectional studies, and experimental studies. Drug utilization studies also fall under pharmacoepidemiology and evaluate factors related to prescribing, dispensing, administering, and taking
1. A patient was prescribed the wrong dose of phenytoin due to brand substitution and received 1025 mg instead of 270 mg, resulting in abnormal CT changes and prolonged drowsiness.
2. Dispensing and administration errors can occur from issues like confusing drug names, incorrect dosages, wrong drugs or routes of administration.
3. It is important for healthcare providers to have proper training, follow safe procedures, double check medications, and report any errors to prevent harm to patients.
complete description of causality assessment with the definition of basic terminologies.& relation with an adverse event and adverse drug reaction, causality terms & assessment criteria.
1) The study evaluated the potential severity of medication administration errors detected by a bar-code medication administration (BCMA) system in six hospitals.
2) The majority (91%) of errors reviewed were evaluated as having minor severity potential, while 9% were evaluated as moderate to severe.
3) "No order" errors, where there was no corresponding order entered, were significantly more likely to be evaluated as moderate or severe than other error types.
Role of hospital pharmacists in transitions of careRosalynn Pangan
Hospital pharmacists play a key role in medication reconciliation during care transitions to reduce medication errors. Medication reconciliation involves creating an accurate list of all medications a patient is taking and reconciling it with physician orders at various transition points like admission, transfer, and discharge. Studies show high rates of unintentional medication discrepancies during transitions that can harm patients if undetected. Pharmacists conducting medication reconciliation at transitions have been shown to identify and resolve many discrepancies, intercepting potential errors. Key elements for successful reconciliation include designating a single list shared by all providers, clearly defining roles, integrating the process into workflow, educating patients, and conducting reconciliation at various transition points in the care process.
Definition and scope of Pharmacoepidemiology ABUBAKRANSARI2
In these slides I shared the information of definition and scope of pharmacoepidemiology. Types of studies - cohort studies, cross-sectional studies etc.
This document provides an overview of drug utilization studies. It defines drug utilization research as the study of how drugs are used in populations with the goal of promoting rational and cost-effective drug use. The document outlines the objectives of drug utilization studies as describing drug use patterns, identifying irrational use, evaluating interventions to improve use, and quality control of drug use. It also discusses the types of information collected in these studies including drug-based, problem-based, patient-based, prescriber-based, and cost-based data. Finally, the document reviews the steps involved in conducting a drug utilization study from identifying the drugs and therapeutic areas to study design, data collection sources and methods, and establishing criteria to evaluate appropriate drug use.
The document summarizes the 2015 update of the American Geriatrics Society Beers Criteria, which provides a list of potentially inappropriate medications that should generally be avoided in older adults. Key points:
- The updated criteria include revisions to existing medications to avoid as well as new sections on medications requiring dose adjustments for kidney function and drug-drug interactions.
- A 13-member expert panel reviewed evidence and reached consensus on the criteria using a systematic, evidence-based process.
- The criteria are intended to improve medication safety for older adults by providing guidance to medical professionals, consumers, and health systems.
The document discusses medication errors and safe medication practices, including defining medication errors, causes of errors, and policies and procedures to prevent errors. Key policies include identifying patients, checking medications against orders, monitoring effects, documenting properly, and reporting any errors. The goal is to ensure the highest quality medications are safely administered as prescribed to prevent wrong drugs and adverse reactions.
A voluntary, Internet-based reporting system for neonatal healthcare providers recently revealed that a broad range of medical errors occur in the NICU.[3] The most frequent error categories reported were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). Errors in patient misidentification, for example, were a common cause of feeding a mother's expressed breast milk to the wrong baby.[3]
This document provides guidelines for preventing medication errors in pediatric patients. It discusses how medication errors are usually the result of failures in healthcare systems rather than individual practitioners. It recommends organizational systems like computerized prescriber order entry and automated dispensing devices to help prevent errors, provided they are programmed carefully with pediatric considerations in mind. Specific recommendations are provided for functions of computerized ordering, programming automated devices, and using technologies like bar coding appropriately in pediatric settings. The goal is to establish redundant systems that can help shape behavior and minimize medication errors in children.
