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Article
Publication date: 28 December 2018

Dave Robinson

The purpose of this paper is to provide a commentary on the article by Lee and colleagues, entitled “Positive Behavioural Support as an alternative to medication”, from…

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Abstract

Purpose

The purpose of this paper is to provide a commentary on the article by Lee and colleagues, entitled “Positive Behavioural Support as an alternative to medication”, from the perspective of Dimensions, a national provider of social care support to people with learning disabilities and/or autism. As a supporter of the NHS England STOMP campaign, Dimensions recognises that people with learning disabilities and/or autism who have displayed “challenging behaviours” are at risk of being wrongly or over prescribed psychotropic medications intended to control that behaviour, and encourages the use of non-medical support strategies as an effective alternative to psychotropic medications.

Design/methodology/approach

Dimensions surveyed the approximately 1,400 people with learning disabilities and/or autism for whom they provide 24-h support. The survey was intended to assess the extent of use of psychotropic medications and the level of adherence to NICE “best practice” guidelines. The survey was the precursor to an awareness raising campaign and development of an operational toolkit intended to inform and empower people supported, families and colleagues to take a more proactive role in the prescription and review of psychotropic medications.

Findings

In total, 54 per cent of people surveyed were being prescribed psychotropic medication, of whom 97 per cent had been prescribed one or more medications for at least six months. Around 51 per cent were having six monthly multi-disciplinary reviews and around 31 per cent had not had a multi-disciplinary review within the preceding 12 months. Only 13 per cent of people taking psychotropic medication had a plan in place that was specifically aimed at reducing or stopping the medication.

Originality/value

Empowering people to participate in and challenge clinical decision making can have a transformative effect on the lives of a group of people who have experienced a significant negative impact from prolonged use of psychotropic medications.

Details

Tizard Learning Disability Review, vol. 24 no. 1
Type: Research Article
ISSN: 1359-5474

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Article
Publication date: 6 May 2014

Olwen Murphy, Graham King, Ian Callanan and Marcus W. Butler

– The purpose of this paper is to examine the recording of clinical indication for prescribed sedative/hypnotic (SH) medications in a large, acute tertiary referral hospital.

Abstract

Purpose

The purpose of this paper is to examine the recording of clinical indication for prescribed sedative/hypnotic (SH) medications in a large, acute tertiary referral hospital.

Design/methodology/approach

All hospital inpatients’ medications (n=367) were audited for prescription details regarding SH medications. Medical notes were then examined for evidence of a recorded indication for such medications.

Findings

SH medications were prescribed to many hospital inpatients (42.5 per cent) during admission. An indication was documented in the nursing or medical records for 24.4 per cent of patients who were prescribed such medications. Nurses rather than by doctors prescribed most SH medications (74 vs 26 per cent, respectively, p=0.003). Some patients receiving SH medications were both over 65 and impaired in their mobility (19.2 per cent). The treatment indication was documented in 47 per cent.

Practical implications

Most patients prescribed SH medications have nothing in their medical record explaining why these drugs are being used, including half of the elderly, less mobile patients. All health professionals dealing with SH medications and doctors in particular need to justify the use of such medications in the medical record. For the particularly high-risk groups where SH medications are potentially more dangerous, explicit guidance on why and how such medications are to be used must be provided by prescribers.

Originality/value

For the first time, data are presented on documentation rates for clinical indication of prescribed SH medications across a large acute hospital, and highlights significant shortcomings in practice. This study should inform other organisations of the need to be mindful of facilitating greater compliance with good prescribing practice.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 4 January 2013

Sia Beng Yi, Janice Chan Pei Shan and Goh Lay Hong

Medication reconciliation is integral to every hospital. Approximately 60 percent of all hospital medication errors occur at admission, intra‐hospital transfer or…

Abstract

Purpose

Medication reconciliation is integral to every hospital. Approximately 60 percent of all hospital medication errors occur at admission, intra‐hospital transfer or discharge. Effectively and consistently performing medication reconciliation at care‐interfaces continues to be a challenge. Tan Tock Seng Hospital (TTSH) averages 4,700 admissions monthly. Many patients are elderly (>65 years old) at risk from poly‐pharmacy. As part of a medication safety initiative, pharmacy staff started a medication reconciliation service in 2007, which expanded to include all patients in October 2009. This article aims to describe the TTSH medication reconciliation system and to highlight common medication errors occurring following incomplete medication reconciliation.

Design/methodology/approach

Where possible, patients admitted into TTSH are seen by pharmacy staff within 24 hours of admission. A form was created to document their medications, which is filed into the case sheets for referencing purposes. Any discrepancies in medicines are brought to doctors' attention. Patients are also counseled about changes to their medications. Errors picked up were captured in an Excel database.

Findings

The most common medication error was prescribers missing out medications. The second commonest was recording different doses and regimens. The reason was mainly due to doctors transcribing medications inaccurately.

