Professional health cards (CPS): informatic health care system in France

The Professional Health Card Public interest group (Groupement d'Intérêt Public-Carte de professionnel de Santé (GIP-CPS)) was founded in 1993 as a joint initiative by the different parties involved in health care in France: the state, the representatives of the health care professions and the compulsory and complementary health insurance organizations. The CPS system enables safe exchange and electronic sharing of medical data. Via Intranet connections and Extranet hosting of medical files, databases, the CPS system enables health care professionals who access servers to be identified with certainty. For email exhanges, the CPS systems guarantees the sender's identity and capacity. The electronic signature gives legal value to the email. The system also enables confidential email. The health card system (CPS) contributes to making the health service efficient. Shared medical files, health care networks, health warning systems or electronic requests for reimbursement of health insurance expenses all use the CPS system. More than 300,000 health care professionals use it regularly. The freedom of movement of patients throughout Europe has led to the growth of exchanges and information sharing between health professionals in the States of the Union. More and more health professionals will be leaving their own countries to work in foreign countries in the future. It is essential that their freedom of movement is accompanied by the ability to prove their rights to practice.     

Lessons from the national asthma mortality study: circumstances surrounding death

The circumstances surrounding all deaths from asthma in New Zealanders under 70 years of age between August 1981 and July 1983 have been analysed from information recorded or recalled by doctors or relatives of the deceased. Factors which may have reduced the time available for effective treatment of these severe attacks are described to draw attention to ways in which mortality might be reduced. For almost half of the 271 deaths medical help had not been called before the patient was in extremis. When medical help was summoned in sufficient time doctors commonly did not give corticosteroids or used them inadequately. Difficulties in using medical care and noncompliance with asthma management were common particularly in Polynesian patients. In 38% of patients some medical inadequacy appeared to contribute to poor long-term care and education. Failure of patients to attend for ongoing medical care, education and preventative treatment, or a medical failure to deliver these may have led to chronically reduced lung function. Any further deterioration may then have more rapidly led to a fatal outcome. Lack of patient or family awareness about how to detect and cope with an unusually severe attack was found and contributed to avoidable fatalities.     

Medicine and pharmacy: our once and future status as professions

Pharmacists are challenged to fulfill in modern health care their historic role as professionals who, working with physicians, hold patients' well-being as their foremost concern. Advances in biomedical science and technology and drastic increases in the cost of care have changed the way medical care is organized, delivered, and paid for. The future of medical care depends on whether professionalism survives or succumbs to the profit motive and whether, faced with increased competition and restricted funding, care-givers will sustain the ethic of providing care to all who need it. The conflict between the medical care that is possible because of scientific advances and the care that will be paid for will be decided politically. Pharmacists can best improve the quality of care by dedicating themselves to rational drug therapy. Drug-use evaluation in hospitals must increasingly demonstrate patient benefit, not just cost savings. Pharmacists can improve the prevention of adverse drug reactions by more timely dissemination of drug information to physicians. Pharmacists should be assertive in identifying nonrational prescribing trends. Pharmacists' responsibility for therapy will expand as the use of biologic manipulation as an adjunct to or substitute for drugs increases. The future will require pharmacists to distinguish between efficiency in providing quality services and narrow economic motivations. Wise choices will help to ensure pharmacy a full partnership in patient care.     

Patient experiences of taking antidepressants for depression: A secondary qualitative analysis

