Features of a mobile health intervention to manage chronic obstructive pulmonary disease: a qualitative study

Background: The use of mobile health (mHealth) interventions has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes. Further research is needed to determine which mHealth features are required to potentially enhance COPD self-management. Aim: The aim of this study was to explore the potential features of an mHealth intervention for COPD management with healthcare providers (HCPs) and patients with COPD. It could inform the development and successful implementation of mHealth interventions for COPD management. Methods: This was a qualitative study. We conducted semi-structured individual interviews with HCPs, including nurses, pharmacists and physicians who work directly with patients with COPD. Interviews were also conducted with a diverse sample of patients with COPD. Interview topics included demographics, mHealth usage, the potential use of medical devices and recommendations for features that would enhance an mHealth intervention for COPD management. Results: A total of 40 people, including nurses, physicians and pharmacists, participated. The main recommendations for the proposed mHealth intervention were categorised into two categories: patient interface and HCP interface. The prevalent features suggested for the patient interface include educating patients, collecting baseline data, collecting subjective data, collecting objective data via compatible medical devices, providing a digital action plan, allowing patients to track their progress, enabling family members to access the mHealth intervention, tailoring the features based on the patient’s unique needs, reminding patients about critical management tasks and rewarding patients for their positive behaviours. The most common features of the HCP interface include allowing HCPs to track their patients’ progress, allowing HCPs to communicate with their patients, educating HCPs and rewarding HCPs. Conclusion: This study identifies important potential features so that the most effective, efficient and feasible mHealth intervention can be developed to improve the management of COPD

Perceptions of Patients Regarding Mobile Health Interventions for the Management of Chronic Obstructive Pulmonary Disease: Mixed Methods Study

Background: Using a mobile health (mHealth) intervention consisting of a smartphone and compatible medical device has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. Objective: This study aims to describe the demographics, use, and access to smartphones of patients with COPD. It also aims to explore and develop an understanding of potential facilitators and barriers that might influence patients using mHealth interventions for COPD management. Methods: This was an explanatory, sequential mixed methods study. Patients who attended respirology clinics completed a questionnaire on technology access and use. We conducted semistructured individual interviews with the patients. Interview topics included the following: demographics, mHealth use, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of mHealth interventions for COPD management. Results: A total of 100 adults completed the survey but 22 participants were excluded because they were not diagnosed with COPD. Of these, 10 patients with COPD participated in the interview. The quantitative component revealed that many patients with COPD owned a mobile phone, but only about one-fourth of the participants (18/77, 23%) owned a smartphone. The likelihood of owning a smartphone was not associated with age, sex, marital status, or geographical location, but patients with high educational status were more likely to own a smartphone. The qualitative component found that patients with COPD, in general, had a positive attitude toward mHealth adoption for COPD management, but several facilitators and barriers were identified. The main facilitators of mHealth adoption are possible health benefits for patients, ease of use, educating patients, and credibility. Alternatively, the barriers to adoption are technical issues, lack of awareness, potential limited uptake from older adults, privacy and confidentiality issues, finances, and lack of interest in mHealth Conclusions: It is important to understand the perceptions of patients with COPD regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management

Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic

Background The beneficial outcomes of oral anticoagulation therapy are dependent upon achieving and maintaining an optimal INR therapeutic range. There is growing evidence that better outcomes are achieved when anticoagulation is managed by a pharmacist with expertise in anticoagulation management rather than usual care by family physicians. This study compared a pharmacist managed anticoagulation program (PC) to usual physician care (UC) in a family medicine clinic. Methods A retrospective cohort study was carried out in a family medicine clinic which included a clinical pharmacist. In 2006, the pharmacist assumed anticoagulation management. For a 17-month period, the PC group (n = 112) of patients on warfarin were compared to the UC patients (n = 81) for a similar period prior to 2006. The primary outcome was the percentage of time patients' INR was in the therapeutic range (TTR). Secondary outcomes were the percentage of time in therapeutic range within ± 0.3 units of the recommended range (expanded TTR) and percentage of time the INR was >5.0 or <1.5. Results The baseline characteristics were similar between the groups. Fifty-five percent of the PC group was male with a mean age of 67 years; 51% of the UC group was male with a mean age of 71 years. The most common indications for warfarin in both groups were atrial fibrillation, mechanical heart valves and deep vein thrombosis. The TTR was 73% for PC and 65% for UC (p 5 were 0.3% for PC patients and 0.1% for UC (p < 0.0001). Conclusion The pharmacist-managed anticoagulation program within a family practice clinic compared to usual care by the physicians achieved significantly better INR control as measured by the percentage of time patients' INR values were kept in both the therapeutic and expanded range. Based on the results of this study, a collaborative family practice clinic using pharmacists and physicians may be an effective model for anticoagulation management with these results verified in future prospective randomized studies

