These guidelines provide recommendations for emergency departments in Washington state on prescribing opioids. Key points include: only providing enough opioids to last until a patient can be seen by their primary care provider; avoiding replacing lost/stolen medications; not prescribing long-acting opioids; encouraging screening for substance abuse issues; and coordinating care for frequent emergency department users. The goal is to address the opioid crisis while still effectively treating patients in need of emergency care.
Detection, reporting and management of adverse eventsKatla Swapna
This document discusses adverse drug reactions (ADRs), including definitions, classifications, detection, reporting, and management. It notes that ADRs are a major clinical problem that can cause suffering and increased healthcare costs. It emphasizes the importance of monitoring and reporting ADRs to improve patient safety. Pharmacists can play an important role by monitoring high-risk patients and drugs, educating on ADR reporting, and assisting in the detection and assessment of ADRs. Timely reporting of ADRs is crucial to help prevent human suffering and unnecessary costs from drug-related injuries.
National list of essential medicine final copynkar2429
This document provides an executive summary of the National List of Essential Medicines of India from 2011. It overviews the process of revising the 2003 list to develop the 2011 list, which included rounds of consultation with experts from across India to determine which medicines should be included based on disease burden and healthcare needs. The revised 2011 list aims to promote rational and affordable medicine use in both public and private healthcare sectors in India. It categorizes medicines by therapeutic area and provides the full list of additions and deletions from the previous 2003 version.
Pharmacovigilance (PV) is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem.
a presentation in CME activities by Saad Specialist Hospital, KSA
Regulatory terminologies used in PV (Pharmacovigilance)MubasheeraMg
This document defines various regulatory terminologies used in pharmacovigilance (PV). It defines key terms like pharmacovigilance, adverse drug reactions, clinical trials, causality assessment, and data mining. It also provides definitions for terms related to evaluating drug safety like absolute risk, incidence, benefits, harms, and effectiveness/risk analysis. Regulatory organizations involved in PV like CIOMS, ICH, and MedDRA are also defined.
Monitoring and Reporting of Adverse Event /Adverse Drug Reaction (Methodolog...SMS MEDICAL COLLEGE
This document discusses adverse drug reactions (ADRs), including definitions, benefits of reporting ADRs, and the ADR reporting process in India. It notes that ADRs are a leading cause of death and hospital admissions. Reporting ADRs helps assess drug safety, provides updated safety information, and can lead to regulatory actions to protect patients. The reporting process in India involves using standard forms to report suspected ADRs to the nearest ADR monitoring center or directly to the national pharmacovigilance program. Reporters include healthcare professionals and consumers.
These are some frequently asked questions in Pharmacovigilance Interview & its Preparation.
"HANDS IN HANDS LEARNING"
FOR ENROLLMENT-
CONTACT US ON-
https://pristynresearch.com/
MAIL ID - pristynresearch@gmail.com
ADDRESS-
1) Parmar Trade Centre, A-wing,105/106, Sadhu Vaswani Chowk, Pune, 411001. Email: info@pristynresearch.com Phone: 09028839789
2)T-21/4 ,Opposite To Expert Global, Garware Stadium Road , Software Technology Park of India(STPI), MIDC, Aurangabad-431001. Email: info@pristynresearch.com Call us: 09607709586
Global Medical Cures™ | INTUNIV- Pediatric PostMarket Adverse Event ReviewGlobal Medical Cures™
Global Medical Cures™ | INTUNIV- Pediatric PostMarket Adverse Event Review
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Detection, reporting and management of adverse eventsKatla Swapna
This document discusses adverse drug reactions (ADRs), including definitions, classifications, detection, reporting, and management. It notes that ADRs are a major clinical problem that can cause suffering and increased healthcare costs. It emphasizes the importance of monitoring and reporting ADRs to improve patient safety. Pharmacists can play an important role by monitoring high-risk patients and drugs, educating on ADR reporting, and assisting in the detection and assessment of ADRs. Timely reporting of ADRs is crucial to help prevent human suffering and unnecessary costs from drug-related injuries.
National list of essential medicine final copynkar2429
This document provides an executive summary of the National List of Essential Medicines of India from 2011. It overviews the process of revising the 2003 list to develop the 2011 list, which included rounds of consultation with experts from across India to determine which medicines should be included based on disease burden and healthcare needs. The revised 2011 list aims to promote rational and affordable medicine use in both public and private healthcare sectors in India. It categorizes medicines by therapeutic area and provides the full list of additions and deletions from the previous 2003 version.
Pharmacovigilance (PV) is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem.
a presentation in CME activities by Saad Specialist Hospital, KSA
Regulatory terminologies used in PV (Pharmacovigilance)MubasheeraMg
This document defines various regulatory terminologies used in pharmacovigilance (PV). It defines key terms like pharmacovigilance, adverse drug reactions, clinical trials, causality assessment, and data mining. It also provides definitions for terms related to evaluating drug safety like absolute risk, incidence, benefits, harms, and effectiveness/risk analysis. Regulatory organizations involved in PV like CIOMS, ICH, and MedDRA are also defined.
Monitoring and Reporting of Adverse Event /Adverse Drug Reaction (Methodolog...SMS MEDICAL COLLEGE
This document discusses adverse drug reactions (ADRs), including definitions, benefits of reporting ADRs, and the ADR reporting process in India. It notes that ADRs are a leading cause of death and hospital admissions. Reporting ADRs helps assess drug safety, provides updated safety information, and can lead to regulatory actions to protect patients. The reporting process in India involves using standard forms to report suspected ADRs to the nearest ADR monitoring center or directly to the national pharmacovigilance program. Reporters include healthcare professionals and consumers.
These are some frequently asked questions in Pharmacovigilance Interview & its Preparation.
"HANDS IN HANDS LEARNING"
FOR ENROLLMENT-
CONTACT US ON-
https://pristynresearch.com/
MAIL ID - pristynresearch@gmail.com
ADDRESS-
1) Parmar Trade Centre, A-wing,105/106, Sadhu Vaswani Chowk, Pune, 411001. Email: info@pristynresearch.com Phone: 09028839789
2)T-21/4 ,Opposite To Expert Global, Garware Stadium Road , Software Technology Park of India(STPI), MIDC, Aurangabad-431001. Email: info@pristynresearch.com Call us: 09607709586
Global Medical Cures™ | INTUNIV- Pediatric PostMarket Adverse Event ReviewGlobal Medical Cures™
Global Medical Cures™ | INTUNIV- Pediatric PostMarket Adverse Event Review
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
pharmacovigilance, adverse effects, causality assessment,methods, who-umc method with case study, FOR DOWNLOAD PPT MAIL ME ON iamgauravchhabra@gmail.com
Herbal medicines have gained lot of popularity, however the side effects associated have been neglected due to lack of knowledge and belief. Hence the Pharmacovigilance of herbal drugs needs to be addressed by educating the common people though campaigns.
This document discusses pharmacovigilance, which involves monitoring the effects of pharmaceutical products after they have been licensed for use, especially in order to identify adverse effects early. It defines key terms like adverse events, adverse reactions, and signals. It describes the WHO program for international drug monitoring and India's national pharmacovigilance program. The pharmacovigilance process involves data collection and management, signal detection, risk assessment, benefit-risk assessment, risk communication, and audit. Various methods for data collection and signal detection are discussed.
The document discusses principles and guidelines for administering nonparenteral medications. It covers oral, enteral, topical, and other non-injectable routes of administration. Key points include applying the six rights of medication administration, ensuring patient safety, educating patients, and following evidence-based practices such as using technology to reduce errors. Guidelines are provided for specific skills like administering oral medications, medications through feeding tubes, and applying topical medications.
This document analyzes reporting of adverse drug reactions (ADRs) by pharmacists in the Pharmacovigilance Programme of India (PvPI) between July 2011 and December 2014. It finds that of 110,000 reports in the database, 16,646 (15%) were reported by pharmacists. Of these, 3,782 (22.7%) were serious reactions while 9,601 (57.7%) were non-serious. Reporting by pharmacists has increased over time. The document concludes that pharmacists can play an important role in pharmacovigilance by detecting, reporting, and assessing ADRs.
Pharamcovigilance of drugs of natural originNiravKumar9
WHO Guidelines on safety monitoring of herbal medicines in Pharmacovigilance system and AYUSHSURAKSHA (Pharmacovigilance of Ayurveda, Unani, Siddha, And Homeopathy) syestem in India.
