Judy Mullan

Challenging the views of self management for asthma

Kelly L. Andrews et al. — Wed, 07 Dec 2011 18:44:48 PST

• Individual nature of asthma and the asthmatic are not well understood or prioritised as a starting point to improve the uptake of self management strategies • Fuller understanding of 4 P’s from a consumer perspective required • Preliminary audience segmentation herein provide a sound platform for future investigations • Consumer focused evaluations are necessary to understand the present barriers and future facilitators of health behaviour change.

Rain, fog, smog and printed educational material

Judy Mullan et al. — Wed, 07 Dec 2011 18:44:47 PST

Patient education is central to the practice of all health professionals. Pharmacists often use printed educational material, such as consumer medicine information, as adjuncts to verbal communication and education of patients about their medications. A relatively large proportion of the Australian population have low literacy skills and cannot read or understand written patient educational materials which are typically written at levels equivalent to year 9 and above. By using simple readability assessment tools such as RAIN, SMOG or FOG and the UK's Department of Health 'Toolkit for producing patient information' health professionals can ensure that printed educational materials are simple and easily read by a wide patient population. These measures will ensure that pharmacists can become more effective educators to improve patients' medication knowledge and understanding, which will assist with optimising compliance and overall therapeutic outcomes.

An investigation into the potential barriers associated with warfarin prescribing in an elderly population residing in Illawarra based aged care facilities

Judy Mullan — Wed, 07 Dec 2011 18:44:46 PST

Warfarin Prescribing: • Systems varied - faxed warfarin-specific chart - faxed warfarin orders - phone calls from GPs - phone call from RN to GP’s secretary dose recorded on chart with a ‘post-it’ note • Common problems - faxes (misplaced or not received) - ? current orders • “If there was a standard package for dealing with nursing homes then we would go along with that and just get used to it” (GP)

Challenges of Older Patients’ Knowledge About Warfarin Therapy

Sayeed Nasser et al. — Wed, 07 Dec 2011 18:44:44 PST

Objective: To review the challenges of warfarin education for older patients (aged 65 years or older) in terms of knowledge, access to warfarin education, and education resources. Methods: A quasi-systematic review of the literature was performed via electronic database searches (eg, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Meditext, and Google Scholar) from 1990 to May 2011. Results: The 62 articles reviewed found that improved patient knowledge results in better anticoagulation control. The review also found that between 50% and 80% of older patients have inadequate knowledge about the basic aspects of warfarin therapy (eg, action, benefits and risks, interactions with other drugs or foods, international normalized ratio management). Demographic factors, such as advancing age, lower family income, and limited health literacy, were found to inversely affect patients’ warfarin knowledge, and access to warfarin education and information resources were often suboptimal in different practice settings. Finally, a number of educational strategies and resources that could be readily incorporated to improve the effectiveness of current warfarin education programs were extracted from the review. Conclusion: This comprehensive review highlights that education about warfarin in older patients is currently suboptimal and may in part contribute to poor therapeutic outcomes. This review article also acknowledges the need to identify, target, and develop educational strategies and resources to further improve older patients’ knowledge about their warfarin therapy.

Trajectories of depression and their relationship with health status and social service use

Chun-Min Chen et al. — Wed, 07 Dec 2011 18:37:09 PST

This longitudinal study was conducted between 1994 and 2004 in a cohort of Southern Taiwan community-living elderly residents. The study aims to explore the trajectories of depression and how these patterns differed between respondents who survived and those who died during data collection phases; this study also investigated how health status change and health/social service use predicted the different trajectories of depression. Eight hundred and ten participants had completed all six waves of the survey or were followed-up at each wave until death in the prospective study in Kaohsiung City. Depressive symptoms were evaluated by the Short Psychiatric Evaluation Schedule (SPES). Changes in levels of depression during the ageing process were identified. Different trajectories clearly reflected heterogeneity within depression and the association with mortality. The study highlighted that diabetes, gastrointestinal problems, heart disease and disability, whether at baseline or as new occurrences, were predictors of health decline. High uses of health/social services were also predictive of increased depression. These findings identified depression as a highly dynamic process, characterized by different trajectories of depression between states of no, mild and severe depression. Greater awareness of these various trajectories should potentially improve the prevention and/or management strategies of depression.