This document discusses quality issues related to patient safety, specifically medication errors. It defines key terms like medical error, adverse event, and near miss. It then identifies systems and personnel issues that can contribute to medication errors, such as staffing levels, the physical environment, and a lack of adherence to policies and procedures. The document also outlines the nurse's role in preventing errors and systems that have been implemented, such as computerized order entry and barcoding. It provides an overview of a trigger tool for measuring adverse drug events and discusses the results of a previous study on using clinical decision support systems to change physician ordering behavior and reduce errors.
Sills MR. Medication Adherence PROM Measures Updates and Pilot Results. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection and Refinement by SAFTINet Stakeholders. 2 July 2012.
This document discusses study eligibility criteria and how to set criteria for systematic reviews. It explains that criteria should be tied to the review questions and consider population, intervention, outcomes, timing, and setting. Criteria can be broad to explore what is known or narrow to focus on specific questions, and finding the right balance is important. The document provides examples of how criteria choices can impact applicability and bias reviews by including or excluding certain studies.
The document discusses how The Assessment Group conducts evaluations and assessments exclusively for the healthcare industry using MDs, PhDs, biostatisticians and market research experts. They use case-based clinician surveys and vignettes to measure the effectiveness and impact of promotional programs on physician decisions and clinical practice patterns. The evaluations provide data to demonstrate return on investment of promotional activities and guide future initiatives.
Introduction to Evidence Based Medicine (EBM)Elsayed Salih
This document provides an overview of evidence-based medicine (EBM), including its definition, importance, and process. It defines EBM as the conscientious use of the best available evidence in making decisions about patient care. The key steps in EBM are asking a clear clinical question using the PICO framework, acquiring evidence through a literature search, appraising the evidence for validity and applicability, and applying the evidence to the individual patient. Examples of question types and appropriate study designs are also discussed.
Antiretroviral Medication Adherence
The document summarizes evidence and recommendations for improving adherence to antiretroviral (ART) medication. It discusses how adherence is critical for treatment success and preventing HIV transmission. Current adherence levels tend to be suboptimal, around 50-60% on average. Key factors that influence adherence include treatment regimen complexity, mental health issues, social support, and the patient-provider relationship. The evidence shows that adherence interventions can effectively improve adherence when they address knowledge, barriers, medication management skills, and provide ongoing support. The recommendations focus on assessing and addressing individual patient barriers, simplifying treatment regimens, maintaining open communication, and involving adherence support teams.
This document discusses evidence-based medicine and the process of conducting clinical trials to evaluate new drugs. It describes how clinical trials progress from early phases evaluating safety and appropriate dosing to later phases assessing efficacy. Key aspects addressed include study design, informed consent, ethics review, and post-marketing surveillance. The goal of drug development is to demonstrate that a new medication has genuine clinical benefit compared to existing options and that its risks are closely monitored.
The development of a Patient Safety Programme for Primary Care is being informed by the learning from two ongoing primary care safety projects. This session highlights the approaches used, the early findings and describes how to sustain and spread the success of this work.
- The document discusses evidence-based practice (EBP) and how to formulate clinical questions and search for evidence using databases and subject headings.
- The EBP process involves identifying a problem, developing a focused clinical question using PICO (population, intervention, comparison, outcome), searching relevant resources, critically appraising the evidence, and implementing in practice.
- Useful databases for finding evidence include CINAHL, MEDLINE, Cochrane Library. Subject headings and filters can help narrow search results.
The document provides information about Drug Information Centres (DIC). It defines a DIC as a service that provides advice and refers queries about drugs to appropriate resources. DICs aim to promote evidence-based practice and improve patient care. They classify DICs as hospital-based, industry-based, or community-based. Clinical pharmacists working in DICs provide written or verbal drug information to healthcare professionals and patients. They respond to queries about various drug attributes like indications, dosages, interactions and side effects. When answering drug information questions, pharmacists gather background details, clarify the question, search multiple sources for relevant data, interpret the findings and formulate an appropriate response to address the query.
Predicting Patient Adherence: Why and HowCognizant
To contain costs and improve healthcare outcomes, players across the value chain must apply advanced analytics to measure and understand patients’ failure to follow treatment therapies, and to then determine effective remedial action. This white paper lays out a framework for enabling patient adherence management and some general prescriptions on how to convert lofty concepts to meaningful action.
