RESUMEN
BACKGROUND: The potential for unsafe acts to result in harm to patients is constant risks to be managed in any health care delivery system including pharmacies. The number of reported errors is influenced by a various elements including safety culture. The aim of this study is to investigate a possible relationship between reported dispensing errors and safety culture, taking into account demographic and pharmacy variables, in Swedish community pharmacies. METHODS: A cross-sectional study was performed, encompassing 546 (62.8%) of the 870 Swedish community pharmacies. All staff in the pharmacies on December 1st, 2007 were included in the study. To assess safety culture domains in the pharmacies, the Safety Attitudes Questionnaire (SAQ) was used. Numbers of dispensed prescription items as well as dispensing errors for each pharmacy across the first half year of 2008 were summarised. Intercorrelations among a number of variables including SAQ survey domains, general properties of the pharmacy, demographic characteristics, and dispensing errors were calculated. A negative binomial regression model was used to further examine the relationship between the variables and dispensing errors. RESULTS: The first analysis demonstrated a number of significant correlations between reported dispensing errors and the variables examined. Negative correlations were found with SAQ domains Teamwork Climate, Safety Climate, Job Satisfaction as well as mean age and response rates. Positive relationships were demonstrated with Stress Recognition (SAQ), number of employees, educational diversity, birth country diversity, education country diversity and number of dispensed prescription items. Variables displaying a significant relationship to errors in this analysis were included in the regression analysis. When controlling for demographic variables, only Stress Recognition, mean age, educational diversity and number of dispensed prescription items and employees, were still associated with dispensing errors. CONCLUSION: This study replicated previous work linking safety to errors, but went one step further and controlled for a variety of variables. Controlling rendered the relationship between Safety Climate and dispensing insignificant, while the relationship to Stress Recognition remained significant. Variables such as age and education country diversity were found also to correlate with reporting behaviour. Further studies on the demographic variables might generate interesting results.
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Errores de Medicación/estadística & datos numéricos , Farmacias/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Cultura Organizacional , Farmacias/organización & administración , Encuestas y Cuestionarios , SueciaRESUMEN
BACKGROUND: The aim was to compare two individualized patient reported outcomes or the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) measuring quality of life in general, and the disease-related version (SEIQoL-DR) measuring quality of life related to disease. Both instruments have been used in clinical practice settings within oncology. The instruments were compared with regard to feasibility, the areas nominated by patients as important and patients' ratings of how they were doing in these areas (Index scores). MATERIAL AND METHODS: The study included 40 patients with gastrointestinal cancer. All patients completed both versions of the instrument on a touch screen computer in relation to a medical consultation. Firstly, the participants were invited to nominate the five domains she/he currently considered to be most important in life. Secondly, they were asked to rate how they were doing in each of these domains. Finally, they were asked to quantify the relative importance of each area. Cohen's effect sizes were calculated to illuminate the clinical importance of mean value differences. RESULTS: Both instruments took less than ten minutes to complete and the procedure was considered feasible by both patients and interviewers. The proportion of patients nominating the same areas in the two versions did not differ, however, the SEIQoL-DW Index score was significantly higher than the corresponding score for the SEIQoL-DR. The detected difference in the mean score measured by effect size was medium. CONCLUSION: The magnitude of the effect size of the difference in Index score imply that the two versions tap into different constructs, i.e. quality of life (QoL) versus health-related QoL (HRQL), supporting the construct validity of the two versions of the instrument. The SEIQoL-DW and the SEIQoL-DR should be considered as complementary rather than interchangeable when used in patients with cancer.