Patient Education.

Judy Mullan — Tue, 11 Oct 2011 17:31:09 PDT

Patient education is an integral part of the practice of all health professionals. To aspire to professionalism requires the individual to obtain and maintain a body of skills and knowledge that they can profess to the world at large. Patient education is a primary healthcare role in which nurses and other healthcare professionals disseminate their knowledge to the community.

Clinical outcomes of a collaborative, home-based post-discharge warfarin management service

L. Stafford et al. — Tue, 11 Oct 2011 17:27:50 PDT

BACKGROUND: Warfarin remains a high-risk drug for adverse events, especially following discharge from the hospital. New approaches are needed to minimize the potential for adverse outcomes during this period.

OBJECTIVE: To evaluate the clinical outcomes of a collaborative, home-based postdischarge warfarin management service adapted from the Australian Home Medicines Review (HMR) program.

METHODS: In a prospective, nonrandomized controlled cohort study, patients discharged from the hospital and newly initiated on or continuing warfarin therapy received either usual care (UC) or a postdischarge service (PDS) of 2 or 3 home visits by a trained, HMR-accredited pharmacist in their first 8 to 10 days postdischarge. The PDS involved point-of-care international normalized ratio (INR) monitoring, warfarin education, and an HMR, in collaboration with the patient's general practitioner and community pharmacist. The primary outcome measure was the combined incidence of major and minor hemorrhagic events in the 90 days postdischarge. Secondary outcome measures included the incidences of thrombotic events, combined hemorrhagic and thombotic events, unplanned and warfarin-related hospital readmissions, death, INR control, and persistence with therapy at 8 and 90 days postdischarge.

RESULTS: The PDS (n = 129) was associated with statistically significantly decreased rates of combined major and minor hemorrhagic events to day 90 (5.3% vs 14.7%; p = 0.03) and day 8 (0.9% vs 7.2%; p = 0.01) compared with UC (n = 139). The rate of combined hemorrhagic and thrombotic events to day 90 also decreased (6.4% vs 19.0%; p = 0.008) and persistence with warfarin therapy improved (95.4% vs 83.6%; p = 0.004). No significant differences in readmission and death rates or INR control were demonstrated.

CONCLUSIONS: This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence in patients taking warfarin following hospital discharge. Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care.

Prescription medication hoarding and borrowing or sharing behaviours in older residents in the Illawarra, New South Wales, Australia

Janette C. Ellis et al. — Tue, 11 Oct 2011 17:27:48 PDT

Aim: To examine prescription medication hoarding and borrowing or sharing (PMHBS) behaviours in older people, particularly which medications are subject to these behaviours and the circumstances that enable these behaviours.

Methods: A mixed methods triangulation design, using consecutive qualitative (focus groups) and quantitative (survey) methodologies in a convenience sample of people older than 65 years, living independently in the Illawarra region (New South Wales).

Results: Focus group participants (n = 28) acknowledged PMHBS behaviours were widespread; however, very few survey respondents (n = 226) admitted to engaging in these behaviours. Main findings in the study were enablers for these behaviours: the prescription medication is considered the same as that prescribed previously; and self-medicating for pain relief.

Conclusions: The prevalence of PMHBS behaviours in this study was low, although it was acknowledged such behaviours occurred in the wider community. Sharing strong pain medication and the same prescription medication appeared to be acceptable in this population.

