Class of 2009 Abstract / OBJECTIVES: To measure the attitudes of Arizona e-prescribing clinicians regarding (1) the importance of key criteria that may be used in the selection of an e-prescribing system; and (2) their satisfaction with key criteria as implemented within their current e- prescribing system. METHODS: This study utilized a print-based questionnaire. The questionnaire was faxed weekly to clinicians who were registered office-based e-prescribers in Arizona until either a response was received or three fax cycles were completed. Clinicians were asked to rate the importance of each e-prescribing feature on a five-point scale, where 1 was not at all important and 5 was extremely important. For each e-prescribing feature, clinicians were asked to rate their satisfaction with their current e-prescribing system on a seven-point scale, where -3 was very dissatisfied and +3 was very satisfied. Demographic data were collected on practice size, practice type, prescription entry, e-prescribing software vendor and system used, year e-prescribing started, and comments. RESULTS: Questionnaires were completed and returned by 114 clinicians. The overall mean for feature importance and satisfaction was 4.22 and 4.92, respectively. Of the 39 criteria, 9 were categorized as having high importance with low satisfaction; and 14 were categorized as having high importance with high satisfaction. The nine criteria with high importance but low satisfaction were related to vendor support, system cost, lack of e-prescribing features, and unrealized benefits. CONCLUSIONS: Arizona e-prescribers are moderately satisfied with the basic functions provided by their electronic prescribing systems. Their dissatisfaction with electronic prescribing systems may be due to vendor support and system costs.

Non-medical prescribers make an increasing contribution to healthcare across the UK yet little is known about influences on their prescribing decision-making. The aim of this programme of research was to explore and describe prescribing decision-making by non-medical prescribers. A two stage programme of research was carried out. Stage 1 was a systematic review of the social and cognitive influences on prescribing decision-making by non-medical prescribers. Despite a paucity of research, various influences on prescribing decision-making were reported including evidence based guidelines, peer support and patient (or parental) relationships and expectations. While confidence and clinical experience as a practitioner were cited as influences, the lack of prescribing experience and aspects of pharmacological knowledge also impacted on prescribing decision-making, resulting in a cautious approach. Stage 2 of the research employed a phenomenological methodology underpinned by the Theoretical Domains Framework of behavioural determinants (TDF). It comprised three phases. In Phase 1, semi-structured interviews with five nurse prescribers and eight pharmacist prescribers in NHS Grampian explored their experiences and perceptions of influences on their prescribing decision-making, and the impact of these influences. Multiple and sometimes contradictory influences were uncovered. Twelve of the fourteen domains of the TDF were found to be influential along with multi-disciplinary working and experience; optimism and reinforcement did not feature. In Phase 2, these participants recorded reflections on prescribing decisions which they considered noteworthy in relation to their practice, and in Phase 3 participants were interviewed about their reflections. Complexity was a feature of many, in the patients’ clinical or social circumstances or in relation to wider concerns. The same 12 domains were found to be influential as were multi-disciplinary working, experience and complexity. This programme of research has produced original findings which it is hoped will impact on the education, training and practice of these increasingly important prescribers.

Controlled substance stewardship, much in the same vein as antimicrobial stewardship, is a professional obligation for prescribers and pharmacists alike in today’s practice environment. This presentation will introduce this concept and present a model for pharmacist-led controlled substance prescribing interventions in a primary care clinic. The Controlled Substances Initiative (CSI) at Penobscot Community Health Care in Bangor, Maine, was implemented in 2013. The interprofessional CSI Committee meets weekly to review patient cases involving controlled substances and communicate best practice recommendations to prescribers. All committee operations are sustained by pharmacists participating in a postgraduate residency training program. To assess the organization-wide impact of the initiative, presenters will share data on controlled substance dose reductions and mortality trends. They will offer pearls for application of this model to other practice settings, including community pharmacies.

Förstudie av Fysisk aktivitet på Recept- ett projekt mellan vårdcentralen Ankaret och Friskis&Svettis i Örnsköldsvik. - ur ett hälsoperspektiv (Pilot study of exercise on prescription, a project between the health center Ankaret and Friskis&Svettis in Örnsköldsvik - from a healthperspective) Bachelor Essay in Swedish. Umeå: Umeå university, Department of Education. Physical activity is a growing problem in Sweden. To improve the situation a working method called FaR was developed. FaR is physical activity on recipe that primary health care providers can prescribe their patients. The aim of this study was to investigate how a project in which, FaR patients are prescribed by the health center to a wellness facility may succeed. The project is taking place in Örnsköldsvik between the primary healthcare center Ankaret and Friskis&Svettis. Qualitative interviews were conducted with patients, prescribers and instructors. The result showed that over all they are positive to the project but it reveals a number of obstacles on the road as the price at Friskis&Svettis and time constraints of prescribers. Instructors will also present a lack of knowledge on training with diseases and motivational theories. It is also found that the patients are requesting more support and feedback during the time of prescription. More time, feedback and knowledge is needed to improve the project.