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Neoplasias/terapia , Calidad de Vida , Encuestas y Cuestionarios , Adulto , Anciano , Progresión de la Enfermedad , Estudios de Factibilidad , Femenino , Humanos , Individualidad , Masculino , Persona de Mediana Edad , Neoplasias/patología , Neoplasias/psicología , Cuidado Terminal/métodos , Cuidado Terminal/normas , Factores de TiempoRESUMEN
OBJECTIVE: The aim was to assess the feasibility and reliability of Velikova's Content Analysis System (VCAS) and the Medical Interaction Process System (MIPS) global scale for evaluation of communication in oncology care. METHODS: Seventy routine physician consultations with gastro-intestinal (GI) cancer patients were audio-recorded. Two coders applied VCAS and MIPS global scale to the consultations. VCAS captures aspects of communication like symptoms, side effects, functional issues (e.g. emotional, social, physical), health-related quality of life and medical decision making. MIPS global scale measures the total impression of the consultation, e.g. patient centredness and psychosocial focus. RESULTS: In total, 61 of 70 consultations were coded. The coding took twice the consultations' actual durations in minutes for VCAS. The time for coding MIPS global scale equalled the consultations length. However, the coder had then listened to the consultation twice before, coding for VCAS. Cohen's kappa for all aspects measured by VCAS varied between 0.20 and 1, mean 0.80. One category (Info on test) had a kappa of 0.20, the other categories were all above 0.60. Weighted Kappa for MIPS global scale varied between 0.25 and 0.73, mean 0.42. CONCLUSIONS: VCAS and MIPS global scale is a feasible combination of tools for evaluating patient-physician communication regarding content, medical decision making and global aspects of communication. VCAS showed high reliability. The MIPS global scale showed lower reliability, due to its sensitivity to the individual coders' unique values, common for all global scales. Further development of the combination of content and global instruments would be valuable.
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Comunicación , Recolección de Datos/métodos , Oncología Médica/estadística & datos numéricos , Neoplasias/psicología , Relaciones Médico-Paciente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría/instrumentación , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To identify what pharmacy students learn during the 6-month advanced pharmacy practice experience (APPE) in Sweden. METHODS: Semi-structured interviews were conducted with 18 pharmacy APPE students and 17 pharmacist preceptors and analyzed in a qualitative directed content analysis using a defined workplace learning typology for categories. RESULTS: The Swedish APPE provides students with task performance skills for work at pharmacies and social and professional knowledge, such as teamwork, how to learn while in a work setting, self-evaluation, understanding of the pharmacist role, and decision making and problem solving skills. Many of these skills and knowledge are not accounted for in the curricula in Sweden. Using a workplace learning typology to identify learning outcomes, as in this study, could be useful for curricula development. CONCLUSIONS: Exploring the learning that takes place during the APPE in a pharmacy revealed a broad range of skills and knowledge that students acquire.
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Educación en Farmacia/métodos , Aprendizaje , Percepción , Preceptoría , Estudiantes de Farmacia/psicología , Actitud del Personal de Salud , Concienciación , Comprensión , Conducta Cooperativa , Curriculum , Toma de Decisiones , Conocimientos, Actitudes y Práctica en Salud , Humanos , Relaciones Interpersonales , Entrevistas como Asunto , Solución de Problemas , Competencia Profesional , Facultades de Farmacia , Suecia , Lugar de TrabajoRESUMEN
BACKGROUND: Qualitative research has shown that gaining control of medicine treatment and increased feelings of safety and empowerment are central concepts in patients' perceptions of a pharmaceutical care (PC) service provided in Sweden. However, little is known about any unique differences among patients receiving PC versus standard pharmacy services (SSs) and the impact of these services on patient-perceived outcomes. OBJECTIVE: To describe and compare patients who had previously received a PC service and patients who had received a SS with regard to their perceptions of medicine use and the pharmacy encounter. METHODS: Cross-sectional survey design comparing matched groups of patients who were previously elected to receive a PC service or who had received SS. Patients who were 60 years or older and used 5 or more prescription medicines concomitantly were included in the survey. Questionnaires included questions about perceptions of safety in drug therapy, general health, drug-related problems (DRPs), medication beliefs, adherence, and experiences of pharmacy encounters. RESULTS: Patients receiving the PC service used more prescription medicines, reported poorer self-reported health, and less perceived safety in their medicine therapy than did patients in SS. PC patients reported that they felt safer with medications, felt a genuine interest from the pharmacist, received important information, and felt more prepared to see the doctor after having spoken to the pharmacist than did patients in SS. DRPs reported to a greater extent by patients receiving the PC service included difficulties opening containers, worries about side effects, experiences of side effects, worries about drug-drug interactions, and inadequate treatment effects. Adherence and medication beliefs showed no statistical difference between groups. CONCLUSION: Patients receiving a PC service are a worried, vulnerable, and information-seeking group. When compared with patients receiving SS, the PC patients are more insecure about their medicine therapy, although talking to a pharmacist increased their self-reported feelings of safety and provided better preparation for visits to the doctor.