This document discusses the process of applying evidence from medical studies to patient care. It addresses determining if a study's patients, interventions, and outcomes are relevant to one's own patients. Some key points discussed are assessing if one's patients have similar characteristics and risk factors as the study's patients, if the interventions used are feasible in one's practice setting, and if the outcomes measured are meaningful to patients. The document emphasizes considering the individual patient's values, preferences, and understanding of potential interventions and implications.
Bipolar TherapyClient of Korean DescentAncestryDecisionChantellPantoja184
Bipolar Therapy
Client of Korean Descent/Ancestry
Decision Point One
B Begin Risperdal 1 mg orally BIDegin Risperdal 1 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client is accompanied today by her mother who must help the client into your office, the client looks very sedated and lethargic
Client's mother explains that “she has been like this since about a week after the last office visit”
Decision Point Two
RESULTS OF DECISION POINT TWO
Discontinue Risperdal and start Lithium sustained release 300 mg orally BID
Client returns to clinic in four weeks
Client no longer lethargic after the end of the first week
Client has a slight decrease in her Young Mania Rating Scale (from 22 to 19)
Client reports that her sleep is again decreasing, but that overall, she is happy
Decision Point Three
Make no changes at this time & reevaluate in 4 weeks
Guidance to Student
Recall that the client is of Korean descent and is positive for CYP2D6*10 allele. As a result, she may be demonstrating slower clearance of Risperdal from her system, resulting in higher than normal levels of Risperdal in the blood, resulting in sedation. The client responded well to the discontinuation of Risperdal and after about a week of drug cessation, she was no longer lethargic/sedate. However, in the following 3 weeks, she had experienced increased symptoms, although a slight improvement in YMSR score was noted. You could make no changes at this time and allow the lithium to remain at its current dose for an additional 4 weeks and reassess. Conversely, you can increase the lithium to 450 mg orally BID and then reassess in 4. The additional milligrams may hasten mood stabilization. Risperdal 0.5 mg orally BID may be appropriate if the clients’ symptoms are worsening, however, you would need to have the client return to the office sooner than 4 weeks for an interim visit to assess effects of drug and presence of somnolence/lethargy.
Rubric Detail
Select Grid View or List View to change the rubric's layout.
Content
Name: NURS_6630_Week5_Assignment_Rubric
Grid ViewList View
Excellent
Point range: 90–100
Good
Point range: 80–89
Fair
Point range: 70–79
Poor
Point range: 0–69
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Points:
Points Range:
9 (9%) - 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.
The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
Feedback:
Points:
Points Range:
8 (8%) - 8 (8%) ...
The document discusses medication non-compliance and various ways to measure it. It notes that 50-75% of chronically ill patients do not take their medication as prescribed. Several validated questionnaires are available to measure adherence, including the Morisky Medication Adherence Scale (MMAS-8) and the General Medication Adherence Scale (GMAS). Measuring adherence through questionnaires, pill counts, pharmacy records, and biomarkers can help healthcare providers understand reasons for non-compliance and address them to improve treatment outcomes.
This document summarizes a presentation on optimizing the use of urine drug testing. It contains 4 learning objectives focused on identifying obstacles to appropriate urine drug testing, describing a clinical approach, explaining legal liability, and advocating for policy responses. The presentation consists of 4 speakers and a moderator and covers developing a consensus on urine drug testing, including general guidelines, test selection, use in diagnosis and treatment. It emphasizes individualizing decisions based on patient history and needs, using preliminary tests for quick results and definitive tests for accuracy, and documenting decisions in medical records.
Learn best practices based on literature and how to perform a complex and accurate medication history. Recognize gaps/inconsistencies in systems that impede medication reconciliation and identify next steps in improving current medication reconciliation within your own practice.
Speaker:
Mary Pat Friedlander, MD
Lawrenceville Family Health Center
Pittsburgh, PA
SOAP NOTE- GASTRITISThe goal of this assignment is to practi.docxpbilly1
This document provides a rubric for evaluating a SOAP note assignment on gastritis. The SOAP note should include the following sections:
1) Subjective: Patient description, chief complaint, history of present illness, review of focus systems, medications, and health history.
2) Objective: Physical exam findings relevant to the chief complaint and systems review. Appropriate examination techniques should be documented.
3) Assessment: Differential diagnoses supported by subjective and objective findings. Scholarly resources should support the differentials.
4) Plan: Comprehensive treatment plan including testing, medications, referrals, education and follow up. The plan should be supported by current guidelines.