L’analyse du phénomène de la transformation des biens de consommation en s'intéressant à l’expansion fonctionnelle de ces biens au cours du temps, a à la fois pu mobilisé et questionné différentes approches théoriques, que ce soit en sciences de gestion, en économie évolutionniste ou encore en ingénierie de la conception.La thèse propose d’évaluer l’expansion fonctionnelle des biens de consommation, afin de comprendre si leur transformation est un phénomène rare ou au contraire permanent. À l’aide d’un nouvel instrument de mesure, tout d’abord, nous rejetons l’hypothèse lancastérienne de la stabilité des biens de consommation au cours du temps, en montrant que leur transformation est permanente et que de nouvelle fonctions émergent d'une manière continue au cours du temps. Ensuite, nous montrons que l’émergence de l’innovation est non-poissonienne et contrôlée, qu’elle n’est pas exclusivement résultat d’un choc externe à la conception, mais qu’une innovation peut émerger indépendamment des besoins du marché ou des nouvelles technologies, à travers des efforts de la conception innovante.Enfin la thèse étudie le rôle de la prescription consumériste dans le maintien de la dynamique du marché au cours du temps, laquelle exige un apprentissage permanent de l’expansion fonctionnelle par les consommateurs. Nous montrons donc comment et pourquoi la prescription facilite ce processus d’apprentissage lequel garantit à son tour, une transformation permanente des biens de consommation, ce qui implique une dynamique continue entre l’offre et la demande. / The analysis of the phenomenon of consumer goods transformation based on the functional expansion of these goods over time, has mobilized and challenged various theoretical approaches, whether in management science, evolutionary economics or engineering design.This thesis proposes to assess the functional expansion of consumer goods, to understand whether the transformation of consumer goods is rare or rather permanent over time. Using a new measuring tool, first, we could reject the lancasterian hypothesis of stability of consumer goods over time, by showing that the transformation of consumer goods is permanent and that new functions emerge constantly over time. Then we have shown that the emergence of innovations is non-poissonian emergence and controlled, that it is not exclusively the result of an external shock from the design, but that innovation can tip regardless of market needs or new technologies, through innovative design efforts.Finally, the thesis examines the role of consumerist prescription in maintaining market dynamics over time. This dynamic requires the continuous learning of functional expansion by consumers. So we show how and why the prescription facilitates the learning process, which in turn ensures a permanent transformation of consumer goods, and implies a continuous dynamic between supply and demand.

Independent and supplementary prescribing are the two main forms of non-medical prescribing (NMP) that have been practised in the UK since 2006. Most available studies have qualitatively investigated the impact of NMP, especially in primary care. This may be due to the fact that prescriptions are issued mainly by general practitioners in primary care. This PhD thesis aimed at investigating the clinical effectiveness of independent pharmacist and diabetes specialist nurse (DSN) prescribers in the management of patients with type 2 diabetes at outpatient clinics in hospitals. A literature review was firstly conducted to explore the current research on NMP around the world and the UK. A systematic review of the previously published randomised control trials (RCT) and non-RCT studies that focused on prescribing interventions of nurses and pharmacist was also conducted to explore the impact of their prescribing interventions in treating type 2 diabetes using HbA1c level as the primary outcome. A programme of work of three retrospective comparative database analytical studies was then carried out to investigate the impact of independent NMPs in type 2 diabetes care. This programme of work used electronic medical records of patients attending outpatient clinics of diabetes centres in two teaching hospitals in Manchester; one employed an independent pharmacist and the other employed DSN prescribers. A group of subjects seen by an NMP in place of a doctor during the study period were the study group and the control group were those who seen only by doctors. The primary outcome was the average yearly change of HbA1c amongst the two groups. Secondary outcomes were yearly change of total cholesterol, blood pressure and serum creatinine as well as body mass index. Five statistical models, which included multivariable regression, propensity score matching and sensitivity analyses, were utilised to control for confounding effects, and the nature of selection bias in the retrospectively comparative effectiveness research using secondary database resources. A total of 330 patients seen by a team including a pharmacist versus 975 by doctors only between January 2006 and January 2013 at one site; and 656 by a team including DSNs versus 3,746 patients seen by doctors only between January 2007 to December 2013 at the other. The studies found both prescribing pharmacists and DSNs are capable of achieving at least non-inferior improvements in diabetes outcome compared to doctors. The pharmacist achieved a mean 0.01% reduction in HbA1c level versus doctors who achieved slight increase (p<0.4). DSNs also achieved a mean 0.07% reduction compared to doctors. However, after adjustment with multivariate and propensity score as well as with propensity score matching, there were no significant differences between the two groups. These findings were consistent with the findings in the systemic review. Although an RCT is the only method that by definition would produce unbiased treatment effects, the use of propensity score methods here, have reduced the potential for bias that may remain unaccounted for in multivariate models without propensity scores. Adjusting for propensity scores using two different methods also gives more confidence that the results are as unbiased as possible. Nonetheless, caution in generalising the results is necessary because of the retrospective nature of the studies and deficiencies in the database used.

