Pharmaceutical care and its relationship to prescribing behaviour of general practitioners

Objective To study the correlation between pharmaceutical care and prescribing routines of general practitioners (GPs).Methods Cross-sectional study; 201 pharmacies, 408 general practices, The Netherlands, 2000/2001. The variation in prescribing behaviour was characterised using 20 validated prescribing indicators based on general practice guidelines. The general construct ‘adherence to guidelines’ served as the dependent variable and was formed by summing the scores of the prescribing indicators. Four possible determinants of the variation were determined on the basis of survey questions: the construct ‘the pharmacist’s attitude towards pharmaceutical care’, and three partial constructs derived from the pharmacist’s care-providing function: the care for the individual patient, the cooperation with general practitioners and the registration of the care provided. A multiple linear regression analysis was then performed.Main outcome measure The weighted score for the prescribing indicators.Results The weighted average score for the prescribing indicators was 65% (SD 3.7). The response rate to the survey was 71%. The pharmacist’s attitude to pharmaceutical care, as well as the degree to which the pharmacist provided care for the individual patient, the degree to which he cooperated with the general practitioner and the degree to which he registered the care provided were not correlated with the ‘adherence to guidelines’ by the general practitioner with whom the pharmacist frequently cooperated.Conclusion Variations between general practitioners in the quality of prescribing, as measured by their adherence to guidelines, were not correlated with pharmaceutical care by the pharmacist with whom they cooperated on a day-to-day basis.     

Differences in prescribing between GPs: impact of the cooperation with pharmacists and impact of visits from pharmaceutical industry representatives

BACKGROUND: Community pharmacists, pharmaceutical industry and differences in prescribing between GPs. OBJECTIVE: To explore the role of the pharmacists and pharmaceutical industry representatives. METHODS: A cross-sectional survey was undertaken of 1434 GPs in The Netherlands in 2001. Prescribing indicators based on general practice guidelines were used to assess the quality of prescribing. Three constructs, based on survey questions, were used as possible determinants for the quality of prescribing: cooperation with the pharmacist; quality of the Pharmacotherapeutic audit meeting (PTAM); and the GP's attitude towards the pharmacist's role. Data were collected about the frequency of visits by pharmaceutical industry representatives. Responses from 324 solo GPs were analysed using multiple linear regression. RESULTS: Response rate: 71%. For the 324 solo GPs the average score for the 20 prescribing indicators was 64% (SD 3.7). For the non-solo GPs this score was 65% (SD 3.8, P < 0.05). The differences between solo and group practices were: the number of visits from pharmaceutical industry representatives (5.7 versus 3.8 visits per month), full time GPs (93% versus 50%), the number of patients per GP (2151, SD 693 versus 1506, SD 742), and the presence of a GP trainer (21 versus 38%). Of the solo GPs, 4.6% are female, compared with 26% of the GPs in non-solo practices. The quality of prescribing in solo practices was not correlated with the GP's attitude towards the pharmacist's role, the way in which GPs cooperated with pharmacists or the quality of the PTAM. More frequent visits from pharmaceutical industry representatives was associated with a lower quality of prescribing. CONCLUSION: There was a negative correlation between quality of prescribing by solo GPs and frequency of visits by pharmaceutical industry representatives. In day-to-day practice, no measurable effects of the cooperation between solo GP and pharmacist on the quality of prescribing were observed.     

An adrenal incidentaloma in a trauma patient; a plea for expectant management

An adrenal incidentaloma was detected in 45-year-old female driver after a car-versus-car collision. The mass, which had a diameter of 5.4 cm, was not a hormone-producing tumour, but because of its size laparoscopic adrenalectomy was performed 2 months later. Pathology examination revealed an old haematoma situated centrally in the right adrenal gland. Posttraumatic adrenal haematoma is found in 25% of autopsies of traumatized patients. Most adrenal haematomas have an ovoid appearance on CT and have a slight hyperattenuation. Follow-up CT of an adrenal haematoma shows a decrease in size and attenuation. It is therefore proposed that adrenal incidentalomas detected during trauma screening should be evaluated by repeating CT after 3 months. If the mass has diminished and its density decreased, it is most probably an adrenal haematoma, in which case unnecessary surgery may be avoided.     

Internet-based data inclusion in a population-based European collaborative follow-up study of inflammatory bowel disease patients： Description of methods used and analysis of factors influencing response rates

AIM: To describe an Internet-based data acquisition facility for a European 10-year clinical follow-up study project of a population-based cohort of inflammatory bowel disease (IBD) patients and to investigate the influence of demographic and disease related patient characteristics on response rates. METHODS: Thirteen years ago, the European Collaborative study group of IBD (EC-IBD) initiated a population-based prospective inception cohort of 2 201 uniformly diagnosed IBD patients within 20 well-described geographical areas in 11 European countries and Israel. For the 10-year follow-up of this cohort, an electronic patient questionnaire (ePQ) and electronic physician per patient follow-up form (ePpPFU) were designed as two separate data collecting instruments and made available through an Internet-based website. Independent demographic and clinical determinants of ePQ participation were analyzed using multivariate logistic regression. RESULTS: In 958 (316 CD and 642 UC) out of a total number of 1 505 (64%) available IBD patients, originating from 13 participating centers from nine different countries, both ePQ and ePpPFU were completed. Patients older than 40 years at ePQ completion (OR: 1.53 (95%CI: 1.14-2.05)) and those with active disease during the 3 mo previous to ePQ completion (OR: 3.32 (95%CI: 1.57-7.03)) were significantly more likely to respond. CONCLUSION: An Internet-based data acquisition tool appeared successful in sustaining a unique Western-European and Israelian multi-center 10-year clinical follow-up study project in patients afflicted with IBD.     

The structure of peritraumatic dissociation: A cross validation in clinical and nonclinical samples

Empirical data have challenged the unidimensionality of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), a widely used measure for peritraumatic dissociation. The aim of this study was to assess the factor structure of the PDEQ in 3 trauma‐exposed samples: (a) trauma‐exposed police officers (N = 219); (b) trauma‐exposed civilians (N = 158); and (c) treatment‐seeking trauma‐exposed civilians (N = 185). Confirmatory factor analyses using measurement invariance testing supported a 2‐factor structure (CFIs .96–.98; RMSEAs .07–.09), but excluded 2 of the original items. Factor 1 was termed Altered Awareness; Factor 2 was termed Derealization. Altered Awareness reflected disturbances in information processing during the traumatic event, whereas Derealization reflected distortions in perception. Hierarchical linear regression analysis showed that Derealization predicted posttraumatic stress severity at 26.5 weeks follow‐up only in the sample of police officers (R² = .45). Future longitudinal research shortly following trauma is required to elucidate causality and underlying mechanisms of peritraumatic dissociation, which may contribute to the development of more accurate screening strategies, as well as more effective strategies for prevention and early intervention.