医疗责任保险将医方从医疗纠纷矛盾中解脱出来

医疗纠纷的实质就是医院和患者之间的矛盾冲突,矛盾的焦点为是否赔偿和赔偿额度的问题。由于赔偿方是医方,而医疗事故鉴定、第三方调解等均需要与医院关系密切的人员参与,导致患者的严重不信任,进而引起“医闹”等不良事件的发生。医疗责任保险转移了赔偿人,赔偿与医方的关系明显减少,是将医方从医疗纠纷矛盾中解脱出来的有效方法。     

Factors related to immunosuppressant medication adherence in renal transplant recipients

Chisholm‐Burns M, Pinsky B, Parker G, Johnson P, Arcona S, Buzinec P, Chakravarti P, Good M, Cooper M. Factors related to immunosuppressant medication adherence in renal transplant recipients. Abstract: Non‐adherence to immunosuppressant medications (ISM) is a significant issue for transplant recipients. This study examines factors influencing ISM adherence in renal transplant recipients (RTRs). Patient‐reported data were collected through a cross‐sectional survey including use of ISMs, adherence behaviors, perceived adherence barriers, beliefs and attitudes toward ISMs, and patient life satisfaction. Logistic regression was conducted to examine how RTRs’ beliefs about use of ISMs, life satisfaction, and ISM adherence barriers were related to adherence. A total of 512 adult commercial insurance enrollees following renal transplantation were included in the analysis. One hundred and seventy‐seven RTRs were non‐adherent (34.5%); the most frequently cited reason was forgetfulness. RTRs aged 18–29 yr were more likely to be non‐adherent than recipients 46–64 yr old (p ≤ 0.001). Non‐adherent RTRs had greater adherence barriers than adherent RTRs (p < 0.001). Adherent RTRs believed their ISMs were more necessary than non‐adherent RTRs (p < 0.001), while non‐adherent RTRs had greater concerns about taking ISMs (p = 0.009) and believed they had less control over their lives than adherent RTRs (p < 0.001). Non‐adherent RTRs had lower life satisfaction (p < 0.001). Non‐adherence is significantly associated with patients’ beliefs about ISMs, perceived barriers, and lower life satisfaction. Strategies to increase ISM adherence are discussed.     

Subtypes of potentially inappropriate medications in older Chinese-Americans during care transitions: Cross sectional retrospective study

Background

The number of Chinese Americans is growing and nearly 20% of older Chinese-American home care patients have at least one potentially inappropriate medications (PIMs) prescribed at hospital discharge. Further examination of PIMs during care transition is warranted, especially among older Chinese-Americans.

Objectives

To describe, during care transitions from hospital to home care: (i) the subtypes of PIMs, (ii) the difference of PIM prevalence prescribed at hospital discharge as compared to home care admission, (iii) the relationship between subtypes of PIMs, and (iv) issues affecting medication reconciliation among older Chinese-Americans.

Methods

This cross-sectional, retrospective study was conducted in a large urban home care agency from June 2010 to July 2011. From data collected by in-home survey and chart abstraction, PIMs were identified using 2002 diagnosis-independent Beers criteria. The difference of PIM prevalence at hospital discharge and at home care admission was analyzed by Wilcoxon Signed Ranks test. The relationship between subtypes of PIMs was evaluated using Phi coefficient.

Participants

82 older (age 65 years and above) Chinese-American home care patients following recent hospital discharge.

Results

3.38% (22) and another 3.72% (28) of prescribed medications were identified as PIMs at hospital discharge and home care admission, respectively. There was no statistically significant difference in PIM prevalence identified at hospital discharge and at homecare admission (z = −1.732, p = .083). PIMs included: long-term use of stimulant laxatives and high-dosages of ferrous sulfate, and a significant relationship between these two PIMS (r = .224, p = .04). More than 80% (n = 65) of study participants reported low education levels and limited English proficiency.

Conclusions

Subtypes of PIMs were ordered during the post-hospital transfers, indicating the necessity to review the appropriateness of medications during this transition. Guidelines such as Beer's criteria regarding appropriateness of medications should be incorporated in medication reconciliation before adding new medications to treat the older adult's health problems. The medication management process needs to be both culturally sensitive and adapted to literacy level; validating the patients’ full understanding of their medications is paramount.     

Developing Strategies for On-Call Staffing: A Working Guideline for Safe Practices

Effective on-call clinical staffing is critical to providing perioperative services to patients requiring emergency surgical care. Without careful monitoring of continuous work hours and hours worked per week, staffing practices can adversely affect the ability of personnel to function and provide care. Managers and perioperative personnel must carefully evaluate their on-call schedule to ensure the provision of safe medical care for their patients. Perioperative leaders at two hospitals partnered to create a safety guideline for on-call staffing practices, which includes zone guides for determining workload intensity. This guideline has served to help managers evaluate the general safety of their staffing plan and identify on-call practices that may need improvement or support in their areas of responsibility. Key recommendations from the guideline can help perioperative managers at other facilities establish clinical staffing plans and on-call practices that are safe and effective.     

4种常用阿尔茨海默病评测量表与提高后的服药依从性相关研究

目的探讨常用的4种阿尔茨海默病神经心理评测量表与提高后的服药依从性是否具有相关性。方法纳入2014年6月-2017年12月该院门诊及住院的31例阿尔茨海默病患者进行前瞻性研究。消除服药依从性的主观消极因素(医务人员、患者及照料者),改善患者服药依从性。同时,进行阿尔茨海默病评定量表认知部分、日常生活能力量表、神经精神症状问卷、基于临床医师对病情变化印象及照料者访谈量表的评测,检验两者相关性,并纳入影响依从性的客观因素进行偏相关关系分析。最后具体分析阿尔茨海默病评定量表认知部分各条目与服药依从性的相关性。结果 4种量表均与服药依从性均无相关性(P>0.05);偏相关分析也未显示出相关性(P>0.05)。阿尔茨海默病评定量表的命令和结构性2个条目分数与服药依从性具有弱相关性(P≤0.05,相关系数分别为0.201及0.177)。结论现有的阿尔茨海默病评测量表不能很好的评测阿尔茨海默病患者的服药依从性。服药依从性可能与实践能力相关。