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1.
Pain Med ; 17(7): 1261-1268, 2016 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-26917624

RESUMO

OBJECTIVE: To examine effects of pre-enrollment opioid use on outcomes of a 12-month collaborative pain care management trial. We hypothesized that participants with opioid use would have worse pain at baseline; use more health care services and analgesics; and have worse pain outcomes during the trial. DESIGN: Secondary analysis of randomized controlled trial data. SETTING: Veterans Affairs (VA) primary care. SUBJECTS: Patients age 18-65 years with chronic pain of at least moderate severity who were enrolled in a 12-month pragmatic trial of a telephone-based collaborative care intervention for chronic musculoskeletal pain. METHODS: Participants were categorized as opioid users (n = 84) or non-users (n = 166) at baseline and trial randomization was stratified by opioid use. We used logistic regression to examine cross-sectional associations with baseline opioid use and mixed-effect models for repeated measures to examine baseline opioid use as a predictor of Brief Pain Inventory (BPI) scores over 12 months. RESULTS: At baseline, 33.6% reported use of prescribed opioids. Baseline opioid users had higher baseline BPI scores and higher health-related disability than non-users. Baseline opioid users also had more outpatient visits (15.0 vs. 10.1; p = 0.001) and received more analgesics (p < 0.001) during the trial. In the final multivariable model examining effects of baseline opioid use on BPI over 12 months, opioid users and nonusers had a non-significant difference of 0.25 points (p = 0.098). In conclusion, although baseline opioid users had worse pain at baseline and used more health care during the study, response to the intervention was not significantly modified by pre-existing opioid therapy.

2.
J Am Pharm Assoc (2003) ; 55(6): 649-655, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26547598

RESUMO

OBJECTIVE: To describe the experiences and opinions of pharmacists serving as site coordinators for the Medication Safety Research Network of Indiana (Rx-SafeNet). SETTING: Retail chain, independent, and hospital/health system outpatient community pharmacies throughout Indiana, with a total of 127 pharmacy members represented by 26 site coordinators. PRACTICE DESCRIPTION: Rx-SafeNet, a statewide practice-based research network (PBRN) formed in 2010 and administered by the Purdue University College of Pharmacy. MAIN OUTCOME MEASURES: Barriers and facilitators to participation in available research studies, confidence participating in research, and satisfaction with overall network communication. RESULTS: 22 of 26 site coordinators participated, resulting in an 85% response rate. Most (72.2%) of the respondents had received a doctor of pharmacy degree, and 13.6% had postgraduate year (PGY)1 residency training. The highest reported benefits of PBRN membership were an enhanced relationship with the Purdue University College of Pharmacy (81% agreed or strongly agreed) and enhanced professional development (80% agreed or strongly agreed). Time constraints were identified as the greatest potential barrier to network participation, reported by 62% of respondents. In addition, the majority (59%) of survey respondents identified no prior research experience. Last, respondents' confidence in performing research appeared to increase substantially after becoming network members, with 43% reporting a lack of confidence in engaging in research before joining the network compared with 90% reporting confidence after joining the network. CONCLUSION: In general, Rx-SafeNet site coordinators appeared to experience increased confidence in research engagement after joining the network. While respondents identified a number of benefits associated with network participation, concerns about potential time constraints remained a key barrier to participation. These findings will assist network leadership in identifying opportunities to positively increase member participation in the future.


Assuntos
Serviços Comunitários de Farmácia , Pesquisa Participativa Baseada na Comunidade/organização & administração , Erros de Medicação/prevenção & controle , Farmacêuticos , Adulto , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Indiana , Liderança , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Farmacêuticos/psicologia , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Inquéritos e Questionários
3.
Prehosp Emerg Care ; 17(1): 73-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23098136

RESUMO

OBJECTIVE: We compared the methicillin-resistant Staphylococcus aureus (MRSA) carrier rate among out-of-hospital care providers with greater than six months' experience in emergency medical services (EMS) care with that of emergency medical technician (EMT) students with two months or less of observation time as part of their clinical training. METHODS: We conducted a prospective study utilizing a convenience sample of out-of-hospital care providers and EMT students in an urban EMS system operating in the Midwest during October and November 2006. One hundred thirty-four out-of-hospital care providers and 152 EMT students were tested for MRSA susceptibility using the cefoxitin disk diffusion method. RESULTS: Contrary to our hypothesis, we did not find a statistically significant difference in MRSA nasal colonization between out-of-hospital care providers (4.5%; 95% confidence interval [CI] 1.0, 8.0) and EMT students (5.3%; 95% CI 1.7, 8.8). A subgroup analysis showed that among out-of-hospital care providers, paramedics had a higher rate of nasal colonization than EMTs (5.6% vs. 2.2%). CONCLUSION: We found that out-of-hospital care providers and EMT students had higher nasal colonization rates than the reported rate for the U.S. population (0.084% at the time the study was conducted and 1.5% currently). It is imperative that both groups adhere to infection control practices.


