Minor ailment consultations: a mismatch of perceptions

□ A structured interview with 240 patients immediately before a general practitioner consultation ascertained whether they had experienced any illness or symptoms which they perceived as minor in the previous two weeks and, if so, whether their current consultation was related to this ailment □ For those 93 consultations which the patient perceived as a minor ailment consultation, the GP's view was ascertained on whether the illness was a minor ailment and whether the patient could have managed their condition alone □ The GP's view frequently contrasted with that of the patient □ For the first time, a subgroup of necessary minor ailment consultations, which the patient could not manage alone, has been identified □ Pharmacists are well‐placed to help patients diagnose and manage those minor ailments for which the patient feels they need professional help, but do not require a GP consultation.     

Influence of age, gender, body weight and valproate comedication on quetiapine plasma concentrations

Quetiapine is a second-generation antipsychotic with a favourable risk/benefit profile that is increasingly used in psychiatric patients. Similar to other antipsychotics, the efficacy and adverse effects of quetiapine depend much more on the actual plasma concentration of the active drug than on the prescribed dose. The present study investigated whether age, gender, body weight or certain comedications influence quetiapine plasma concentration by determining quetiapine plasma levels by tandem mass spectrometry in 94 (36 male and 58 female) patients aged 42.2 +/- 20.0 years. Older age was a significant predictor of a higher quetiapine plasma concentration, with a mean increase of weight-corrected concentration/dose ratio of 11% per 10 years of age (P = 0.003). In females, the concentration/dose (C/D) ratio was 35.4% higher than in males (adjusted mean 0.144 ng/ml/mg for males versus 0.195 ng/ml/mg for females, respectively; P = 0.035). However, after correction for weight, the gender difference in C/D ratio dropped to 22% and significance was lost (P = 0.133). Valproate comedication was associated with a 77% increase in quetiapine plasma levels (P = 0.016). In conclusion, older age, body weight and comedication with valproate have to be considered when prescribing quetiapine. Higher plasma levels in female patients need to be replicated in larger samples.     

A comparative study of pharmacist and GP management of anticoagulant therapy following deviation from the target international normalised ratio

□ Pharmacists manage patients who deviate from the prescribed international normalised ratio (INR) at least as effectively as GPs □ A trend was observed for reduced duration of periods where patients reside outside the prescribed range despite the magnitude of any deviation being similar between pharmacist and GP management.     

The use of sublingual glyceryl trinitrate and aspirin in angina patients and enhancement of coronary heart disease databases

□ Audit involving 95 per cent of community pharmacists in one LHCC □ Data were gathered using a semi‐structured questionnaire □ A list of all participating patients was sent to each GP surgery in the locality to enhance their CHD database □ Not all appropriate angina patients are receiving aspirin □ Patients' knowledge of GTN management was poor and should be improved upon by input from healthcare professionals     

Use of health information touchscreens by community pharmacy users in six local community pharmacies

□ Considerable update of touchscreen availability □ Wide variety of information accessed □ Number of accesses broadly comparable with NHS Direct call figures □ Sixty‐four per cent of touchscreen users are under the age of 35 years □ Supermarket pharmacy had most accesses     

Poor correlation between predicted ideal and prescribed digoxin dose: a community‐based pharmacokinetic study in the elderly

□ This study assessed if population‐based pharmacokinetics predicted measured plasma digoxin concentrations in elderly community‐managed patients □ Twenty‐seven per cent of the sample showed plasma concentrations consistent with a therapeutic level over an entire 24‐hour dosing schedule; 36 per cent showed therapeutic levels for at least some of the dosing schedule; the remainder showed digoxin concentrations not consistent with achieving a therapeutic plasma concentration for any part of the dosing schedule □ The mean daily prescribed dose of digoxin was significantly lower than that predicted from population kinetics.     

