Measuring adolescent drinking-refusal self-efficacy: Development and validation of the Drinking Refusal Self-Efficacy Questionnaire-Shortened Adolescent version (DRSEQ-SRA)

BackgroundThis study aimed to develop and validate a shortened version of the Drinking Refusal Self-Efficacy Questionnaire-Revised Adolescent version (DRSEQ-RA) using a large sample of adolescents.MethodsSecondary school students (N = 2609, M = 14.52 years, SD = 0.94) completed the DRSEQ-RA (consisting of subscales: Social Pressure; Opportunistic; Emotional Relief) and the Alcohol Use Disorders Identification Test (AUDIT). These data were analysed using non-parametric item response theory (NIRT) including Mokken scalability coefficients, and confirmatory factor analysis.ResultsSocial Pressure subscale items were better able to distinguish between adolescents with lower or higher levels of drinking refusal self-efficacy, while the Opportunistic and Emotional Relief subscale items were able to distinguish adolescents with low drinking-refusal self-efficacy. The DRSEQ-RA was reduced from 19-items to a 9-item scale and retained the original three-factor structure. The reduced scale was named the Drinking Refusal Self-Efficacy Questionnaire-Shortened Revised Adolescent version (DRSEQ-SRA). The DRSEQ-RA and the DRSEQ-SRA have almost identical psychometric properties. They both demonstrated good fit to the data, each explained 18% of the variance in alcohol consumption, Adj. R² = 0.18, p < .001 respectively. The DRSEQ-RA and the DRSEQ-SRA also have excellent scale and subscale internal reliability (αs = 0.92–0.99).ConclusionsThe DRSEQ-SRA is a short, 9-item, measure of adolescent drinking-refusal self-efficacy which demonstrates both reliability and validity. A significant advantage is brevity. The DRSEQ-SRA may be a valuable tool for identifying risk of adolescent drinking and prevention/treatment planning in settings where survey administration time is critical.     

中文版Morisky服药依从性评估量表在炎症性肠病患儿中应用的信效度评价

目的 探讨中文版Morisky服药依从性量表(包括监护人版和未成年人版)在炎症性肠病患儿中应用的信度与效度，并明确炎症性肠病患儿服药依从性现状与特征。方法 纳入炎症性肠病患儿141例，以中文版Morisky量表为评估工具，以现场发放与回收问卷的形式收集数据，采用克伦巴赫(Cronbach''s)a 系数和因子分析分别评价量表内部一致性信度和结构效度，采用Spearman检验评估患儿服药依从性与其疾病严重程度的相关性。结果 监护人版和未成年人版Morisky量表的Cronbach''s a系数分别为0.701和0.738；因子分析结果共提取3个公因子，累积方差贡献率分别为67.94%和72.24%；141例患儿的用药依从性评估得分为6.75(4.75，8.0)分，其中，依从性不良、中等与极好的患儿分别为58例(41.1%)，39例(27.7%)和44例(31.2%)；患儿用药依从性得分与其疾病严重程度呈显著负相关关系(R_s=-0.286，P=0.001)。结论 中文版未成年人版和监护人版Morisky量表均具有较好的信度与效度，可用于评估炎症性肠病患儿的服药依从性。近一半炎症性肠病患儿服药依从性差，忘记服药是影响依从行为的主要障碍，且患儿用药依从性与其疾病严重程度呈显著负相关，临床应予以高度重视。     

1例结核性脑膜炎患者治疗的药学监护与分析

目的：探讨1例结核性脑膜炎患者的药学监护和用药。方法：临床药师以疗效、药物不良反应为切入点,对患者病情进行分析并协助医师制定个体化用药方案,监护患者接受治疗的全过程。结果：在临床医师和临床药师的共同参与下,患者的病情逐渐好转,最终痊愈出院。结论：临床药师可以发挥自己的专业特长,协助临床医师优化治疗方案,实施药学监护,促进临床合理用药。     

Mealtime-related dosing directions for proton-pump inhibitors in gastroesophageal reflux disease: Physician knowledge,patient adherence