Pharmacovigilance is the science of detecting, assessing, understanding, and preventing adverse effects of medicines. The goals of pharmacovigilance include early detection of unknown safety problems, quantifying risks, and preventing patients from being harmed. Adverse drug reactions are a major cause of mortality and healthcare costs worldwide. Ongoing pharmacovigilance is needed to monitor drug safety after approval and promote rational, safer drug use. Healthcare professionals play a key role by thoroughly investigating and reporting any suspected adverse drug reactions.
The WHO Congress on Traditional Medicine held in Beijing in November 2008:
1) Brought together over 70 Member States to discuss traditional medicine.
2) Adopted the Beijing Declaration promoting safe and effective use of traditional medicine.
3) Called on WHO Member States and other stakeholders to take steps to integrate traditional, complementary and alternative medicines into national health care systems.
ROLE OF PHARMACOVIGILANCE AGAINST ADVERSE DRUG REACTIONAnindya Banerjee
The document discusses the role of pharmacovigilance in monitoring adverse drug reactions (ADRs). It summarizes that pharmacovigilance aims to improve drug safety by identifying ADRs from reported cases and analyzing benefit-risk ratios of medications. Historical drug disasters like thalidomide and sulfanilamide poisonings demonstrated the importance of post-market drug safety monitoring. The document outlines the objectives, reporting process, and future of pharmacovigilance in India including expanding stakeholder reporting and standardizing methodology.
Rational prescribing,dispensing and use of drugsAhmad Ali
The document discusses rational drug use and dispensing. It defines rational drug use as using the right drug for the right patient in the right dose at the right time through the right route while ensuring cost-effectiveness. Rational dispensing involves accurately interpreting prescriptions, checking for errors, precisely filling medications, properly labeling containers with instructions, and educating patients. The key steps in rational dispensing are receiving prescriptions, interpreting instructions, checking drugs, filling accurately, labeling clearly, and providing instructions to patients.
The document discusses hospital formularies, which are lists of approved pharmaceutical agents used in hospitals. A hospital formulary is developed and maintained by a pharmacy and therapeutics committee to select the most useful and safe medicines for patient care. It provides prescribers with information on drug toxicity, side effects, and benefits. The formulary development process involves evaluating drugs and inclusion criteria. It aims to standardize high quality prescribing and inventory management while removing irrational drug combinations.
pharmacovigilance from pharmaceutical administration topic presented by konatham kumar reddy from chilkur balaaji college of pharmacy hyderabad telangana
This document provides an introduction to clinical pharmacy presented by Ian and Judith Coombes to students in Sri Lanka. In 3 sentences:
The presentation discusses the role of clinical pharmacy in improving patient care by identifying and resolving medication-related issues, outlines differences between healthcare systems in Australia and Sri Lanka, and emphasizes the need for pharmacists to adopt a patient-centered approach through effective communication and consultation to optimize drug therapy and prevent adverse events.
PHARMACOVIGILANCE - A Worldwide masterkey for Drug MonitoringVenugopal N
This document provides a history of pharmacovigilance and discusses key aspects of the field. It begins with important milestones in drug safety regulation dating back to the early 20th century. It then defines pharmacovigilance and describes stakeholders, methods used like individual case safety reporting, and the roles of organizations like the WHO and national regulatory authorities. The document emphasizes the importance of post-market drug safety monitoring to protect public health.
The document discusses the marketing and regulation of over-the-counter (OTC) drugs, including the differences between OTC and prescription drugs, the OTC drug review process conducted by the FDA, and the role of pharmacists in counseling patients on the safe and effective use of OTC medications. Key points covered include the benefits and risks of OTC drug use, the FDA approval pathways for OTC products, and best practices for pharmacist counseling on OTC selections and their appropriate use.
Pharmacovigilance for ASU Drugs Dr Joban Modha UG, Dept. of Rasasastra & Bhaishajya Kalpana Gujarat Ayurved University, Jamnagar
1. What is Pharmacovigilance.
2. How and why it started.
3. What is the goal of Pharmacovigilance.
4. Pharmacovigilance in India.
5. National Pharmacovigilance Programme for ASU.
6. How to report.
7. Pharmacovigilance and Ayurveda
8. Why Ayurvedic Medicines need PV.
This document provides guidelines for reporting adverse drug reactions (ADRs). It outlines the essential information to include in an ADR report under five sections: (1) patient information including demographics, medical history, and test results; (2) suspected drugs and their details; (3) suspected ADR description, treatment, outcomes, and seriousness; (4) other medications; and (5) reporter information. For a valid report, the mandatory fields that must be included are patient initials, age, gender, reaction details, suspected drug name and dosage, seriousness, and outcomes as well as the reporter's name and date of reporting. Complete information is ideal but at minimum the mandatory fields should be reported.
Narcotic controlled drugs policy and procedurelastKnikkos
This document outlines policies and procedures for handling narcotic and controlled drugs in MOH hospitals. It defines key terms and assigns responsibilities to various departments and roles. The pharmacy department is responsible for receiving, storing, and dispensing these drugs, while maintaining proper documentation. Nurses are responsible for auditing drug counts. Strict protocols are established for prescribing, dispensing, administering, storing, recording use, and disposing of unused portions of narcotic and controlled drugs. Prescriptions must meet specific requirements and be properly documented.
This document discusses the opioid epidemic in America and proposes actions to address it. It summarizes that:
1) Nearly 200,000 Americans have died from prescription opioid overdoses since 1999, and up to 40% of long-term opioid therapy patients may be addicted.
2) Keeping chronic opioid therapy doses low can help reduce overdose risk. Many overdose deaths occur at doses of 50 mg or more per day, while most patients receive lower doses.
3) Immediate actions are needed to curb new inappropriate long-term opioid prescriptions, including more selective initial prescribing, checking prescription monitoring programs, and limiting initial supplies. Policies and regulations also need to be updated to reflect risks of addiction
Medical care responding_to_us_opioid_epidemic_von_korff_franklin_4-22-2016 (3)Paul Coelho, MD
This document discusses the opioid epidemic in America and proposes actions to address it. The key points are:
1) America is experiencing an unprecedented epidemic of prescription opioid addiction and overdose, with almost 200,000 deaths since 1999 mostly affecting patients prescribed opioids.
2) Proposed actions to address the epidemic include avoiding unnecessary opioid prescriptions, changing policies to reflect risks of addiction/overdose, and enhancing surveillance of opioid prescribing and patient safety.
3) Additional actions proposed are increasing clinical monitoring of patients on long-term opioid therapy, consistently offering to taper doses or discontinue opioids as an option, and ensuring treatment for addicted patients.
pharmacovigilance, adverse effects, causality assessment,methods, who-umc method with case study, FOR DOWNLOAD PPT MAIL ME ON iamgauravchhabra@gmail.com
Herbal medicines have gained lot of popularity, however the side effects associated have been neglected due to lack of knowledge and belief. Hence the Pharmacovigilance of herbal drugs needs to be addressed by educating the common people though campaigns.
This document discusses pharmacovigilance, which involves monitoring the effects of pharmaceutical products after they have been licensed for use, especially in order to identify adverse effects early. It defines key terms like adverse events, adverse reactions, and signals. It describes the WHO program for international drug monitoring and India's national pharmacovigilance program. The pharmacovigilance process involves data collection and management, signal detection, risk assessment, benefit-risk assessment, risk communication, and audit. Various methods for data collection and signal detection are discussed.
The document discusses principles and guidelines for administering nonparenteral medications. It covers oral, enteral, topical, and other non-injectable routes of administration. Key points include applying the six rights of medication administration, ensuring patient safety, educating patients, and following evidence-based practices such as using technology to reduce errors. Guidelines are provided for specific skills like administering oral medications, medications through feeding tubes, and applying topical medications.
This document analyzes reporting of adverse drug reactions (ADRs) by pharmacists in the Pharmacovigilance Programme of India (PvPI) between July 2011 and December 2014. It finds that of 110,000 reports in the database, 16,646 (15%) were reported by pharmacists. Of these, 3,782 (22.7%) were serious reactions while 9,601 (57.7%) were non-serious. Reporting by pharmacists has increased over time. The document concludes that pharmacists can play an important role in pharmacovigilance by detecting, reporting, and assessing ADRs.
Pharamcovigilance of drugs of natural originNiravKumar9
WHO Guidelines on safety monitoring of herbal medicines in Pharmacovigilance system and AYUSHSURAKSHA (Pharmacovigilance of Ayurveda, Unani, Siddha, And Homeopathy) syestem in India.
