Challenges in chronic illness management : a qualitative study of Australian pharmacists' perspectives

Objective: To explore pharmacists' views on managing patients with chronic illness; to understand the incentives and barriers they perceive and the solutions they propose to overcome these barriers. Setting: Hospital pharmacists, with experience in managing people with chronic illnesses, working in western Sydney, Australia, were interviewed during June and July 2008. Method: A qualitative study involving group and individual interviews using a semi-structured interview guide. Results: Hospital pharmacists identified lack of communication between different healthcare providers and with patients as a contributing factor to lack of continuity of care and this was perceived as a major barrier in managing patients with chronic illnesses. Pharmacists were also concerned about the effects of medication costs, and poor patient knowledge regarding their disease and medications, and the effects on adherence. Suggested solutions included taking a teamwork approach in the management of chronic illness and providing more information to patients to improve adherence. Conclusion: The identified incentives and barriers have provided valuable information on what pharmacists face in managing patients with chronic illness. Most of the solutions suggested by them have been tested and proven unsuccessful. Develop successful health policy to address the identified barriers remains a challenge.6 page(s

Heart failure exacerbation leading to hospital admission : a cross-sectional study

Objectives: The aim of this pilot study was to investigate cause(s) of heart failure (HF). Setting: The emergency department and medical wards at Malmö University Hospital. Method: A cross sectional pilot study. Main outcome measures: Comparison of compliance, comprehension and optimal treatment on a population basis between men and women, younger (≤75 years) and elderly (>75 years) patients, and patients in different New York Heart Association (NYHA) classes, in order to assess if exacerbation could have been caused by any of these factors. Results: Of the 47 patients included, 60% reported high compliance, with significant differences between women and men, and between patients in NYHA class IV and patients in NYHA class III. Comprehension on self-care was poor. Only 30% weighed themselves regularly and 45% did not limit the amount of fluids. No more than 28% reported they would contact a health professional in the case of experiencing more symptoms. Suboptimal treatment was also found to be a great concern. The majority were treated with recommended agents, but had not achieved target dose as recommended in the guidelines. Conclusion: This pilot study indicates suboptimal HF management of patients with HF prior to hospital admission due to HF exacerbation. A larger study is needed to assess the extent of the problem, and establish the need and nature of management improvement in different patient subgroups.8 page(s

Quantifying health professionals' patterns of work and communication and the impact of health information technology : a workshop on how to design and use the Work Observation Method by Activity Timing (WOMBAT) tool

Health information technology changes the way health professionals work and communicate. Measuring these changes and assessing their impact presents many challenges. This workshop is designed to introduce participants to the use of the Work Observation Method By Activity Timing (WOMBAT) approach for undertaking quantitative studies to measure patterns of work and communication. The WOMBAT approach is based upon a time and motion methodology which has an added advantage of allowing researchers to accurately record multiple dimensions of health professionals' work using a tablet computer. An aim of this workshop is to facilitate the conduct of work measurement studies which allow comparisons between settings and countries by using a standardised approach. The objectives are to: Demonstrate how studies can be designed using WOMBAT. Discuss core design features of direct observational studies of health professionals' work including sampling methods, observer training and measures of inter-rater reliability. Present findings from previous studies which have applied the WOMBAT technique to illustrate the types of questions which can be answered. Provide participants with an opportunity to use the WOMBAT tool. This will be a practical workshop designed for researchers who are interested in gaining skills in designing and conducting quantitative studies of health professionals' patterns of work and workflow.1 page(s

A Qualitative study of Australians' opinions about personally controlled electronic health records

Background: A personally controlled electronic health record (PCEHR) system is being implemented in Australia. Every Australian that wants a PCEHR will be able to opt-in from July 2012. Aim: To explore the opinions of Australian consumers and healthcare providers about the PCEHR. Methods: In this qualitative study, consumers and healthcare providers were interviewed using a semi-structured interview guide. Results: Perceived benefits identified by participants regarding the PCEHR included instant access to clinical information, and safer and more efficient healthcare delivery. The risk of unauthorised access and breaches of privacy were some of the perceived drawbacks. Although consumers seemed unwilling to opt-in to have a PCEHR, the vast majority of healthcare providers were positive towards this development and predicted better and safer healthcare as a result. Conclusions: Consumers and healthcare providers appeared uniformed about the imminent PCEHR. The wide-spread unwillingness among participants to opt-in to have a PCEHR could potentially jeopardise successful implementation and uptake of this system. A well-designed system without security glitches and with individualised information from trusted healthcare providers regarding the benefits of having a PCEHR appears critical in engaging consumer opt-in.6 page(s

The Precise Observation System for the Safe Use of Medicines (POSSUM) : an approach for studying medication administration errors in the field

