Darbo tikslas – įvertinti elektroninio recepto, kaip vieno iš el. sveikatos komponentų, panaudojimo tiesioginius ir netiesioginius kaštus bei galimą naudą. Metodologija: siekiant pasiekti užsibrėžtą tikslą buvo atliekama sisteminė elektroninio recepto ekonominio įvertinimo analizė. Tyrimo metu remtasi kaštų-naudingumo analizės metodologijos gairėmis. Nustatant su tiesioginiais ir netiesioginiais kaštais susijusius kintamuosius, buvo atliktos sveikatos priežiūros specialistų ir įmonių apklausos. Palyginamuoju būdu apskaičiuota galima nauda pacientams. Gauti rezultatai diskontuoti į dabartinę vertinę reikšmę. Atlikta sistemos jautrumo analizė. Rezultatai: Dabar veikiančios receptų sistemos vidutiniai metiniai kaštai sudaro 30.082.691,68 litų. Iš jų 1.489.601,90 litų tenka tiesioginėms išlaidos, o likusioji 28.593.189,71 litų dalis – netiesioginėms išlaidoms. Tarp netiesioginių išlaidų 53,49 proc. sudaro gydytojų darbo laiko išrašant receptus piniginė išraiška, o vaistininkų darbo laiko vertė – 46,51 proc. Elektroninio recepto naudojimo kaštai kasmet sudarytų 19.443.948,08 litus, kurių tarpe 13,85 proc. tenka tiesioginiams kaštams, 86,15 proc. – netiesioginiams kaštams. Tarp netiesioginių išlaidų 63,91 proc. sudaro gydytojų darbo laiko piniginė išraiška, o likusioji dalis - 36.09 proc. vaistininkų darbo laiko vertė. Išvados: Lietuvoje kuriami elektroninio recepto modeliai naudoja naujausias šiuo metu esančias informacines technologijas, turinčias aukščiausius saugumo ir... [toliau žr. visą tekstą] / Object: evaluate the costs and impact of electronic prescription running stage for routine operation. Methodology: Systemic analysis of electronic prescription economical evaluation. It was used guidelines of Cost-Benefit analysis methodology. To estimate the parameters of direct and indirect costs it was made questioning of associated health care specialists and companies; for indirect impact for patients – comparative evaluation. All monetary values are converted onto a comparable base by presenting them in present values, using the discounted cash flow technique. The results of the evaluation were tested by a sensitivity analysis. Results: Present average costs per year – 30,082,691.68 litas. 1,489,601.90 litas – directs costs; 28,593,189.71 – indirect costs. Indirect costs consist of 53.49 % - payment issues for physicians and 46.51 % - for pharmacists. The costs of electronic prescription could be 19,443,948.08 litas per year. This consists of 13.85 % direct and 86.15 % indirect costs (63.91 % – payment issues for physicians; 36.09 % - for pharmacists). Conclusions: Present Lithuanian “e-recept” models use the newest information technologies with the highest standards of safety and security. Preferable method of evaluation of electronic prescribing model is Cost-Benefit analysis. In utilization of this method it was counted that electronic prescription system could help minimize direct and indirect cost by 39.43 % per year. All impact of utilization of electronic... [to full text]

This research examined the effect of increasing attention on OxyContin in the news media on prescribing practices of the drug in Nova Scotia. Using data collected as part of a study looking at representations of OxyContin in North American newspapers between 1995 and 2005, this research assessed the trends in prescribing practices of OxyContin in relation to the increased media attention. Data from the original media study was combined with administrative data from the Nova Scotia Prescription Monitoring Program to examine OxyContin prescribing trends between September 1996 and December 2007, with a specific focus on changes in the volume of OxyContin prescribed as a proportion of all opioids prescribed and as a proportion of strong opioids prescribed. Peaks in print media attention in both the United States and Canada were followed by statistically significant changes in OxyContin prescribing. These changes differed among prescribers in different District Health Authorities and specialties.

