Medicines and driving: evaluation of training and software support for patient counselling by pharmacists

Background : The consumption of some psychotropic medicines has a negative effect on the fitness to drive. Pharmacists are expected to give useful advice to patients on their participation in traffic. However, almost no information is available on this topic. Objective : To assess the effect of training and implementation of new dispensing guidelines with regard to driving-impairing medicines, in two types of dispensing support tools. User acceptance was measured as well as the effect on pharmacists' attitudes & awareness, self-reported behaviour and knowledge. Setting Pharmacists from East Flanders in Belgium. Methods : Two intervention groups and a control group participated. The intervention groups followed a training and were provided with a dispensing support tool containing information on the effect of medicines on driving ability, which was either stand-alone (USB stick) or integrated into the daily used software (ViaNova). The three groups filled out a questionnaire prior to and after the intervention period. Main outcome measure : Answers to a pre/post-questionnaire on attitudes and awareness, self-reported behaviour, knowledge and user acceptance. Results : Many pharmacists were already strongly interested in the topic at the beginning of the study. Positive changes in attitude, self-reported behaviour and knowledge were measured mostly in the group of pharmacists for which the information was integrated in their daily used software. These pharmacists asked significantly more about the patients' driving experience, informed them more about driving-related risk and gave more detailed information on impairing effects of medicines. The knowledge of the participating pharmacists on the topic 'medicines and driving' remained generally low. The participants acknowledge the importance of being aware of the topic medicines and driving but they report a lack of information or education. They strongly prefer a tool that integrates the information in their daily used software. Conclusion : Dispensing support tools with information on the potential impairing effect of a medicine on the fitness to drive increases awareness, reported risk communication behaviour as well as knowledge of pharmacists on this topic. Computerised dispensing support tools are most effective when the information is integrated into the daily used dispensing software

Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial

Contains fulltext : 70099.pdf ( ) (Open Access)BACKGROUND: Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP) aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses. METHODS: The DTP is a complex educational intervention that consists of two workshops, a coaching program, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics. One hundred duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in a cluster-randomised controlled trial. Primary outcomes will be the number of cognitive assessments and dementia diagnoses in a period of 9 months following workshop participation. Secondary outcomes are measured on GP and nurse level: adherence to national guidelines for dementia, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs' electronic medical records, self-registration forms and questionnaires. Statistical analysis will be performed using the MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and the possible causal relations between the rate of success of the intervention components and the outcomes. DISCUSSION: We developed multifaceted dementia training programme. Novelties in this programme are the training in fixed collaborative duos and the inclusion of an individual coaching program. The intervention is designed according to international guidelines and educational standards. Exploratory analysis will reveal its successful elements. Selection bias and contamination may be threats to the reliability of future results of this trial. Nevertheless, the results of this trial may provide useful information for policy makers and developers of continuing medical education. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT00459784

For which clinical rules do doctors want decision support, and why? A survey of Dutch general practitioners.

Despite the promise of decision support for improving care, alerts are often overridden or ignored. We evaluated Dutch general practitioners’ intention to accept decision support in a proposed implementation based on clinical rules regarding care for elderly patients, and their reasons for wanting or not wanting support. We developed a survey based on literature and structured interviews and distributed it to all doctors who would receive support in the proposed implementation (n = 43), of which 65 percent responded. The survey consisted of six questions for each of 20 clinical rules. Despite concerns about interruption, doctors tended to choose more interruptive forms of support. Doctors wanted support when they felt the rule represented minimal care, perceived a need to improve care, and felt responsible for the action and that they might forget to perform the action; doctors declined support due to feeling that it was unnecessary and due to concerns about interruption

Impact of Physical Therapist Attitudes and Beliefs on the Outcomes of Patients with Low Back Pain

Introduction: Physical therapist attitudes and beliefs about low back pain (LBP) have been shown to influence patientbeliefs and affect clinician behavior. The purpose of this project was to investigate physical therapist attitudes and beliefsabout LBP, identify factors that influence those beliefs, and determine if attitudes and beliefs have an impact on patientoutcomes. Methods: This study was a retrospective cohort design that included a survey of physical therapists and thecollection of patient outcomes from Focus on Therapeutic Outcomes, Inc. (FOTO). Attitudes and beliefs were measured using the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Outcomes were measured using Computerized Lumbar Functional Scale change scores (CLFS), CLFS residual scores, number of visits, and Fear Avoidance Beliefs Scale physical activity subscale (FABQpa). Results: Complete attitudes and beliefs scales were collected from 140 physical therapists. PABS-BM and PABS-BPS scores were predicted by a model that included age between 18 and 34, board certification, and NPQ scores. A multiple variate model could not be developed for HC-PAIRS scores, as NPQ score was the only significant predictor. A linear model containing HC-PAIRS scores and change in FABQpa scores predicted 16.1% of the variability in CLFS scores and 12.8% of the variability in thenumber of visits. HC-PAIRS was a univariate logistic predictor for a greater than expected CLFS change for the 10 patient cut-off sample. Receiver operating characteristic (ROC) curve identified an HC-PAIRS cut-off score of 30.50. This score had a sensitivity of .564 and specificity of .641. Scores on the PABS-PT scale were not multivariate predictors of any outcome measure. Conclusion: Several factors predicted LBP-related attitudes and beliefs, with the most consistent predictor being knowledge of current pain science. The LBP attitudes and beliefs of physical therapists were not consistent predictors of outcomes. HC-PAIRS scores were found to be related to outcomes in 8 of the 33 performed analyses; however, this relationship was not in the predicted direction. Physical therapists who believed there was a stronger relationship between pain and disability had better outcomes

Evidence-Based Practice among Dutch Occupational Therapists: Barriers, Perceptions, and Use of Resources

This study explored how evidence-based practice (EBP) is perceived by Dutch occupational therapists (OTs), what sources of evidence they use to make clinical decisions, and what barriers they experience when implementing EBP. Two-hundred members of the Dutch Association of Occupational Therapy (EN) practicing as OTs in the Netherlands were randomly selected. The data collection process resulted in a 54.6% response rate. Dutch OTs valued EBP greatly. Participants reported evaluating the quality of research evidence to be the greatest barrier to EBP. A barrier unique to this study was difficulty in using evidence written in foreign languages, which was likely to decrease the use of more robust sources of evidence. Support from the workplace was important in increasing the use of EBP. The findings suggested that EBP is not implemented optimally in the Dutch OT community. Cooperation between OTs, employers, educators, researchers, and EN is necessary in addressing existing barriers