ObjectiveTo describe physicians’ knowledge, patients’ adherence, and perceptions of both regarding mealtime-related dosing directions for proton-pump inhibitors (PPIs).DesignChart review and survey of patients and physicians.SettingUnited States, with data collected between January and July 2011.ParticipantsPatients being treated for gastroesophageal reflux disease (GERD) with PPIs and their prescribing physicians.Main outcome measuresPatient- and physician-reported perception of PPI mealtime-related directions as important/inconvenient (seven-point Likert scale; 7 = very important/very inconvenient); physician-reported knowledge of PPI mealtime-related dosing directions based on whether the agent is labeled to be taken 30–60 minutes before eating (DIR—esomeprazole magnesium [Nexium—AstraZeneca], lansoprazole, and omeprazole) or labeled to be taken regardless of meals (NoDIR—dexlansoprazole [Dexilant—Takeda], rabeprazole, and pantoprazole); and patient-reported PPI mealtime-related directions received and adherence to directions.ResultsPhysicians (n = 262) recruited 501 patients who had been prescribed PPIs (262 DIR/239 NoDIR; mean age 51 years, 37% men, 56% nonerosive GERD [29% undocumented]). Across PPIs, physicians frequently reported incorrect directions or “did not know directions” (29% for esomeprazole to 69% for pantoprazole). While 98% of patients reported receiving directions from their physicians and 55% from their pharmacists, only 65% of DIR patients and 18% of NoDIR received directions consistent with product labeling. Physicians perceived greater inconvenience than patients (4.4 vs. 1.6, P < 0.001) and greater importance (5.2 vs. 4.5, P < 0.001) of mealtime-related directions. Overall, 81% of patients reported taking their PPI as directed.ConclusionWhile this patient cohort was adherent to directions given, physicians’ directions were often inconsistent with product labeling. Understanding physician and patient knowledge gaps may be critical to ensuring patients receive appropriate directions, improving patient adherence to specific dosing instructions, attaining positive therapy outcomes, and identifying opportunities for pharmacist-led interventions.     

Physician-pharmacist collaboration on chronic non-cancer pain management during the opioid crisis: A qualitative interview study

BackgroundManagement of chronic non-cancer pain is complex, requiring clinicians to balance pain management with the risk of opioid abuse. The role of ambulatory care pharmacists in chronic pain management is well-established, but little research has explored the feasibility of building collaboration on chronic pain and opioid management between physicians and community pharmacists.ObjectiveTo explore physician and pharmacist perspectives on the opioid crisis and the possibility of physician and community pharmacist collaborations to manage chronic non-cancer pain in the context of the opioid crisis.MethodsSemi-structured interviews were performed with a snowball convenience sample 15 physicians and 25 pharmacists in North Carolina between November 2016 and April 2017. Transcribed data were analyzed using applied thematic analysis, and resulting codes were organized into themes and domains which emerged from analysis.ResultsBoth physicians and pharmacists described current care deficiencies and steps needed to mitigate opioid abuse and diversion. Physicians discussed the need for additional supports and resources for chronic pain management and regarded positively the role of the community pharmacist in chronic pain management and mitigating opioid abuse. Pharmacists identified cost as the major barrier to implementing new services, and expressed willingness to participate in new chronic pain and opioid interventions.ConclusionWithin the study sample, strong interest exists for collaboration between physicians and community pharmacists. This highlights a potential opportunity to expand care for patients with chronic non-cancer pain.     

“My pharmacist”: Creating and maintaining relationship between physicians and pharmacists in primary care settings

BackgroundPharmacists and physicians are being increasingly encouraged to adopt a collaborative approach to patient care, and delivery of health services. Strong collaboration between pharmacists and physicians is known to improve patient safety, however pharmacists have expressed difficulty in developing interprofessional working relationships. There is not a significant body of knowledge around how relationships influence how and when pharmacists and physicians communicate about patient care.ObjectivesThis paper examines how pharmacists and primary care physicians communicate with each other, specifically when they have or do not have an established relationship.MethodsThematic analysis of data from semi-structured interviews with nine primary care physicians and 25 pharmacists, we examined how pharmacists and physicians talk about their roles and responsibilities in primary care and how they build relationships with each other.ResultsWe found that both groups of professionals communicated with each other in relation to the perceived scope of their practice and roles. Three emerging themes emerged in the data focusing on (1) the different ways physicians communicate with pharmacists; (2) insights into barriers discussed by pharmacists; and (3) how relationships shape collaboration and interactions. Pharmacists were also responsible for initiating the relationship as they relied on it more than the physicians. The presence or absence of a personal connection dramatically impacts how comfortable healthcare professionals are with collaboration around care.ConclusionThe findings support and extend the existing literature on pharmacist-physician collaboration, as it relates to trust, relationship, and role. The importance of strong communication is noted, as is the necessity of improving ways to build relationships to ensure strong interprofessional collaboration.     

