Exploring the health and social care needs of older people with a drug problem

A sample of 291 people aged 16–25 responded to an interviewer-completed questionnaire seeking information on their quantity and rate of alcohol consumption. The survey was conducted in licensed premises in the centre of a large English city. Analysis revealed that men drank more than women, but adjusting for body size and recommended alcohol intake removed this difference. Most respondents planned to drink far more than recommended upper limits. However, they did so at a moderate rate of intake over many hours and only a minority planned to drink so fast that they would become extremely drunk. “Binge” drinking was typically defined by this sample to be fast and excessive drinking. There was no evidence of a distinct minority of bingers, for intake was a skewed unimodal distribution. Binge drinking is a politically highly charged concept, but is rarely defined with any precision. It is confused with drinking to excess and with drunkenness. This study suggests that drinking rate must be a key part of any competent definition. Study participants were on a drinking “bout” that involved drinking too much for health over 5 or 6?hours, but were not planning to get very drunk. Young people need to be encouraged to drink less even when they are not getting drunk, and warnings about binges and their dire consequences may distract from this message.     

长程使用糖皮质激素患者的临床药学监护

目的:在长程使用糖皮质激素患者中进行药学监护,探讨其临床应用价值.方法:随机选取我院2013年1月～2015年1月收治的60例长程使用糖皮质激素患者作为研究对象,以随机数字表法将其平均分为观察组与对照组.观察组给予临床药学监护,对照组行常规治疗,未进行临床药学监护,对比分析两组临床效果.结果:观察组在各项疾病知识掌握度指标、用药治疗依从性指标以及视力损伤、糖尿病、骨质疏松等用药不良反应发生率上均优于对照组,P＜0.05,差异有统计学意义.结论:对长程使用糖皮质激素的患者采取药学监护可以有效减少患者用药不良反应提高依从性,提高患者对疾病知识的掌握水平,值得在临床推广.     

Optimising drug utilisation in long term care

Providing quality long term care for the elderly while containing costs is presenting major challenges for governments and policy makers. Although international variability exists with respect to the number of medications and other factors influencing suboptimal pharmacotherapy, suboptimal pharmacotherapy among elderly persons is common. This international problem requires a creative and multifaceted approach to improve and rationalise prescribing. We outline the non-regulatory efforts and regulatory means to approaching this problem. The recent introduction of a prospective payment system for long-term care in the US has underscored the importance of a regulatory approach to counter-balance the cost containment efforts which bundle the cost of medications into a prospectively set per diem rate. An examination of how US regulatory bodies are considering improving prescribing is provided. Considering the case of coronary heart disease, we provide data regarding the performance of a quality indicator aimed at stimulating quality prescribing for this medical condition. Although the use of regulatory approaches can improve prescribing, it is also recognised that a more holistic approach involving multidisciplinary teams and greater focus on the patient is the ultimate aspiration. This is particularly the case with the elderly in whom appropriate drug therapy can have a major impact on outcomes. A major cultural shift in the way society views and treats the elderly may be required in order to produce dramatic improvements in long term care for older people.