BackgroundDepression is one of the most commonly encountered mental health problems leading to significant morbidity and mortality and high medical and societal costs. Antidepressant prescribing in the UK has more than doubled in the last decade. There are a variety of factors that have been shown to affect a patient's experience of taking antidepressants The aim of this research was to explore patient narratives interviews about depression and its treatment in order to improve patient and health professional understanding of what it is like to use antidepressants.MethodsThis study involved a supplementary secondary qualitative analysis of 80 in-depth narrative interviews from Healthtalkonline. Patients' experiences of using medicines for depression were explored in the context of their social, occupational and emotional impact, to identify any additional issues and to clarify what type of information people want to find after being prescribed a medicine. The interviews were conducted by the University of Oxford and had received ethical approval and been consented and copyrighted for this purpose. Data were analyzed thematically.ResultsThe most prominent theme was the coexistence of several conflicting issues around the use of medicines and participants were mostly influenced by the reality of their experiences, beliefs, attitudes and interaction with health care. Antidepressants appear to occupy a central place in many people' lives. Many people described how their medicines had helped them and how this served as a reinforcement to continue taking them in order to maintain a “normal life.” Those who had stopped taking their antidepressants were likely to have experienced adverse reactions and had unsatisfactory interactions with health care professionals. A lack of information about antidepressants was a major cause of dissatisfaction often shaping attitudes to antidepressants'.ConclusionsPeople's experiences with antidepressant use have a major impact on treatment continuation and hence treatment outcomes. Further studies are needed on depressed patients' beliefs about their depression and treatment and how they relate to different stages of illness, their interactions with health care and their adherence to antidepressants.     

Apollinaire Bouchardat and his Formulaire magistral

The anniversary of Bouchardat two centuries ago (1806) is a opportunity to reanalyse his book Nouveau Formulaire Magistral, published during more than 90 years (1840-1932), and to emphasize its interest for historians. This book, addressed to physicians and pharmacists, is a huge source of information on health care during the XIXth century. One can find data on Paris' hospitals, as well as usual pharmaceutical formulas or information on spa. Bouchardat and its formulary reflect also the main opinions during this century where pharmaceutical specialties are not well accepted by health care professionals who considered that it was a way for the patients to take care of their diseases without the control of a physician. Bouchardat is also a precursor if one consider that a number of similar books were published after the late phase of the XIXth century to help doctors to prescribe properly the drugs. Some of them will be published on several years, as for the Bouchardat's formulary. Finally, Bouchardat appears as an encyclopaedist of pharmacy and medicine. He succeeded to give a unique synthesis of state of the art information for his time, using his double training of pharmacist and physician. It is probably why this book survived more than 40 years after the death of the initial author.     

Prescribing and partnership with patients

There have been widespread changes in society and the roles of professionals. This change is also reflected in health care, where there is now acceptance of the need to involve patients in decision making. In prescribing specifically, the concordance agenda was developed alongside these initiatives to encourage improved medication taking and reduce wastage. However the extent to which these partnerships are delivered in practice remains unclear. This paper explores some of the issues to be considered when preparing patients and professionals for partnership and summarizes the limited evidence of barriers to, and benefits of, this approach. Firstly patients must be given the confidence, skills and knowledge to be partners. They need information about medicines, provided in ways known to be acceptable to them. Likewise professionals may need new skills to be partners. They need to understand the patient agenda and may need training and support to change the ways in which they consult with patients. There are also practical issues such as the perceived increase in time taken when consulting in partnership mode, room layout, computer interfaces and record keeping. Health care professionals other than doctors are also expected to behave in partnership mode, whether this is as prescribers in their own right or in supporting the prescribing of others. Whilst much has been claimed for the benefit of partnership approaches, hard evidence is limited. However whilst there is still much more to understand there will be no going back to the paternalistic model of the mid 20th century.     

Issues potentially affecting quality of life arising from long-term medicines use: a qualitative study

Background Polypharmacy is increasing and managing large number of medicines may create a burden for patients. Many patients have negative views of medicines and their use can adversely affect quality of life. No studies have specifically explored the impact of general long-term medicines use on quality of life. Objective To determine the issues which patients taking long-term medicines consider affect their day-to-day lives, including quality of life. Setting Four primary care general practices in North West England Methods Face-to-face interviews with adults living at home, prescribed four or more regular medicines for at least 1 year. Interviewees were identified from primary care medical records and purposively selected to ensure different types of medicines use. Interviews were recorded, transcribed and analysed thematically. Results Twenty-one interviews were conducted and analysed. Patients used an average of 7.8 medicines, 51 % were preventive, 40 % for symptom relief and 9 % treatment. Eight themes emerged: relationships with health professionals, practicalities, information, efficacy, side effects, attitudes, impact and control. Ability to discuss medicines with health professionals varied and many views were coloured by negative experiences, mainly with doctors. All interviewees had developed routines for using multiple medicines, some requiring considerable effort. Few felt able to exert control over medicines routines specified by health professionals. Over half sought additional information about medicines whereas others avoided this, trusting in doctors to guide their medicines use. Patients recognised their inability to assess efficacy for many medicines, notably those used for prophylaxis. All were concerned about possible side effects and some had poor experiences of discussing concerns with doctors. Medicines led to restrictions on social activities and personal life to the extent that, for some, life can revolve around medicines. Conclusion There is a multiplicity and complexity of issues surrounding medicines use, which impact on day-to-day lives for patients with long-term conditions. While most patients adapt to long-term medicines use, others did so at some cost to their quality of life.     

