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J Med Internet Res ; 13(2): e44, 2011 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-21715286


BACKGROUND: Older adults often have multiple chronic problems requiring them to manage complex medication regimens overseen by various clinicians. Personal health applications (PHAs) show promise assisting in medication self-management, but adoption of new computer technologies by this population is challenging. Optimizing the utility of PHAs requires a thorough understanding of older adults' needs, preferences, and practices. OBJECTIVE: The objective of our study was to understand the medication self-management issues faced by older adults and caregivers that can be addressed by an electronic PHA. METHODS: We conducted a qualitative analysis of a series of individual and group semistructured interviews with participants who were identified through purposive sampling. RESULTS: We interviewed 32 adult patients and 2 adult family caregivers. We identified 5 core themes regarding medication self-management challenges: seeking reliable medication information, maintaining autonomy in medication treatment decisions, worrying about taking too many medications, reconciling information discrepancies between allopathic and alternative medical therapies, and tracking and coordinating health information between multiple providers. CONCLUSIONS: This study provides insights into the latent concerns and challenges faced by older adults and caregivers in managing medications. The results suggest that PHAs should have the following features to accommodate the management strategies and information preferences of this population: (1) provide links to authoritative and reliable information on side effects, drug interactions, and other medication-related concerns in a way that is clear, concise, and easy to navigate, (2) facilitate communication between patients and doctors and pharmacists through electronic messaging and health information exchange, and (3) provide patients the ability to selectively disclose medication information to different clinicians.

Envejecimiento , Cuidadores , Comorbilidad , Quimioterapia , Pacientes , Autocuidado , Anciano , Anciano de 80 o más Años , Ansiedad , Comunicación , Terapias Complementarias , Toma de Decisiones , Revelación , Interacciones de Drogas , Quimioterapia Asistida por Computador , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Registros Electrónicos de Salud , Correo Electrónico , Femenino , Personal de Salud , Humanos , Masculino , Informática Médica , Persona de Mediana Edad , Pacientes/psicología , Autonomía Personal , Farmacias , Médicos
J Gen Intern Med ; 23(10): 1615-20, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18622651


BACKGROUND: Overuse of antibiotics in the treatment of acute respiratory tract infection (ARI) contributes to the growing problem of antibiotic-resistant infections. OBJECTIVE: To identify factors that influence community practitioners to prescribe antibiotics and examine how they differ from the recommendations of the Centers for Disease Control and Prevention (CDC) guideline for treatment of ARI. DESIGN: Paper case vignette study using a fractional factorial design. PARTICIPANTS: One hundred one community practitioners and eight faculty members. MAIN MEASUREMENTS: We asked community practitioners to estimate how likely they would be to prescribe antibiotics in each of 20 cases of ARI and then used multiple regression to infer the importance weights of each of nine clinical findings. We then compared practitioners' weights with those of a panel of eight faculty physicians who evaluated the cases following the CDC guidelines rather than their own judgments. MAIN RESULTS: Practitioners prescribed antibiotics in 44.5% of cases, over twice the percentage treated by the panel using the CDC guidelines (20%). In deciding to prescribe antibiotic treatment, practitioners gave little or no weight to patient factors such as whether the patients wanted antibiotics. Although weighting patterns differed among practitioners, the majority (72%) gave the greatest weight to duration of illness. When illness duration was short, the rate of prescribing (20.1%) was the same as the rate of the faculty panel (20%). CONCLUSIONS: Based on hypothetical cases of ARI, community practitioners prescribed antibiotics at twice the rate of faculty following CDC practice guidelines. Practitioners were most strongly influenced by duration of illness. The effect of duration was strongest when accompanied by fever or productive cough, suggesting that these situations would be important areas for practitioner education and further clinical studies.