The document proposes a pilot study to investigate the feasibility of integrating behavioral health outcomes data into routine clinical practice. The study would measure how frequently providers collect outcomes data from patients and enter it into the health records system. It would also survey patients and providers on their perceptions of the value of receiving feedback on treatment progress. If found feasible, a follow-up study would assess the quality and cost impacts of incorporating outcomes monitoring more broadly.
Measuring and Enhancing Your Academic Medical ImpactMarion Sills
Overview of measuring and enhancing the impact of your scholarly work in academic medicine. The talk reviews how impact is defined and measured, how to improve your own impact metrics and how to describe the impact of your scholarly contributions to science.
Adding Social Determinant Data Changes Children’s Hospitals’ Readmissions Per...Marion Sills
Adding social determinant data to risk adjustment models for pediatric readmissions led to minimal changes in model performance at the discharge level, but resulted in changes to hospital performance rankings. Specifically:
- Adding social determinant variables from electronic health records and zip codes to existing clinical risk adjustment models did not meaningfully improve the accuracy or fit of models predicting individual readmissions.
- However, accounting for social determinants did change some hospitals' risk-adjusted readmission rates and performance deciles compared to peers. This suggests social determinants may influence hospital performance evaluations and penalties if unadjusted.
- Including social determinants in readmissions modeling more fully captures factors influencing readmissions and provides a more accurate assessment of hospital quality.
Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Pra...Marion Sills
Kwan BM, Sills MR, Graham D, Hamer MK, Fairclough DL, Hammermeister KE, Kaiser A, Diaz-Perez MJ, Schilling LM. Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Practice-Based Research Network. JABFM. In Press.
Practice Variability in and Correlates of Patient-Centered Medical Home Chara...Marion Sills
Schilling LM, Sills MR, Fairclough D, Kwan MB. Practice Variability in and Correlates of Patient-Centered Medical Home Characteristics. SAFTINet Convocation. Aurora, Colorado. 13 Feb 2013.
This document describes the design and methods of a prospective cohort study examining the association between practice-level medical home characteristics and asthma outcomes in children and adults. The study will use surveys of medical home characteristics and secondary data from 2011-2013. Asthma control and exacerbations will be measured repeatedly from July 2012 to December 2013. Hierarchical linear models will assess the relationship between medical home scores and asthma outcomes, adjusting for potential confounders. Sensitivity analyses will address issues like misclassification bias. Results will be presented separately for children and adults.
Sills MR. Inpatient capacity margin at children's hospitals during the fall 2009 H1N1 influenza pandemic. Presentation to the Colorado Emergency Medicine Research Center. 14 June 2010.
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
Patient-reported outcomes for asthma in children and adultsMarion Sills
Patient-reported outcomes for asthma in children and adults. Guided Discussion to Facilitate SAFTINet Stakeholders' Selection of an Asthma PROM. Teleconference. 1 April 2011
Sills MR. Cardiovascular Cohorts PROM Measures Updates and Action Items. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholder Community. 21 March 2012.
Sills MR. Evolution of PRO Measure for Cardiovascular Cohorts in SAFTINet. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholders. 2 May 2012.
Sills MR. Medication Adherence PROM Measures and Self Efficacy. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholders. 21 May 2012.
Cer safti net overview edrc 1 feb 2011Marion Sills
Sills MR. Overview of Comparative Effectiveness Research Using SAFTINet as an Example. Methods Talk presented to the Emergency Department Research Conference, Department of Pediatrics, 1 February 2011.
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Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
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CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
2. +
Overview
What medication adherence domains should we measure?
Medication adherence: quantified
Barriers
Self-efficacy
What instruments should we use?
Who would be surveyed (PEC: all patients) and how?
How would we use the findings in our research?
How would our partners use the instruments?
3. +
Overview
What medication adherence domains should we measure?
Medication adherence: quantified
Barriers
Self-efficacy
What instruments should we use?
Who would be surveyed and how?
How would we use the findings in our research?
How would our partners use the instruments?
