Consultation behaviour of doctor-shopping patients and factors that reduce shopping

Rationale, aims and objectives To investigate the subsequent behaviour of doctor‐shopping patients (defined as those attending multiple hospitals for the same complaint) who consulted our department and factors related to cessation of doctor shopping. Methods Patients who presented without referral to the Department of General Medicine at Chiba University Hospital in Japan (our department) completed a questionnaire at their first visit. A follow‐up questionnaire was also sent to them in order to assess doctor shopping after 3 months. Then items in the questionnaires were investigated for significant differences between patients who continued or stopped doctor shopping. Logistic regression analysis was performed with items showing a significant difference between patients who stopped doctor shopping and those who continued it, in order to identify independent determinants of the cessation of shopping. Results A total of 978 patients who presented spontaneously to our department consented to this study, and 929 patients (95.0%) completed questionnaires correctly. Among them, 203 patients (21.9%) were identified as doctor shoppers. The follow‐up survey was completed correctly by 138 patients (68.0%). Among them, 25 patients (18.1%) were found to have continued doctor shopping, which was a significantly lower rate than before (P < 0.001). Logistic regression analysis selected the following factors as independent determinants of the cessation of doctor shopping: ‘confirmation of the diagnosis’ (odds ratio: 8.12, 95% confidence interval: 1.46–45.26), and ‘satisfaction with consultation’ (odds ratio: 2.07, 95% confidence interval: 1.42–3.01). Conclusion Doctor shopping decreased significantly after patients consulted our department, with ‘confirmation of the diagnosis’ and ‘satisfaction with consultation’ being identified as contributing factors.     

Bone health issues in breast cancer survivors: a Medicare Current Beneficiary Survey (MCBS) study

Purpose

Breast cancer treatments (chemotherapy and hormone therapy) can cause a rapid loss in bone mineral density, leading to osteoporosis and fractures later in life. Fortunately, preventative measures (vitamin D, exercise, etc.) can delay bone loss if employed early enough. This study compares the prevalence of osteoporosis and osteoporosis-related discussions with physicians among female breast cancer survivors and females with no cancer history to determine if breast cancer patients are being correctly advised on their high risk of bone loss.

Methods

The 2003 Medicare Current Beneficiary Survey, a nationally representative sample of 550 women with a breast cancer history and 6,673 women with no cancer history aged ≥65, was used. The first set of dependent variables collected information on bone health (osteoporosis, falls, and fractures). The second set of dependent variables collected information on bone health discussions with their physician. Multivariate logistic regression models were used to evaluate whether breast cancer was independently associated with bone health issues.

Results

After adjustment for confounders, a breast cancer diagnosis was found to be associated with a higher prevalence of an osteoporosis diagnosis over their lifetime (adjusted odds ratio (OR_adj)?=?1.32, 95 % confidence interval (95 % CI)?=?1.08–1.61) and falls in the previous year (OR_adj?=?1.23, 95 % CI?=?1.01–1.51) compared to respondents without a cancer diagnosis. However, breast cancer respondents were not more likely than respondents without a cancer diagnosis to discuss osteoporosis with their physician (OR_adj?=?1.20, 95 % CI?=?0.96–1.50) or be told they are at high risk for osteoporosis (OR_adj?=?1.41, 95 % CI?=?0.95–2.10).

Conclusions

A breast cancer diagnosis was associated with an increased prevalence of osteoporosis and falls. Nevertheless, breast cancer respondents were not more likely to discuss osteoporosis with their physician nor were they more likely to be considered high risk for osteoporosis. Increased dialogue between physician and breast cancer patient pertaining to bone loss is needed.     

Violence and burnout in health care emergency workers in Santiago,Chile: A survey-based cross-sectional study

Shortage of quantitative studies regarding health risks for emergency services workers is a concern for Chilean’s occupational health organizations.ObjectiveTo explore the incidence of violence and burnout in emergency services of the Metropolitan Region of Chile, and associations with workers’ characteristics and workplace conditions.MethodsA cross-sectional study was carried out from January to August 2016. A self-reported questionnaire explored about frequency and seriousness of violence episodes and about symptoms of burnout with the Maslach Burnout Inventory.ResultsOf the 565 workers participating, 71% (95% CI 66.7–74.5) said violence episodes occurred at least once a week; 71.3% (95% CI 67.3–75.0) were victims of some aggression in the previous 12 months. Patients companions, relatives or friends arose as the main aggressors and the severity of the episodes was considered slight or moderate by more than 50% of participants. Fifty-seven respondents (10.5%, CI 95% 8.1–13.5) classified as having a burnout syndrome. Having been a victim of violence was associated to high emotional exhaustion (OR_adj = 1.7, 95% CI: 1.1–2.8) and depersonalization (OR_adj = 2.0, 95% CI 1.3–3.3).ConclusionsViolence is a problem in the emergency departments of Chile’s Metropolitan Region. Burnout is also present and independently associated to violence.     

Validation of a method for recording pharmaceutical interventions

What is known and objective: The validation of a method for recording pharmaceutical interventions measures the instrument’s ability to provide consistent values when the same analysis is performed several times. Our aim was to validate the inter‐rater reliability of the method used to record pharmaceutical interventions in our hospital. Methods: We recorded interventions in a database, entering variables related to the patient, treatment and impact of the recommendation. We also recorded the type, cause and clinical significance of the negative outcome associated with use of the medicinal product (NOM). Twenty interventions performed during a 3‐year study period (2007–2009) were randomly tested for consistency to analyse the kappa (κ) coefficient statistic of the recommendations as coded by nine senior and junior clinical pharmacists. Results and discussion: There were 87·8% global consistency for NOM cause, 66·1% for intervention impact and 95·0% for NOM type. Agreement was substantial for ‘intervention reasons’, with a κ value of 0·74 (95%CI 0·61–0·87), fair for ‘intervention impact’, with a κ value of 0·24 (95%CI 0·15–0·32) and excellent for ‘NOM type’, with a κ value of 0·87 (95%CI 0·71–1·00), respectively. Our results are globally good, especially with regard to the analysis of intervention reasons and NOM type, which matches other authors’ findings. Furthermore, our validation method is suitable for recording and considering the impact of pharmaceutical interventions. What is new and conclusion: We describe a systematic method for clinical pharmacists to record their activities and assess their value. This methodology should help in the development of clinical pharmacy in Spain and should be translatable to other settings.