The problem of non-compliance with drug therapy

Non-compliance with drug treatment is widespread. When patients are given medication by their doctors, nearly half do not take the drug or do not take it as prescribed, and most will stop the treatment as soon as they are feeling better. A major problem in identifying the non-compliant patient is the unreliability of many of the measures used for assessing compliance. There are few social and demographic characteristics associated with non-compliance. The type of disease, also, generally has little influence on the level of compliance. Psychological factors such as the patients' levels of anxiety, motivation to recover, attitudes towards their illness, the drug and the doctor, as well as the attitudes and beliefs of significant others in their environment do influence the patients' levels of compliance. Many of the factors that are related to non-compliance with drug regimens are within the control of health care professionals. Contrary to the beliefs of many doctors, studies do not support the view that drug non-compliance is a deviant form of behaviour influenced by patient characteristics.     

Chronic medicine users’ self-managing medication with information - A typology of patients with self-determined,security-seeking and dependent behaviors

BackgroundInformation on medicines is key for safety and quality of care in long-term treatment courses with medicines. Little is known on how patients self-manage medication with information, and how interactions with health professionals influence such self-managing.ObjectiveThe objective of this study was to investigate how patients manage long-term medication with information, and how interactions with health professionals influence this managing, with the aim of developing a typology of patients’ practices for managing with information. A secondary objective was to generate theoretical reflections on patients' roles in establishing resilience in health care systems.MethodsQualitative interviews with 15 chronic medicine users. A Safety-II-approach was used to obtain knowledge of what worked for medicine users, at the same time as acknowledging hindrances. Data were analyzed using thematic analysis and Halkiers’ method for ideal-typologizing.ResultsFour types of practices for managing medication with information were identified, distinguished by patients’ ways of self-managing on their own and through relations with health professionals: Ideal-type I: Self-determined and highly self-managing; Ideal-type II: Security-seeking and self-managing; Ideal-type III: Dependent with limited self-managing; Ideal-type IV: Co-managing with close family. The findings suggest that patients with a high degree of self-managing medication with information have good chances for facilitating quality of medical treatment. For patients who are more dependent on oral information from health professionals, the character of dialogue facilitated or hindered their self-managing. All patients had the best options for managing medication when being recognized by health professionals through dialogues.ConclusionA typology of 4 types of managing practices was developed, characterized by patients' different abilities to self-manage medication with information and their relations to health professionals. Recognizing patients’ different behaviors for managing medication with information is important for maximizing treatment quality of long-term medical treatment in a modern and resilient healthcare system.     

Assessing the validity of diagnostic information in administrative health care utilization data: experience in Saskatchewan

Administrative health care utilization databases have been promoted as resources for pharmacoepidemiologic research for several years, but the validity of the diagnostic data in many systems has not been thoroughly investigated. This work outlines issues in assessing the validity of diagnostic information from a broad perspective, using results from the datafiles of the province of Saskatchewan to illustrate them and, where possible, contrasting them with findings from other databases. An evaluation of the validity of health care utilization data should be more than a simple check of coding and data entry errors. Comparisons of data records with information external to the computer system, an examination of the internal consistency of the data (especially in systems consisting of several data sources) and, where practicable, an assessment of the cohesiveness of the data within the context of current medical knowledge should be performed on a broad range of diagnoses and procedures. Careful consideration should also be given to the generalizability of results from the database. Summaries of such evaluations for all databases used for population-health research purposes should be widely disseminated. We caution researchers to continue to seek ways to validate their results in each use of these databases.     