Survey of Canadian Pharmacists’ Responses to Warnings of Potential Interactions Between Ceftriaxone and Calcium in IV Solutions

ABSTRACT Background: In 2007, because of a potential interaction between ceftriaxone and calcium-containing IV solutions, Roche Laboratories (manufacturer of Rocephin [ceftriaxone] in the United States) issued letters to health care professionals advising them of changes to the product monograph. Subsequently, warning letters were also issued by the US Food and Drug Administration (FDA) and Health Canada. The Health Canada recommendations and their implications for clinical practice generated debate in the Canadian hospital pharmacy community.Objective: To evaluate the response to the warnings among hospital pharmacists and their respective institutions.Methods: An anonymous, voluntary 10-question survey was distributed to members of the Pharmacy Specialty Networks of the Canadian Society of Hospital Pharmacists. Requests to participate were solicited via 2 e-mail messages. Responses were analyzed descriptively.Results: A total of 152 pharmacists participated in the survey. Fortythree respondents (28.3%) reported being very concerned and 86 (56.6%) reported being somewhat concerned about the Health Canada Notice to Hospitals. About half (77/152 [50.7%]) of the respondents felt that the Health Canada notice did not need to be strictly heeded. Two-thirds (98/145 [67.6%]) reported that their institutions had addressed the risk of an interaction through a change in policy regarding the administration of ceftriaxone. Eighty-eight (61.5%) of 143 participants indicated that their institution’s official position on the notice was that it represented a “relative contraindication” (i.e., the benefit may outweigh the risk).Conclusions: Warning letters issued by the manufacturer, the FDA, and Health Canada generated concern within the Canadian hospital pharmacy community. However, a large proportion of hospital pharmacy practitioners did not agree with strict adherence to the Health Canada notice.RÉSUMÉ Contexte : En 2007, à cause d’une interaction potentielle entre la ceftriaxone et les solutions intraveineuses contenant du calcium, Roche Laboratories (fabricant de Rocephin [ceftriaxone] aux États-Unis) ont émis une mise en garde aux professionnels de la santé les informant d’une modification à la monographie du produit. Par la suite, des mises en garde ont également été émises par la Food and Drug Administration (FDA) des États-Unis et par Santé Canada. Les recommandations de Santé Canada et leurs conséquences sur la pratique clinique ont soulevé un débat au sein de la communauté de la pharmacie hospitalière.Objectif : Évaluer la réponse à la mise en garde parmi les pharmaciens d’hôpitaux et leurs établissements respectifs.Méthodes : Un sondage anonyme à participation volontaire comportant 10 questions a été remis aux membres des Réseaux de spécialistes en pharmacie de la Société canadienne des pharmaciens d’hôpitaux. Les invitations à participer au sondage ont été communiquées au moyen de deux courriels. Les réponses ont été analysées de façon descriptive.Résultats : Au total, 152 pharmaciens ont participé au sondage. Quarante-trois répondants (28,3%) ont déclaré être très préoccupés et 86 (56,6%) ont déclaré être quelque peu préoccupés par l’Avis aux hôpitaux de Santé Canada. Environ la moitié (77/152 [50,7%]) des répondants estimaient qu’il n’était pas nécessaire de suivre à la lettre l’avis de Santé Canada. Les deux-tiers (98/145 [67,6%]) ont déclaré que leur établissement avait pris des mesures contre le risque d’interaction en modifiant leur politique d’administration de la ceftriaxone. Par ailleurs, 88 (61,5%) de 143 répondants ont indiqué que la position officielle de leur établissement relativement à cet avis était que celui-ci représentait une « contre-indication relative » (c.-à-d. que les bienfaits pouvaient l’emporter sur le risque).Conclusions : Les mises en garde émises par les fabricants, par la FDA et par Santé Canada ont soulevé des inquiétudes au sein de la communauté des pharmaciens d’hôpitaux du Canada. En revanche, une forte proportion des praticiens de la pharmacie hospitalière n’étaient pas d’accord pour observer à l’avis de Santé Canada

Patients’ and physicians’ satisfaction with a pharmacist managed anticoagulation program in a family medicine clinic

