Thesis (MAppSc(Pharm))--University of South Australia, 2000

This thesis is about change, community and the health system. It is about women. It is about challenging the status quo and advocating for and with the less powerful. It is about fore grounding previously silenced voices, valuing the subjugated knowledge of people other than those who make the decisions. Many voices are woven together, including those of the author, community health workers, non-government agency workers, people who use community health services, and members of the public. This is a narrative of a group of people researching the issue of community participating in community health, concentrating on the Blue Mountains district of NSW. The inquiry centred on the premise that community participating is both desirable and achievable. The group spoke to over 100 people, and the conclusion was reached that, while community participation is promoted by the NSW Health Department, at present it is an idea that has not been thought through, is ill defined, and lacks support in practice. Debates about health and illness take place within a medical discourse, and there must be a reorientation to viewing health as a social phenomenon if community participation in decision making is to occur / Doctor of Philosophy (PhD)

Thesis (Ed.D.)--Teachers College, Columbia University, 1995. / Includes tables. Typescript; issued also on microfilm. Sponsor: Elizabeth M. Maloney. Dissertation Committee: Herve Varenne. Includes bibliographical references (leaves 153-167).

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Thesis (Ph.D.) -- University of Western Sydney, Hawkesbury, 1997. / Bibliography : leaves 361-375.

Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates < 80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.

Masters in Public Administration - MPA / South Africa

Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates <80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements. / The Pharmaceutical Trust for Educational and Charitable Objects (PTECO) (now known as Pharmacy Research UK).

No description available.

Transformation of service delivery in the Westcoast winelands region's hospitals: challenges and prospects