Utility and value of a medicines information service provided by pharmacists: a survey of health professionals

Objectives Many health professionals lack the time and skills to search for and appraise information on medicines. A solution might be to use others skilled in evidence appraisal, who make recommendations or provide information tailored to patients' needs. The objectives of this study were to assess how advice provided to health professionals by the northwest of England regional medicines information centre is used, whether it is useful for patient care and to measure satisfaction with the service. Methods A questionnaire was designed and sent to health professionals who contacted the centre between September 2008 and March 2009. Enquirers contacting the centre more than once were sent a questionnaire only in response to their first enquiry during the study period. Non‐responders were sent a reminder. Key findings Questionnaires were sent to 672 enquirers; 68% were returned. Nearly all respondents used the advice provided. Of the 430 respondents who provided data on how they used the information, 81% used it to manage a current patient and 29% to plan the care of future patients; nearly all considered it useful. Where data were given (n = 366), half used it to check if current or proposed management was appropriate, 45% to make changes to therapy and 35% to advise another health professional. In addition to patient care, one‐quarter (n = 105/430) of respondents used the information for continuing professional development and 16% (n = 69/430) for training or teaching. Conclusions Health professionals value the enquiry‐answering service and use the advice provided for patient care, continuing professional development and educating patients and other health professionals. The service is responsive, supporting the care of patients needing immediate and future management.     

The future of health care.

Future changes in patient care to curb costs and refocus on health versus medical care are discussed, and efforts at the New England Medical Center (NEMC) to measure patient outcomes and reorganize the delivery of care are described. Medical care is not the only determinant of an individual's health; lifestyle choices and the community also play important roles. The rate of increase in the cost of medical care must be contained. The future of health-care reform will be predicated on packages for the administration of care; for any given condition, all of the elements of medical care would be combined so that clinical and functional outcomes are achieved at a given price (episode-of-illness pricing). The success of medical care should be determined on the basis of the patient's ability to function, not on clinical indicators alone. Also, the prices for new generations of drugs should be determined on whether the new drugs improve patients' quality of life. Health-care professionals in hospitals should not be divided according to their specialties; instead, they should compose multidisciplinary teams that can care for patients over time. NEMC is developing a process and structure in which various health-care professionals work together to design health-care plans that cover a full episode of illness. The future of health care will also be influenced by global trends, including international medical-care inflation, standardization of process and outcome measurements, and a shift in emphasis from medicine to health. The health-care industry is in transition as this country searches for the best way to improve the health and functioning of each citizen.(ABSTRACT TRUNCATED AT 250 WORDS)     

Expectations for the pharmacists in the management of infectious diseases

In the 21 century, the management of infectious diseases has become increasingly important. Especially, the establishment of the infection prevention and control system is very important in the healthcare-settings for patient safety. And from this background, infection control teams (ICT) which perform the infectious diseases management have been organized in many institutions. These ICT members are medical doctors, nurses, medical technologists and pharmacists and the role of the pharmacist in the ICT is very important. The pharmacist should play a role as a specialist for antimicrobial agents, antiseptics and disinfectants. The roles and responsibilities of the pharmacist for infection control are leading the antimicrobial stewardship, promoting the appropriate and rational use of antimicrobial agents, advising the health system on the selection and use of appropriate antiseptics, disinfectants and sterilants, developing guidelines for risk assessment, treatment, and monitoring of patients and health care workers. Establishing internal pharmacy policies, procedures and quality control programs to prevent contamination, educating health professionals, patients, and the public activity are also included. It is expected that the infection control pharmacist should contribute to the management of infectious diseases and patient safety in the healthcare-settings.     

