摘要:

A model defined by the methodologies of the social sciences and health services research

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00843.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

This review examines two methodologies that are being increasingly used in health services research (HSR): the Delphi and nominal group techniques. The Delphi is a survey technique for decision making among isolated respondents while the nominal group technique (NGT) is a highly controlled small group process for the generation of ideas. Typical applications of the techniques are for the development of consensus guidelines or standards in areas where research based evidence is absent or inconclusive. We discuss methodological issues associated with these techniques, namely, sample size and composition, response rates, anonymity, feedback and consensus, and reliability and validity. We also illustrate the range of applications of the techniques in HSR, including pharmacy practice. Although not widely used to date, both methodologies are potentially valuable additions to the practice researcher's toolbox.

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00844.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Activities undertaken by community pharmacists may be monitored in individual pharmacies to analyse the division of labour before and after changes in work practices, and for general insight into the current roles of pharmacists. Studies based in community pharmacies have used work sampling techniques, with activities recorded by observers at defined intervals. Sampling methods and the selection of observation periods have varied between studies, with activities recorded at one‐ to‐ five‐minute intervals or at random. Differing classifications of activities also limit the comparison of findings. There exists a need for further research in this area to address sampling issues and limitations imposed by observers in pharmacies and to provide data relevant to present day practice. Self‐reporting of activities using electronic bar code readers and reminders may be feasible for data collection from multiple‐pharmacist pharmacies or larger samples of p

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00845.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

An observational study of prescribing for dyspepsia, in Glasgow, used Scottish Prescribing Analysis (SPA) and Prescribing Information for Scotland Computer Programme (PRISMS) data to monitor the implementation of a set of locally produced guidelines on dyspepsia. The main outcomes measured were the proportion of cimetidine prescribed generically, the ratio of prescriptions for cimetidine and ranitidine, the number of prescriptions for omeprazole per 1,000 patients per month and the total number of prescriptions for tripotassium dicitratobismuthate (De‐Nol) per month. The results suggest that the dyspepsia guidelines have been successfully implemented as there has been an increase in the proportion of cimetidine prescribed generically, an increase in the use of cimetidine as the H2antagonist of choice and an increase in the use of the recommended triple therapy regimen to eradicateHelicobacter pyloriinfection from patients with peptic ulcer disease. This study shows that consensus guidelines on a common clinical condition can be widely accepted in primary care if appropriately designed, developed and implemented. Their implementation can be followed from routine prescription informatio

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00846.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Validated data collection instruments were used to assess the health status and existing drug therapy of 79 patients (16 male, 63 female; mean age 84 [±9] years) in two private nursing homes in Norfolk. The homes had already been found to be above average standard in terms of medicines supply, storage and administration. The most common symptoms of long term chronic disease were associated with neurological, cardiovascular, arthritic, psychiatric or diabetic diagnoses. Fifty nine patients had some memory impairment; 77 suffered from additional health problems which could arise from inappropriate therapy or dosing. All patients received most of their medicines from nursing staff. The mean (±SD) number of items received per day was 7.1 (±3.4). Of drugs prescribed for regular use, 79 per cent were given in accordance with the wishes of the prescriber. In contrast, only 21 per cent of medicines prescribed for use when necessary (prn) were given as intended. Thirty three per cent ofprnmedicines, some prescription only, had been given in the absence of any GP knowledge or instruction. Although there were written procedures for drug administration, there was only 58 per cent compliance with these guidelines. Drug administration charts proved to be an incomplete record of pre‐existing drug allergy, topical application, self‐medication and drugs used in routine nursing procedures, eg, bladder wa

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00847.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

A survey of pharmaceutical care in two private nursing homes in Norfolk identified concerns relating to the extent and nature of patient therapy as well as its administration and documentation (see p83). With the support of medical and nursing staff, relevant policy documents were reviewed by the investigating pharmacist and then implemented. A laxative policy was also introduced. During the next five months, monthly medication reviews were made for the 60 patients (eight male, 52 female; mean age 84 [±9] years) who remained from the original survey. Recommendations concerning individual drug therapy were subsequently evaluated. Of the 44 recommendations for changes in prescribing and administration of drugs that were accepted by the medical/nursing staff, 37 produced positive outcomes for the patient. Compared with the baseline data, there were significant increases in the number of patients who were free of possible drug induced problems (P<0.05) or no longer constipated (P<0.005) and a significant increase in the proportion of medicines administered in accordance with the prescriber's wishes (P<0.05). The accuracy and completeness of drug administration records had improved and guidelines for nurse prescribing had been rationalised. The mean daily number of items taken by patients had fallen by 1.5. Based on these data, provision of pharmaceutical care to private nursing homes should produce significant cost savings and improve patient care