Bakgrund: Distriktssköterskor har i Sverige haft förskrivningsrätt sedan mitten av 1990-talet. Anledningen från början var att underlätta för läkarna, framför allt på landsbygden där läkartätheten var låg. Socialstyrelsen genomförde år 2000 en uppföljning av hur förskrivningsrätten användes. Författarna ville se om och/eller hur förskrivningen har förändrats samt hur förskrivningen ser ut i Sverige jämfört med andra länder. Syfte: Syftet med studien var att beskriva distriktssköterskans erfarenheter av att förskriva läkemedel i hemsjukvården samt deras uppfattning om förskrivningsrättens framtida utveckling inom distriktssköterskeproffessionen. Metod: Författarna valde att använda en kvalitativ metod i studien och som datainsamlingsmetod användes intervjuer med öppna frågor. Vid datanalysen användes en induktiv ansats där författarna bearbetade materialet med stöd av kvalitativ innehållsanalys. Resultat: Distriktssköterskan upplever att förskrivningsrätten är en bra kompetens att ha och att den underlättar i det dagliga arbetet. Olika faktorer påverkar hur väl förskrivningen fungerar. Möjlighet till regelbunden fortbildning och kontinuitet i arbetslaget främjar förskrivningen. Däremot saknas till viss del funktionella IT-system som underlättar förskrivningen. Dessutom finns många av de läkemedel som får förskrivas redan att tillgå utan recept. Därför upplever distriktssköterskan förskrivningsrätten ibland som en otillräcklig resurs inom distriktssköterskeprofessionen som skulle kunna utnyttjas på ett effektivare sätt. / Background: Since the middle of the 1990’s district nurses in Sweden have had the ability to prescribe drugs. In the beginning the reason was to help the physicians. The Swedish Social Board monitored in the year 2000 how this prescribing was used. The authors wanted to investigate if and/or how the prescribing has changed and also how the prescribing is used in Sweden compared to other countries. Aim: The aim with the study was to describe the district nurses’ experiences of prescribing drugs in homecare nursing and their opinion of the future development of prescribing in their profession. Method: The authors chose to use a qualitative method in the study and the method of data gathering was interviews based on open questions. At the analysis of data an inductive approach was used and the authors processed the material using qualitative content analysis. Results: District nurses experience that the prescribing facilitates their daily work. Access to regular education and continuity in the working team promotes the prescribing. Some essential IT systems are missing which would facilitate prescribing. Furthermore a large amount of the drugs that can be prescribed are already available without prescription. Therefore prescribing drugs is sometimes perceived as an insufficient resource in district nurses profession that could be utilized in a more effective way.

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This research was initiated as a response to a request for assistance from a group of students at the Nelson R Mandela School of Medicine who had reported feeling unprepared to prescribe medicines. This led to an interest in the level of competence shown by students in making prescribing decisions and the extent to which they were confident of their prescribing judgments. Student prescribing competence and confidence were assessed using quantitative and qualitative methods. The quantitative assessment comprised a test where students were asked to rate their confidence in some of their responses. A stratified sample of 10 of these student interviewed, where they were asked to choose treatment for four paper cases. Prescribing skills were found to be lacking, with test results averaging 47%. appropriate treatment selected for only 4 of the total of 40 paper cases. Upon reviewing the literature, it became apparent that poor prescribing skills, leading to the problem of irrational prescribing was a worldwide phenomenon The study aimed to address areas of weak prescribing skill using a short intense intervention comprising of several different learning strategies. Student change in confidence following the course was assessed using an evaluation form where students rated their perceived changes in key competences. Students showed improved confidence for each of the prescribing abilities measured. These findings have been compiled into 3 research publications, the texts of which are bound together as they were submitted together to comply with the research requirement of an M.Ed. The findings are reported in a paper titled Building successful therapeutics into a problembased medical curriculum in Africa in the South African Journal of Higher Education (see Appendices). I was also interested in how prescribing ability builds as students develop new prescribing skills. The student interviews provided an opportunity to explore the variation shown between the students relating to the quality of the treatment they prescribed for a given paper case. A sample of two sets of paper cases were assessed using a phenomenographic method, yielding two different perspectives of student experience. The research outlined above is the focus of the dissertation, which also includes an exploration of the teaching and learning issues which guided the design of the intervention and which I believe led to the positive finding of improved student prescribing confidence. Also included in the dissertation is an analysis of the quantitative assessment according to the cognitive categories of Bloom's Taxonomy, as well as qualitative data gathered from student interviews which revealed an understanding about prescribing abilities which predominated at differing Bloom cognitive levels for different students. In the second paper titled Undergraduate medical students' reasoning with regard to the prescribing process which has been submitted to Medical Teacher, (see Appendices) the range of student cognition associated with prescribing is explored. Each question from the quantitative assessment of prescribing abilities were grouped according to the Bloom Category it had been assigned, student scores according to each Bloom category were calculated. Students scored highest for the lowest cognitive category ('knowledge') and lowest for the highest ranked cognitive categories( 'evaluation' and 'synthesis'). These findings along with the qualitative findings and the phenomenographic assessment were reported here. / Thesis (M.Ed.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