Evaluating the Implementation of a Warfarin-Specific Medication Chart in Residential Aged Care Facilities

Margaret Jordan et al. — Tue, 11 Oct 2011 17:27:46 PDT

Eleven interactive education sessions were held for 56 nurses involved in warfarin management. The strategy was trialled in 3 RACFs for 23 residents for 3 months. Qualitative evaluation was by semi-structured interviews. Compared to previous methods, 8 of 9 GPs found the charts easier to prescribe warfarin; 100% found that communication was enhanced, the chart easy to use and time-saving. Six out of 12 (50%) Registered Nurses found the charts enhanced communication, saved time, and provided more information than previous methods. Ten of 11 RNs found the dose easier to find and the charts easy to use. All GPs and RNs (100%) recommended adopting the strategy in their RACFs.

Older adults' perceptions and understanding of direct-to-consumer advertising.

Sandra C. Jones et al. — Mon, 10 Oct 2011 21:21:16 PDT

Purpose – This paper aims to investigate older consumers' perceptions of the effects of direct-to-consumer advertising (DTCA), their views on the amount and type of information that should be provided, and their understanding of information typically contained. Design/methodology/approach – Participants were 97 adult members of a social/education group, aged 55 to 87, who completed a questionnaire during the group's usual weekly meeting. There were four versions of the questionnaire; two types of medication (arthritis versus diabetes) and two ad formats (short versus long). Findings – There was little difference between the versions in the accuracy of participants' recall of key pieces of information, suggesting that providing additional information may convey little additional benefit. Participants reported limited perceived benefits of DTCA, and expressed concern that DTCA may cause people to ask their doctor for inappropriate medicines, rely more on medicines to solve their health, and become more confused. Practical implications – This study suggests that there is a need to consider consumers' perceptions of benefits and costs of DTCA when deciding whether to introduce it (e.g. in Australia) or remove it (e.g. New Zealand). Further, at least for older consumers, providing large quantities of information may increase cognitive demands without producing additional benefits. Originality/value – The majority of previous studies of DTCA have used either student samples (with manipulated salience of information) or general population surveys. This study utilised a sample of older adults, including 55 per cent with arthritis and 13 per cent with diabetes. Further, as this study used US ads with an Australian population, one can be confident that participants' knowledge of the medications was purely from the ads read and not from previous exposure.

Trajectories of depression and their relationship with health status and social service use (Conference paper)

Hern Chia Chiu et al. — Mon, 10 Oct 2011 21:13:58 PDT

An exploratory study of older adults' perceptions of DTCA for prescription medications

Sandra C. Jones et al. — Mon, 10 Oct 2011 20:33:36 PDT

There are many arguments for and against Direct-To-Consumer-Advertising (DTCA) and their impact on the consumer. A study involving 97 older consumers was carried out to investigate their perceptions about long or short versions of written DTCA for arthritis or diabetes medication. The results indicate that even though the ads may improve doctor-patient discussion about medications, they would not necessarily empower them to make decisions. Some of the consumers also believed that DTCA might cause people to ask for inappropriate medicines, become confused and possibly stop seeking medical advice.

Building research capacity through community-based projects

Kathryn M. Weston et al. — Mon, 10 Oct 2011 20:02:49 PDT

Research during general practitioner (GP) training has historically been underrepresented in the medical curriculum. Few GPs in Australia have postgraduate research qualifications and few engage actively in research. The development of an integrated and innovative curriculum at an Australian university provides a unique opportunity to embed research and critical analysis (RCA) at every stage of the programme.

Managing mouth and skin care post chemotherapy/radiotherapy

Judy Mullan — Mon, 10 Oct 2011 20:02:45 PDT

After reading this article, the pharmacist should be able to: • Provide a customer with information about appropriate mouth care during and following chemotherapy and radiotherapy. • Recommend appropriate therapy for gastrointestinal symptoms experienced post-chemotherapy and radiotherapy. • Provide a customer with information about appropriate skin care following chemotherapy/radiotherapy.

