Depression, Comorbidities, and Prescriptions of Antidepressants in a German Network of GPs and Specialists with Subspecialisation in Anthroposophic Medicine: A Longitudinal Observational Study

Background. Depression is a major reason for counselling in primary care. Our study aims at evaluating pharmacological treatment strategies among physicians specialised in anthroposophic medicine (AM). Methods. From 2004 to 2008, twenty-two German primary care AM-physicians participated in this prospective, multicentre observational study. Multiple logistic regression was used to determine factors associated with a prescription of any antidepressant medication. Results. A total of 2444 patients with depression were included (mean age: 49.1 years (SD: 15.4); 77.3% female). 2645 prescriptions of antidepressants for 833 patients were reported. Phytotherapeutic preparations from Hypericum perforatum were the most frequently prescribed antidepressants over all (44.6% of all antidepressants), followed by amitriptyline (16.1%). The likelihood of receiving an antidepressant medication did not depend on comorbidity after controlling for age, gender, physician specialisation, and type of depression (adjusted OR (AOR)=1.01; CI: 0.81–1.26). Patients who had cancer were significantly less likely to be prescribed an antidepressant medication than those who had no cancer (AOR=0.75; CI: 0.57–0.97). Conclusion. This study provides a comprehensive analysis of everyday practice for the treatment of depression in AM -physicians. Further analysis regarding the occurrence of critical combinations is of high interest to health services research

Educational intervention to improve physician reporting of adverse drug reactions (ADRs) in a primary care setting in complementary and alternative medicine

<p>Abstract</p> <p>Background</p> <p>Recent studies have shown that adverse drug reactions (ADRs) are underreported. This may be particularly true of ADRs associated with complementary and alternative medicine (CAM). Data on CAM-related ADRs, however, are sparse.</p> <p>Objective was to evaluate the impact of an educational intervention and monitoring programme designed to improve physician reporting of ADRs in a primary care setting.</p> <p>Methods</p> <p>A prospective multicentre study with 38 primary care practitioners specialized in CAM was conducted from January 2004 through June 2007. After 21 month all physicians received an educational intervention in terms of face-to-face training to assist them in classifying and reporting ADRs. The study centre monitored the quantity and quality of ADR reports and analysed the results.</p> <p>To measure changes in the ADR reporting rate, the median number of ADR reports and interquartile range (IQR) were calculated before and after the educational intervention. The pre-intervention and post-intervention quality of the reports was assessed in terms of changes in the completeness of data provided for obligatory items. Interrater reliability between the physicians and the study centre was calculated using Cohen's kappa with a 95% confidence interval (CI). We used Mann Whitney U-test for testing continuous data and chi-square test was used for categorical data. The level of statistical significance was set at <it>P </it>< 0.05.</p> <p>Results</p> <p>A total of 404 ADRs were reported during the complete study period. An initial 148% increase (<it>P </it>= 0.001) in the number of ADR reports was observed after the educational intervention. Compared to baseline the postinterventional number of ADR reportings was statistically significant higher (P < 0.005) through the first 16 months after the intervention but not significant in the last 4-month period (median: 8.00 (IQR [2.75; 8.75]; P = 0.605). The completeness of the ADR reports increased from 80.3% before to 90.7% after the intervention. The completeness of the item for classifying ADRs as serious or non-serious increased significantly (<it>P </it>< 0.001) after the educational intervention. The quality of ADR reports increased from kappa 0.15 (95% CI: 0.08; 0.29) before to 0.43 (95% CI: 0.23; 0.63) after the intervention.</p> <p>Conclusion</p> <p>The results of the present study demonstrate that an educational intervention can increase physician awareness of ADRs. Participating physicians were able to incorporate the knowledge they had gained from face-to-face training into their daily clinical practice. However, the effects of the intervention were temporary.</p

Prescribing patterns in dementia: a multicentre observational study in a German network of CAM physicians

<p>Abstract</p> <p>Background</p> <p>Dementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM) by analysing prescribing patterns and comparing them to current treatment guidelines in Germany.</p> <p>Methods</p> <p>Twenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including <it>Ginkgo biloba</it>.</p> <p>Results</p> <p>During the 5-year study period (2004-2008), 577 patients with dementia were included (median age: 81 years (IQR: 74-87); 69% female). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical <it>Ginkgo biloba </it>was the most frequently prescribed anti-dementia drug overall (67.6% of all) followed by cholinesterase inhibitors (17.6%). The adjusted odds ratio (AOR) for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88), co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90), and heart failure (AOR = 4.85; CI: 3.42-6.88). The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). The prescription of <it>Ginkgo biloba </it>was associated with sex (female: AOR = 0.41; CI: 0.19-0.89), patient age (AOR = 1.06; CI: 1.02-1.10), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16).</p> <p>Conclusions</p> <p>This study provides a comprehensive analysis of everyday practice for treatment of dementia in primary care in physicians with a focus on CAM. The prescribing frequency for anti-dementia drugs is equivalent to those found in other German studies, while the administration of <it>Ginkgo biloba </it>is significantly higher.</p