Pharmacovigilance is the science of detecting, assessing, understanding, and preventing adverse effects of medicines. The goals of pharmacovigilance include early detection of unknown safety problems, quantifying risks, and preventing patients from being harmed. Adverse drug reactions are a major cause of mortality and healthcare costs worldwide. Ongoing pharmacovigilance is needed to monitor drug safety after approval and promote rational, safer drug use. Healthcare professionals play a key role by thoroughly investigating and reporting any suspected adverse drug reactions.
The WHO Congress on Traditional Medicine held in Beijing in November 2008:
1) Brought together over 70 Member States to discuss traditional medicine.
2) Adopted the Beijing Declaration promoting safe and effective use of traditional medicine.
3) Called on WHO Member States and other stakeholders to take steps to integrate traditional, complementary and alternative medicines into national health care systems.
ROLE OF PHARMACOVIGILANCE AGAINST ADVERSE DRUG REACTIONAnindya Banerjee
The document discusses the role of pharmacovigilance in monitoring adverse drug reactions (ADRs). It summarizes that pharmacovigilance aims to improve drug safety by identifying ADRs from reported cases and analyzing benefit-risk ratios of medications. Historical drug disasters like thalidomide and sulfanilamide poisonings demonstrated the importance of post-market drug safety monitoring. The document outlines the objectives, reporting process, and future of pharmacovigilance in India including expanding stakeholder reporting and standardizing methodology.
Rational prescribing,dispensing and use of drugsAhmad Ali
The document discusses rational drug use and dispensing. It defines rational drug use as using the right drug for the right patient in the right dose at the right time through the right route while ensuring cost-effectiveness. Rational dispensing involves accurately interpreting prescriptions, checking for errors, precisely filling medications, properly labeling containers with instructions, and educating patients. The key steps in rational dispensing are receiving prescriptions, interpreting instructions, checking drugs, filling accurately, labeling clearly, and providing instructions to patients.
The document discusses hospital formularies, which are lists of approved pharmaceutical agents used in hospitals. A hospital formulary is developed and maintained by a pharmacy and therapeutics committee to select the most useful and safe medicines for patient care. It provides prescribers with information on drug toxicity, side effects, and benefits. The formulary development process involves evaluating drugs and inclusion criteria. It aims to standardize high quality prescribing and inventory management while removing irrational drug combinations.
pharmacovigilance from pharmaceutical administration topic presented by konatham kumar reddy from chilkur balaaji college of pharmacy hyderabad telangana
This document provides an introduction to clinical pharmacy presented by Ian and Judith Coombes to students in Sri Lanka. In 3 sentences:
The presentation discusses the role of clinical pharmacy in improving patient care by identifying and resolving medication-related issues, outlines differences between healthcare systems in Australia and Sri Lanka, and emphasizes the need for pharmacists to adopt a patient-centered approach through effective communication and consultation to optimize drug therapy and prevent adverse events.
PHARMACOVIGILANCE - A Worldwide masterkey for Drug MonitoringVenugopal N
This document provides a history of pharmacovigilance and discusses key aspects of the field. It begins with important milestones in drug safety regulation dating back to the early 20th century. It then defines pharmacovigilance and describes stakeholders, methods used like individual case safety reporting, and the roles of organizations like the WHO and national regulatory authorities. The document emphasizes the importance of post-market drug safety monitoring to protect public health.
The document discusses the marketing and regulation of over-the-counter (OTC) drugs, including the differences between OTC and prescription drugs, the OTC drug review process conducted by the FDA, and the role of pharmacists in counseling patients on the safe and effective use of OTC medications. Key points covered include the benefits and risks of OTC drug use, the FDA approval pathways for OTC products, and best practices for pharmacist counseling on OTC selections and their appropriate use.
Pharmacovigilance for ASU Drugs Dr Joban Modha UG, Dept. of Rasasastra & Bhaishajya Kalpana Gujarat Ayurved University, Jamnagar
1. What is Pharmacovigilance.
2. How and why it started.
3. What is the goal of Pharmacovigilance.
4. Pharmacovigilance in India.
5. National Pharmacovigilance Programme for ASU.
6. How to report.
7. Pharmacovigilance and Ayurveda
8. Why Ayurvedic Medicines need PV.
This document provides guidelines for reporting adverse drug reactions (ADRs). It outlines the essential information to include in an ADR report under five sections: (1) patient information including demographics, medical history, and test results; (2) suspected drugs and their details; (3) suspected ADR description, treatment, outcomes, and seriousness; (4) other medications; and (5) reporter information. For a valid report, the mandatory fields that must be included are patient initials, age, gender, reaction details, suspected drug name and dosage, seriousness, and outcomes as well as the reporter's name and date of reporting. Complete information is ideal but at minimum the mandatory fields should be reported.
Narcotic controlled drugs policy and procedurelastKnikkos
This document outlines policies and procedures for handling narcotic and controlled drugs in MOH hospitals. It defines key terms and assigns responsibilities to various departments and roles. The pharmacy department is responsible for receiving, storing, and dispensing these drugs, while maintaining proper documentation. Nurses are responsible for auditing drug counts. Strict protocols are established for prescribing, dispensing, administering, storing, recording use, and disposing of unused portions of narcotic and controlled drugs. Prescriptions must meet specific requirements and be properly documented.
This document discusses the opioid epidemic in America and proposes actions to address it. It summarizes that:
1) Nearly 200,000 Americans have died from prescription opioid overdoses since 1999, and up to 40% of long-term opioid therapy patients may be addicted.
2) Keeping chronic opioid therapy doses low can help reduce overdose risk. Many overdose deaths occur at doses of 50 mg or more per day, while most patients receive lower doses.
3) Immediate actions are needed to curb new inappropriate long-term opioid prescriptions, including more selective initial prescribing, checking prescription monitoring programs, and limiting initial supplies. Policies and regulations also need to be updated to reflect risks of addiction
Medical care responding_to_us_opioid_epidemic_von_korff_franklin_4-22-2016 (3)Paul Coelho, MD
This document discusses the opioid epidemic in America and proposes actions to address it. The key points are:
1) America is experiencing an unprecedented epidemic of prescription opioid addiction and overdose, with almost 200,000 deaths since 1999 mostly affecting patients prescribed opioids.
2) Proposed actions to address the epidemic include avoiding unnecessary opioid prescriptions, changing policies to reflect risks of addiction/overdose, and enhancing surveillance of opioid prescribing and patient safety.
3) Additional actions proposed are increasing clinical monitoring of patients on long-term opioid therapy, consistently offering to taper doses or discontinue opioids as an option, and ensuring treatment for addicted patients.
This document provides information on best practices for prescribing opioid therapy and managing pain patients, including key facts on the pain management epidemic. It discusses definitions of chronic pain and addiction. Guidelines are provided on initial patient assessment, implementing opioid therapy if appropriate, identifying addiction risks, prescribing protocols, urine drug testing protocols, and legislation related to prescription drug monitoring programs. The goal is to provide physicians with tools and guidelines for safely and effectively managing patients with chronic pain.
DRUG DISTRIBUTION SYSTEM IN HOSPITAL.pptxAnilDhakal14
The document summarizes the key aspects of drug distribution systems within hospitals. It discusses the various methods of dispensing drugs to inpatients, including individual prescription ordering, complete floor stock systems, a combination approach, and unit dose systems. It also covers labeling policies, dispensing to outpatients and ambulatory patients, and controlled drug handling procedures. The overall drug distribution process in a hospital is complex and involves prescribing, requisitioning, transfers from pharmacy stores to patient administration through both inpatient and outpatient channels. Standard operating procedures and verification steps are needed to ensure safe and quality drug distribution.
The document discusses various pharmacy environments including mail order pharmacies, which fill prescriptions for chronic medications and mail them to patients, long-term care facilities where pharmacists provide medication management for residents, and home infusion pharmacies that deliver intravenous therapies directly to patients' homes. It also covers the roles of pharmacists and pharmacy technicians in these alternative care settings as well as concepts like managed care organizations.
This document discusses rational drug use and provides strategies to promote it. It defines rational drug use according to WHO as using medicines appropriately for clinical needs in terms of drug choice, dosage, duration and cost. Common problems with irrational use include polypharmacy, overuse of antibiotics and injections. Reasons for irrational use include lack of skills/knowledge, inappropriate drug promotion, profits from drug sales, and lack of coordinated policies. Consequences are antimicrobial resistance, adverse drug reactions, and wasted resources. The document recommends educational and regulatory strategies to improve prescribing and dispensing practices and ensure appropriate drug use.