4. +
Medication Adherence Measures
Options in SAFTINet
self-report: simple to obtain in real time
other real-time methods: more cumbersome and costly
pill counts, drug levels, direct observation, etc.
prescription fulfillment data
in SAFTINet: only for Medicaid patients
only tells whether they filled the prescription
Patient
(person)
Medication adherence
(behavior)
Self-efficacyBarriers
5. +
Medication Adherence Measures
Feedback from PEC
Medication adherence would be helpful to know
most clinicians ask this already
the simpler the better
Barriers would be useful
helped refine the list of domains to cover based on clinical
experience
Self-efficacy—no clear direction yet from PEC
Patient
(person)
Medication adherence
(behavior)
Self-efficacyBarriers
6. +
Overview
What medication adherence domains should we measure?
What instruments should we use?
Medication adherence: quantified
Barriers
Self-efficacy
Who would be surveyed and how?
How would we use the findings in our research?
How would our partners use the instruments?
7. +
Review of Self-Reported Medical
Adherence Measures
Garfield S, et al. Suitability of measures of self-reported
medication adherence for routine clinical use: A systematic
review. BMC Med Res Methodol. 2011; 11: 149.
Inclusion Criteria: Studies that report development, reliability or
validation of a retrospective self report adherence measure
against a non-questionnaire measure
Exclusion Criteria: (excerpt)
non-English
no instrument available
only relevant to single disease or medication
med adherence questions not separable from other questions
8. +
Review findings
58 measures in 76 papers
Length: 1 to 21 questions
Formats: face to face interview, telephone interview, self
administration and computer program
43/58 specified a time period
~half had a measure of barriers too, but these were usually not
comprehensive or developed with patient feedback
54/58 had validation data
11. +
Narrowing down the field
Selected studies with only 1 question: 21/58
Selected studies with significant findings for validation study:
16/58
Selected studies not limited to an HIV positive or Mental Health
population: 5/58
Rationale: focus on less symptomatic population
12. +
Scale
[Ref #] Scale type Time period Sample size Population
Validated
against
Validity
Results
Adherence
Self Report
Questionnair
e (ASRQ)
[25-27] Likert
None
Specified 245
Patients from
GP practice
taking
antihyperten
sives MEMS
Significant
association
(p=0.0004)
216
Patients from
GP Practices
taking
antihyperten
sives MEMS
Sensitivity=
46%;
Specificity=6
6%
Gehi [41] Likert
Previous
month 1015
Outpatients
with
documented
chronic heart
disease
Develop-
ment of CV
events
Significant
association
(p=0.03)
bivariate
analysis,
0.06
multivariate
analysis)
Inui [46] Dichotomous
Previous 2
months 241
Patients with
HTN Pill count
Sensitivity =
55%;
Specificity =
88%
13. +
Scale
[Ref #] Scale type Time period Sample size Population
Validated
against
Validity
Results
Medical
Outcomes
Study
Adherence
question [57] Likert
Previous 4
weeks 139
Patients >18
with HTN,
DM, hyper-
cholesterole
mia, hypo-
thyroidism or
requiring
HRT
Pharmacy
refill records
Spearman
Rho=
0.261(p=0.05
)
Visual
Analogue
Scale (VAS)
six month
version [89]
Continuous
(visual
analogue)
Previous 6
months 1985
Patients >18
with DM MEMS
VAS higher
than MEMS
adherence
mean
difference
15% (p value
not reported)
15. +
Gehi Question
In the past month, how often did you take your medications as the
doctor prescribed?
“All of the time” (100%)
“Nearly all of the time” (90%)
“Most of the time” (75%)
“About half the time” (50%)
“Less than half the time” (<50%)
16. +
Medical Outcomes Study
Adherence question
How often have you taken your prescribed medication in the
past 4 weeks? (Select one)
none of the time
a little of the time
some of the time
a good bit of the time
most of the time or all of the time
Similar to Gehi question
17. +
Inui Question
Many patients find it difficult to take their medicines
or stick to their diets as their doctors say they
should. Over the past two months since you were
last in clinic, do you think you have taken your
medicine as you should, on schedule and regularly?
Yes
No
18. +
Visual Analogue Scale (VAS) six
month version
What percent of time over the past 6 months did you take your
prescribed diabetes medication?
Place an “x” on a horizontal line
anchored by 0% and100%
demarcations provided for every 10th percentile
19. +
Self-Reported Medical Adherence
Measures
Recommendations on selecting a measure quantifying
medication adherence?