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Actitud Frente a la Salud , Servicios Comunitarios de Farmacia/organización & administración , Farmacéuticos/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Miedo , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Medicamentos bajo Prescripción/administración & dosificación , Medicamentos bajo Prescripción/efectos adversos , Rol Profesional , Encuestas y Cuestionarios , SueciaRESUMEN
PURPOSE: The aim of this study was to investigate the prevalence and concomitant use of prescription medicines and self-medication, including over-the-counter (OTC) medicines, vitamins, and complementary and alternative medicines (CAMs) among Finnish children aged under 12 years. METHODS: We carried out a nationwide postal survey of the use of medicines by a representative sample (n = 6000) of Finnish children aged under 12 years in spring 2007. A response rate of 67% (n = 4032) was achieved. The current use of prescription medicines and the use of OTC medicines, vitamins, and CAMs in the preceding 2 days were the main outcome measures. RESULTS: In total, 17% of children had used prescription medicines and 50% some self-medication. The corresponding figures for OTC medicines, vitamins, and CAMs use were 17, 37, and 11%, respectively. Drugs for obstructive airway diseases were the most common prescription medicines, whereas analgesics and antipyretics, including non-steroidal-anti-inflammatory-medicines (NSAID), were the most common OTC medicines reported. Vitamin D was the most common vitamin, while fish oils and fatty acids were the most common CAMs used. Ten percent of the children had used prescription medicines and self-medication concomitantly. CONCLUSIONS: Most of the children's medication consists of self-medication, and especially of vitamin use. However, also a considerable proportion had used prescription medicines, and a minority prescription medicines and self-medication concomitantly. In three of the cases, a combination of prescription and OTC medicine with a potential risk for interactions were found. Physicians should be aware of this wide use of self-medication when prescribing medicines.
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Revisión de la Utilización de Medicamentos , Encuestas y Cuestionarios , Niño , Preescolar , Interacciones Farmacológicas , Prescripciones de Medicamentos , Femenino , Finlandia , Humanos , Lactante , Recién Nacido , Masculino , Medicamentos sin Prescripción , AutomedicaciónRESUMEN
OBJECTIVE: The aim of this study was to identify how persons' with rheumatoid arthritis (RA) understand the concepts of health and quality of life (QoL). METHODS: A phenomenograpic approach was used to gauge variations in understanding of health and QoL. Semistructured interviews were conducted with 22 persons having RA. The interviews were audiotaped, transcribed verbatim, and analyzed, resulting in a descriptive system consisting of categories and subcategories. RESULTS: Health was primarily associated with being healthy/being free from disease, being able to function normally, experiencing well-being, and having a healthy lifestyle. Two above-mentioned domains, "being healthy" and "being able to function normally" overlapped with respondents' understanding of QoL. Additional perceived domains included attitudes towards life and, social and physical environments. CONCLUSION: The results show that patients' understanding of the two concepts of health and QoL partially overlap and partially differ. PRACTICE IMPLICATIONS: Patients' understanding of the concepts is individual and diverse, which needs to be taken into account in patient-physician consultations to ensure good communication. Furthermore, the interpretation of results based on patient-reported outcomes instruments measuring health status and/or QoL needs to be further studied over time to identify possible changes in these conceptions.
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Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Actividad Motora , Calidad de Vida , Percepción Social , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Educación en Salud , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Investigación Cualitativa , Suecia , Grabación en CintaRESUMEN
OBJECTIVE: To identify individual and social factors associated with pharmacy students' level of reflection in an advanced pharmacy practice experience (APPE). METHODS: A postal questionnaire, including a reflective assignment, was sent to all pharmacy interns (n=262) at Uppsala University, Sweden, for 4 semesters in 2005-2007. RESULTS: In a univariate analysis, 7 factors were found to be associated with students' level of reflection. After controlling for covariates, 3 social factors were found to be independently associated with reflection: having a formal preceptor (OR=5.3), being at a small pharmacy (OR=19.8), and students' perception of the importance of discussing critical thinking with the preceptor (OR=1.2). No correlation could be observed between level of reflection and critical thinking, nor learning style. CONCLUSION: Social components seem to be of higher importance than individual components in students' reflective levels after pharmacy internship experience. Trained preceptors are important to foster reflection skills.