Perceptions and self-reported competency related to testing,management and treatment of hepatitis C virus infection among physicians prescribing opioid agonist treatment: The C-SCOPE study

BackgroundThis study evaluated competency related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT).MethodsC-SCOPE is a study consisting of a self-administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and USA between April-May 2017. A 7-point scale was used to measure < average competence (score >4 of 7) related to HCV testing, management and treatment.ResultsAmong 203 physicians (40% USA, 45% Europe, 14% Australia/Canada) 21% were addiction medicine specialists, 29% psychiatrists, and 70% were metro/urban [mean PWID managed, 51; years of experience, 11]. The majority perceived HCV testing (82%) and treatment (85%) among PWID as important. The minority reported < average competence with respect to regular screening (12%) and interpretation of HCV test results (14%), while greater proportions reported < average competence in advising patients about new HCV therapies (28%), knowledge of new treatments (37%), and treatment/management of HCV (40%). In adjusted analysis, factors independently associated with < average self-reported competency related to the ability to treat HCV and manage side effects included fewer years in medical practice, fewer numbers of patients treated for HCV infection in the past six months, not having obtained information on screening, diagnosing or treatment of HCV, not having attended any training on HCV in the past year, and not having read or consulted AASLD/IDSA, EASL or other guidelines for HCV.ConclusionPhysicians treating HCV infection among PWID attending OAT clinics recognized the importance of HCV testing and treatment. However, self-perceived competency related to HCV management and treatment was low, highlighting the importance of improved HCV education and training among physicians practicing in clinics offering OAT.     

The importance of understanding patient and physician preferences for psoriasis treatment characteristics: a systematic review of discrete-choice experiments

Abstract

Introduction: Treatment adherence continues to be a major challenge in psoriasis. Patient preference studies, especially discrete-choice experiments, are gaining popularity to gather insights into patient reported treatment outcomes. This systematic literature review aimed to critically assess all discrete choice experiments exploring patients’ and physicians’ preferences for psoriasis treatment characteristics.

Methods: PubMed and EMBASE databases were searched using keywords “psoriasis” and “preferences” to identify relevant literature. Discrete-choice experiments conducted in French or English from the year 2000 onwards, that focused on evaluating psoriasis treatment preferences in patients and/or physicians, were included. The relative importance of treatment attributes was assessed and studies were critically appraised using validated checklists.

Results: Out of 987 articles identified, 25 articles fulfilled the inclusion criteria. Overall, patients and physicians prioritize efficacy-specific outcomes. Patients are shown to place greater importance to process attributes when compared to physicians, especially route and location of administration. Physicians focus primarily of efficacy attributes, however when the top two attributes are considered, safety outcomes increasingly become considered important. Of the studies, 60% conducted subgroup analysis, of which many reported associations between specific patient characteristics and preferences. Factors such as age, disease severity, and duration of condition significantly affected preferences for treatment attributes.

Conclusions: This review provides insight into the types of attributes that patients and physicians value most, and therefore can help improve shared decision-making. The findings of this study also encourage regulatory agencies to continue integrating patient preferences in their decision-making.     

The role of pharmaceutical marketing and other factors in prescribing decisions: The Yemeni experience

BackgroundPrescribing decisions are a complex phenomenon and influenced by many pharmacological and non-pharmacological factors. Little is known about the actual prescribing behaviors of physicians or the factors behind their prescribing decisions.ObjectiveThe objective of this study was to explore the factors that influence physicians' prescribing decisions and the role of the marketing activities by pharmaceutical companies in this decision-making process.MethodsA semi-structured interview with the critical incident technique method was used to encourage physicians to describe the particular situations of prescribing for specific newly marketed drugs. All interviews were transcribed verbatim and thematic content analysis with systematic and comprehensive coding was employed to identify categories of physicians' reasons for either prescribing or not of the study drugs.ResultsFactors that influence prescribing of the study drugs (223 critical incidents) were categorized in six major themes. Drug characteristics, the most frequently mentioned by physicians as reasons of prescribe, were implicated in 70 (31.4%) incidents, followed by pharmaceutical company mentioned in 53 (23.8%) incidents, indications, 31 (13.9%) incidents, and patient contexts, 26 (11.7%) incidents. Environmental factors as information and evidence were implicated in 22 (9.9%) incidents, and physician factor, 21 (9.4%) incidents.ConclusionPrescribing is a complex process and physicians integrate different factors. Although physicians make a considerable on patient contexts and treatment outcomes, they still rely on their personal experiences when making prescribing in addition to firms' source of information and firms' marketing activities.     