This case study describes a 24-year-old woman who presented with exacerbated chronic knee pain and demanded specific opioid medications. Her past history included heroin addiction but reported being sober for 4 years. On examination, her knee showed no changes but she displayed atypical irritable behavior. The physician suspected drug seeking behavior and refused to prescribe opioids given concerns about relapse of addiction. This case highlights the importance of thoroughly evaluating the potential causes of aberrant behavior before making assumptions about addiction or misuse.
Medication adherence is defined as a patient conforming to a healthcare provider's recommendations regarding timing, dosage, and frequency of medication. It involves filling prescriptions and refilling on time. Non-adherence can be caused by patient factors like forgetfulness or cost barriers, physician factors like complex regimens, and health system factors like fragmented care. Pharmacists can improve adherence through education on medication purpose, usage, and side effects. Adherence is especially important for chronic conditions and can be monitored through patient assessments.
This document discusses drug abuse, misuse, and control. It begins by defining drug use, misuse, and abuse. It then discusses the definition of rational drug use according to the WHO. Over 50% of drugs are prescribed or used inappropriately. The document outlines various types of drug misuse and their effects. It discusses why people use psychoactive drugs and factors that influence drug choice. Adverse impacts of drug misuse are outlined. The roles of industries, prescribers, patients, and communities in drug misuse are examined. Withdrawal effects and pharmaceutical care approaches are summarized.
This presentation discusses the opioid epidemic, guidelines for prescribing opioids, and strategies for managing postoperative pain with reduced opioid use. It provides objectives about understanding the societal costs of the opioid epidemic, complying with state prescribing laws, and following guidelines for different types of pain. The presentation reviews CDC guidelines for prescribing opioids, the Arizona prescription drug monitoring program, factors influencing opioid use, and results from a study showing most patients use fewer opioids than prescribed after surgery. It emphasizes multimodal analgesia, patient education, and tapering or discontinuing certain medications before surgery to reduce postoperative opioid needs.
1) This case discusses the challenges of managing acute pain in a hospitalized patient on chronic opioids who underwent foot amputation surgery.
2) The patient was prescribed escalating doses of opioids, including extended-release morphine up to 165mg 3 times daily as well as IV and oral hydromorphone. He developed somnolence and hypoxemia.
3) After holding the extended-release morphine, the patient's pain worsened and muscle spasms developed. He was prescribed diazepam which led to respiratory depression and an opioid/benzodiazepine overdose requiring naloxone and ICU admission.
The document discusses guidelines for prescribing opioid analgesics, including considerations for risk assessment, equianalgesic dosing, monitoring patients, guidelines for opioid rotation, and classes of opioids like partial agonists. It provides information on the public health issues surrounding opioid misuse and abuse as well as clinical best practices for safely prescribing opioids for pain management.
Self-medication involves using medicines to treat minor ailments without medical supervision. It is commonly practiced worldwide and promoted by WHO in rural areas with limited access to healthcare. Over-the-counter (OTC) drugs are approved for self-medication to treat minor conditions. While OTC drugs provide convenience, their misuse can be dangerous. Some OTC drugs have been banned in India due to health risks, including Nimesulide for liver toxicity and cough syrups containing codeine due to addiction concerns. Community pharmacists should take responsibility for proper OTC use by patients through consultation and education.
This document discusses medication errors that can occur in hospitals. It defines medication errors as any error in prescribing, dispensing, or administering drugs, regardless of whether harm occurs. Medication errors are a major cause of preventable patient harm. The document classifies medication errors as mistakes, slips, or lapses, depending on where the error occurs in the medication use process. It also discusses different ways medication errors have been estimated to cause deaths in other countries to highlight the significant impact of these errors.
This document discusses the legal standard of "corresponding responsibility" that pharmacists have when dispensing prescriptions. A pharmacist must ensure each prescription is issued for a legitimate medical purpose by an authorized prescriber. While prescribers are responsible for proper prescribing, pharmacists have a duty to determine if a prescription is valid. The document outlines factors a pharmacist should consider to determine if a prescription has a legitimate medical purpose, such as prescription details, patient behavior, and prescriber characteristics. It also discusses legal cases and DEA guidance on prescribing and dispensing controlled substances. Overall, the document provides an overview of a pharmacist's legal responsibilities to validate prescriptions and factors that could indicate a prescription is not for a legitimate medical
The document discusses rational use of medicines and the role of pharmacists in promoting rational use. It defines rational use of medicines according to WHO as ensuring patients receive appropriate medicines based on their clinical needs at the lowest cost. Pharmacists can promote rational use by properly managing drug stocks, dispensing medications correctly with patient education, and participating in pharmacovigilance programs. The document also outlines several other strategies to improve rational use, including developing treatment guidelines, regulating drug promotion, and educating both healthcare providers and the public.
Study of Analgesic usage In a Tertiary Care.pptxHariHaran726642
This document outlines a study to assess analgesic usage patterns at the outpatient departments of a tertiary hospital in India. The study will involve collecting data on analgesics prescribed to patients aged 18-60 across several outpatient departments. The objectives are to document conditions analgesics are prescribed for, determine any cases requiring caution, and assess prescribing practices to promote rational analgesic use. Data on analgesic class, dosage, frequency, number prescribed, and generic name will be gathered from prescriptions and analyzed statistically. The goal is to identify commonly prescribed analgesics and provide information to optimize pain management and treatment.
This document outlines steps for analyzing and dispensing prescriptions properly according to good practice principles. It discusses accepting prescriptions, ensuring clinical evaluation, calculating quantities, assembling items, labeling, entering data, finalizing, and documenting prescriptions. Key steps include interpreting prescriptions for legality, completeness, correctness of dose/duration, checking for interactions or allergies, taking a medication history, and verifying any unclear information with the prescriber. The goal is to deliver the right medication to the right patient in the proper dosage and package with clear instructions.
Drug distribution systems in Hospitals for Out patient and Inpatientanand kakde
This document discusses various drug distribution systems in hospitals. It describes systems for both outpatients and inpatients. For outpatients, locations for outpatient pharmacies are discussed, including having a separate pharmacy or combining services with the inpatient pharmacy. The process of dispensing drugs to outpatients is outlined. For inpatients, methods like individual prescriptions, floor stock systems, and unit dose systems are described. Floor stock involves storing drugs at nursing units and can include charge or non-charge drugs. Unit dose systems like centralized and decentralized models are defined. Benefits of unit dose include reducing errors and having easier drug accounting.
This document contains summaries of several research papers on topics related to chronic pain, suicide risk, and bipolar disorder:
1) One study found that tapering opioid doses for chronic pain patients was associated with increased risks of overdose and mental health crisis compared to patients who did not taper. Higher tapering speeds were linked to even greater risks.
2) Another study observed chronic pain patients undergoing opioid tapering or transition to buprenorphine treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine use predicted dropout. Pain levels varied after treatment.
3) Research on combat veterans found that those exposed to combat had higher rates of PTSD, suicide attempts, strokes and chronic pain
Labeling Woefulness: The Social Construction of FibromyalgiaPaul Coelho, MD
This document discusses the social construction of fibromyalgia and how it has been established as a legitimate disease label despite a lack of clear biological or clinical evidence. It argues that fibromyalgia serves social and economic purposes for various groups, including patients, doctors, pharmaceutical companies, and the media, but poses risks by medicalizing psychosocial problems. The document proposes that widespread pain is a normal human experience for some that is best addressed by exploring psychosocial factors rather than believing the solution lies in neurobiology. Examining fibromyalgia as a social construct may be more helpful for patients than continuing to medicalize their experiences.
Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrosp...Paul Coelho, MD
This study analyzed outcomes for 240 patients with chronic pain who were prescribed long-term opioid therapy above 90 mg morphine-equivalent daily doses. Patients were offered an outpatient opioid taper or transition to buprenorphine if taper was not tolerated. 44.6% successfully tapered, 18.8% transitioned to buprenorphine, and 36.6% dropped out of treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine/z-drug use predicted greater dropout. Pain intensity changes after treatment were mixed, with over half of tapered patients reporting increased pain and about half of transitioned patients reporting decreased pain.
This document appears to be a questionnaire assessing symptoms of widespread pain and calculating a WPI (Widespread Pain Index) score and SS (Symptom Severity) score. It asks the respondent to indicate areas of pain on a diagram and rate the severity of symptoms like fatigue, thinking difficulties, and unrefreshed sleep. It also inquires about additional symptoms like abdominal pain, depression, and headaches. The final section rates pain-related worry and fear on a scale. Additional questions determine if the respondent has a workers compensation or disability claim related to their pain complaint.