Medication administration errors (MAEs) in hospital are frequent and significantly more likely to result in serious harm to patients than other medication error types. Many interventions have been proposed in order reduce MAEs and the amount of harm associated with these errors. A major limitation in assessing the effectiveness of these interventions has been the lack of robust measures for assessing changes in MAEs and associated harms. Drawing upon extensive foundational research we have developed a robust approach and data collection software to be applied in direct observational studies of nurses to allow measurement of changes in MAE rates. We report how this approach is being applied in a large stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce MAEs in a paediatric hospital.5 page(s

A Qualitative study of Swedes' opinions about shared electronic health records

European countries are world-leading in the development and implementation of e-Health. In Sweden, all primary healthcare centres and most hospitals use digital records. Some regions use the same software which allows for clinical information to be shared (regionally shared EHRs), but there is a movement towards making all EHRs inter-operable to allow for a National Patient Summary (NPS). The aim of this study was to explore the opinions of Swedish consumers and health professionals about shared EHRs and the NPS. Semi-structered phone interviews were conducted with consumers and health professionals. The majority of interviewed health professionals were currently using regionally shared EHRs. In their experience, having access to regionally shared EHRs facilitated a holistic patient approach, assisted in patient follow-up, and reduced inappropriate (over)prescribing. Consumers had a poor level of knowledge about shared EHRs and the NPS. Unlike health professionals, consumers perceived a NPS to be of great value. The findings indicate that there was a discrepancy between health professionals and consumers' knowledge of, and the perceived need for, a NPS.5 page(s

Impact of medication reconciliation and review on clinical outcomes

Objective: To examine the evidence regarding the effectiveness of medication reconciliation and review and to improve clinical outcomes in hospitals, the community, and aged care facilities. Data Source: This systematic review was undertaken in concordance with the PRISMA statement. Electronic databases, including MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for relevant articles published between January 2000 and March 2014. Study Selection and Data Extraction: Randomized and nonrandomized studies rating the severity of medication discrepancies and medication-related problems identified during medication reconciliation and/or review were considered for inclusion. Data were extracted independently by 2 authors using a data collection form. Data Synthesis: Of the 5292 articles identified, 83 articles met the inclusion criteria. Medication reconciliation identified unintentional medication discrepancies in 3.4% to 98.2% of patients. There is limited evidence of the potential of these discrepancies to cause harm. Medication reviews identified medication-related problems or possible adverse drug reactions in 17.2% to 94.0% of patients. The studies reported conflicting findings regarding the impact of medication review on length of stays, readmissions, and mortality. Conclusions: The evidence demonstrates that medication reconciliation has the potential to identify many medication discrepancies and reduce potential harm, but the impact on clinical outcomes is less clear. Similarly, medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Overall, there is limited evidence that medication reconciliation and medication review processes, as currently performed, significantly improve clinical outcomes, such as reductions in hospital readmissions.15 page(s

Communication about medication management during patient–physician consultations in primary care : a participant observation study

Objective To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations. Setting Two primary care centres in southern Sweden. Participants Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis. Results Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further. Conclusion Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.No data are available

Little things matter : a time and motion study of pharmacists' activities in a paediatric hospital

How healthcare providers distribute their time can impact on the quality and safety of care delivered, and this has been widely studied in hospitals providing care to adult patients. Children are different to adults and the workflow of healthcare providers in paediatric settings is largely unknown. The aim of this study was to quantify how clinical pharmacists working in a paediatric hospital spend their time. A direct observational time and motion study was conducted where two independent observers shadowed seven pharmacists covering eight wards for over 60 hours. Pharmacists spent the majority of time performing medication review (32.6%), followed by communication, non-clinical tasks, supply, medication discussion and in-transit. They were interrupted 3.5 times per hour and spent 4.4% of observed time multi-tasking. This is the first study to quantify how pharmacists in a paediatric hospital distribute their time. These results could act as useful baseline data against which to measure the impact of innovations, such as electronic medication management systems, on pharmacists' workflow.7 page(s

Electronic medication information sources : understanding the needs and preferences of health professionals

Background: To improve the accessibility and usability of local medication information, the pharmacy department at the study hospital consolidated the electronic medication information and restructured the manner in which it is presented to clinicians. Aim: To examine the electronic medication information needs of clinicians and to explore their preferences and views on the proposed 'new' medication information repository. Method: Doctors (n = 12), nurses (n = 15) and pharmacists (n = 8) from the study hospital participated either in a 30-minute focus group or semi-structured interview. Results: Doctors and nurses did not use the local medication information and viewed the new medication information repository as not very useful. Users identifi ed a range of issues related to the design and layout of the new repository. Clinicians are unlikely to use information if it is not visible during their work processes. Conclusion: Electronic medication information needs and preferences of clinicians were identifi ed as well as areas where redesign of electronic medication information sources is needed. It is not possible to meet the electronic medication information needs and preferences of all clinical users of a system or application.4 page(s