Background A pharmacist managed anticoagulation service was initiated in a multi-physician family medicine clinic in December 2006. In order to determine the patient and physician satisfaction with the service, a study was designed to describe the patients’ satisfaction with the warfarin education and management they received from the pharmacist, and to describe the physicians’ satisfaction with the level of care provided by the pharmacist for patients taking warfarin. A self-administered survey was completed by both eligible patients receiving warfarin and physicians prescribing warfarin between December 2006 and May 2008. The patient survey collected information on patient demographics, satisfaction with warfarin education and daily warfarin management. The physician survey collected data about the satisfaction with patient education and daily anticoagulation management by the pharmacist. Results Seventy-six of 94 (81%) patients completed the survey. Fifty-nine percent were male with a mean age of 65 years (range 24–90). Ninety-six percent agreed/strongly agreed the pharmacist did a good job teaching the importance of warfarin adherence, the necessity of INR testing and the risks of bleeding. Eighty-five percent agreed/strongly agreed the risk of blood clots was well explained, 79% felt the pharmacist did a good job teaching about dietary considerations and 77% agreed/strongly agreed the pharmacist explained when to see a doctor. All patients felt the pharmacist gave clear instructions on warfarin dosing and INR testing. Four of nine physicians (44%) completed the survey. All agreed/strongly agreed the pharmacist was competent in the care provided, were confident in the care their patients received, would like the pharmacist to continue the service, and would recommend this program to other clinics. Conclusions Patients and family physicians were satisfied with the pharmacist managed anticoagulation program and recommended continuation of the program. These results support the role of the pharmacist in the management of anticoagulation in a multi-physician family medicine clinic

How Two Small Pharmacy Schools’ Competency Standards Compare with an International Competency Framework and How Well These Schools Prepare Students for International Placements

International standards of pharmacy curricula are necessary to ensure student readiness for international placements. This paper explores whether curricula from two pharmacy programs, in Australia and Canada, are congruent with international standards and if students feel prepared for international placements. Nationally prescribed educational standards for the two schools were compared to each other and then against the International Pharmaceutical Federation (FIP) Global Competency Framework. Written student reflections complemented this analysis. Mapping results suggested substantial agreement between the FIP framework and Australia and Canada, with two gaps being identified. Moreover, the students felt their programs prepared them for their international placements. Despite differences in countries, pharmacy programs, and health-systems all students acclimatized to their new practice sites. Implications are that if pharmacy programs align well with FIP, pharmacists should be able to integrate and practise in other jurisdictions that also align with the FIP. This has implications for the mobility of pharmacy practitioners to countries not of their origin of training

ARTICLE Survey of Canadian Pharmacists ’ Responses to Warnings of Potential Interactions Between Ceftriaxone and Calcium in IV Solutions

Background: In 2007, because of a potential interaction between ceftriaxone and calcium-containing IV solutions, Roche Laboratories (manufacturer of Rocephin [ceftriaxone] in the United States) issued letters to health care professionals advising them of changes to the product monograph. Subsequently, warning letters were also issued by the US Food and Drug Administration (FDA) and Health Canada. The Health Canada recommendations and their implications for clinical practice generated debate in the Canadian hospital pharmacy community. Objective: To evaluate the response to the warnings among hospital pharmacists and their respective institutions. Methods: An anonymous, voluntary 10-question survey was distributed to members of the Pharmacy Specialty Networks of the Canadian Society of Hospital Pharmacists. Requests to participate were solicited via 2 e-mail messages. Responses were analyzed descriptively. Results: A total of 152 pharmacists participated in the survey. Fortythree respondents (28.3%) reported being very concerned and 86 (56.6%) reported being somewhat concerned about the Health Canada Notice to Hospitals. About half (77/152 [50.7%]) of the respondents felt that the Health Canada notice did not need to be strictly heeded. Two-thirds (98/145 [67.6%]) reported that their institutions had addressed the risk of an interaction through a change in policy regarding the administration of ceftriaxone. Eighty-eight (61.5%) of 143 participants indicated that their institution’s official position on the notice was that it represented a “relative contraindication ” (i.e., the benefit may outweigh the risk). Conclusions: Warning letters issued by the manufacturer, the FDA, and Health Canada generated concern within the Canadian hospital pharmacy community. However, a large proportion of hospital pharmacy practitioners did not agree with strict adherence to the Health Canada notice

Use of Evidence-Based Therapy at Discharge for Patients with Acute Myocardial Infarction: Retrospective Audit of Medical Records