Fibromyalgia is a condition that causes chronic aches and pains all over the body, fatigue, and often a sleep disorder. The doctor diagnosed the patient with fibromyalgia based on a score of 13 or more on the fibromyalgia questionnaire from the American College of Rheumatology, which is consistent with the syndrome. By focusing on and managing the diagnosis of fibromyalgia, the patient's other pain symptoms can decrease.
This document contains two studies related to psychological treatments for chronic conditions:
1) A study of chronic fatigue syndrome patients found that poorer outcomes were predicted by membership in a self-help group, receiving sickness benefits, and symptoms of dysphoria. Severity and duration of symptoms did not predict response.
2) A randomized controlled trial of 125 fibromyalgia patients compared operant behavioral therapy, cognitive behavioral therapy, and attention placebo. Both behavioral therapies significantly reduced pain intensity while cognitive therapy improved cognitive and affective variables and operant therapy improved physical functioning and behaviors. The attention placebo resulted in no improvement or deterioration.
This document summarizes three studies on the risks and efficacy of opioids for chronic non-cancer pain (CNP). The first study finds that while opioids were associated with small improvements in pain and physical functioning compared to placebo, they also increased the risk of vomiting. Comparisons to other medications found similar benefits to pain and functioning. The second study finds no difference in pain-related function between opioid and non-opioid groups over 12 months, and higher rates of adverse effects and pain intensity in the opioid group. The third study finds limited effectiveness of opioids for CNP, as opioid users did not report improvements in outcomes after 2 years. Regarding risks, higher opioid doses are associated with increased overdose risk across several patient groups in
1) This randomized clinical trial compared opioid vs nonopioid medication therapy over 12 months for patients with chronic back, hip, or knee pain.
2) It found no significant difference in pain-related function between the two groups, but pain intensity was significantly better in the nonopioid group. Adverse effects were significantly more common in the opioid group.
3) The study concludes that opioid therapy was not superior to nonopioid medications for improving pain-related function over 12 months, and the results do not support initiating opioids for moderate to severe chronic musculoskeletal pain.
Mortality quadrupled among opioid-driven hospitalizations notably within lowe...Paul Coelho, MD
This study analyzed national hospitalization data from 1993-2014 to examine trends in mortality and characteristics of hospitalizations related to opioids compared to other drug and non-drug hospitalizations. The key findings were:
1) Mortality among opioid-related hospitalizations quadrupled from 0.43% before 2000 to 2.02% in 2014, increasing 0.12 percentage points per year relative to other drug hospitalizations.
2) While total opioid-related hospitalizations remained stable, diagnoses shifted from opioid dependence/abuse to opioid/heroin poisoning, which have higher mortality rates. Hospitalizations for poisoning grew by 0.01 per 1,000 people annually after 2000.
3) Patients hospitalized for opioid/
Prescriptions filled following an opioid-related hospitalization.Paul Coelho, MD
This study analyzed prescription drug fills within 30 days of discharge for 36,719 patients hospitalized for opioid misuse. Only 16.7% received medications approved for opioid dependence, while 40.3% filled antidepressant prescriptions and 22.4% filled opioid pain medication prescriptions. Concurrently, 13.9% filled benzodiazepine prescriptions and 7.4% filled both benzodiazepine and opioid prescriptions, indicating a need for improved education on risks. Overall, more effort is required to ensure patients receive recommended post-hospitalization treatment and support services.
This study examined the risk of psychiatric hospitalization in the offspring (second generation) of Finns who were evacuated to Sweden without parents during World War II (first generation), compared to offspring of Finns who were not evacuated. The study found that daughters of mothers who were evacuated during childhood had an elevated risk of psychiatric hospitalization, especially for mood disorders. However, there was no increased risk found for offspring of evacuated fathers or for male offspring of evacuated mothers. This suggests that early childhood adversity experienced by the first generation, such as war-related trauma, may be associated with mental health problems that persist into the second generation.
Correlation of opioid mortality with prescriptions and social determinants -a...Paul Coelho, MD
This study analyzed Medicare Part D data from 2013-2014 to examine the relationship between opioid prescription rates, socioeconomic factors, and opioid-related mortality rates at the county level in the United States. The results showed that higher county-level opioid prescription rates, especially those from emergency medicine, family medicine, internal medicine, and physician assistants, were associated with higher opioid-related mortality rates. Higher poverty levels and proportions of white populations in counties also correlated with increased mortality. Additionally, prescribers in the highest quartile of opioid prescription rates had a disproportionate impact on mortality compared to the remaining 75% of prescribers.
This report examines CMS's oversight of Medicare Part D beneficiaries who receive opioid prescriptions and providers who prescribe opioids to these beneficiaries. It finds that while CMS provides guidance to Part D plan sponsors on monitoring beneficiaries at high risk of opioid overuse, it lacks complete data on the full population of beneficiaries at risk. It also finds that CMS oversees prescribing through its contractor NBI MEDIC but does not specifically analyze opioid prescription data or require reporting on actions taken regarding inappropriate opioid prescribing. The report concludes that CMS needs more comprehensive oversight to reduce the risks of opioid misuse, overdose, and inappropriate prescribing among Medicare beneficiaries.
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
The place-of-antipsychotics-in-the-therapy-of-anxiety-disorders-and-obsessive...Paul Coelho, MD
This document summarizes a research article about the use of antipsychotic drugs in the treatment of anxiety disorders and obsessive-compulsive disorders. The review finds evidence that certain second-generation antipsychotics (SGAPs), like quetiapine, risperidone, and aripiprazole, can be effective for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). Quetiapine in particular receives a recommendation as a first-line treatment for GAD. However, the review finds insufficient evidence for SGAPs in the treatment of social anxiety disorder and panic disorder. First-generation antipsychotics are not recommended for any anxiety disorders based on their side effect profiles
Structured opioid refill clinic epic smartphrases Paul Coelho, MD
#*** I explained to the patient the risks of combining opioids and benzodiazepines based on medical literature. We agreed to slowly taper the patient off benzodiazepines and trial safer alternatives for sleep and anxiety issues.
#*** I showed the patient their fibromyalgia screening questionnaire results, which were consistent with a fibromyalgia diagnosis. Fibromyalgia can amplify other painful conditions and is often the primary source of morbidity when present with other chronic pain diagnoses.
#*** We discussed the patient's high risk opioid regimen based on their dose exceeding CDC guidelines. While willing to work on a harm reduction plan, it will require a taper or switching to buprenorphine due to safety concerns.
Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, an...Paul Coelho, MD
This document summarizes the key issues regarding the use of opioids for chronic pain treatment:
1) An overreliance on opioids to treat chronic pain has contributed to the prescription opioid abuse epidemic in the US, as outpatient use allows for abuse and diversion of these addictive drugs.
2) While clinical trials show opioids effectively treat acute pain and are initially effective for chronic pain, real-world use reveals increased risks of abuse, addiction, and poor functional outcomes over the long-term.
3) The evidence supporting chronic opioid therapy was limited and observational in nature, yet convinced the medical community until larger population studies showed increased abuse rates contrary to initial assumptions.
The potential adverse influence of physicians’ words.Paul Coelho, MD
The physician's words can inadvertently amplify patients' symptoms and increase somatic distress if not carefully considered. Learning about potential side effects from medications, procedures, or test results can lead patients to experience and report those effects more frequently through psychological mechanisms like misattribution and increased attention to bodily sensations. Discussing concepts like nocebo and viscerosomatic amplification with patients can help provide reassuring explanations for symptoms and make them feel less intrusive. Physicians should thoughtfully consider their word choices and focus on benefits as well as side effects to minimize undue distress.
This document is an evidence report published by the Institute for Clinical and Economic Review (ICER) that evaluates the comparative clinical effectiveness and value of cognitive and mind-body therapies for chronic low back and neck pain. It was authored by Jeffrey Tice and others from ICER. The report assesses the clinical evidence on therapies such as cognitive behavioral therapy and mindfulness-based stress reduction and presents economic analyses of the long-term cost-effectiveness and potential budget impact of these therapies. It also incorporates input from clinical experts and stakeholders.
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
When it comes to creating marketing strategies that target older adults, it is crucial to have insight into their media habits and preferences. Understanding how older adults consume and use media is key to creating acquisition and retention strategies. We recently conducted our seventh annual survey to gain insight into the media preferences of older adults in 2024. Here are the survey responses and marketing implications that stood out to us.
Basics of Electrocardiogram
CONTENTS
●Conduction System of the Heart
●What is ECG or EKG?
●ECG Leads
●Normal waves of ECG.
●Dimensions of ECG.
