The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists.
The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients' current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant).
The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists' recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher.
This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process.
Interprofessional competence can be defined as knowledge and understanding of their own and the other team members' professional roles, comprehension of communication and teamwork and collaboration in taking care of patients.
To evaluate whether students perceived that they had achieved interprofessional competence after participating in clinical teamwork training.
Six hundred and sixteen students from four undergraduate educational programs-medicine, nursing, physiotherapy and occupational therapy-participated in an interprofessional course at a clinical education ward. The students filled out pre and post questionnaires (96% response rate).
All student groups increased their perceived interprofessional competence. Occupational therapy and medical students had the greatest achievements. All student groups perceived improved knowledge of the other three professions' work (p = 0.000000) and assessed that the course had contributed to the understanding of the importance of communication and teamwork to patient care (effect size 1.0; p = 0.00002). The medical students had the greatest gain (p = 0.00093). All student groups perceived that the clarity of their own professional role had increased significantly (p = 0.00003). Occupational therapy students had the greatest gain (p = 0.000014).
Active patient based learning by working together in a real ward context seemed to be an effective means to increase collaborative and professional competence.
The study objectives were to explore the potential need for and use of complementary and alternative (CAM) services among women diagnosed with breast cancer and to investigate reasons for nonreceipt of CAM.
The Alaska Breast Cancer Needs Assessment Survey was completed by female breast cancer survivors in Alaska. The survey assessed physical and psychologic symptoms, services received, satisfaction with treatment, communication with providers, and informational needs. Survey responses were obtained from 309 women with breast cancer, with a mean age of 56 years and high level of education.
Results revealed that most breast cancer survivors have significant needs for CAM services, and yet only a small proportion actually receives them. For example, virtually all women reported symptoms potentially amenable to treatment via individual counseling or nutritional interventions; however, only 29% and 45%, respectively, received such services. Women who did and those who did not receive CAM services (e.g., counseling, massage, meditation, and supplementation) generally did not differ in terms of their need for such services as measured via symptoms that could be supported by these interventions. However, the majority failed to be referred for such treatments or were unable to access them if referred.
Results suggest that while access to services played a small role in nonreceipt of CAM services, the largest reason for CAM nonreceipt was failure to recognize their potential benefit on the part of providers and at least some patients. Raising awareness about the potential value of CAM among care providers for women with breast cancer is crucial, as it will likely lead to more CAM acceptance and utilization. Once providers accept and refer for CAM, patients' quality of life may be considerably enhanced, as the extant literature has demonstrated the potential value of CAM for breast cancer survivors.
To meet the needs of adults with chronic diseases, Canadian health care is moving toward more interdisciplinary, collaborative practice. There is limited high-quality evidence to support practice in this area. Occupational therapists can play a significant role in this area of practice and research.
To develop an agenda of priority areas within collaborative chronic disease research to which occupational therapy can make a contribution.
The project involved literature and Internet review, a consensus meeting with a range of stakeholders, a survey of occupational therapists, and synthesis of findings to create a research agenda.
An interdisciplinary and intersectoral group of stakeholders identified seven main priority areas. One priority is specific to occupational therapy while the remaining six cross disciplines.
The research agenda can support funding applications and encourage interdisciplinary research collaboration to ultimately produce research evidence that can benefit people with chronic diseases.
This article describes an evaluation of a curriculum approach to integrating interprofessional education (IPE) in collaborative mental health practice across the pre- to post-licensure continuum of medical education.
A systematic evaluation of IPE activities was conducted, utilizing a combination of evaluation study designs, including: pretest-posttest control group; one-group pre-test-post-test; and one-shot case study. Participant satisfaction, attitudes toward teamwork, and self-reported teamwork abilities were key evaluative outcome measures.
IPE in collaborative mental health practice was well received at both the pre- and post-licensure levels. Satisfaction scores were very high, and students, trainees, and practitioners welcomed the opportunity to learn about collaboration in the context of mental health. Medical student satisfaction increased significantly with the introduction of standardized patients (SPs) as an interprofessional learning method. Medical students and faculty reported that experiential learning in practice-based settings is a key component of effective approaches to IPE implementation. At a post-licensure level, practitioners reported significant improvement in attitudes toward interprofessional collaboration in mental health care after participation in IPE.
IPE in collaborative mental health is feasible, and mental health settings offer practical and useful learning experiences for students, trainees, and practitioners in interprofessional collaboration.
Currently, far too many older adults consume inappropriate prescriptions, which increase the risk of adverse drug reactions and unnecessary hospitalizations. A health education program directly informing patients of prescription risks may promote inappropriate prescription discontinuation in chronic benzodiazepine users.
This is a cluster randomized controlled trial using a two-arm parallel-design. A total of 250 older chronic benzodiazepine users recruited from community pharmacies in the greater Montreal area will be studied with informed consent. A participating pharmacy with recruited participants represents a cluster, the unit of randomization. For every four pharmacies recruited, a simple 2:2 randomization is used to allocate clusters into intervention and control arms. Participants will be followed for 1 year. Within the intervention clusters, participants will receive a novel educational intervention detailing risks and safe alternatives to their current potentially inappropriate medication, while the control group will be wait-listed for the intervention for 6 months and receive usual care during that time period. The primary outcome is the rate of change in benzodiazepine use at 6 months. Secondary outcomes are changes in risk perception, self-efficacy for discontinuing benzodiazepines, and activation of patients initiating discussions with their physician or pharmacist about safer prescribing practices. An intention-to-treat analysis will be followed.The rate of change of benzodiazepine use will be compared between intervention and control groups at the individual level at the 6-month follow-up. Risk differences between the control and experimental groups will be calculated, and the robust variance estimator will be used to estimate the associated 95% confidence interval (CI). As a sensitivity analysis (and/or if any confounders are unbalanced between the groups), we will estimate the risk difference for the intervention via a marginal model estimated via generalized estimating equations with an exchangeable correlation structure.
Targeting consumers directly as catalysts for engaging physicians and pharmacists in collaborative discontinuation of benzodiazepine drugs is a novel approach to reduce inappropriate prescriptions. By directly empowering chronic users with knowledge about risks, we hope to imitate the success of individually targeted anti-smoking campaigns.
ClinicalTrials.gov identifier: NCT01148186.
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