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The purpose of this paper is to explore the perceptions of staff towards psychotropic Pro Re Nata (PRN) medication in a residential care setting.

Three male and seven female participants were interviewed using a semi-structured interview. Transcripts were analysed using thematic analysis.

Four themes pertaining to PRN medication emerged from the data: behaviour change, calming effect, importance of timing and perceived uniqueness.

The participant group was not homogenous and findings may have been different in a more qualified cohort. This care setting may not be representative of other environments where PRN medication is administered. The findings do, however, highlight some of the challenges facing the administration of PRN medication in mental health and care settings.

The awareness of these themes is significant for improving staff knowledge, training practices and policies towards the use and administration of psychotropic PRN medication.

This is the first study to engage in a thematic analysis of staff views towards the administration of PRN medication.

The purpose of this study is to identify patient experience unique to online pharmacy services (OPS) based on the characteristics of OPS (i.e. interactivity and virtuality) and to reveal how patient experience is derived from OPS and thereby enhances patient adherence from both online social support and patient experience perspectives.

The Stimulus-Organism-Response framework was used to conceptualize this study; both primary and secondary data for 296 validated participants were collected on a real OPS platform. A structural equation modeling approach combined with partial least squares was employed for the quantitative analysis.

Social presence and user engagement can be identified as patient experience in the OPS context; online emotional support has a stronger association with patients' social presence than it does with patients' user engagement; patients' social presence has a stronger association with their medication adherence than it does with diet adherence, while patients' user engagement has a stronger association with their diet adherence than it does with medication adherence; patients' medication knowledge negatively moderates the relationship between user engagement and diet adherence.

This study identifies patient experience in accordance with unique characteristics of OPS, and it reveals the nuanced underlying mechanisms by which online social support is associated with patient experience and by which patients' experience is associated with their adherence. This study enriches the literature on patient adherence, patient experience and OPS, providing insights for healthcare providers, OPS designers and policymakers.

The majority of adults with intellectual disabilities (ID) are prescribed at least one, if not multiple medications, with psychotropic medications being the most commonly prescribed. Direct care staff play an important role in psychotropic medication administration and monitoring, yet little is known about their knowledge and comfort with medication. The paper aims to discuss this issue.

A 15-item survey, focusing on self-reported knowledge and comfort with psychotropic medication, was completed by 152 direct care staff employed at three agencies providing residential services for individuals with ID across Ontario.

In total, 62 per cent of staff respondents reported that psychotropic medications were among the top medications regularly taken by the individuals they support, with behaviour listed as the most commonly reported reason for taking this medication. The majority of staff reported monitoring medication, however, the frequency of monitoring varied considerably. Generally, staff reported feeling comfortable and knowledgeable about medication use, but, most reported a desire for additional medication training.

This is the first Canadian study to examine staff knowledge and comfort regarding medication use, and the first study to assess PRN (“as needed”) as well as regularly administered medications.

Aim ‐ To describe prescription drug use in a nationwide prison population and compare it with contemporary drug use in other relevant populations as well as in a prison population 25 years ago. Method ‐ Detailed medication sheets from 37 prisons, covering 90% of the Norwegian prison population, were collected. All drugs were transcribed into the Anatomical Therapeutic Chemical classification system, and Defined Daily Doses/100 inmates were calculated. Data enabling relevant comparisons were gathered from reliable sources. Results ‐ Among the 2,617 inmates investigated, 48% used no medication. Sixteen percent used both psychotropic and somatic drugs, 17% psychotropic drugs only, and 19% somatic drugs only. Strong correlations between drug use and gender, age, and prison characteristics were demonstrated. Psychotropic drug use was higher than in the general population but lower than in a psychiatric hospital unit. Somatic drug use was lower than in the general population, except non‐steroid antiinflammatory agents, antihistamines, and drugs to alleviate obstructive airway diseases. Psychotropic drug use, particularly antidepressant use, was higher than in prisons 25 years ago. Conclusion ‐ High levels of use of all psychotropic and a number of somatic drugs were demonstrated in this nationwide prison population. Treatment studies are needed in order to ascertain whether the high levels of use of particularly psychotropic medications are indeed improving the mental health of prisoners.

The purpose of this paper is to identify psychotropic medication being prescribed for people with intellectual disability “as and when required” (PRN); the indications, frequency of use, rate of poly-pharmacy and contribution of PRN medication towards this. The paper also aimed to identify individual and environmental factors associated with PRN medication prescribing.