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Educación en Farmacia , Internado no Médico , Autoevaluación (Psicología) , Estudiantes de Farmacia , Pensamiento , Adulto , Educación Basada en Competencias , Evaluación Educacional , Femenino , Humanos , Masculino , Modelos Educacionales , Preceptoría , Competencia Profesional , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , SueciaRESUMEN
RATIONALE, AIM AND OBJECTIVE: As the prescribing of drugs in secondary care is known to influence prescribing in primary care and because an understanding of prescribers' reasoning is essential for evaluating prescribing appropriateness, the aim of this study was to investigate secondary care doctors' views of appropriate prescribing, using qualitative individual interviews. METHOD: Qualitative, semi-structured individual interviews were conducted with 15 hospital doctors working in different medical specialities. The interviews, covering the doctors' views of the meaning of 'appropriate' prescribing, were audiotaped and analysed from an interpretivist perspective. RESULTS: Three different main themes were identified in the analysis of how the doctors perceived appropriate prescribing: 'individualization of treatment', 'cost' and 'time'. Most importantly, treatment should be adjusted to the individual patient, although cost should also be justified. Ongoing medication reviews should be carried out, to adjust to changes in patient-related factors over time. CONCLUSIONS: The hospital doctors brought up continuous review as a necessary part of appropriate prescribing. Thus, from the prescribers' point of view, this time perspective should be explicitly incorporated in definitions of appropriate prescribing, in addition to individualization of treatment and cost considerations.
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Prescripciones de Medicamentos/normas , Médicos/psicología , Pautas de la Práctica en Medicina , Hospitales de Enseñanza , Humanos , Entrevistas como Asunto , SueciaRESUMEN
OBJECTIVE: The aim of this study was to characterize the content of patient-physician communication in standard oncology care. METHODS: The sample consisted of 19 patients with gastrointestinal cancer. The consultations were audio-recorded, transcribed verbatim, and analyzed according to qualitative content analysis. RESULTS: The analysis resulted in seven main categories: Disease and treatment, Healthcare planning, Everyday living, Psychological well-being, Coping with disease, Expressions of concerns and feelings, and Other aspects of communication. The main focus during the consultations was on disease and treatment. Physicians tended to concentrate on response to treatment and types and severity of side effects and how to treat them. More patient-centered subjects of psychosocial character like coping and psychological well-being were discussed only briefly, if at all. CONCLUSIONS: This study adds to the information given by the existing communication analysis systems, and hence we suggest a development of the psychosocial content categories of those systems to make them more valid.
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Adaptación Psicológica , Comunicación , Neoplasias Gastrointestinales/terapia , Oncología Médica , Relaciones Médico-Paciente , Derivación y Consulta , Necesidades y Demandas de Servicios de Salud , Humanos , Psicología , Calidad de Vida/psicología , Apoyo SocialRESUMEN
OBJECTIVE: To test the reliability, feasibility, and responsiveness of a categorization scheme for assessing pharmacy students' levels of reflection during internships. METHODS: Pharmacy interns at Uppsala University were asked to write a reflective essay about patient counseling at the start and end of their internships. A modified version of Kember's categorization scheme for assessing the level of reflection was used to evaluate these essays. RESULTS: Based on their essay scores, the students' levels of reflection increased during the internship course (p < 0.001) The mean time for categorization was 3 minutes per essay. The interrater reliability of the 182 essays was kappa = 0.63. CONCLUSIONS: The evaluation of the categorization scheme showed that it has good interrater reliability, feasibility, and responsiveness. This scheme might be useful in pharmacy practice educational settings, but needs further validation.