The community pharmacist as a member of a primary health care team in South Africa — perceptions of pharmacists,doctors and nurses

The growing emphasis on primary health care (PHC) has drawn increased attention to disease prevention and health promotion activities from many health professionals, among them pharmacists. This paper explores the role of the community pharmacist as a member of the PHC team in South Africa, through the perceptions of pharmacists, nurses and doctors. Data were collected by survey and interviews. The results reveal a scenario where pharmacists are eager to engage in PHC activities, whereas nurses and doctors are more cautious in their support. Although they see pharmacists as health professionals, and are of the opinion that they should play a part in the PHC team, doctors and nurses strongly protect their own domains when it comes to allocation of potential tasks. This raises some difficulties with regard to the effective implementation of PHC. Based on the South African reality and a literature review, suggestions are made to develop models of PHC centres which would potentially overcome some of the problems raised.     

The use of pictograms in the health care: A literature review

BackgroundThe ability of patients to understand pharmacotherapy information is critical to the successful use of medications. One of the risk factors that may predispose the patient to non-adherence is the low retention of verbal information. Thereby, one way to facilitate the understanding of patients regarding prescribed pharmacotherapy is to incorporate pictograms to transmit information in a clear, expeditious, and simple manner.ObjectiveTo evaluate literature on the use of pictograms for health professionals and assess their impact on helping patients increase the understanding of and compliance with medical instructions.MethodsSearches were conducted from February to March 2012. We searched articles in databases, using the keywords: “pictograms,” “health,” “health care professionals,” “medication” and “pictorial representation.” After this step, we performed a manual sorting, evaluating titles and abstracts. The articles were carefully examined according to the following variables: (1) geographic location and setting of the studies; (2) study design; (3) number of pictograms used; (4) education; (5) sample size; (6) age of participants; (7) function of pictograms; (8) limitations described in the literature evaluated.ResultsThe research identified 136 published studies. After the exclusion process, 24 studies met inclusion criteria and from those, 50% were conducted in Africa, and 51.4% were considered effective. In the evaluation of the function of the pictograms, to verify their utility, 23 studies used to educate patients on the use of medications. The translation and cultural adaptation of pictograms was performed in five studies, and one study considered this process as validation.ConclusionIn this review, the literature contained only a few studies employing pictograms by health professionals, and most of these were meant for the use of medications. Moreover, the specific results reinforce the need for more studies in this area to provide a more complete approach about pictograms in the heath care.     

Patients' views of the value of “brown bag” medication reviews

Objective — To explore and describe patients' views of the value of brown bag medication reviews. Method — Semi‐structured, tape‐recorded interviews were conducted with 20 patients who had participated in a brown bag medication review scheme. Setting — A health authority area in south‐east inner London. Key findings — Patients perceived the following benefits from brown bag reviews: clinical problems resolved; better understanding of their medications, leading to increased confidence; and appreciation that an interest was being taken in their health care. Reviews had given patients a sense of empowerment, and had made them realise that they had a right to information about their medical treatment and medication. As a result they were likely to be more proactive in seeking information in future. Reviews had made patients realise that pharmacists were knowledgeable about medicines, where previously many had thought that only doctors had sufficient knowledge. Reviews had enhanced relationships between patients and pharmacists. However, some patients still perceived their doctor as the authoritative source of information about medicines. Patients' accounts indicated that much of the information provided by the pharmacist was new, raising the issue of what information was routinely being provided by pharmacists. Conclusions — Brown bag reviews were regarded by patients as beneficial and they wanted them to be available in the future. Patients' perceptions of pharmacists as health professionals and providers of information on medicines were enhanced by brown bag reviews.     

Concordance: what is the relevance for pharmacists?

Non‐adherence (or non‐compliance) to prescribed medicines has long been regarded as problematic. The concept of concordance, rather than seeking ways to persuade people to take their medicines, instead focuses on the need to adopt a different model of the patient‐prescriber relationship. Much of the discussion about concordance thus far has related to the relationship between doctors and patients. In this article, the role of the pharmacist and ways in which pharmacists could usefully engage with the concordance model, both as part of the primary health care team and as independent practitioners, are considered. Concordance was developed as an ideal to which to aspire and needs to make the transition into practice. It is however important to note that if the move towards concordance is to happen and be successful it will require the support, enthusiasm and commitment of patients and health care professionals generally.