8 research outputs found
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 gegenĂĽber 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 fĂĽr 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
durchgefĂĽhrt. 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 fĂĽr 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 fĂĽhren.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