Prevalence and factors affecting home blood pressure documentation in routine clinical care: a retrospective study.

BACKGROUND: Home blood pressure (BP) is closely linked to patient outcomes. However, the prevalence of its documentation has not been examined. The objective of this study was to analyze the prevalence and factors affecting documentation of home BP in routine clinical care. METHODS: A retrospective study of 142,973 encounters of 9,840 hypertensive patients with diabetes from 2000 to 2005 was performed. The prevalence of recorded home BP and the factors associated with its documentation were analyzed. We assessed validity of home BP information by comparing the difference between home and office BP to previously published prospective studies. RESULTS: Home BP was documented in narrative notes for 2.08% of encounters where any blood pressure was recorded and negligibly in structured data (EMR flowsheets). Systolic and diastolic home BP in narrative notes were lower than office BP readings by 9.6 and 2.5 mm Hg, respectively (p < 0.0001 for both), consistent with prospective data. Probability of home BP documentation increased by 23.0% for each 10 mm Hg of office systolic BP (p < 0.0001), by 6.2% for each $10,000 in median income of zip code (p = 0.0055), and by 17.7% for each decade in the patient's age (p < 0.0001). CONCLUSIONS: Home BP readings provide a valid representation of the patient's condition, yet are seldom documented despite their potential utility in both patient care and research. Strong association between higher patient income and home BP documentation suggests that the cost of the monitors may be a limiting factor; reimbursement of home BP monitoring expenses should be pursued.

Leadership Succession Preparedness and Sense of Urgency in Canadian Hospital Pharmacy.

BACKGROUND: Leadership turnover is unavoidable in all organizations, including hospital pharmacy departments. Succession planning can promote organizational stability, among other benefits. OBJECTIVES: To gather a contemporary, nationwide measure of the level of preparedness for department leadership succession and to gain related insight from a variety of pharmacy leaders. METHODS: This study was an environmental scan of Canadian hospital pharmacy leaders. An online survey was conducted to identify the current rate of succession planning; to describe existing succession plans; to determine the perceived need for succession planning; and to describe strategies for, barriers to, and facilitators of succession planning. RESULTS: Eighty-three responses were received. Thirteen respondents (16%) reported that their hospital pharmacy departments had a succession plan, and 13 (16%) of individuals had known successors. Most respondents (64/75 [85%]) perceived succession plans to be rare or nonexistent across Canada. However, 72% (54/75) felt that succession planning was needed for their own leadership position. The most common barriers to succession planning were a lack of formal structure or tools, lack of plan implementation, unionization, and lack of career ladder positions. Select facilitators to succession planning identified by respondents were having a strong existing leadership and having an abundant pool of capable successors. CONCLUSIONS: Most Canadian hospital pharmacy departments and individual leaders represented in this survey were not prepared with succession plans. A collective effort to proactively enact succession planning in Canadian hospital pharmacy departments would have multiple benefits for existing and aspiring leaders and, ultimately, the profession as a whole.

CONTEXTE: Tout organisme, y compris les services de pharmacie d'hôpitaux, fait face au renouvellement inévitable de sa direction. La planification de la relève peut, entre autres avantages, favoriser la stabilité organisationnelle. OBJECTIFS: Brosser un portrait national et actuel de la capacité des services de pharmacie de faire face au renouvellement de leur direction et obtenir le point de vue de différents leaders en pharmacie sur le sujet. MÉTHODES: La présente étude est une analyse du contexte des leaders en pharmacie hospitalière du Canada. Un sondage en ligne a permis de déterminer le degré actuel de planification de la relève, de décrire les plans de relève mis en place, de déterminer dans quelle mesure une planification de la relève est nécessaire et de décrire les stratégies à adopter pour mener une planification de la relève ainsi que les éléments y faisant obstacle ou la facilitant. RÉSULTATS: Les investigateurs ont reçu 83 réponses. Treize répondants (16 %) ont indiqué que les services de pharmacie de leur hôpital possédaient un plan de relève et tous les 13 (16 %) connaissaient les successeurs. La plupart des répondants (64/75 [85 %]) croyaient que les plans de relève étaient rares, voire inexistants, au Canada. Cependant, 72 % (54/75) estimaient que leur poste de direction nécessitait une planification de la relève. Les obstacles à la planification de la relève le plus souvent évoqués étaient : l'absence de structure ou d'outils formels, l'absence de mise en oeuvre d'un plan, la syndicalisation et le manque de postes offrant des possibilités d'avancement. Parmi les éléments facilitant la planification de la relève, les répondants ont mentionné : la présence d'un leadership fort et l'accès à un important bassin de candidats compétents. CONCLUSIONS: La plupart des services de pharmacie d'hôpitaux canadiens et des dirigeants représentés dans le sondage n'étaient pas en mesure de s'appuyer sur un plan de relève. Un travail collectif de mise en oeuvre proactive d'une planification de la relève dans les services de pharmacie d'hôpitaux canadiens aurait de multiples avantages pour les dirigeants en place et ceux appelés à le devenir et, ultimement, pour la profession dans son ensemble.

Cost comparison of psoriasis treatments.

BACKGROUND: Knowledge of the cost of various psoriasis therapeutic options is essential to the prescribing clinician. OBJECTIVE: To compare the cost of various psoriasis treatments over a 10-year period in the province of Ontario, Canada. METHODS: We used a hypothetical patient with plaque-type psoriasis of moderate severity with a Psoriasis Area and Severity Index of 10, body surface area of 20%, and no joint involvement. The costs to treat this hypothetical patient with different therapeutic regimens were compared in this study. RESULTS: In a 60 kg patient, alefacept was the most costly form of therapy, based on two 12-week treatments per year, followed by infliximab 5 mg/kg. In a 90 kg patient, infliximab 5 mg/kg was the most costly, followed by alefacept. The least costly treatment was ultraviolet B phototherapy. CONCLUSION: With the knowledge of these data, informed prescribing by the dermatologist may reduce the financial burden to the patient, the provincial health care system, and insurance companies.