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Educación en Farmacia , Internado no Médico , Estudiantes de Farmacia/psicología , Escritura/normas , Adulto , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Educación del Paciente como Asunto/métodos , Rol Profesional/psicología , Reproducibilidad de los Resultados , Autoevaluación (Psicología) , Suecia , PensamientoRESUMEN
RATIONALE, AIM AND OBJECTIVE: Factors influencing doctors in prescribing of drugs have mostly been studied in primary care. Studies performed in hospital care have primarily focused on new drugs, not prescribing in general. An in-depth understanding of the prescribing process in the more specialized secondary care is not only important for secondary care itself, but because it also influences prescribing in primary care. The aim of this study is therefore to identify factors that secondary care doctors believe influence them in prescribing drugs, using a qualitative approach. METHOD: Semi-structured interviews were conducted with 15 hospital doctors in different medical specialities and the interviews were analysed from an interpretivist perspective. The information gathered was on how prescribing decisions were made in general and how the doctors chose a specific drug therapy, including information sources used. RESULTS: According to our interviews, the hospital doctors took patient-specific factors and cost into consideration when prescribing, informed by different written information sources and commercial verbal information. Personal practice, colleagues and therapeutic tradition at the hospital or clinic, were influential in the prescribing of drugs. The themes identified should not to be seen as individual influences; many of them probably act in combination. CONCLUSIONS: If changes in prescribing behaviour are desired, factors warranting more attention include understanding how to influence therapeutic traditions and the doctor's personal habits for prescribing. The importance of clinical experience and information exchange with colleagues should not be underestimated in providing information about drugs to hospital doctors.
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Actitud del Personal de Salud , Prescripciones de Medicamentos , Cuerpo Médico de Hospitales/psicología , Pautas de la Práctica en Medicina , Costos de los Medicamentos , Femenino , Humanos , Masculino , Mercadotecnía , Medicina , Grupo Paritario , Guías de Práctica Clínica como Asunto , Investigación Cualitativa , EspecializaciónRESUMEN
OBJECTIVE: The objective of this secondary analysis of data from a cross-sectional, nation-wide survey, was to test a hypothesized model with two latent concepts (readiness and adherence), based on the theory of trigger events. A secondary objective was to compare this model with two simpler models, without the concept of readiness. METHODS: Data consisted of a consecutive sample of 828 HIV patients > or = 18 years on antiretroviral treatment at 30 out of 32 HIV Clinics in Sweden (response rate 97.5%). Structural equation modeling (SEM) was used to test the models against the empirical data. Chi2 test was used to compare fit between models. RESULTS: The hypothesized model, with two latent concepts (readiness and adherence), fitted the data best (chi(2)=223.508, d.f.=129, p-value<0.0001, GFI=0.970, CFI=0.913, RMSEA=0.030), and significantly better than the models with adherence as the only latent concept. CONCLUSION: Although the SEM technique could not rule out that other models might also fit the data equally well, the hypothesized model, where readiness and adherence were two separate latent concepts, fitted data the best. This supports readiness as a distinct factor that influences adherence and hence treatment outcome. Increased attention should therefore be attached to interventions that focus on the individual' readiness for behavioural change, i.e. factors amendable to change and that can be addressed by the patients themselves. PRACTICE IMPLICATIONS: Based on these results it seems necessary to shift focus from adherence to readiness, especially in conditions where treatment can be postponed such as antiretroviral treatment.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Modelos Psicológicos , Aceptación de la Atención de Salud/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Cooperación del Paciente/psicología , Reproducibilidad de los Resultados , SueciaRESUMEN
BACKGROUND: There is a need for evidence to support expanded pharmacist services, especially regarding subjective outcomes experienced by patients. However, it is unclear what aspects of life are actually affected by such services. OBJECTIVES: The aims of this study are to identify patients' perceptions of both an expanded pharmacist service and its impact on subjective outcomes such as health and quality of life, and to elicit variables that may be targeted in future evaluation of the impact of such services. METHODS: In-depth interviews were performed with 12 respondents receiving a patient medication record service. The interviews were analyzed using a qualitative constant comparative method. RESULTS: The service was perceived very differently by unique respondents in regards to its purpose and content, as well as its outcomes. It was difficult for respondents to describe the service as separate from other health care experiences. Gaining control of drug treatment and a perceived feeling of increased safety were central concepts in patients' description of the service. Talking spontaneously about health effects of the service carried no meaning for the respondents. CONCLUSIONS: The value of enhanced patient consultation, empowerment, the feeling of safety, and increased drug knowledge are important to patients receiving this kind of service and should be central in choosing outcome measures when studying such services.