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00848.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

An extended information service on prescription medicines was evaluated in four community pharmacies over a period of 11 months, including a three‐month pilot phase. Written patient information leaflets (PILs) and structured verbal advice designed according to the preferences of local people were provided by the pharmacist to patients prescribed any of three study drugs — amoxycillin, atenolol or ibuprofen. A total of 1,614 PILs were issued. Data were collected from a sample of 311 recipients about their perception and recall of the information service. Altogether, 64 per cent remembered receiving the study leaflet and 56 per cent remembered receiving some verbal information from the pharmacist. More than 80 per cent of service recipients supported the provision of both verbal and written information by the pharmacist. In the main study period (n=203), the types of information respondents could recall receiving most frequently were when to take the medicine (67 per cent), the name of the medicine (53 per cent) and side effects (41 per cent). Sixty seven per cent (40) of those receiving amoxycillin, 61 per cent (43) taking atenolol and 38 per cent (28) taking ibuprofen recognised a side effect of their medicine given in both the leaflet and verbal advice. For all three drugs, side effects were recognised most frequently when included in both the written and verbal information. Support for this aspect of the pharmacist's extended role has been demonstrated in practice and the feasibility of service implementation is discus

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00849.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The 16‐item Krantz Health Opinion Survey (KHOS) and the 18‐item Multidimensional Health Locus of Control (MHLC) were used to measure Thai consumers' and pharmacists' attitudes and beliefs about self‐care and personal responsibility for health. A face‐to‐face interview was conducted with 193 consumers at Silpakorn university pharmacy, Thailand, and with 34 pharmacists who worked occasionally at the pharmacy. All subjects were asked to indicate their responses to each of the 34 statements on a continuous measure ranging from strong disagreement to strong agreement. The KHOS results showed that Thai pharmacists had more favourable attitudes than Thai consumers towards receiving health care information and were more actively involved in their health care. The MHLC results showed that Thai consumers believed more than Thai pharmacists that their health was under the control of “powerful others”. Out of five demographic variables (sex, age, marital status, education and income), education was found to be the best predictor of Thai consumers' attitudes and beliefs. However, none of these variables could be used to predict Thai pharmacists' attitude

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00850.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

In this study, health promotion activity in community pharmacies and pharmacists' perceptions of the barriers to increasing health promotion activity were investigated. A stratified sample (30) was investigated using a structured interview. Health promotion activities were undertaken in all pharmacies in the study. The number of times advice was given or a query dealt with was estimated to be around 1,400 per week for this sample. Health promotion activity was 2.5 times more likely to be reactive than proactive. Other issues were identified which suggest that pharmacists' activities in this field tend to be passive and product orientated. Barriers identified included remuneration issues, space, time, training and insufficient liaison with other health professionals and health promotion units.

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00851.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Extemporaneous preparations are drugs that are compounded for individual patients or made in larger batches for stock‐keeping. This study aimed to assess the prescribing of extemporaneous preparations in Swedish primary care, both therapeutically and pharmaceutically. An analysis of the extent to which alternative commercial drugs were available at the time of the prescription was also conducted.Information was taken from the Swedish diagnosis and therapy survey for the time period October, 1986, to September, 1988, inclusive. This survey collects from a random sample of physicians the details of all prescriptions they write during one week, as well as the corresponding diagnoses. The present study analysed the 1,043 extemporaneous prescriptions written during that period.The majority (62 per cent) were considered to be therapeutically appropriate in that they formed recommended treatment for the diagnosis in question according to the medical literature. Another 15 per cent were neither recommended nor questioned in the consulted sources; 20 per cent were designated as controversial because they were recommended in some sources and questioned in others. About 3.5 per cent were considered to be therapeutically inappropriate, ie, the literature suggested that their use should be abandoned. One per cent were pharmaceutically inappropriate. Many preparations probably could have been replaced by commercial alternatives, about half differing from available commercial alternatives only by strength and/or vehicle. Whether substitutions could have been made in practice would depend on the clinical picture in the individual patient cas

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00852.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY