Survey of pharmacists’ and physicians’ perceptions of therapeutic interchange

Therapeutic interchange has long been an integral part of drug formulary management, but physicians’ and pharmacists’ attitudes toward such programs are relatively unknown. This survey was undertaken to determine pharmacists’ attitudes, physicians’ potential response to a hypothetical interchange, and how well pharmacists predicted physicians’ responses. A survey that described a drug interchange program and several potential responses to the proposed switch was provided to 300 staff physicians at a 512-bed community facility in southwest Florida; the survey was also mailed to pharmacy directors or clinical pharmacy coordinators at 42 southwest Florida hospitals. Responses were obtained from 98 physicians and 95 pharmacists. Most physicians would not cooperate with an interchange if they were not familiar with the proposed drug; 16% would continue to prescribe the original drug, knowing that the new agent would be provided; and 58% would switch to another agent with which they had clinical experience. Only 26% of physicians would follow the interchange program. In contrast, 48% of pharmacists believed that physicians would continue to order the original therapy, 32% believed that physicians would order the new agent, and only 20% believed that physicians would switch to an alternative drug (P < .005 vs physician responses). Clearly, pharmacists’ expectations of physicians’ response to a therapeutic interchange differ significantly from the physicians’ expected behavior. This difference has potentially important implications for actual versus projected cost savings of therapeutic interchange. This paper was presented as a poster at the American Society of Health System Pharmacists Clinical Meeting and Exhibits in New Orleans, Louisiana, December, 1996. (Work completed while employed by Manatee Memorial Hospital in Bradenton, Florida.)     

Patients’ and professionals’ evaluations of quality of care in oncology outpatient clinics

Purpose

The purpose of this study is to compare patients' and professionals' evaluations of the quality of care in oncology outpatient clinics.

Methods

The data were drawn from a 2011 survey of 1,379 patients and 155 professionals conducted in 15 % of oncology outpatient clinics in Quebec, Canada. Respondents completed self-administered questionnaires that addressed the aspects of timeliness (TIM), patient-centred care (PCC), communication (COM), quality of the physical environment (QPE), and continuity (CONT). Patients’ and professionals’ mean scores (maximum?=?4) for each aspect were compared using mixed model analysis.

Results

Patients’ and professionals’ perceptions of quality of care were largely positive, with mean scores for all items of 3.66 and 3.37, respectively. However, for the majority of aspects of quality, the professionals' scores were lower than those of patients. The aspects rated most positively by both groups were PCC, COM and CONT. Timeliness was the least positively evaluated, with mean scores of 3.34 for patients and 3.16 for professionals.

Conclusions

In many respects, cancer patients and professionals share relatively common views about the most and least positive aspects of the quality of care, although professionals tend to be more critical. Aspects evaluated less favourably by both groups and those on which opinions differ are good candidates for improvements. Some ideas for solutions are proposed. Positive patient feedback is especially important in cancer care, where attraction and retention of professionals is a key concern.     

Effects of practice setting on GPs’ provision of care

Objective

To define a physician classification system based on practice settings and to analyze the service provision associated with those classifications.

Design

A cross-sectional, retrospective study.

Setting

Province of Quebec.

Participants

All GPs in Quebec in 2002 who had been practising for at least 2 years.

Main outcome measures

Practice setting variables were based on physician income in the different settings. Service provision was assessed using indicators related to continuity, comprehensiveness, accessibility, and productivity of services provided by the GPs. A multiple correspondence analysis with ascending hierarchical classification was conducted to construct the taxonomy of GPs based on their practice settings.

Results

Our study produced 7 practice setting models. Two were essentially single-practice models. The 5 others combined several settings. Service provision varied from one model to another. Continuity was greater in the private practice model, in which older GPs were predominant, while accessibility was greater in multi-institutional practice models, in which younger GPs were more active.

Conclusion

To ensure balance between continuity, accessibility, and comprehensiveness in primary care services provided by GPs, it is important to consider the service provision associated with different practice models.     