Identification of psychosocial factors which influence patient adherence with antihypertensive medication

□ It is estimated that only 50 per cent of hypertensive patients adhere to medication regimens □ In this study evaluation of self‐efficacy and the theory of planned behaviour was used to identify psychosocial factors which impact on patient adherence to antihypertensives □ High self‐efficacy, intentions to comply with the medication regimen, possessing a positive attitude towards taking medication, perceiving pressure from significant others to take medication as prescribed, and perceiving control over taking medication were determinants of good adherence □ The successful identification of factors which influence adherence will allow health‐care providers to implement interventions, aimed at enhancing adherence with antihypertensive medication.     

Gender differences in HIV risk behaviors among young adults and adolescents entering a Massachusetts detoxification center

We examined gender differences in HIV risk behaviors among young substance abusers 17 through 25 years of age. A voluntary and confidential survey inquiring about HIV‐related risk behaviors was administered to clients (N = 200 respondents) on intake at a drug detoxification center in Massachusetts. Female respondents were more likely than males to report having shared their needles (p < 0.01), having had sex in exchange for drugs or money (p < 0.01), sex with an HIV‐infected partner (p < 0.01), and sex with an injection‐drug user (p < 0.01). They were also more likely to report having been diagnosed with an STD (p < 0.01). Nineteen percent of females (compared to 32% of males) reported always having used condoms for vaginal sex (p = 0.08), and 16% of females compared to 35% of males reported always having used condoms for anal sex (p = 0.06). In our cohort of substance‐abusing youth, adolescent and young adult females were more likely than males to report unsafe injection‐drug use and sexual practices. The results of this study suggest that programs designed to decrease HIV risk among high‐risk substance abusers in detoxification centers should be gender specific.     

Subjective Report of Side Effects of Prescribed and Nonprescribed Psychostimulant Use in Young Adults

Background: Side effects of prescribed and nonprescribed psychostimulant use are understudied. Objectives: The study examined side effects of prescribed and nonprescribed psychostimulant use in a college sample with attention to possible gender differences. Methods: 2716 undergraduates (1448 male) between the ages of 17 and 57 years (M = 19.43 years, SD = 1.7 years) completed an online survey that included questions about the subjective side effects of prescribed and nonprescribed psychostimulant use. Results: Results suggested that prescribed users more frequently reported side effects, compared to nonprescribed users. For prescribed users, females more frequently reported appetite, somatic, and anxiety-related side effects compared to males. For nonprescribed users, while females reported more somatic and anxiety-related side effects, males more frequently reported loss of sex drive and sweating as side effects. Conclusions/Importance: These findings suggest prescribed users of psychostimulants more frequently report side effects with prominent gender differences in line with gender roles.     

Gender and liver fibrosis in chronic hepatitis: the role of iron status

BACKGROUND: The role of gender in the progression of fibrosis in chronic hepatitis C is still under investigation. AIM: To investigate whether gender affects the progression of liver disease and/or hides other risk factors. METHODS: A prospective series of 121 consecutive patients with chronic hepatitis C underwent liver biopsy. Grading and staging for chronic hepatitis were each evaluated according to Ishak's classification. RESULTS: In univariate and multivariate analysis on the whole group of patients, male gender was not associated either with significant liver fibrosis (Ishak's score > 2) or with cirrhosis (Ishak's score > 4). On the contrary, in univariate analysis on patients aged < or = 50 years, male gender was nearly significantly (P = 0.06) predictive of liver fibrosis, whereas it was not in patients > 50 years. Hepatic iron grading, along with age, was an independent factor associated with fibrosis. Moreover, the values of all the variables which describe iron status were significantly higher in males aged < or = 50 years in comparison with females of the same age. CONCLUSIONS: In chronic hepatitis C, male gender may be predictive of liver fibrosis only in patients aged < or = 50 years. Among fibrogenetic factors hidden by gender, iron status could play a major role.     