合肥市某区社区医生对国家基本药物制度的认知及影响因素分析

目的 通过社区医生对基本药物制度的认知及影响因素的分析,为进一步提高基本药物使用率提供相关对策和建议。方法 对合肥市某区8个社区卫生服务中心和2个乡镇卫生院所有在岗的215名社区医生进行问卷调查。调查内容主要包括社区医生对基本药物制度的认知、基本药物使用情况和实施后效果评价等。结果 不同年龄（F=6.595,P=0.002）、婚姻状况（t=2.40,P=0.040）、工作年限（F=7.12,P=0.009）和受教育程度（F=5.47,P=0.006）的社区医生对国家基本药物制度的认知比较,差异均有统计学意义（P<0.05）;多因素logistic回归分析,社区医生的年龄、个人年收入和专业技术职务均为国家基本药物制度认知的影响因素（P<0.05）。结论 社区医生对国家基本药物制度的认知不足,应加强对社区医生的宣传教育工作,提高国家基本药物制度的运行效果。     

Patients with rare diseases using pharmacists for medication information

Objectives:To determine whether patients with a rare illness (1) use pharmacists for medication information more or less frequently than physicians and the Internet, (2) perceive pharmacists as a more or less credible medical information resource than physicians and the Internet, and (3) obtain different types of medication information from pharmacists, physicians, and the Internet.Design:Cross-sectional survey.Setting:Online data collected between 2008 and 2009.Patients:Adult, English-proficient vasculitis patients (n = 232) who were taking at least one medication to treat their vasculitis.Intervention:Administration of online survey.Main outcome measures:Patient use of pharmacists, physicians, and the Internet for medication information; perceived credibility of pharmacists, physicians, and the Internet as sources of medication information; and types of medication information obtained from pharmacists, physicians, and the Internet.Results:Participants consulted physicians and the Internet more than pharmacists for medication information; only 96 participants (41.4%) ever used pharmacists for vasculitis medication information. Females and participants who used community pharmacies were significantly more likely to consult pharmacists for medication information as compared with males and patients who did not use community pharmacies. Participants perceived pharmacists were a less credible source of medication information than physicians and the Internet. Participants used physicians and/or the Internet more than pharmacists for five of eight types of medication information, including adverse effects and drug effectiveness.Conclusion:Vasculitis patients consulted sources other than pharmacists for medication information. Several factors, including perceived pharmacist credibility and a noncommunity-based pharmacy, may contribute to infrequent patient use of pharmacists as a medication information source. Future qualitative research should document how patients with rare disease perceive and interact with pharmacists to understand why many view pharmacists as only moderately credible sources of medication information.     

Reflexive thematic analysis of job-related problems associated with pharmacist suicide, 2003–2019

BackgroundFew qualitative studies have focused on suicide and specific job-related problems associated with suicide in pharmacists. Greater knowledge of specific work-related stressors amongst pharmacists could inform suicide prevention strategies.ObjectiveTo identify job-related stressors associated with pharmacist suicides and compare stressors to those previously reported in physicians and nurses.MethodsFree-text law enforcement and medical examiner data for pharmacist suicides were extracted from the National Violent Death Registry (NVDRS) for 2003–2019. Reflexive thematic analysis was deployed via a deductive approach utilizing codes and themes found in previous research on nurse and physician suicides. New codes were also identified through inductive coding.ResultsA total of 291,872 suicides occurred between 2003 and 2019, of which 392 were pharmacist deaths. Of these, 62 pharmacist suicides were coded with job-related problems. Almost all deductive themes/codes extracted from nurses and physicians were present in pharmacists. Common codes found in the pharmacist dataset that were also found previously in physicians and nurses were: history of mental health, substance use disorder, hopelessness impending or proceeding job loss, and access to lethal weapons and/or drugs. Novel codes were added through inductive content analysis. Codes novel to pharmacists were: verbalized suicidal ideation (SI) or intent, diversion for the purpose of suicide, and the fear of job loss. Disciplinary action at the institutional level was associated with the fear of job loss and cited as the event triggering suicide completion.ConclusionPharmacists have similar job-related stressors associated with suicide as physicians and nurses. Evaluating the process of disciplinary action is warranted. Future research is indicated to evaluate causal relationship between work-related stressors and mental health outcomes leading to suicide in pharmacists.     

临床药师参与1例药物性肝损伤患者的药学监护

摘 要 目的：探讨临床药师参与药物性肝损伤实施因果分析和药学监护的过程、方法及其作用。方法：临床药师通过RUCAM评估量表对1例药物性肝损伤患者进行因果关系分析,协助医师制定用药方案,排查可能引起急性肝损伤的药物,协同医生详细询问患者既往用药史,建立详细用药清单,在护肝治疗同时加强对患者肝功能的监护。结果与结论：临床药师结合患者的临床症状、实验数据和药物作用特点等情况提出建议,使患者症状得到改善,病情得到控制。临床药师通过实施药学监护,协助医师优化治疗方案,减少不必要的药物联用,减少了药物性肝损伤的发生。     

The physician perspective on pharmacist-physician collaboration and trust

BackgroundHealth care has shifted to focus less on individual practitioners and more on providing interprofessional and collaborative patient care. A strong working relationship among pharmacists and physicians is imperative for patient care and safety.ObjectivesThe objective of this research was to examine physician perspectives of the relationship between physicians and pharmacists, specifically evaluating the qualities and actions necessary for pharmacists to establish trust to provide the best quality of patient care.MethodsSemistructured qualitative key informant interviews were conducted with 11 physicians. Questions were designed to gather information about the physicians’ experiences with pharmacists and perceived barriers and opportunities for building trust and collaboration. The Unified Theory of Trust and Collaboration was used as a theoretical framework.ResultsThe ability to cooperate was the most important aspect identified by all 11 physicians in creating effective collaboration along with respect, knowledge, communication, and trust. Common barriers identified with the pharmacist-physician relationship were the lack of identity, rapport, knowledge, positive attitude, and communication.ConclusionBuilding trust and narrowing the gaps of communication are crucial in achieving effective collaborative practice among health professionals. Pharmacists and physicians must have the capability to cooperate with one another, understand the common moral responsibility they share, recognize the implications of their personal behavior on their professional relationships, and focus on their scope of practice without crossing boundaries. Through positive behaviors of civility, communication, adaption, and mutual respect in their individual roles, pharmacists and physicians can enhance their relationship and practice collaboratively.     

Impact of pharmacy care services on patients’ perceptions of health care quality for diabetes

ObjectivesTo (1) construct and evaluate a measure of patients’ perceptions of the quality of diabetes care and (2) determine the impact of pharmacy care services (PCSs) on patients’ perceptions of the quality of their diabetes care while controlling for patient-related factors.DesignTwo-phased study using a single-group, pretest–posttest design.SettingCommunity pharmacies that provided PCSs to diabetic patients as part of the Patient Self-Management Program for Diabetes in North Carolina, Georgia, Ohio, and Wisconsin.Participants218 patients with diabetes covered by self-insured employers’ health plans.InterventionsPharmacist-provided care services using scheduled consultations, clinical goal setting, monitoring, and collaborative drug therapy management with physicians and referrals to diabetes educators.Main outcomes measuresChanges in patients’ perceptions of quality measured by a self-administered questionnaire that included a six-item scale of information quality, a five-item scale of provider quality, and a one-item overall rating of care.ResultsThe assessment of the baseline data (Phase I) demonstrated that the measures of perceived quality possessed acceptable psychometric properties. After PCSs were implemented (Phase II), the scores for the information scale improved significantly (paired t = 7.64, P < 0.01), as did the scores for the provider scale (paired t = 6.30, P < 0.01) and the overall rating (paired t = 5.54, P 7lt;0.01). In multivariate analyses, the improvement in perceived quality was not explained by the change in glycosylated hemoglobin when controlling for age, gender, race/ethnicity, and baseline quality perceptions.ConclusionPCSs enhanced patients’ perceived quality of their diabetes care. The improvement in perceived quality was not explained by the change in glycemic control, which suggests that nonclinical factors in care are important to patients’ evaluations of quality.