No description available.

<p>Infusions, decoctions, alcoholic preparations and other dosage forms of Artemisia afra are frequently used in South African traditional medicine. Generally when these preparations are made without applying good manufacturing practices they do not meet microbial quality control standards, safety and toxicity criteria and encourage poor patients compliance. To overcome the aforementioned disadvantages of traditional dosage forms a sold dosage form, i.e. a table might be recommended. The first objective of this study was to formulate and manufacture a rapid release tablet dosage of Artemisia afra that would contain an amount of plant material equivalent to that found in its traditional liquid dosage forms and that would meet conventional pharmaceutical standards. The second objective was to conduct a pilot study to obtain a preliminary profile of the bioavailability of select flavonoids presents in both the tablet and traditional liquid preparation of Artemisia afra in humans.</p>

Master of Pharmacy / Medicines are a fundamental healthcare intervention, but the benefits they provide depend entirely on the way in which they are used. This begins with prescribing, a complex task with substantial risks. Systematic evaluation of biomedical factors may be viewed as an essential component of this task, but prescribers also integrate an array of individual, social, cultural, environmental and commercial factors into their prescribing decisions. Furthermore, social and cultural characteristics of the prescriber’s workplace may influence how well prescribing decisions are carried out. Whilst numerous research efforts have helped to construct an in-depth understanding of non-biomedical influences on GP’s prescribing patterns, the characteristics of corresponding sorts of influences in teaching hospitals have not been well determined. In hospitals, supervised medical trainees, registrars and consultants prescribe within the framework of medicines management systems involving nurses, pharmacists and patients. Currently, little is known about whether each of these groups has distinct beliefs, attitudes and values that may affect either prescribing behaviour or how prescribing skills of medical trainees are acquired. The aim of this study was to explore the social and cultural dynamics of prescribing and prescriber training in teaching hospitals. To do this, established qualitative methods were employed. Junior doctors, registrars, consultants, nurses, and pharmacists from two metropolitan teaching hospitals were sampled purposively and invited to participate in semi-structured interviews. A brief questionnaire was used to collect demographic and contextual information. In the interviews, participants were asked about their attitudes towards prescribing, their perceptions of roles and responsibilities, how they communicated prescribing decisions, their perceptions of influences on prescribing, and their perceptions of factors contributing to prescribing errors. Participants were also asked for their opinions on various aspects of new prescriber training. Sampling proceeded until redundancy of themes was established. A pilot study was conducted with one participant from each professional group to optimise the interview schedule, and then using this tool, a further 38 participants were interviewed. In total, eight consultants, eight registrars, nine junior doctors, eleven pharmacists, and seven nurses participated. Using reiterative content analysis of a third of all transcripts, a coding scheme was developed, which was used to label and categorise the remaining transcripts. Categories were further developed and refined. The resultant core themes were cross indexed against the five different health professional types using thematic charts to explore patterns. The main lines of enquiry for this research were mapped, the properties of these categories and interrelationships explored in detail, and a model of the prescribing process was developed. Prescribing at the teaching hospitals was a complex process consisting of multiple steps undertaken by several different health professionals of varying levels of experience from three different health care disciplines. Because of the intricate separation of responsibilities, the operation of the process was highly reliant on the behaviours of each player and their relationships with each other. Key prescribing decisions associated with patient admissions were made, almost exclusively, by medical teams. Prescribing was therefore chiefly characterised by factors influencing the behaviours of the doctors. Their behaviours were influenced by factors relating to their individual characteristics (eg, knowledge, skills, experience); but also by a web of socio-cultural determinants inherent to the environment in which they worked. These factors were related to: the organisational structure of the prescribing process; the knowledge characteristics of the doctors; the communication patterns they used; the underlying assumptions they made about prescribing; and the work environment.