● Abnormalities of ECG
CONDUCTION SYSTEM OF THE HEART
ECG:
●ECG is a graphic record of the electrical activity of the heart.
●Electrical activity precedes the mechanical activity of the heart.
●Electrical activity has two phases:
Depolarization- contraction of muscle
Repolarization- relaxation of muscle
ECG Leads:
●6 Chest leads
●6 Limb leads
1. Bipolar Limb Leads:
Lead 1- Between right arm(-ve) and left arm(+ve)
Lead 2- Between right arm(-ve) and left leg(+ve)
Lead 3- Between left arm(-ve)
and left leg(+ve)
2. Augmented unipolar Limb Leads:
AvR- Right arm
AvL- Left arm
AvF- Left leg
3.Chest Leads:
V1 : Over 4th intercostal
space near right sternal margin
V2: Over 4th intercostal space near left sternal margin
V3:In between V2 and V4
V4:Over left 5th intercostal space on the mid
clavicular line
V5:Over left 5th intercostal space on the anterior
axillary line
V6:Over left 5th intercostal space on the mid
axillary line.
Normal ECG:
Waves of ECG:
P Wave
•P Wave is a positive wave and the first wave in ECG.
•It is also called as atrial complex.
Cause: Atrial depolarisation
Duration: 0.1 sec
QRS Complex:
•QRS’ complex is also called the initial ventricular complex.
•‘Q’ wave is a small negative wave. It is continued as the tall ‘R’ wave, which is a positive wave.
‘R’ wave is followed by a small negative wave, the ‘S’ wave.
Cause:Ventricular depolarization and atrial repolarization
Duration: 0.08- 0.10 sec
T Wave:
•‘T’ wave is the final ventricular complex and is a positive wave.
Cause:Ventricular repolarization Duration: 0.2 sec
Intervals and Segments of ECG:
P-R Interval:
•‘P-R’ interval is the interval
between the onset of ‘P’wave and onset of ‘Q’ wave.
•‘P-R’ interval cause atrial depolarization and conduction of impulses through AV node.
Duration:0.18 (0.12 to 0.2) sec
Q-T Interval:
•‘Q-T’ interval is the interval between the onset of ‘Q’
wave and the end of ‘T’ wave.
•‘Q-T’ interval indicates the ventricular depolarization
and ventricular repolarization,
i.e. it signifies the
electrical activity in ventricles.
Duration:0.4-0.42sec
S-T Segment:
•‘S-T’ segment is the time interval between the end of ‘S’ wave and the onset of ‘T’ wave.
Duration: 0.08 sec
R-R Interval:
•‘R-R’ interval is the time interval between two consecutive ‘R’ waves.
•It signifies the duration of one cardiac cycle.
Duration: 0.8 sec
Dimension of ECG:
How to find heart rhytm of the heart?
Regular rhytm:
Irregular rhytm:
More than or less than 4
How to find heart rate using ECG?
If heart Rhytm is Regular :
Heart rate =
300/No.of large b/w 2 QRS complex
= 300/4
=75 beats/mins
How to find heart rate using ECG?
If heart Rhytm is irregular:
Heart rate = 10×No.of QRS complex in 6 sec 5large box = 1sec
5×6=30
10×7 = 70 Beats/min
Abnormalities of ECG:
Cardiac Arrythmias:
1.Tachycardia
Heart Rate more than 100 beats/min
English Drug and Alcohol Commissioners June 2024.pptxMatSouthwell1
Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
Test bank clinical nursing skills a concept based approach 4e pearson educati...rightmanforbloodline
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
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1. Washington Emergency Department Opioid Prescribing Guidelines
1. One medical provider should provide all
opioids to treat a patient’s chronic pain.
2. The administration of intravenous and
intramuscular opioids in the ED for the relief
of acute exacerbations of chronic pain is
discouraged.
3. Emergency medical providers should not
provide replacement prescriptions for
controlled substances that were lost,
destroyed or stolen.
4. Emergency medical providers should not
provide replacement doses of methadone for
patients in a methadone treatment program.
5. Long-acting or controlled-release opioids
(such as OxyContin®, fentanyl patches, and
methadone) should not be prescribed from
the ED.
6. EDs are encouraged to share the ED visit
history of patients with other emergency
physicians who are treating the patient using
an Emergency Department Information
Exchange (EDIE) system.
7. Physicians should send patient pain
agreements to local EDs and work to include
a plan for pain treatment in the ED.
8. Prescriptions for controlled substances
from the ED should state the patient is
required to provide a government issued
picture identification (ID) to the pharmacy
filling the prescription.
9. EDs are encouraged to photograph patients
who present for pain related complaints
without a government issued photo ID.
10. EDs should coordinate the care of
patients who frequently visit the ED using an
ED care coordination program.
11. EDs should maintain a list of clinics that
provide primary care for patients of all payer
types.
12. EDs should perform screening, brief
interventions and treatment referrals for
patients with suspected prescription opiate
abuse problems.
13. The administration of Demerol®
(Meperidine) in the ED is discouraged.
14. For exacerbations of chronic pain, the
emergency medical provider should contact
the patient’s primary opioid prescriber or
pharmacy. The emergency medical provider
should only prescribe enough pills to last
until the office of the patient’s primary
opioid prescriber opens.
15. Prescriptions for opioid pain medication
from the ED for acute injuries, such as
fractured bones, in most cases should not
exceed 30 pills.
16. ED patients should be screened for
substance abuse prior to prescribing opioid
medication for acute pain.
17. The emergency physician is required by
law to evaluate an ED patient who reports
pain. The law allows the emergency
physician to use their clinical judgment when
treating pain and does not require the use of
opioids.
2. BACKGROUND
The emergency department (ED) is the largest ambulatory source for opioid analgesics with 39% of all
opioids prescribed, administered, or continued coming from emergency departments.1
According to the
Drug Abuse Warning Network (DAWN), the estimated number of ED visits for nonmedical use of opioid
analgesics more than doubled from 2004 to 2008 (from 144,600 to 305,900 visits).2
As the use of
prescription opioids for chronic non-cancer pain has increased, so have unintended consequences related to
opioids. In Washington from 1995-2009, there was a 17 fold increase in unintentional poisoning deaths3
and
a 7 fold increase in poisoning hospitalizations involving prescription opioids4
. There has been a 6 fold
increase in state-funded substance abuse treatment admissions for prescription opioids in Washington from
2003-20105
.
These guidelines are intended to help EDs reduce the inappropriate use of opioid analgesics while
preserving the vital role of the ED to treat patients with emergent medical conditions. These guidelines were
developed by the Emergency Department Opioid Abuse Work Group sponsored by the Washington State
Department of Health (DOH). This work group is composed of members representing:
Washington State Department of Health
Washington State Department of Social and Health Services
Washington Department of Labor and Industries
Washington Chapter of the American College of Emergency Physicians
Washington State Emergency Nurses Association
Washington Poison Center
Washington Pain Physicians
RECOMMENDATIONS
1. One medical provider should provide all opioids to treat a patient’s chronic pain.
The emergency physician is not in a position to monitor the effects of chronic opioid therapy and therefore
should not prescribe opioids for the treatment of chronic pain. Repeated prescribing of opioids from the ED
is a counter-therapeutic enabling action that delays patients from seeking appropriate pain control and
monitoring.
Guidelines for the treatment of chronic pain from the Washington State Agency Medical Directors Group6
and the Medical Quality Assurance Commission7
recommend that all pain medicine be prescribed by one
practitioner. The American Pain Society’s guidelines8
recommend that all patients on chronic opioid therapy
should have a clinician who accepts primary responsibility for their overall medical care.
Prescribing pain medicine for chronic pain from the ED should be limited to only the immediate treatment
of acute exacerbations of pain associated with objective findings of uncontrolled pain. Chronic pain
treatment requires monitoring the effects of the medication on pain levels and patient’s level of functioning.
The emergency medical provider is not capable of providing this monitoring. The absence of prescription
opioid monitoring places the patient at risk for harm from excess or unnecessary amounts of these
medications. The ED physician's one-time relationship with the patient does not allow proper monitoring of
the patient’s response to chronic opioids.
3. 2. The administration of intravenous and intramuscular opioids in the ED for the relief of acute
exacerbations of chronic pain is discouraged.
Parenteral opioids should be avoided for the treatment of chronic pain in the ED because of their short
duration and potential for addictive euphoria. Generally, oral opioids are superior to parenteral opioids in
duration of action and provide a gradual decrease in the level of pain control. When there is evidence or
reasonable suspicion of an acute pathological process causing the acute exacerbation of chronic pain then
parenteral opioids may be appropriate. Under special circumstances some patients may receive intravenous
or intramuscular opioids in the ED when an ED care plan is coordinated with the patient’s primary care
provider.