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Registros Médicos , Servicios Farmacéuticos , Humanos , Percepción , Investigación CualitativaRESUMEN
OBJECTIVE: The aim of this study was to compare the level of adherence and motivation in two independent cross-sectional samples of HIV-infected patients conducted in 1998 and 2002, and to investigate the relationship between adherence and motivation. METHOD: Consecutive HIV-infected patients on treatment at a Swedish clinic were asked to complete an anonymous questionnaire. In 1998, 60 patients participated and in 2002, 53 participated. In 2002, the 9-item Morisky Medication Adherence Scale (MMAS) was added to the questionnaire set. MAIN OUTCOME MEASURE: Self-reported adherence and motivation. RESULTS: In 1998, 28.1% of the respondents were considered adherent, while the corresponding proportion was 57.4% in 2002 (P = 0.002). The mean summary score for MMAS was 10.7 in 2002 (13 = perfect adherence). The proportion considered motivated were 22.4% in the 1998 survey and 41.3% in 2002 (P = 0.038). Of the respondents considered motivated in the 2002 survey, 46.7% scored the maximum summary score on the MMAS, while 8.7% of the non-motivated respondents did so (P = 0.016). CONCLUSION: The respondents in 2002 were more adherent and motivated than the respondents in 1998 and a relationship between motivation and adherence was found. The difference in adherence and motivation might be due to a new treatment model at the clinic.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Motivación , Cooperación del Paciente/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto , Actitud Frente a la Salud , Estudios Transversales , Femenino , Infecciones por VIH/psicología , Hospitales Universitarios , Humanos , Masculino , Pacientes Ambulatorios/psicología , Pacientes Ambulatorios/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/métodos , Reproducibilidad de los Resultados , Suecia , Factores de TiempoRESUMEN
OBJECTIVE: To summarise published HIV-specific research on readiness theories, factors influencing readiness, instruments to measure readiness and interventions to increase readiness for treatment. METHODS: Medline and PsychInfo were searched until August 2004. RESULTS: Two HIV-specific readiness theories were identified. Fear of side effects, emotions emerging from the diagnosis and lack of trust in the physician were some barriers to overcome in order to reach readiness. Of the three measurement instruments found, the index of readiness showed the most promise. Multi-step intervention programs to increase readiness for HIV treatment had been investigated. CONCLUSION: Readiness instruments may be useful tools in clinical practice but the predictive validity of the instruments needs to be further established in the HIV-infected population. PRACTICE IMPLICATIONS: Readiness instruments and practice placebo trials may serve as complements to routine care, since health care providers currently have no better than chance probability in identifying those patients who are ready to adhere.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH , Evaluación de Necesidades/organización & administración , Evaluación en Enfermería/métodos , Cooperación del Paciente/psicología , Adaptación Psicológica , Fármacos Anti-VIH/efectos adversos , Comunicación , Emociones , Miedo , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Negativismo , Evaluación en Enfermería/normas , Educación del Paciente como Asunto , Relaciones Médico-Paciente , Valor Predictivo de las Pruebas , Teoría Psicológica , Investigación Cualitativa , Reproducibilidad de los Resultados , Proyectos de Investigación , Encuestas y Cuestionarios , ConfianzaRESUMEN
Creams, ointments and solutions applied to the skin surface by patients as part of a daily routine might be expected to provide a more variable dosage than do standard tablets. However, adherence to treatment in dermatology has been little studied. This article reviews recent publications in the field. These are dominated by questionnaire-based studies, which tend to over-estimate adherence. Reduced adherence to dermatological treatment is noted in 34-45% of patients. It is likely that the percentage of patients who practice truly optimal treatment in their daily life is even lower considering the variable practice of self-treatment. Self-reported psychiatric morbidity contributes to poor adherence to dermatological treatment, while a well-functioning doctor-patient interaction is a major determinant of good adherence, as is patient satisfaction. In conclusion, adherence to dermatological treatment is unsatisfactory and there is a need for intervention and change in clinical routines. The therapeutic and economic benefits may be considerable. The immediate challenge is to stimulate a change in patient behaviour and improve self-treatment at home.