Research limitations/implications

This is a descriptive study and no statistical tests were carried out. Data entry was done by different pharmacy staff, and not a dedicated person; hence, data might be under‐reported.

Practical implications

The findings demonstrate the importance of medication reconciliation on admission. Accurate medication reconciliation can help to reduce transcription errors and improve service quality.

Originality/value

The article highlights medication reconciliation's importance and has implications for healthcare professionals in all countries.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 8 August 2016

Sue Holttum

– The purpose of this paper is to consider four recent articles relating to how included service users are in decision making about their medication in mental health services.

Abstract

Purpose

The purpose of this paper is to consider four recent articles relating to how included service users are in decision making about their medication in mental health services.

Design/methodology/approach

One article describes conversations between a psychiatrist and service users about medication. The second paper describes a study in which young people were supported with the aim of developing their confidence to challenge medication decisions. The third paper reports on interviews with both professionals and service users about medication decisions. The fourth paper presents a theory of how the wider context can affect medication decision making in mental health.

Findings

The first paper shows how a psychiatrist can persuade service users to accept medication decisions. The second paper shows how some young people can challenge medication decisions if they have the right support. The third paper illustrates how both professionals and service users may doubt service users’ ability to decide about medication, and pessimistically suggests that shared decision making may be unrealistic. In contrast to this, the fourth paper offers hope of changing how mental health services are organised in order to enable service users to be more empowered about medication decisions.

Originality/value

A model of shared decision making is being imported into mental health from physical health. These four papers illustrate problems with a simple transfer from physical to mental health. The present paper points to differences in apparent awareness of different clinical researchers of the need to tackle service users’ disempowerment in mental health care, showing how some researchers are tackling this.

Details

Mental Health and Social Inclusion, vol. 20 no. 3
Type: Research Article
ISSN: 2042-8308

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Article
Publication date: 13 July 2012

Uri Gabbay, Noga Yosef, Neta Feder‐Krengel and Joseph Meyerovitch

The developing generic market has huge advantages of availability and affordability of therapy. The question of whether a therapeutic equivalent substitute under an…

Abstract

Purpose

The developing generic market has huge advantages of availability and affordability of therapy. The question of whether a therapeutic equivalent substitute under an unfamiliar name may cause confusion that leads to medical errors has not been sufficiently studied. This paper seeks to answer this question.

Design/methodology/approach

The study was triggered following sporadic reports according to which patients mistakenly consider therapeutic equivalents as unrelated medications rather than substitutes. Family physicians and pharmacists in one of eight districts of Clalit, Israel's largest healthcare provider were surveyed. The survey's questions recall episodes of medication uncertainty, confusion, misidentification, and medication mistakes associated with switching from one therapeutic equivalent to another. A total of 66 physicians and 63 pharmacists responded to the surveys (61 percent and 45 percent, respectively).

Findings

The results recall uncertainty, confusion, misidentification, and mainly cases of medication mistakes in which patients consumed both therapeutic equivalents simultaneously as was reported by 81 percent of physicians and 70 percent of pharmacists.

Research limitations/implications

There are two limitations in this work, the first is the study type, which is recall survey; the second is the response rate which is not unusual among health care professionals. However, the high face‐validity and the consistency of the findings in both physicians and pharmacists surveyed indicates high validity of the study conclusions.

Practical implications

A practical implication is unique medication error of consuming both therapeutic equivalents simultaneously. The authors wish to raise awareness of the potential of such error, which may be difficult to disclose as each of the therapeutic equivalents is apparently the intended medication but consuming them simultaneously results practically in doubling the intended dose. Given the forecast for generic market growth, awareness is not enough and worldwide regulatory cooperation should be made otherwise these types of medication errors will inevitably emerge.

Originality/value

The study is original as a literature search revealed no studies evaluating potential medication mistakes attributed to a switch between therapeutic equivalents.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 6
Type: Research Article
ISSN: 0952-6862

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Book part
Publication date: 25 March 2010

Yuriy Pylypchuk

Purpose – To examine the effects of health insurance types on the use of prescribed medication that treat patients with hypertension, diabetes, and asthma. The study…

Abstract

Purpose – To examine the effects of health insurance types on the use of prescribed medication that treat patients with hypertension, diabetes, and asthma. The study distinguishes between individuals with private health maintenance organization (HMO) plans and private non-HMO plans. The study also distinguishes between people with health insurance and drug coverage and people with health insurance and no drug coverage.

Methods – Joint discrete factor models are estimated to control for endogeneity of each type of coverage.

Findings – The main findings suggest that the effect of health insurance varies across patients with different conditions. The strongest and most significant effect is evident among patients with hypertension while the weakest and least significant is among patients with asthma. These findings suggest that patients with asymptomatic conditions are more likely to exhibit moral hazard than patients with conditions that impose immediate impairment. Additional results suggest that, relative to the uninsured and people with health insurance but no drug coverage, patients with drug coverage are more likely to initiate drug therapy and to consume more medications.

Originality – The results of the study indicate that moral hazard of drug utilization is condition specific. The variation in “silence” of conditions’ symptoms could be a key reason for difference in insurance effects among patients with hypertension, diabetes, and asthma.

Details

Pharmaceutical Markets and Insurance Worldwide
Type: Book
ISBN: 978-1-84950-716-5

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Article
Publication date: 30 June 2021

Hongze Yang, Zeyu Peng, Xitong Guo and Kee-Hung Lai

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Internet Research, vol. 31 no. 6
Type: Research Article
ISSN: 1066-2243

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Article
Publication date: 14 August 2021

Edward da Costa, Danielle Adams, Munzer Salmeh, Omar Mahmoud and Ekim Yetkili

The over-reliance on psychotropic medication for the management of patients with learning disabilities with behaviour that challenges is well documented.This paper aims to…

Abstract

Purpose

The over-reliance on psychotropic medication for the management of patients with learning disabilities with behaviour that challenges is well documented.This paper aims to discuss the application of the methodology of clinical audit within community learning disability mental health services to adapt interventions including optimising prescribing practice and behavioural interventions aiming to reduce behaviour that challenges in people with learning disabilities.

Design/methodology/approach

Questionnaire-based review of documentation in electronic patient records, covering relevant audit standards in line with NICE and Royal College of Psychiatrists, was carried out in the North Essex Community Learning Disability Service, Hertfordshire Partnership NHS Foundation Trust. The audit included patients on the caseload of consultant psychiatrists.

Findings

The audit demonstrated that the prescribing of psychotropic medication was within BNF maximum limits for all patients, evidence of “consent” procedures was being followed in the majority, and there was some evidence of deprescribing attempts.Improvement was required in several areas e.g. undocumented off label prescribing in a significant proportion of patients. Objective measures to record the severity of behaviours and the effects of the medication were being used by clinicians in only a small proportion of patients. A significant proportion of patients have prescribed medication in the absence of appropriate psychological or environmental interventions.

Originality/value

As a result of the audit findings, the action plan made recommendations such as the development of a database for tracking the prescribing of psychotropic medicines and routine use of standardised measures. This action has been supported by the pharmacy team. Positive developments include a clinical psychologist taking on the role of leading the development of behavioural intervention strategies.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 15 no. 4
Type: Research Article
ISSN: 2044-1282

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Book part
Publication date: 17 October 2005

Jennifer Davis-Berman and Frances G. Pestello

This article presents a typology of the medicated self, as developed through in-depth interviews with twenty-two social work students and practitioners. Utilizing an…

Abstract

This article presents a typology of the medicated self, as developed through in-depth interviews with twenty-two social work students and practitioners. Utilizing an interactionist perspective, the experience of taking psychiatric medication is examined in both samples, using a comparative analysis. Emphasis is placed on the impact of taking psychiatric medication on the sense of self. The data suggest that the development of a medicated self is complex and varied, and includes a small number of those who feel that medication led to an improved self, and the majority who felt damaged by their experience with medication, and expressed varying degrees of ambivalence about its use. Despite this ambivalence, most of our respondents seemed to develop an altruistic, empathetic self geared toward helping others. This self emerged in spite of respondents saying that their self was damaged. Implications are presented, and conclusions and suggestions for further work on the impact of psychiatric medication use on the self are presented.

Details

Studies in Symbolic Interaction
Type: Book
ISBN: 978-0-7623-1186-6

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Book part
Publication date: 20 August 2012

Frank R. Lichtenberg

Purpose – To examine the effect of pharmaceutical innovation on the functional status of nursing home residents.Methodology/approach – Estimation of econometric models of…

Abstract

Purpose – To examine the effect of pharmaceutical innovation on the functional status of nursing home residents.

Methodology/approach – Estimation of econometric models of the ability of nursing home residents to perform activities of daily living (ADLs) using cross-sectional, patient-level data from the 2004 National Nursing Home Survey. The explanatory variables of primary interest are the characteristics (e.g., the mean vintage (FDA approval year)) of the medications used by the resident. We control for age, sex, race, marital status, veteran status, where the resident lived prior to admission, primary diagnosis at the time of admission, up to 16 diagnoses at the time of the interview, sources of payment, and facility fixed effects.

Findings – The ability of nursing home residents to perform ADLs is positively related to the number of “new” (post-1990) medications they consume, but unrelated to the number of old medications they consume. I estimate that if 2004 nursing home residents had used only old medications, the fraction of residents with all five ADL dependencies (number of activities for which the resident is not independent) would have been 58% instead of 50%.

Social implications – During 1990–2004, pharmaceutical innovation reduced the functional limitations of nursing home residents by between 1.2% and 2.1% per year.

Originality/value of chapter – The first public-use survey of nursing homes that contains detailed information about medication use, and better data on functional status than previous surveys, is used to help explain why there has been a significant decline in the functional limitations of older people.

Details

The Economics of Medical Technology
Type: Book
ISBN: 978-1-78190-129-8

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