3. Emergency medical providers should not provide replacement prescriptions for controlled substances
that were lost, destroyed or stolen.
Patients misusing controlled substances frequently report their prescriptions were lost or have been stolen.
Pain specialists routinely stipulate in pain agreements with patients that lost or stolen controlled substances
will not be replaced. Most pain agreements between chronic pain patients and physician, including the
HRSA toolkit sample pain agreement9
, states that prescriptions will not be replaced.EDs should institute a
policy not to replace prescriptions that are requested on the basis of being lost, stolen, or destroyed.
4. Emergency medical providers should not provide replacement doses of methadone for patients in a
methadone treatment program.
Methadone should not be prescribed or administered as opioid substitution therapy from the ED. Methadone
has a long half-life and patients who are part of a daily methadone treatment program, that miss a single
dose, will not go into opioid withdrawal for 48 hours. Opioid withdrawal is not an emergency medical
condition. The emergency medical provider should consider the patient may have been discharged from a
methadone treatment program for noncompliance or is not enrolled. The emergency medical provider or
admitting physician should call the methadone treatment program if the patient is admitted to the hospital.
The patient’s status in the methadone treatment program should be verified and the patient’s methadone
dose should be documented for continued dosing while hospitalized.
5. Long-acting or controlled-release opioids (such as OxyContin®, fentanyl patches, and methadone)
should not be prescribed from the ED.
Long acting opioids should not be prescribed from the ED because this treatment requires monitoring which
the emergency medical provider cannot provide. Methadone and oxycodone are involved in more
unintentional opioid overdose deaths than any other prescription opioid.10
6. EDs are encouraged to share the ED visit history of patients with other emergency physicians who are
treating the patient using an Emergency Department Information Exchange (EDIE) system.
The ED Opioid Abuse Work Group is coordinating the creation of an ED monitoring program similar to the
prescription monitoring programs used in over 30 states.11
The ED monitoring program is titled the
Emergency Department Information Exchange (EDIE) and is being independently operated by Collective
Medical Technology, which has no financial relationship with DOH. EDIE will allow participating hospitals
to share patient visit information to a central database when the patient presents to an ED. The database can
identify patients with multiple ED visits, and share this information with the emergency medical provider;
this allows the provider to appropriately treat the patient and work to prevent drug seeking behavior. The
exchange of medical information between emergency medical providers who have treated the patient is
HIPAA compliant. Sharing patient visit information between urgent care centers and the ED is also
encouraged.
4. 7. Physicians should send patient pain agreements to local EDs and work to include a plan for pain
treatment in the ED.
By having a record of the patient’s pain agreement, the emergency physician can have a more complete
picture of the patient’s request and the prescribing provider’s expectations.
8. Prescriptions for controlled substances from the ED should state the patient is required to provide a
government issued picture identification (ID) to the pharmacy filling the prescription.
Patients diverting prescriptions can provide a fictitious name when registering in the ED and receive
prescriptions under the fictitious name. Washington law does not require the patient to present an ID when
filling a controlled substance prescription.
Emergency physicians should contact local law enforcement to report patients who provide false
information in an attempt to obtain controlled substances. Local law enforcement should prosecute patients
who provide false identifying information when registering in the ED. Attempting to obtain controlled
substances by fraud, deceit, or subterfuge is a felony under RCW 69.50.403. Reporting this crime is
specifically permitted under RCW 69.50.403 which states ―Information communicated to a practitioner in
an effort unlawfully to procure a controlled substance or unlawfully to procure the administration of such
substance, shall not be deemed a privileged communication.‖
ED prescription pads and computer generated printed prescriptions should be printed to require photo ID for
controlled substances. Exception to this recommendation should be granted in rare circumstances where the
patient sustained a traumatic event, such as an automobile crash, and their identification was destroyed or
lost.
9. EDs are encouraged to photograph patients who present for pain related complaints without a
government issued photo ID.
Patients who lack picture ID should be photographed. Photographing the patient improves patient safety by
providing a means of positive ID of the person treated. Patients who present to multiple EDs and provide
false information to obtain controlled substances often do not provide photo ID. This is done to hide the
patient’s history of several ED visits from the ED staff. Photographing patients may dissuade them from
providing false information because the photograph provides documentation they presented to the ED.
Triage documentation provided to the emergency physician should indicate if the patient provided ID.
Patients may be more likely to provide false ID as programs to track ED visits across the state, such as the
Emergency Department Information Exchange (EDIE) and the WA Prescription Monitoring Program, are
implemented.
10. EDs should coordinate the care of patients who frequently visit the ED using an ED care coordination
program.
ED care coordination programs should contact the patient’s primary care physician to notify them of the
patient’s ED over utilization and formulate an ED care plan. When the patient does not have a primary care
provider an ED care plan should be created by an ED physician. This plan should stress the importance of
seeing a primary care provider for chronic medical conditions and chronic pain management. The ED care
plan should be filed into a dedicated section of the hospital electronic health record.
11. EDs should maintain a list of clinics that provide primary care for patients of all payer types.
EDs should encourage patients to seek primary care in non-emergent care settings. ED physicians and staff
should counsel over utilizing patients on appropriate venues for their symptoms and provide patients with an
up-to-date list of clinic resources. The emergency physician should not feel compelled to prescribe opioids
due to the patient's lack of a primary care physician.
5. 12. EDs should perform screening, brief interventions and treatment referrals for patients with suspected
prescription opiate abuse problems.
The Washington State Screening, Brief Intervention, Referral and Treatment (WASBIRT) Program has
proven the effectiveness of providing brief intervention, brief therapy and treatment referral to high-risk
substance abusers who frequent hospital EDs, with substantial declines in illicit drug use. Among high-risk
users of prescription opioids, at six-month follow-up, there was a 41% reduction in days of drug use (from
12.8 to 7.5 days) for individuals who received only a brief intervention, and a 54% reduction (from 14.4
days to 6.6 days) for individuals who received a brief intervention, followed by brief therapy or chemical
dependency treatment.12
With proper training, brief interventions can be delivered in the ED by nurses, case
managers, crisis counselors, social workers, or a chemical dependency professional. The 2010 National
Drug Control Strategy recommends expansion of brief interventions in health care settings.13
Patients often find themselves in the ED after their dependence or addiction has led them to a turning point
in their life, such a traumatic event or hitting rock bottom. Without immediate intervention the patient can
easily fall back into addiction. The ED should maintain an easy to understand guide on local addiction
recovery resources, including all payer types. A list of chemical dependency service providers certified by
the Division of Behavioral Health and Recovery can be found online.14
13. The administration of Demerol® (Meperidine) in the ED is discouraged.
Demerol® use has been to shown induce seizures through the accumulation of a toxic metabolite with a
long half life that is excreted by the kidney. Demerol® has the lowest safety margin for inducing seizures of
any opioid. Numerous reviews of meperidine’s pharmacodynamic properties have failed to demonstrate any
benefit to using meperidine in the treatment of common pain problems.15,16
14. For exacerbations of chronic pain, the emergency medical provider should contact the patient’s
primary opioid prescriber or pharmacy. Emergency medical providers should only prescribe enough
pills to last until the office of the patient’s primary opioid prescriber opens.
Opioid prescriptions for exacerbations of chronic pain from the ED are discouraged. Chronic pain patients
should obtain opioid prescriptions from a single opioid prescriber that monitors the patient’s pain relief and
functioning. Prescribing pain medicine from the ED for chronic pain is a form of unmonitored opioid
therapy which is not safe. In exceptional circumstances, the emergency medical provider may prescribe
opioid medication for acute exacerbations of chronic pain, when the following safeguards are followed:
1. Only prescribe enough opioid pain medication to last until the patient can contact their primary
prescriber, with a maximum of a two day supply of opioid (rather than a quantity sufficient to last until
the patient’s next scheduled appointment). The emergency medical provider should attempt to contact
the primary opioid prescriber prior to prescribing any opioids. If the patient’s primary opioid provider
feels further opioid pain medicine is appropriate, it can be prescribed by that provider, during office
hours.
2. The patient’s primary opioid prescriber is contacted first to approve further opioids for the patient. If
approved, a limited prescription can be prescribed from the ED to last until the patient is able to see
their primary opioid prescriber. This reinforces the idea that patients should obtain pain medicine only
from the primary opioid provider.