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Queratolíticos/administración & dosificación , Cooperación del Paciente , Enfermedades de la Piel/tratamiento farmacológico , Administración Cutánea , Factores de Confusión Epidemiológicos , Dermatología , Humanos , Encuestas y CuestionariosRESUMEN
Effectively co-ordinated treatment support from healthcare providers (doctors, nurses and pharmacists) may improve patients' adherence to treatment. The objective of this study was to identify patients' and providers' perceptions of the roles of different healthcare providers in dermatological treatment. Focus groups were used in two types of fora: patients with chronic dermatological diseases (n =2x6) and healthcare providers (n =2x6), including doctors, nurses and pharmacists working in dermatological care. Data were analysed according to the Consensual Qualitative Research approach. The respondents viewed the roles of the providers as complementary, but poorly co-ordinated. Treatment support is provided mainly by the nurse. During the doctor's appointment, diagnosis and treatment decisions are often prioritized, leaving limited time for treatment support. The pharmacist's provision of support is constrained by the lack of privacy and clinical history of individual patients. The most apparent "gap" in the chain of treatment support was between the pharmacist and the other providers. There was a wish for improved interprofessional collaboration to avoid giving conflicting advice. There is a need to improve interprofessional collaboration in dermatology, in order to optimize treatment support in clinical practice.
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Enfermeras y Enfermeros , Farmacéuticos , Rol Profesional , Enfermedades de la Piel/terapia , Adulto , Anciano , Actitud del Personal de Salud , Enfermedad Crónica , Dermatología , Femenino , Grupos Focales , Humanos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Rol de la Enfermera , Aceptación de la Atención de Salud , Enfermedades de la Piel/patología , SueciaRESUMEN
Adherence to long-term therapy for chronic illness is on average 50%. However, regarding adherence to dermatological treatment the existing literature is limited. The aim of the study was to acquire an understanding of issues associated with adherence to dermatological therapy. Focus group interviews were used in two types of fora: patients with chronic dermatological diseases and health care providers, including doctors, nurses and pharmacists working in dermatological care. Results reveal the providers' view of a suboptimal rate of adherence. According to both providers and patients, factors affecting adherence were patients' expectations and experiences of therapeutic effect, possibilities for the patient to take active part in treatment decisions, as well as mode of administration and type of medication. Suggested strategies for improvement are individualized patient education, continuous treatment support with assessment of medication-taking behaviour and enhanced communication skills among the providers.
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Cooperación del Paciente/psicología , Relaciones Profesional-Paciente , Enfermedades de la Piel/terapia , Adulto , Anciano , Actitud del Personal de Salud , Actitud Frente a la Salud , Servicios de Información sobre Medicamentos , Quimioterapia/psicología , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Participación del Paciente , Enfermedades de la Piel/psicología , SueciaRESUMEN
OBJECTIVE: To identify rheumatoid arthritis patients' perceptions about what should govern priority setting for the new class of high-cost anti-rheumatics, the TNF inhibitors. METHODS: Qualitative study employing semi-structured interviews of 22 patients diagnosed with rheumatoid arthritis at three hospitals in the region of Stockholm, Sweden. The interviews were conducted from December 1999 to March 2000. RESULTS: Patients suggest that a basis for priority setting should be need, including priority to persons with severe and/or early disease, and to those not responding to other anti-rheumatics. Some patients believe that age and productivity have to be taken into account in priority setting, while others oppose this view. Some patients want the individual physician to carry out priority setting, while others consider this too arbitrary. Respondents often suggest criteria unfavourable to themselves. Alongside suggestions for priority setting criteria, there is also a notion that, ideally, priority setting should not have to take place at all. CONCLUSIONS: Patients' views of priority setting are not necessarily influenced by the patients' individual needs and may contribute to the development of priority guidelines. Knowledge of the patients' perceptions of priority setting for a specific treatment might also support patient-provider discussions on priority setting.