No description available.

Cette thèse s’intéresse aux certifications avec « label », chartes et systèmes participatifs de l’économie solidaire, ou « dispositifs de qualité ». Elle contribue à l’analyse sociologique de ces dispositifs, dans un secteur qui connaît leur multiplication et leur diversification depuis les années 1990. L’enquête repose sur des entretiens au sein de douze réseaux (commerce équitable, AMAP, SEL…), des observations, l’analyse de documents et la passation d’un questionnaire. La genèse des dispositifs met en évidence leur rôle dans la construction d’une identité collective. Leur fonctionnement soulève des enjeux démocratiques. Les représentations de la confiance et de la qualité qui les sous-tendent révèlent le positionnement des collectifs vis-à-vis de la production standard et les uns par rapport aux autres. Leurs usages économiques et identitaires s’inscrivent dans la démarche contestataire des membres les plus actifs. L’hétérogénéité entre les attentes de ces derniers et celles des autres adhérents concourt aux difficultés liées à l’instauration des dispositifs de qualité. Ceux-ci ne sont pas uniquement destinés à l’orientation des acheteurs mais également à la promotion, par des producteurs engagés, de valeurs se voulant alternatives à celles de l’économie classique. / This thesis focuses on solidarity economy’s certification labels, charters and participatory systems, as “quality devices”. It contributes to the sociological analysis of these devices, in a sector in which they are increasing in number and have become more diverse since the 1990’s. This investigation relies on interviews in twelve networks (fair-trade, community-supported agriculture, LETS…), observations, document analysis and the administration of a questionnaire.The history of these measures accounts for the role they play in the construction of a collective identity. The way they operate raises democratic issues. Their underlying representations of confidence and quality reveal the positioning of these networks on standard production and in relation to each other. Their uses as economic and identity-shaping tools need to be viewed as part of a protest strategy adopted by the networks’ most active members. Differences in expectations among network members give rise to difficulty in implementing quality measures. They are not only intended to help buyers but also created by committed producers in order to promote values they consider as “alternative” in regards to classical economy.

This study compared perceptions of prescribers and pharmacists (N = 89) regarding multiple aspects of prescription drug abuse. Questionnaires were developed to assess perceptions regarding the prevalence of prescription drug abuse, self-perceived communication competence, and additional communication and prescription drug abuse domains. Pharmacists perceived a larger percentage of patients (41%) to be abusing opioid pain relievers as compared with their prescriber colleagues (17%). Both prescribers and pharmacists indicated improvements in prescriber–pharmacist communication would serve to deter prescription drug abuse. Self-efficacy beliefs for detecting and discussing prescription drug abuse with patients were low for both cohorts. Implications and limitations are noted.

The exponential growth in medical pharmaceuticals and related clinical trials have created a need to better understand the decision-making factors in the processes for developing hospital medication formularies. The purpose of the study was to identify, rank, and compare major factors impacting hospital formulary decision-making among three prescriber groups serving on a hospital's pharmacy and therapeutics (P&T) committee. Prescribers were selected from the University of Texas, MD Anderson Cancer Center which is a large, multi-facility, academic oncology hospital. Specifically, the prescriber groups studied were comprised of physicians, midlevel providers, and pharmacists. A self-administered online survey was disseminated to participants. Seven major hospital formulary decision-making factors were identified in the scientific literature. Study participants were asked to respond to questions about each of the hospital formulary decision-making factors and to rank the various formulary decision-making factors from the factor deemed most important to the factor deemed least important. There are five major conclusions drawn from the study including three similarities and two significant differences among the prescriber groups and factors. Similarities include: (1) the factor "pharmacy staff's evaluation of medical evidence including formulary recommendations" was ranked highest for all three prescriber groups; (2) "evaluation of medications by expert physicians" was ranked second for physicians and midlevel providers while pharmacists ranked it third; and (3) the factor, "financial impact of the treatment to the patient" was fifth in terms of hospital formulary decision-making statement and ranking by all three prescriber groups. Two significant differences include: (1) for the hospital-formulary decision making statement, "I consider the number of patients affected by adding, removing, or modifying a drug on the formulary when making hospital medication formulary decisions," midlevel providers considered this factor of significantly greater importance than did physicians; and (2) for the ranked hospital formulary decision-making factor, "financial impact of treatment to the institution," pharmacists ranked this factor significantly higher than did physicians. This study contributes to a greater understanding of the three prescriber groups serving on a P&T committee. Also, the study contributes to the body of literature regarding decision-making processes in medicine and specifically factors impacting hospital formulary decision-making. Furthermore, this study has the potential to impact the operational guidelines for the P&T committee at the University of Texas, MD Anderson Cancer Center as well as other hospitals.