If the primary opioid provider cannot be reached, then the patient’s pharmacy should be contacted. The
pharmacy should verify recent prescriptions for pain medication from the primary opioid prescriber and not
from multiple prescribers. The ED physician should confirm that recent opioid prescriptions reported by the
pharmacy match what the patient reports. No opioids should be prescribed if the patient misrepresents the
opioid prescriptions. Providing false information in an effort to obtain prescription opioids is an aberrant
6. medication taking behavior that can signal an addiction problem. Such misrepresentation is unlawful in
Washington (RCW 69.50.403).
Urine drug testing for illicit and prescribed substances requires a working knowledge of the potential for
false positive and false negative results and the need for confirmatory testing. A discussion on the
limitations of urine testing is beyond the scope of this guideline. Other chronic pain guidelines address urine
drug testing in detail6
. Urine drug testing has to potential to identify patients using illicit drugs or not taking
medications they report being prescribed. Both of these situations are grounds for denying further opioid
prescriptions. Clinicians knowledgeable at interpreting the results of the urine drug testing are encouraged to
perform urine drug testing before prescribing opioids for exacerbations of chronic pain.
15. Prescriptions for opioid pain medication from the ED for acute injuries, such as fractured bones, in
most cases should not exceed 30 pills.
Patients should receive only enough opioid medication prescribed from the ED to last them until they see a
physician for follow-up. For acute injuries with objective findings such as fractured bones, the
emergency medical provider should not prescribe more than 30 pills. Large prescriptions promote a
longer period of time to elapse before the patient’s pain control and function can be evaluated by a
physician. Large prescriptions also increase the potential for diversion and abuse. Some fractures, such a
fractured ribs or fractured clavicle, often heal within 30 days without further medical evaluation; the
emergency provider is discouraged from prescribing more than 30 opioid pills. The patient should have a
medical evaluation if they require opioid therapy beyond 30 pills. Infrequently and in exceptional cases, it
may be necessary to prescribe more than 30 opioid pills.
Opioid medications should be used only after determining that alternative therapies do not deliver adequate
pain relief. The lowest dose of opioids that is shown to be effective should be used. A trial of schedule III
(eg hydrocodone) opioids should be prescribed before prescribing schedule II opioids17
.
16. ED patients should be screened for substance abuse prior to prescribing opioid medication for acute
pain.
Patients with a history of or current substance abuse are at increased risk of developing opioid addiction
when prescribed opioids for acute pain.18,19
Emergency medical providers should ask the patient about a
history of or current substance abuse prior to prescribing opioid medication for the treatment of acute pain.
A non-opioid regime should be offered to ED patients with acute pain and a history of or current substance
abuse. A history of or current substance abuse should not exclude an ED patient from being prescribed
opioids for acute pain but it should prompt a discussion with the patient about the potential for addiction.
Consideration should be given to prescribing a smaller quantity of opioid medication, with follow up opioid
monitoring in patients with a history of or current substance abuse. The patient’s primary care physician
should be notified of their patients’ treatment. Emergency medical providers wishing to perform more
extensive screening for the risk of opioid addiction are encouraged to use tools such as the Opioid Risk
Tool.20
17. The emergency physician is required by law to evaluate an ED patient who reports pain. The law
allows the emergency physician to use their clinical judgment when treating pain and does not require
the use of opioids.
The Emergency Medical Treatment and Active Labor Act (EMTALA) does not require the emergency
medical provider to provide pain relief for patients that do not have an emergency medical condition. Once a
medical screening exam determines patient does not have an emergency medical condition, there is no
obligation under EMTALA to treat a patient’s pain in the ED. The EMTALA definition of a medical
emergency makes reference to severe pain as a symptom that should be investigated that may be resultant to
an emergency medical condition. EMTALA does not state that severe pain is an emergency medical
7. condition. The Center for Medicare Services (CMS) requires the hospital to have policies for accessing a
patient’s pain and documenting the assessment. EMTALA does not obstruct the emergency medical
provider from applying their professional judgment to withhold opioid treatment of pain for ED patients
without an emergency medical condition.
Disclaimer: This document should not be used to establish any standard of care. No legal proceeding,
including medical malpractice proceedings or disciplinary hearings, should reference a deviation from any
part of this document as constituting a breach of professional conduct. These guidelines are only an
educational tool. Clinicians should use their own clinical judgment and not base clinical decisions solely on
this document. The following recommendations are not founded in evidence-based research but are based
on promising interventions and expert opinion. Additional research is needed to understand the impact of
these interventions on decreasing unintentional drug poisoning and on health care costs. All of the
following recommendations should be implemented in concert and collaboration with public health entities
and other relevant stakeholders.
1
National Center for Health Statistics. Medication therapy in ambulatory medical care: United States, 2003-04. Vital and Health
Statistics, Series 13, number 163, December, 2006. Accessed on 10/16/09 at
http://www.cdc.gov/nchs/data/series/sr_13/sr13_163.pdf#page=26#page=26
2
Cai R, Crane E, Poneleit K, Paulozzi L. Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs -
-- United States, 2004—2008. MMWR Morb Mortal Wkly Rep 2010;59(23);705-709.
Accessed on 5/24/11 at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5923a1.htm?s_cid=mm5923a1_w.
3
Washington State Department of Health, Center for Health Statistics, Death Certificate Records (2011 release).
4
Washington State Department of Health, Center for Health Statistics, Comprehensive Hospital Abstract Reporting System
(CHARS – 2011 release).
5
Washington State Department of Social and Health Services (DSHS), Division of Behavioral Health and Recovery, Treatment
Report and Generation Tool.
6
Agency Medical Director’s Group, Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain, March 2007. Accessed
on 10/16/09 at: http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf.
7
Medical Quality Assurance Commission, Adopted Pain Management Rules, May 2011 (effective 1/2/12). Accessed on 6/7/11 at:
http://www.doh.wa.gov/hsqa/Professions/PainManagement/files/mdpapainmgmt.pdf
8
American Pain Society–American Academy of Pain Medicine Opioids Guidelines Panel, Clinical Guidelines for the Use of
Chronic Opioid Therapy in Chronic Noncancer Pain. J Pain, 2009; 10(2):113-120. Accessed on 10/20/09 at:
http://www.jpain.org/article/S1526-5900(08)00831-6/abstract.
9
HRSA Toolkit accessed on 10/23/2009 at: http://hrsa.dshs.wa.gov/pharmacy/ChronicPainAgreement.pdf
10
CDC - Injury - Poisoning in the United States - Issue Brief. Accessed on March 22, 2010 at:
http://www.cdc.gov/HomeandRecreationalSafety/Poisoning/brief.htm.
11
For more information see the National Alliance for Model State Drug Laws, Prescription Drug Monitoring Project. Accessed on
10/23/2009 at http://www.namsdl.org/presdrug.htm.
12
Estee, S., et al., ―Use of Alcohol and Other Drugs Declined Among Emergency Department Patients Who Received Brief
Interventions for Substance Use Disorders through WASBIRT‖ – Report 4.60.WA.2007.1. Olympia, WA: Department of Social and
Health Services, Research and Data Analysis Division, May 2, 2007. Accessed on 10/16/09 at:
http://www.dshs.wa.gov/RDA/research/4/60/default.shtm.
13
Office of National Drug Control Policy, 2010 National Strategy. Accessed on 6/7/11 at:
http://www.whitehousedrugpolicy.gov/strategy/
14
Directory of Certified Chemical Dependency Services in Washington State Accessed on 10/20/09 at:
http://www.dshs.wa.gov/DASA/services/certification/Directory/Directory.shtml.
15
Chalverus, CA. Clinically significant meperidine toxicities. J Pharm Care in Pain & Symptom Control 2001; 9(3):37-55.
16
Latta, KA, Ginsberg, B, Barkin, RL. Meperidine: A critical review. Am J Therapeutics, 2002, 9:53-68.
17
Unintentional Drug Poisoning in the United States, CDC Issue Brief, July 2010, accessed May 27, 2011 at
http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdf
18
Braden J, Russo J, Fan M, Edlund M, Martin B, DeVries A, Sullivan MD. Emergency department visits among recipients of
chronic opioid therapy. Arch Intern Med in press.
19
Edlund MJ, Fan M, DeVries A, Braden J, Martin B, Sullivan MD. Trends in use of opioids for chronic non-cancer pain among
individuals with mental health and substance use disorders: the TROUP study. Clin J Pain 2010;26:1-8.
20
Accessed on May 18, 2020 at http://www.partnersagainstpain.com/printouts/Opioid_Risk_Tool.pdf.