Health related quality of life of residents in nursing homes

Einleitung Unsere Gesellschaft hat eine ethische Verpflichtung gegenüber den alten Menschen, ihnen einen angenehmen Lebensabend zu ermöglichen. Insbesondere gilt dies für pflegeabhängige Menschen, wie es bei einem großen Teil der Pflegeheimbewohner der Fall ist. Die Pflegenden sollen den Bewohnern trotz Pflegeabhängigkeit ein möglichst selbstständiges und selbstbestimmtes Leben ermöglichen und damit deren Lebensqualität erhalten. Da Pflegeeinrichtungen aufgefordert sind, Lebensqualitätsdaten zu veröffentlichen, sollten hierfür geeignete Instrumente genutzt werden. Ziel der Dissertation war es, ein Instrument für die Messung der gesundheitsbezogenen Lebensqualität (HRQOL) in Pflegeheimen zu testen sowie die HRQOL bei Eintritt in ein Pflegeheim und im Verlauf zu evaluieren. Des Weiteren wurde der Zusammenhang zwischen HRQOL und Pflegeabhängigkeit untersucht. Methodik Eine prospektive Längsschnittstudie wurde in 11 zufällig ausgewählten Pflegeheimen in Berlin und Brandenburg von 2008 bis 2010 durchgeführt. Die HRQOL wurde aus Sicht der Bewohner mittels des Nottingham Health Profile (NHP) in sechs Dimensionen mit 38 Items gemessen und die Pflegeabhängigkeit aus der Perspektive der Pflegenden mittels Pflegeabhängigkeitsskala ermittelt. Die Erhebung des kognitiven Status erfolgte mittels des Mini-Mental-Status-Tests (MMSE). Bei einer voraussichtlichen Aufenthaltsdauer von mindestens vier Wochen wurde die informierte Zustimmung von den Bewohnern respektive ihren gesetzlichen Vertretern eingeholt. Messzeitpunkte für die HRQOL waren die 2., 4. und 12. Woche nach Pflegeheimeintritt. Ergebnisse Von insgesamt 553 neu eingezogenen Pflegeheimbewohnern konnten 286 Bewohner in die Studie zur Testung des NHP eingeschlossen werden. Das Durchschnittsalter betrug 84 Jahre, 69 % der Bewohner waren weiblich. Der NHP konnte bei Bewohnern mit normalem kognitivem Status und mit moderater kognitiver Einschränkung (MMSE > 16 Punkte) angewendet werden. Insgesamt konnte der NHP bei 44 % der Bewohner ausgewertet werden. Die stärksten Einschränkungen der HRQOL waren in den Dimensionen Physische Mobilität (MW ± SD: 53,5 ± 24,0) und Energieverlust (43,7 ± 37,1) zu sehen, in den anderen Dimensionen waren die Werte kleiner 25 (Wert 100 = schlechteste HRQOL). Während des Heimaufenthaltes verbesserte sich die Physische Mobilität signifikant (p = 0,002). Die Emotionale Reaktion verschlechterte sich signifikant (p = 0,047). Die Pflegeabhängigkeit verringerte sich während des Heimaufenthaltes. Es zeigte sich keine signifikante Korrelation zwischen Pflegeabhängigkeit und HRQOL. Schlussfolgerung Der NHP kann bei Bewohnern mit normalem kognitivem Status und moderater kognitiver Einschränkung angewendet werden. Um das Ziel der Pflege, die Erhaltung und Förderung der bestmöglichen HRQOL, zu erreichen, ist die Erhebung der HRQOL aus Sicht der Bewohner notwendig. Hierdurch bieten sich eine zusätzliche Perspektive und ein Informationsgewinn besonders im emotionalen Bereich. Einschränkungen und Probleme der Bewohner, die bei der täglichen Versorgung keine Berücksichtigung finden (können), können durch die Erfassung der HRQOL zu zielgerichteten Interventionen führen.Introduction Our society has the ethic obligation towards elder people to enable them to spend their remaining years in comfort. This particularly applies to care dependent people, as is the case with most of the nursing home residents. Nursing staff should ensure that residents lead an independent and self-determined life where possible, despite their care dependency, and thus maintain their quality of life. As nursing institutions are required to publish quality of life data they should use the relevant instruments. This dissertation aims at testing an instrument for measuring health-related quality of life (HRQOL) in nursing homes and at evaluating HRQOL upon admission to a nursing home and later. Furthermore, the relation between HRQOL and care dependency were examined. Methods A prospective longitudinal study was conducted in 11 randomly selected nursing homes in Berlin and Brandenburg from 2008 to 2010. The HRQOL from the nursing home residents’ perspective was measured using the Nottingham Health Profile (NHP) in six dimensions with 38 items; care dependency from the nursing staff’s perspective was measured using the care dependency scale. The cognitive status was examined by means of the Mini-Mental-Status-Examination (MMSE). Informed consent was obtained from the residents or their legal representatives for a probable duration of at least four weeks. The times for measuring HRQOL were set for the second, fourth and twelfth week upon admission to the nursing home. Results 286 residents out of a total of 553 newly admitted nursing home residents were included in the NHP test study. The average age was 84 years, 69% of the residents were female. The NHP was used for residents of normal cognitive status and with moderate cognitive restrictions (MMSE >16 points). The NHP was evaluated for 44% of the residents. The strongest limitations to the HRQOL were found in the dimensions of physical mobility (MW±SD: 53.4±24.0) and loss of energy (43.7±37.1), the other dimensions showed values smaller than 25 (value 100 = worst HRQOL). Physical mobility improved significantly during home stays (p=0.002). Emotional reaction deteriorated significantly (p=0.047). Care dependency decreased during the nursing home stay. There was no significant correlation between care dependency and HRQOL. Conclusions The NHP can be applied to residents of normal cognitive status and with moderate cognitive restrictions. For achieving the aim of nursing care, i.e. maintaining and developing a best possible HRQOL, it is vital to examine the HRQOL from the nursing home residents’ perspective. This offers additional perceptions and increasing information, especially in the emotional areas. Restrictions or problems of residents not considered during daily care may be recorded and lead to target- oriented interventions