Assuntos
Portador Sadio/epidemiologia , Auxiliares de Emergência/estatística & dados numéricos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Estudantes de Ciências da Saúde/estatística & dados numéricos , Adulto , Portador Sadio/microbiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Meio-Oeste dos Estados Unidos/epidemiologia , Mucosa Nasal/microbiologia , Exposição Ocupacional/estatística & dados numéricos , Prevalência , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Infecções Estafilocócicas/microbiologia , Serviços Urbanos de Saúde/estatística & dados numéricos , Recursos Humanos
4.
Am J Emerg Med ; 31(10): 1495-500, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24035046

RESUMO

OBJECTIVE: Many patients discharged from the emergency department (ED) require urgent follow-up with specialty providers. We hypothesized that a unique specialty referral mechanism that minimized barriers would increase follow-up compliance over reported and historical benchmarks. METHODS: Retrospective review of all patients requiring urgent (within 1 month) specialty referrals in 2010 from a safety net hospital ED to dermatology, otolaryngology, neurology, neurosurgery, ophthalmology, urology, plastic surgery, general surgery, or vascular surgery clinics. After specialist input, all patients received a specific follow-up appointment before ED discharge via a specific scheduling service. Necessity for payment at the follow-up visit was waived. RESULTS: Of the 1174 receiving referrals, 85.6% of patients scheduled an appointment and 80.1% kept that appointment. After logistic regression analysis, the factors that remained significantly associated (P < .05) with appointment-keeping compliance were the specialty clinic type (dermatology, 61.5%, to ophthalmology, 98.0%), insurance status (other payer, 87.5%; commercial, 82.8%; Medicaid, 77.9%; Medicare, 85.7%; charity care program, 88.1%; self-pay, 73.0%), age (<18 years, 80.1%; 18-34 years, 75.0%; 35-49 years, 79.2%; 50-64 years, 85.9 %; >64 years, 93.9%), and mean length of time between ED visit and clinic appointment (kept, 10.5 days; not kept, 14.3 days). The specialty clinic (neurology, 72.8%, to vascular surgery, 100%; P < .001) was significantly associated with the likelihood of patients to complete the appointment-making process. Race/Ethnicity was not associated with either scheduling or keeping an appointment. CONCLUSION: A referral process that minimizes barriers can achieve an 80% follow-up compliance rate. Age, insurance, specialty type, and time to appointment are associated with noncompliance.


Assuntos
Serviço Hospitalar de Emergência , Medicina/organização & administração , Melhoria de Qualidade/organização & administração , Encaminhamento e Consulta/organização & administração , Adolescente , Adulto , Fatores Etários , Idoso , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Cooperação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/organização & administração , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
5.
Prehosp Disaster Med ; 28(5): 520-2, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23702188

RESUMO

BACKGROUND: Pain associated with pediatric trauma is often under-assessed and under-treated in the out-of-hospital setting. Administering an opioid such as fentanyl via the intranasal route is a safe and efficacious alternative to traditional routes of analgesic delivery and could potentially improve pain management in pediatric trauma patients. OBJECTIVE: The study sought to examine the effect of introducing the mucosal atomization device (MAD) on analgesia administration as an alternative to intravenous fentanyl delivery in pediatric trauma patients. The hypothesis for the study is that the introduction of the MAD would increase the administration of fentanyl in pediatric trauma patients. METHODS: The research utilized a 2-group design (pre-MAD and post-MAD) to study 946 pediatric trauma patients (age <16) transported by a large, urban EMS agency to one of eight hospitals in Marion County, which is located in Indianapolis Indiana. Two emergency medicine physicians independently determined whether the patient met criteria for pain medication receipt and a third reviewer resolved any disagreements. A comparison of the rates of fentanyl administration in both groups was then conducted. RESULTS: There was no statistically significant difference in the rate of fentanyl administration between the pre-MAD (30.4%) and post-MAD groups (37.8%) (P = .238). A subgroup analysis showed that age and mechanism of injury were stronger predictors of fentanyl administration. CONCLUSION: Contrary to the hypothesis, the addition of the MAD device did not increase fentanyl administration rates in pediatric trauma patients. Future research is needed to address the barriers to analgesia administration in pediatric trauma patients.