Data were collected from nursing and medical records for the 119 service users in the acute assessment and treatment unit and NHS residential care settings managed by specialist intellectual disability services covering Leicester, Leicestershire and Rutland over a month period. Data were analysed using descriptive statistics and logistic regression to calculate adjusted odds ratios for predictor variables.

In total, 72 per cent of the service users were prescribed and 25 per cent were administered PRN medication over the study period. The most common indications for PRN prescribing were aggression and agitation. Lorazepam and chlorpromazine were the most frequently prescribed PRN medications. The rate of poly-pharmacy was 41 and 38 per cent of this was attributable to PRN medication. Male gender and history of challenging behaviour were found to be significant factors associated with PRN medication prescribing.

PRN medications are commonly prescribed in people with intellectual disabilities and contribute to poly-pharmacy. Whilst PRN medication continues to remain an effective therapeutic option in situations where environmental and behavioural approaches are proving insufficient, their use should always be in conjunction with effective review mechanisms.

A batch size model developed for the therapeutic product problem has been instrumental in assisting the staff of a large general hospital to resolve problems associated with the transactional process of the preparation of intravenous medications for administration. The model is a variation of a basic profit maximisation model and is characterised by variable batch preparation cost, a variable planning period, fixed per unit base cost, and zero shortage costs since preparation of a new batch can take place without delay. The variable planning period is transformed into a fixed planning horizon which is at least several multiples of the planning period and is fixed. Development of the model is presented and illustrated with a hypothetical situation, followed by a real case — the determination of the optimal batch size for the intravenous drug, Cefazolin.

This paper assesses the patients' healthcare information needs and expectations when they attend a rheumatology outpatient clinic. It proposes that obtaining the patients' perspectives about the services they use is an essential service-development tool. The aim of this paper is to expand the current domains used to evaluate these perspectives.

This paper is an exploratory study, looking at quality assessment and improvement based on Donabedian's quality model in a rheumatology outpatient setting. A structured interview schedule addressing care pathways was used and 70 consecutive patients were recruited.

The article provides insights about how relevant change can be brought about when service development is contemplated. It suggests that patients are important stakeholders in the ongoing service development process.

Because rheumatological conditions tend to be chronic and require long-term follow-up, the results may lack generalisability. Therefore, researchers are encouraged to test propositions in different clinical settings.

The article highlights healthcare delivery areas that are not meeting patient expectations. Some recommendations (such as informing waiting patients regularly about any delays) require minimal additional resources for successful implementation. Service providers need to obtain the patients' healthcare perspectives to ensure that services are built around their needs.

This article fulfils an identified need to study how patients perceive service quality.

Within the context of health care reform and its evaluation, a major gap exists in relation to our understanding of the values which seniors hold regarding their health care. This paper reports on a modified participatory, ethnographic study of such values, using transcribed interviews with ten seniors from across Canada. Members of the National Advisory Council of Canada, most of whom are themselves seniors, participated in designing the study, carrying out the interviews and interpreting the results. Clusters of values were identified concerning health care services, service providers and the overall health care system. While the numbers involved in this study preclude generalizing to the population, a number of recommendations emerged from the study which could impact on future research and begin to influence health policy at local and national levels.

There is mixed evidence regarding the efficacy of low-intensity integrated care interventions in reducing the use of emergency services and costs of care. The purpose of this paper is to examine the effects of a low-intensity intervention formulated for older adults and delivered in an urban medical center serving low-income individuals.

The intervention included an initial evaluation of stress, psychiatric symptomatology and health habits; potential referrals for lifestyle management and psychiatric treatment; and training for physicians about the impact of lifestyle change in older adults. Participants included older adults (at or above 50 years of age) seen as outpatients in an urban medical center serving a low-income community (n=945). Participants were entered into the intervention at any point during this two-year period. Mixed models analyses examined all visits for all enrolled individuals over a two-year period, comparing visits before the individual received the initial intervention evaluation to those received after this evaluation. Outcomes included total health care costs incurred, average cost per visit, and emergency department (ED) usage within the facility.

The intervention was associated with reduced likelihood of emergency department use and reduced costs per visit following the intervention. These effects were seen across all participants.

Limitations of the study include the lack of control group.

This program is easy to disseminate and could improve the quality of care and costs.

This study is among the few available to document a decrease in medical costs, as well as decreased ED utilization following a low-intensity integrated care intervention.