Antibacterianos/uso terapéutico , Toma de Decisiones , Prescripciones de Medicamentos , Medicina Familiar y Comunitaria/métodos , Personal de Salud , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Enfermedad Aguda , Adulto , Antibacterianos/efectos adversos , Prescripciones de Medicamentos/normas , Medicina Familiar y Comunitaria/tendencias , Femenino , Personal de Salud/tendencias , Humanos , Masculino , Médicos de Familia/tendencias , Guías de Práctica Clínica como Asunto/normas , Infecciones del Sistema Respiratorio/diagnóstico
Health Serv Res ; 40(1): 101-16, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15663704


OBJECTIVE: To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practices. DATA SOURCES/STUDY SETTING: Antibiotic prescription rates based on claims data from four managed care organizations in Colorado during baseline (winter 2000) and study (winter 2001) periods. STUDY DESIGN: A nonrandomized controlled trial of a household and office-based patient educational intervention was performed. During both periods, Colorado physicians were mailed antibiotic prescribing profiles and practices guidelines as part of an ongoing quality improvement program. Intervention practices (n=7) were compared with local and distant control practices. DATA COLLECTION/EXTRACTION METHODS: Office visits were extracted by managed care organizations using International Classification of Diseases-9-Clinical Modification codes for acute respiratory tract infections, and merged with pharmacy claims data based on visit and dispensing dates coinciding within 2 days. PRINCIPAL FINDINGS: Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practices, and decreased from 39 to 37 percent at the local control practices, and from 34 to 30 percent at the intervention practices (p=.18 compared with distant control practices). Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practices, from 55 to 45 percent at the local control practices, and from 60 to 36 percent at the intervention practices (p<.002 and p=.006 compared with distant and local control practices, respectively). CONCLUSIONS: In office practices, there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis. In contrast, patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician-directed efforts.

Antibacterianos/uso terapéutico , Bronquitis/tratamiento farmacológico , Resistencia a Medicamentos , Utilización de Medicamentos/normas , Educación del Paciente como Asunto , Faringitis/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Enfermedad Aguda , Adolescente , Adulto , Antibacterianos/farmacología , Bronquitis/diagnóstico , Niño , Preescolar , Colorado , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Programas Controlados de Atención en Salud/normas , Persona de Mediana Edad , Faringitis/diagnóstico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Práctica Privada/normas
J Am Geriatr Soc ; 52(1): 39-45, 2004 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-14687313


OBJECTIVES: : To measure and improve antibiotic use for acute respiratory tract infections (ARIs) in the elderly. DESIGN: : Prospective, nonrandomized controlled trial. SETTING: : Ambulatory office practices in Denver metropolitan area (n=4 intervention practices; n=51 control practices). PARTICIPANTS: : Consecutive patients enrolled in a Medicare managed care program who were diagnosed with ARIs during baseline (winter 2000/2001) and intervention (winter 2001/2002) periods. A total of 4,270 patient visits were analyzed (including 341 patient visits in intervention practices). INTERVENTION: : Appropriate antibiotic use and antibiotic resistance educational materials were mailed to intervention practice households. Waiting and examination room posters were provided to intervention office practices. MEASUREMENTS: : Antibiotic prescription rates, based on administrative office visit and pharmacy data, for total and condition-specific ARIs. RESULTS: : There was wide variation in antibiotic prescription rates for ARIs across unique practices, ranging from 21% to 88% (median=54%). Antibiotic prescription rates varied little by patient age, sex, and underlying chronic lung disease. Prescription rates varied by diagnosis: sinusitis (69%), bronchitis (59%), pharyngitis (50%), and nonspecific upper respiratory tract infection (26%). The educational intervention was not associated with greater reduction in antibiotic prescription rates for total or condition-specific ARIs beyond a modest secular trend (P=.79). CONCLUSION: : Wide variation in antibiotic prescription rates suggests that quality improvement efforts are needed to optimize antibiotic use in the elderly. In the setting of an ongoing physician intervention, a patient education intervention had little effect. Factors other than patient expectations and demands may play a stronger role in antibiotic treatment decisions in elderly populations.

Antibacterianos/uso terapéutico , Educación del Paciente como Asunto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Colorado , Femenino , Humanos , Modelos Logísticos , Masculino , Medicare , Estudios Prospectivos , Resultado del Tratamiento