Assuntos
Analgésicos Opioides/administração & dosagem , Serviços Médicos de Emergência , Fentanila/administração & dosagem , Ferimentos e Lesões , Administração Intranasal/instrumentação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Indiana , Lactente , Masculino , Nebulizadores e Vaporizadores , Estudos Retrospectivos
6.
Am J Hosp Palliat Care ; 34(8): 697-703, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27432319

RESUMO

INTRODUCTION: Palliative sedation for refractory existential distress (PS-ED) is ethically troubling but potentially critical to quality end-of-life (EOL) care. Physicians' in postgraduate training support toward PS-ED is unknown nor is it known how empathy, hope, optimism, or intrinsic religious motivation (IRM) affect their support. These knowledge gaps hinder efforts to support physicians who struggle with patients' EOL care preferences. METHODS: One hundred thirty-four postgraduate physicians rated their support of PS for refractory physical pain (PS-PP) or PS-ED, ranked the importance of patient preferences in ethically challenging situations, and completed measures of empathy, hope, optimism, and IRM. Predictors of PS-ED and PS-PP support were examined using binary and multinomial logistic regression. RESULTS: Only 22.7% of residents were very supportive of PS-ED, and 82.0% were very supportive of PS-PP. Support for PS-PP or PS-ED did not correlate with levels of empathy, hope, optimism, or IRM; however, for residents with lower IRM, greater optimism was associated with greater PS-ED support. In contrast, among residents with higher IRM, optimism was not associated with PS-ED support. CONCLUSIONS: Comparing current results to published surveys, a similar proportion of residents and practicing physicians support PS-ED and PS-PP. In contrast to practicing physicians, however, IRM does not directly influence residents' supportiveness. The interaction between optimism and IRM suggests residents' beliefs and characteristics are salient to their EOL decisions. End-of-life curricula should provide physicians opportunities to reflect on the personal and ethical factors that influence their support for PS-ED.


Assuntos
Atitude do Pessoal de Saúde , Sedação Profunda/psicologia , Dor Intratável/tratamento farmacológico , Cuidados Paliativos/métodos , Médicos/psicologia , Estresse Psicológico/tratamento farmacológico , Empatia , Existencialismo , Feminino , Humanos , Internato e Residência , Modelos Logísticos , Masculino , Otimismo , Assistência Terminal/métodos
7.
Res Social Adm Pharm ; 12(2): 336-40, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26143488

RESUMO

BACKGROUND: Access and availability of unused and expired medication (UEM) due to improper disposal and storage is a serious issue, potentially leading to abuse and environmental concerns. OBJECTIVE: To describe the extent of the UEM issue in Indiana (U.S. State), identify patient beliefs about UEM, and determine any association between those beliefs and various personal/demographic characteristics. RESULTS: A needs assessment was conducted among community pharmacy patients. A convenience sample of 200 patients from 15 community pharmacies that are part of a practice-based research network (PBRN) in Indiana completed a survey concerning UEM beliefs and behaviors from Feb-March, 2014. Approximately 40% of patients were aware of a UEM take-back location in their community, although only 15% had utilized a UEM take-back location. Seventy-seven percent of patients were willing to drive to a take-back location to return UEM. Particularly vulnerable populations lacking knowledge regarding UEM and access to proper disposal were identified. CONCLUSIONS: While states have made efforts to increase accessibility for UEM return, there remains a need for more disposal locations for both non-controlled and controlled medication.


Assuntos
Serviços Comunitários de Farmácia , Medicamentos sob Prescrição , Gerenciamento de Resíduos , Adulto , Idoso , Cultura , Feminino , Humanos , Indiana , Masculino , Pessoa de Meia-Idade
8.
Innov Pharm ; 6(2)2015.
Artigo em Inglês | MEDLINE | ID: mdl-28163979

RESUMO

Community pharmacy practice-based research networks (CP PBRNs) are a relatively new arena for pharmacists. While some lessons may be gleaned from primary care PBRNs, the experiences of CP PBRNs have much to offer the profession in terms of organization and practice. In 2012, we reported on our early experiences developing the Medication Safety Research Network of Indiana (Rx-SafeNet) after establishing the Network in 2010. Over the past 3 years, our CP PBRN of approximately 180 members has managed further growth by revisiting policies and procedures, maintaining CP PBRN member relationships, and preparing for financial sustainability. We look forward to furthering our CP PBRN projects in the coming years and collaborating with other CP PBRNs to enhance medication safety in Indiana and beyond.

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