Master of Pharmacy / Medicines are a fundamental healthcare intervention, but the benefits they provide depend entirely on the way in which they are used. This begins with prescribing, a complex task with substantial risks. Systematic evaluation of biomedical factors may be viewed as an essential component of this task, but prescribers also integrate an array of individual, social, cultural, environmental and commercial factors into their prescribing decisions. Furthermore, social and cultural characteristics of the prescriber’s workplace may influence how well prescribing decisions are carried out. Whilst numerous research efforts have helped to construct an in-depth understanding of non-biomedical influences on GP’s prescribing patterns, the characteristics of corresponding sorts of influences in teaching hospitals have not been well determined. In hospitals, supervised medical trainees, registrars and consultants prescribe within the framework of medicines management systems involving nurses, pharmacists and patients. Currently, little is known about whether each of these groups has distinct beliefs, attitudes and values that may affect either prescribing behaviour or how prescribing skills of medical trainees are acquired. The aim of this study was to explore the social and cultural dynamics of prescribing and prescriber training in teaching hospitals. To do this, established qualitative methods were employed. Junior doctors, registrars, consultants, nurses, and pharmacists from two metropolitan teaching hospitals were sampled purposively and invited to participate in semi-structured interviews. A brief questionnaire was used to collect demographic and contextual information. In the interviews, participants were asked about their attitudes towards prescribing, their perceptions of roles and responsibilities, how they communicated prescribing decisions, their perceptions of influences on prescribing, and their perceptions of factors contributing to prescribing errors. Participants were also asked for their opinions on various aspects of new prescriber training. Sampling proceeded until redundancy of themes was established. A pilot study was conducted with one participant from each professional group to optimise the interview schedule, and then using this tool, a further 38 participants were interviewed. In total, eight consultants, eight registrars, nine junior doctors, eleven pharmacists, and seven nurses participated. Using reiterative content analysis of a third of all transcripts, a coding scheme was developed, which was used to label and categorise the remaining transcripts. Categories were further developed and refined. The resultant core themes were cross indexed against the five different health professional types using thematic charts to explore patterns. The main lines of enquiry for this research were mapped, the properties of these categories and interrelationships explored in detail, and a model of the prescribing process was developed. Prescribing at the teaching hospitals was a complex process consisting of multiple steps undertaken by several different health professionals of varying levels of experience from three different health care disciplines. Because of the intricate separation of responsibilities, the operation of the process was highly reliant on the behaviours of each player and their relationships with each other. Key prescribing decisions associated with patient admissions were made, almost exclusively, by medical teams. Prescribing was therefore chiefly characterised by factors influencing the behaviours of the doctors. Their behaviours were influenced by factors relating to their individual characteristics (eg, knowledge, skills, experience); but also by a web of socio-cultural determinants inherent to the environment in which they worked. These factors were related to: the organisational structure of the prescribing process; the knowledge characteristics of the doctors; the communication patterns they used; the underlying assumptions they made about prescribing; and the work environment.

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.