ABSTRACTBackground: Various guidelines are available outlining optimal therapy for patients with acute myocardial infarction. Canadian institutions providing care for such patients have been encouraged to evaluate their care processes using specific indicators.Objective: To determine the proportion of patients with acute myocardial infarction discharged from a single health authority for whom acetylsalicylic acid (ASA), adrenergic &szlig;-receptor antagonists (&szlig;-blockers), angiotensin-converting enzyme (ACE) inhibitors, or 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) had been prescribed.Methods: Patients treated over a 12-month period (April 1, 2004, to March 31, 2005) for whom the most responsible diagnosis was acute myocardial infarction were eligible for inclusion in this review. Retrieved data included diagnosis, demographic information, comorbidities, and medications at the time of admission and discharge. Rates of discharge prescribing for the 4 drug classes were calculated for all patients and for &ldquo;ideal&rdquo; patients (those without documented contraindications). Rates were compared with published benchmark values.Results: Medical records for a total of 346 eligible patients were reviewed. Mean age was 65.3 years (standard deviation 13.4 years), and 226 (65.3%) of the patients were male. The coded diagnosis was ST-elevation myocardial infarction for 91 patients (26.3%), non-STelevation myocardial infarction for 164 (47.4%), and myocardial infarction not specified for 91 (26.3%). For &ldquo;ideal&rdquo; patients, the prescribing rates were 99.0% (308 of 311 patients) for ASA, 96.3% (310 of 322 patients) for &szlig;-blockers, 90.4% (264 of 292 patients) for ACE inhibitors, and 88.8% (278 of 313 patients) for statins.Conclusions: Rates of prescribing of ASA, &szlig;-blockers, ACE inhibitors, and statins for &ldquo;ideal&rdquo; patients discharged after treatment for acute myocardial infarction exceeded the published Canadian benchmark rates (&ge; 90% for ASA, &ge; 85% for &szlig;-blockers and ACE inhibitors, &ge; 70% for statins).R&Eacute;SUM&Eacute;Contexte : Il existe diverses lignes directrices d&eacute;crivant le traitement optimal pour les patients ayant subi un infarctus aigu du myocarde. Les &eacute;tablissements de sant&eacute; canadiens qui soignent de tels patients ont &eacute;t&eacute; encourag&eacute;s &agrave; &eacute;valuer leurs processus de soins en utilisant des indicateurs pr&eacute;cis.Objectif : D&eacute;terminer la proportion de patients ayant subi un infarctus aigu du myocarde et ayant re&ccedil;u leur cong&eacute; d&rsquo;une seule r&eacute;gie de la sant&eacute; avec une prescription d&rsquo;acide ac&eacute;tylsalicylique (AAS), d&rsquo;antagoniste des r&eacute;cepteurs &beta;-adr&eacute;nergiques (&beta;-bloquant), d&rsquo;inhibiteur de l&rsquo;enzyme de conversion de l&rsquo;angiotensine (ECA) ou d&rsquo;inhibiteur de la 3-hydroxy- 3-m&eacute;thylglutaryl-coenzyme A (HMG-CoA) r&eacute;ductase (statine).M&eacute;thodes : Les patients trait&eacute;s sur une p&eacute;riode de 12 mois (entre le 1er avril 2004 et le 31 mars 2005) et dont le diagnostic le plus responsable &eacute;tait celui d&rsquo;infarctus aigu du myocarde &eacute;taient admissibles &agrave; l&rsquo;analyse. Les donn&eacute;es recueillies incluaient le diagnostic, les renseignements d&eacute;mographiques, les comorbidit&eacute;s et les m&eacute;dicaments au moment de l&rsquo;admission et du cong&eacute;. Un taux de prescription au cong&eacute; pour les quatre classes de m&eacute;dicaments a &eacute;t&eacute; calcul&eacute; pour tous les patients et pour les patients &laquo; id&eacute;aux &raquo; (ceux sans contre-indications document&eacute;es). Ces taux ont &eacute;t&eacute; compar&eacute;s aux r&eacute;f&eacute;rences optimales publi&eacute;es.R&eacute;sultats : Les dossiers m&eacute;dicaux d&rsquo;un total de 346 patients admissibles ont &eacute;t&eacute; analys&eacute;s. L&rsquo;&acirc;ge moyen des patients &eacute;tait de 65,3 ans (&eacute;cart-type de 13,4 ans) et 226 (65,3 %) des patients &eacute;taient des hommes. Le diagnostic cod&eacute; &eacute;tait un infarctus du myocarde avec &eacute;l&eacute;vation du segment ST (91 patients ou 26,3 %), un infarctus du myocarde sans &eacute;l&eacute;vation du segment ST (164 ou 47,4 %) et infarctus du myocarde non pr&eacute;cis&eacute; (91 ou 26,3 %). Pour les patients &laquo; id&eacute;aux &raquo;, les taux de prescription &eacute;taient de 99,0 % (308 des 311 patients) pour l&rsquo;AAS, de 96,3 % (310 des 322 patients) pour les &beta;-bloquants, de 90,4 % (264 des 292 patients) pour les inhibiteurs de l&rsquo;ECA et de 88,8 % (278 des 313 patients) pour les statines.Conclusions : Les taux de prescription d&rsquo;AAS, de &beta;-bloquants, d&rsquo;inhibiteurs de l&rsquo;ECA et de statines pour les patients &laquo; id&eacute;aux &raquo; ayant re&ccedil;u leur cong&eacute; apr&egrave;s le traitement de l&rsquo;infarctus du myocarde d&eacute;passaient les taux de r&eacute;f&eacute;rence canadiens publi&eacute;s (&ge; 90% pour l&rsquo;AAS, &ge; 85% pour les &szlig;-bloquants et les inhibiteurs de l&rsquo;ECA, &ge; 70% pour les statines)