CT enterography of Crohn’s disease

CT enterography (CTE) is a technique using neutral oral contrast, intravenous contrast and thin cut, multiplanar CT acquisitions to optimize small bowel imaging. One of the primary indications for CTE is the detection and evaluation of Crohn’s disease. This article summarizes the advantages/disadvantages, scanning technique, imaging findings, performance and pitfalls of CTE for the evaluation of Crohn’s disease.     

Nurses’ communication regarding patients’ use of complementary and alternative medicine

Background

: Many people integrate complementary and alternative medicine (CAM) into their health care. Nurses potentially play a significant role in communicating with patients about their CAM utilisation.

Occupational therapists’ and physiotherapists’ perceptions of implementing Occupational Performance Coaching

Purpose: Occupational Performance Coaching (OPC) has been proposed as an intervention for working with caregivers towards achievement of goals for themselves and their children. Preliminary studies indicate the effectiveness of OPC; however, translation into practice requires an understanding of therapists’ perceptions of applying OPC in their service delivery settings. This study explored physio- and occupational-therapists’ experiences of using OPC and their perceptions of the contextual factors which influence its implementation.

Method: Interviews and a focus group were used to gather physio- (n?=?4) and occupational- (n?=?12) therapists’ perspectives of applying OPC in their work with caregivers of children with disabilities. Data were analysed thematically.

Results: One overarching theme and three major themes emerged. The overarching theme, “Listening better” pervaded all other themes. Three major themes, each with subthemes, were: (1) Sharing power, (2) Reprioritising processes, and (3) Liberating but challenging. Implementing OPC drew on skills that were familiar to therapists and aligned with existing values when working with families but challenged some aspects of their practice.

Conclusions: From physio- and occupational-therapists’ perspectives, OPC is applicable in a range of paediatric service environments. However, therapist and service-level flexibility appeared to be key contextual factors in adhering to intervention principles.

• Implications for Rehabilitation

• Occupational Performance Coaching (OPC) is a strengths-focused intervention in which caregiver engagement and active involvement is prioritised.

• Therapists reported distinct changes to the process of therapy and outcomes achieved following OPC training and implementation.

• Most therapists indicated that OPC enabled them to operationalisation person-centred principles to a greater extent which they perceived enhanced the way therapy was delivered and the benefit to services users.

• Some flexibility in service structures may be needed to implement OPC in the way it was intended.

     

Impact of cancer patients’ quality of life on that of spouse caregivers

Goals of work This study aimed to examine the correlation between quality of life (QOL) in cancer patients and that of their spouse caregivers and to identify factors that influence this correlation.Patients and methods This cross-sectional study collected data from 121 cancer patient/spouse caregiver dyads. The Functional Assessment of Cancer Therapy Scale-General (FACT-G) was used to measure patients QOL, and the Caregiver Quality of Life Index (CQLI) was used to measure spouse caregivers QOL. Correlation coefficients between patients and caregivers QOL were computed for four dimensions of QOL, as well as a total score for QOL. Correlations between patients and caregivers total QOL scores were furthered analyzed by three groups of factors: disease-/treatment-related, caregiving-related, and relationship-related variables.Main results Only the social/family and functional dimensions of patient QOL and total score for patient QOL were associated with each dimension of their caregivers QOL and with the total score (r=0.27–0.44). Physical and emotional dimensions of patients QOL did not significantly influence spouse caregivers QOL for any dimension nor for the total score. Factors influencing the association between patients and caregivers overall QOL included cancer diagnosis, length of hospitalization, caregiving intensity and duration, marital satisfaction, and caregiving self-esteem.Conclusions Social and functional aspects of patients QOL play a significant role in determining the QOL of their spouse caregivers. The strength of association between patients and spouse caregivers overall QOL can be moderated by some factors.     

Recovering Memories of the Offense in “Amnesic’’ Sexual Offenders

This paper describes a technique designed to assist sexual offenders to recover memories of their offense. We have consistently observed that some sexual offenders present as having no recall of their offense although they are able to remember other events of the day of the offense. This failure to recall offense details prevents the offenders from making an appropriate disclosure which, in turn, blocks attempts to identify their offense pathways and develop relapse prevention plans. The memory recovery technique we describe is based on experimental literature on memory and we outline its use with 22 clients, 20 of whom showed satisfactory recovery of their memories.     