Predictors of herbal medicine use in a Swedish health practice

OBJECTIVE: The aim of this study was to characterise users of herbal medicines and assess the effect of socio-demographic characteristics, perceived health and chronic disease on the use of herbal medicine in a multi-ethnic Swedish health practice population. METHODS: A questionnaire was completed by 1433 (out of a total of 1776) patients aged 16 years and above who visited the Jordbro Health Centre (JHC) in Stockholm, Sweden, between 14 January and 30 June 2002. The results were linked to computerised medical records. RESULTS: Altogether 320 (22.3%) of this patient population used some form of herbal medicine. The bivariate analysis showed that the use of herbal medicine were more common among patients aged 45-64 years, females, high educated, patients born in Nordic countries or Europe compared to other age groups, males, low educated, patients born outside Europe and without chronic disease. In the logistic regression analysis when the effects of confounders were taken into account, females, high educated patients and patients with chronic disease had higher odds for use of herbal medicine than males, low educated and patients without chronic disease. The odds ratios (ORs) and 95% confidence interval (95% CI) were 1.95 (1.40-2.76) for female as compared with male patients; 2.10 (1.49-2.97) for subjects with a high level of education compared with subjects with a low educational level and 1.62 (1.15-2.29) for subjects with chronic disease compared with subjects without chronic disease. The common diagnoses were musculo-skeletal, respiratory and circulatory disorders, signs and symptoms and external causes according to the International Classification of Diseases (ICD10). There were no significant differences between users and non-users of herbal medicine regarding the number of consultations with any physician or the general practitioner (GP), contacts with the health care centre, use of prescribed medicines or number of days of sick leave during the past year. CONCLUSION: Females, well-educated patients and patients with chronic disease had higher odds for use of herbal medicine than others irrespective of other socio-demographic characteristics, and herbal medicine was seen to be used independently of conventional medicine.     

Do older patients feel able to cope with illness following telephone consultations? A multi-practice survey in the UK

BACKGROUND: Worldwide, patients are offered a telephone consultation as a first point of access to a health care professional. Whilst older patients form a significant proportion of callers, this group has expressed reservation about consultations that preclude a physical examination. OBJECTIVE: This study compares how two groups of patients (< 70 years, > or = 70 years) perceive their ability to cope with illness following a telephone consultation. METHODS: Nine hundred and fifty-six patients from deprived inner city areas receiving telephone consultations with a General Practitioner (GP)/Family doctor or nurse at five practices in South Yorkshire, UK were surveyed within 24 h of the consultation. A 49% response rate was achieved; the mean age of respondents in the respective groups was 78.5 years and 48 years. The questionnaire included the Patient Enablement Instrument (PEI), a self-reported measure of patients' ability to cope with illness measure of patients' ability to cope with illness and supplementary questions on access to GPs in the practice. RESULTS: There was a low response rate from younger patients and males in particular. Ethnic minority groups were hardly represented among the respondents. How ever, scores on the PEI following telephone consultations were no different between older and younger respondents (Mann-Whitney U test, p = 0.56). Regression analysis with PEI scores as the dependent variable and fitting age and differences in responses to the questionnaire as explanatory variables yielded an R(2) of 0.02 suggesting that 'age' per se was a poor predictor of 'enablement'. CONCLUSIONS: These data support an inclusive policy in the provision of telephone access to health care professionals in primary care. We conclude that older patients are not disadvantaged by consulting a primary care professional by telephone.     

A patient‐held medication record and a patient medication profile to support the continuity of acute cancer care

□ The sharing of care of patients receiving medical oncology care is vulnerable to errors in their documented drug history □ A patient‐held medication record identified over 90 per cent of patients' medications but was ‘forgotten’ by the patient in a third of contacts with a pharmacist □ Discrepancies between the medication records of GPs, community pharmacists and the medical oncology clinic were highly prevalent □ A posted patient medication profile issued by the hospital pharmacist to both the patient's GP and their community pharmacist was associated with a significant convergence in their records (discrepancies reduced from 17 to 6 % P<0.001) □ The patient‐held record had little impact on the accuracy of practitioners' records and its value lies more in facilitating patient education than rectifying errors in documentation