National Quality Evaluation of Medication Use for Pediatric Otitis Media With Effusion.

OBJECTIVES: Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear without the presentation of signs or symptoms of acute ear infection. The point prevalence of OME reaches as high as 60% in children younger than 2 years of age. We used the National Health Insurance Research Database (NHIRD) to investigate the use of medication in children with OME before receiving ventilation tube insertion (VTI). METHODS: Data of pediatric patients (age ≤ 12 years) who had OME and received VTI from January 1, 2011, to December 30, 2012, were retrieved from the Taiwan NHIRD. We surveyed the use of 4 medications to understand whether health care providers achieved the standards of medication use recommended by clinical practice guidelines. RESULTS: This study examines the factors affecting the use of medication for pediatric OME. Overall, according to the study's operational definitions, the use of systemic antibiotics was most common (59.9%), followed by systemic antihistamines (23.4%), systemic steroids (8.8%), and intranasal steroids (9.6%). Systemic antibiotics use was associated with 12 factors. Ten of the 12 factors increase the use of systemic antibiotics, including namely age (age > 2 years), comorbidities, teaching hospital, and community hospital. In contrast, namely catastrophic illness and watchful waiting are the 2 factors that decrease systemic antibiotics use. For the use of systemic antihistamines, systemic steroids, and intranasal steroids were related to 6, 5, and 2 factors, respectively. CONCLUSIONS: The rate of drug use differs from the rate of use recommended by commonly used clinical practice guidelines. We found that the higher the number of factors that influenced the patients' drug use, the higher the rate of drug use. According to these results, drafting a treatment guideline for OME patients in accordance with current clinical practices in Taiwan is highly recommended.

The relationship between organizational climate, job stress, workplace burnout, and retention of pharmacists.

OBJECTIVES: This study explored the relationship between organizational climate, job stress, workplace burnout, and retention of pharmacists. This study adopted a cross-sectional design and conducted a questionnaire survey of pharmacists working at three teaching hospitals (a district teaching hospital, a regional teaching hospital, and a medical center). METHODS: The sampling criteria were a license to practice pharmacy and a willingness to sign a written consent form to participate in this study. RESULTS: One hundred ten questionnaires were distributed, of which 101 contained valid responses, yielding a valid return rate of 91.82%. A significant correlation was evident between organizational climate, job stress, workplace burnout, and retention. Hierarchical regression analysis revealed that demographic variables, organizational climate, job stress, and workplace burnout had a predictive power of 55.6% for retention (F = 9.712***, P < .001). Organizational climate had a significant positive correlated with retention (ß =  0.401*, P < .001). CONCLUSIONS: The results of this study can help hospitals to create a friendly and healthy workplace, instruct hospital managers how to improve their organizational climates, and reduce pharmacists' job stress and workplace burnout, thereby enhancing the quality of pharmacy service and medication safety and eventually improving pharmacists' intention to stay.

The development and use of a pharmacist-specific Mini-CEX for postgraduate year trainees in Taiwan.

BACKGROUND: Clinical pharmacists must have a complex combination of academic knowledge and practical experience that integrates all aspects of practice. Taiwan's Ministry of Health and Welfare in 2007 launched the Postgraduate Year (PGY) training program to increase the standard of pharmaceutical care. This study aims to develop a pharmacist-specific Chinese-language Mini-Clinical Evaluation Exercise (Mini-CEX) to evaluate the professional development of postgraduate year trainees. METHOD: The specialized Mini-CEX was developed based on the core competencies of pharmacists, published literature, and expert opinion. A pilot test and evaluator workshop were held prior to the administration of the main test. Fifty-three samples were recruited. The main study was conducted at two regional teaching hospitals and a medical center teaching hospital in Taiwan between February and June 2012. The results were analyzed with the kappa statistic (inter-rater reliability) and descriptive statistics, while the Kruskal-Wallis test was used to examine the PGY trainees' Mini-CEX scores based on their performances. RESULTS: Trainees who had recently completed PGY programs (C-PGY) and 2nd year PGY trainees (PGY2) earned excellent scores, while the 1st year PGY trainees (PGY1) earned satisfactory scores in overall performance. C-PGY and PGY2 trainees also performed significantly better than PGY1 trainees in the organization and efficiency domain, and the communication skills domain. CONCLUSION: This study demonstrates the feasibility of using the newly developed pharmacist-specific Chinese-language version of the Mini-CEX instrument to evaluate the core competencies of PGY trainees in clinical settings.