An expansion of Simons’ integrated hypothesis of trigger point formation

Simons’ integrated hypothesis proposed a model of trigger point (TrP) activation to explain known TrP phenomena, particularly endplate noise. We propose an expansion of this hypothesis to account for new experimental data and established muscle pathophysiology.     

Exploratory survey of patients’ needs and perceptions of psychosocial oncology

Cancer is a major disease that affects a significant proportion of the population worldwide. With a decrease in mortality due to advancements in oncology treatment, there is an expanding role for psychosocial oncology. A satellite clinic for medical treatment (only chemotherapy) of cancer is available at the Guelph General Hospital (GGH). Patients accessing the chemotherapy clinic at GGH have minimal access to psychosocial or supportive care and it is not known if the existing services are addressing the psychosocial symptoms of cancer patients. Participants were asked to complete an anonymous survey which included self-report measures of depression, symptom severity, quality of life, and social support while receiving treatment at this facility. There was a great deal of variability in the patients’ emotional symptoms at this satellite clinic, though many patients reported emotional difficulties. Greater social work presence may lead to better identification of patients who would benefit from psychosocial oncology services.     

A Descriptive Analysis of Middle School Students’ Conceptions of Autism

The purpose of this study is to document the content and accuracy of middle school students’ spontaneously generated definitions of autism in order to inform future peer education interventions. Authors evaluated 450 middle school students’ written definitions of autism for accuracy and content. Most students (n = 321; 71.3%) provided accurate definitions of autism; the remaining definitions consisted of (a) a combination of accurate and inaccurate information (n = 45; 10.0%), (b) reporting “Don’t know” (n = 43; 9.6%), (c) inaccurate information (n = 20; 4.4%), and (d) combinations of uncertainty in the presence of accurate and inaccurate information (n = 21; 4.6%). Accurate responses reflected only basic understanding that autism was a disability; few accurate responses identified social, communicative, or restrictive patterns of behavior as core difficulties for individuals with autism. Middle school students reported inaccurate information across varied content, such as etiology, core symptoms, and associated problems. Results suggest that peer education messages should highlight information regarding the defining features, etiology, consequences, and outcomes related to autism.     

Workplace managers’ view of the role of co-workers in return-to-work

Purpose: Theoretical and empirical research findings attest to the workplace being a social environment in which co-workers have a critical influence on the employment outcomes and return-to-work (RTW) success of other employees. However, co-workers do not have a formal role in RTW planning. The aim of this study was to explore how managers responsible for developing and implementing RTW procedures view the role of co-workers in this process.

Method: An exploratory qualitative pilot study was conducted in Canada. Participants (1 male; 13 females; mean experience in RTW?=?11.8 years) were workplace (n=8) or RTW managers (n=6) with direct oversight of RTW plans. The participants were recruited via invitation from a research institute and were drawn from three different provinces. Data were gathered via open-ended questions and were coded and subject to thematic analysis.

Findings: Three key themes were identified: (1) Managers view RTW as having little relevance to co-workers but expect them to cooperate with the arrangements; (2) Formal procedures are inadequate when psychosocial barriers to work resumption are present, so managers use informal strategies to engage co-workers’ emotional and social support; and (3) Managers have difficulty integrating RTW procedures with other legal obligations, such as privacy and confidentiality requirements.

Conclusion: Existing arrangements for the development and implementation of RTW are sufficient most of the time, but may be inadequate when an injured worker presents with psychosocial barriers to work resumption.

• Implications for Rehabilitation

• Standard RTW arrangements can be inadequate when a RTW plan requires active co-worker support.

• Privacy and confidentiality provisions can result in managers using informal procedures for information exchange and to engage co-workers.

• The use of risk management strategies – assessment, consultation and communication – could be used to include co-workers when workplace issues threaten the success of a RTW plan.