Adherence Self Report Questionnaire (ASRQ)
6 levels, more text per level
Gehi Question
5 levels, brief text and percentages for each level
Medical Outcomes Study Adherence question
5 levels, brief text for each level
Inui Question
yes/no question
Visual Analogue Scale (VAS) six month version
20. +
Medication Adherence from Claims
Fulfillment Data
Medication possession ratio (MPR) = (days of medication
supplied) ÷ (# days between the first and last fills)
Proportion of days covered (PDC): the proportion of all days
within a specified time period a patient had enough medication
Percentage of doses taken as prescribed: the percentage of
prescribed doses taken as directed during a specified time
period
Cumulative medication gap (CMG) = (# days in which a
medication was not available) ÷ (# days between the first and
last fills)
21. +
Overview
What medication adherence domains should we measure?
What instruments should we use?
Medication adherence: quantified
Barriers
Self-efficacy
Who would be surveyed and how?
How would we use the findings in our research?
How would our partners use the instruments?
22. +
Medication Adherence Measures:
Barriers Measure
Starting point for which barriers to ask about
what barriers have been shown to matter in research studies
what barriers do you encounter in your own practices (known to be
very context dependent)
emphasize barriers that are amenable to real-world intervention
(e.g., prescribe a daily rather than twice-daily medication)
Patient
(person)
Medication adherence
(behavior)
Self-efficacyBarriers
23. +
Medication Adherence Measures:
Barriers Measure
Starting point for which barriers to ask about
what barriers have been shown to matter in research studies
RAND Corporation systematic review of barriers found to predict
measured medication adherence
regimen complexity
cost-sharing (e.g., prescription copayments, formulary tiers,
coinsurance, pharmacy benefit caps or monthly prescription limits,
formulary restrictions, and reference pricing)
depression (found effect only as comorbidity of diabetes)
beliefs about medications (perceived risks of having a side effect
and perceived impact and need for the medication)
24. +
Medication Adherence Measures:
Barriers Measure
Based on the RAND list, and eliminating depression, here is a
sample barriers measure, modified by PEC
Which of the following things make it harder for you to take
your medication(s) as prescribed?
I am worried about the side effects of the medication(s)
I do not feel like I need the medication(s) for my health
I do not feel like the medication(s) make me feel any better
It is hard to take medication(s) more than once a day
I have so many medications to take
I cannot afford to pay for the medication(s)
I sometimes forget to take my medication(s)
25. +
Medication Adherence Measures:
Barriers Measure
No systematic review of barriers measures
Per PubMed, the ASK-20 and ASK-12 are
commonly cited
not disease specific
validated
ASK-12
contains the questions most often identified as barriers by patients
taking the ASK-20
Three domains – Inconvenience/forgetfulness, Treatment beliefs,
Behavior – each with a subscale
26. +
Medication Adherence Measures:
Barriers Measure
ASK-12 total score demonstrated adequate internal consistency
reliability with a Cronbach’s alpha of 0.75
ASK-12 score correlates with self-report measures and objective
measures
Morisky Adherence Survey (-0.74)
proportion of days covered as indicated by claims (r=-0.20; P=0.059)
Score
range 12-60
higher score = greater barriers
In a clinical setting it is not necessary to score the instrument, only
review the items in the dark blue boxes
29. +
Overview
What medication adherence domains should we measure?
What instruments should we use?
Medication adherence: quantified
Barriers
Self-efficacy
Who would be surveyed and how?
How would we use the findings in our research?
How would our partners use the instruments?
30. +
Medication Adherence Measures: Self-
efficacy
Medication Adherence Self-Efficacy Scale (MASES)
Ogedegbe et al 2003
Validated in African-American patients with hypertension
Please rate how sure you are that you can carry out the
following tasks ALL OF THE TIME: (all answers are on a 3
point scale: Not at all sure, somewhat sure, very sure)
Get refills for your medications before you run out
Make taking your medications part of your routine
Fill your prescriptions whatever they cost
Always remember to take your blood pressure medications
Take your blood pressure medications for the rest of your life
31. +Situations come up that make it difficult for people to take their medications as prescribed by their
doctors. Below is a list of such situations. We want to know your opinion about taking your blood
pressure medication(s) under each of them. Please indicate your response by checking the box that
most closely represents your opinion. There are no right or wrong answers. For each of the
situations listed below, please rate how sure you are that you can take your blood pressure
medications ALL OF THE TIME
1. When you are busy at home
2. When you are at work
3. When there is no one to remind you
4. When you worry about taking them for the rest of your life
5. When they cause some side effects
6. When they cost a lot of money
7. When you come home late from work
8. When you do not have any symptoms
9. When you are with family members
10. When you are in a public place
11. When you are afraid of becoming dependent on them
32. +
Overview
What medication adherence domains should we measure?
What instruments should we use?
Medication adherence: quantified
Barriers
Self-efficacy
Who would be surveyed and how?
How would we use the findings in our research?
How would our partners use the instruments?
33. +
Options for Med Adherence PRO
Administration
Easier to administer to all patients than to only those with select
diagnoses
Having just one screening question is more practical
Administer medication adherence measure first
then administer barriers +/- self-efficacy questions
only administer barriers +/- self-efficacy questions to those with non-
adherence
Administer barriers +/- self-efficacy questions first and leave the
medication adherence question for last
34. +
Overview
What medication adherence domains should we measure?
What instruments should we use?
Medication adherence: quantified
Barriers
Self-efficacy
Who would be surveyed and how?
How would we use the findings in our research?
How would our partners use the instruments?
35. +
Research Utility
Which domains would we use?
medication adherence
barriers measure total score
self-efficacy total score
How would we use these in an analytic model?
PCMH
Medication adherence
Self-efficacyBarriers
Disease control
36. +
Research Utility
How would we use fulfillment data in an analytic model?
Verify self-report data
As an outcome or intermediate variable in the PCMH model
PCMH
Prescription fulfillment
Disease control
37. +
Overview
What medication adherence domains should we measure?
What instruments should we use?
Medication adherence: quantified
Barriers
Self-efficacy
Who would be surveyed and how?
How would we use the findings in our research?
How would our partners use the instruments?
38. +
Utility to Practices
Which of the components of the proposed PRO would have
clinical (and other use) utility to the practices?
What related activities are the practices already doing?
Some clinicians are asking about medication adherence and
barriers but not documenting responses in a field
Nurses check the list of active medications at intake, asking which
they are still taking and why they stopped those they are no longer
taking
Meaningful use phase 2 will require goal-setting and a barriers
format might meet these criteria
ACO activities related to identifying high-risk patients for
hospitalization (next slide)
39. +
Example of Medication Adherence
Question Already In Use
How many prescription medications are you currently taking every day
(H-8)?
None (0) (skip to Social Needs) 1-2 (0) 3 OR MORE (1)
In a TYPICAL WEEK how often did you forget to take or decide NOT to
take one or more of your medications (H-8)?
NEVER (0) RARELY (0) SOMETIMES (1) USUALLY (1) ALWAYS
(1)
How sure are you that you understand the reason you are taking your
medications (H-8)?
VERY SURE (0) SOMEWHAT SURE (0) NOT VERY SURE (1)
How often do you get your medications at more than one pharmacy?
NEVER (0) RARELY (0) SOMETIMES (1) USUALLY (1) ALWAYS
(1)
Editor's Notes
Maria: Would focus on the beliefs aspect
We don’t know about side effect, relief of symptoms, and beliefs
Alycin: I would like to know about cost as a barrier because then I would get them on an assistance program
Jeanne: One thing missing is the forgetting issue—why they forget is not clear
If I hear of this I tell them about pill boxes
Jena: Another barrier is I feel asymptomatic, I feel fine
Collapse the insurance/formulary within the not affording to pay
Parinda: I like leaving the med adherence question for last; they may be more likely to be honest if they recognize we can recognize and validate their responses to the barriers issues
Jeanne: This means we would give the long questionnaire to everyone. In real world, having one screening question might be more practical—just target the people who are reporting those who are not taking the medications regularly
Jena: Instead of asking how often they take their meds, ask how often you forget to take their meds
Alicyn: the RN gives them the med list and have the patients cross of meds they are not taking anymore at triage
Parinda: I would like to take this to our PCPs and get their input, how they address it now
MCPN: Pre-appointment checklist: various questions is 2 pages long and we could add 1 more question to this—administered as the patient checks in for the visit in the waiting room. It’s the same issue with the ACT because someone has to decide that this patient needs to fill out this form until it gets back to the provider. It would be easier to ask of all patients.
From a clinician’s perspective, I don’t just want to know about CV meds, so it makes more sense to ask about all of the meds.