Integrating research teaching and experience into a graduate medical curriculum

Judy Mullan et al. — Mon, 10 Oct 2011 20:02:43 PDT

Few Australian medical practitioners have post-graduate research qualifications or engage actively in research and many graduating doctors believe their knowledge of basic research skills is lacking (Millar, 2009). In developing a medical curriculum for the new Graduate School of Medicine (GSM), at the University of Wollongong, we took the opportunity to embed and integrate research and critical analysis (RCA) throughout the 4-year postgraduate program with the long-term aim of developing research-aware doctors practising evidence-based medicine. As part of the RCA program, all students conduct their own community-based research project during their 12-month placement in a regional or rural area of New South Wales. Their research project aims to consolidate and expand the research skills introduced throughout the curriculum since its commencement in 2007. This presentation reports on the success of the program in providing important research experience and skills.

To develop and trial a new warfarin education program

Judy Mullan — Mon, 10 Oct 2011 20:02:40 PDT

The principal purpose of this study was to identify, develop and trial a new warfarin education program to enhance warfarin knowledge, management and compliance in a wider patient population, inclusive of the ‘high risk’ group. This ‘high risk’ group included patients who were elderly, had low literacy skills and came from non-English speaking backgrounds.

Effective patient education is a central part of the practice of all health professionals because it helps to ensure safe and effective warfarin management. With recent increases in warfarin prescribing and warfarin-related adverse drug events the need for an effective patient warfarin education program is more apparent.

The study aims to improve currently available warfarin education programs delivered to warfarin prescribed patients in a home-based setting. The new program is conceptually based on five key elements: improved health professional/patient communication and partnerships; improved warfarin compliance; simple, easy-to-read warfarin information, improved continuity of care between hospital and community settings; and improved patient follow-up. Unfortunately, during the course of the study, many similar strategies and interventions targeting these key elements were incorporated into the customary program, as well as the new program, which may have impacted on the final results of the study.

The study was conducted from February 2003 to February 2004, on consenting patients who were prescribed warfarin and admitted to Illawarra Health’s The Ambulatory Care Team (TACT). This prospective study included 50 intervention patients receiving the new warfarin education program, and 52 control patients receiving the customary warfarin education program offered to TACT patients. Many of these patient participants also came from the ‘high risk’ group, which included; the elderly, those with low literacy skills and those from non-English speaking backgrounds.

The evaluation phase of the study involved comparing and contrasting the effectiveness of the new warfarin education program against the customary warfarin education program, in terms of the patients’ warfarin knowledge, management and compliance. The patients’ satisfaction with the information received and their therapeutic outcomes (therapeutic INR scores, healthcare visits and warfarin-related adverse drug events) were also compared and contrasted between the two programs.

The findings of this study suggest that the new warfarin information booklet (APPENDIX 12) was written in a better quality, easier-to-read format, than was the Boots warfarin information booklet (2003). Overall, the trend in the results suggested that the new warfarin education program more effectively educated patients, including the ‘high risk’ patients, about their warfarin therapy, as compared to the customary warfarin education program. The patients receiving the new warfarin education program were more knowledgeable about their warfarin, more confidently managed and complied with their warfarin therapy at home, and achieved better therapeutic outcomes, than did patients who received the customary warfarin education program. Interestingly, both the new and the customary warfarin education programs used in this study appeared to be more effective than other available warfarin education programs, achieving better warfarin knowledge scores and therapeutic outcomes, with fewer warfarin-related adverse drug events and healthcare visits.

The implications of this study are that by targeting the five key elements of an effective warfarin education program we can help to improve warfarin knowledge, management and compliance in many patients, including those from the ‘high risk’ group. Education based on the five key elements empowers patients to make educated decisions about their warfarin therapy; which in turn help to optimise their warfarin-related therapeutic outcomes and minimise warfarin-related adverse drug events.

One of the major benefits of this research, is that the five key elements of an effective patient education program, used in this new warfarin education program, can be generically applied to other patient medication education programs.

An investigation into the potential barriers associated with warfarin prescribing in an elderly population residing in Illawarra-based aged care facilities

Judy Mullan et al. — Mon, 10 Oct 2011 20:02:37 PDT

Prescription medication borrowing and sharing: risk factors and management

Janette Ellis et al. — Mon, 10 Oct 2011 20:02:35 PDT

Prescription medication borrowing and sharing is a behaviour that has been identified in patients of all ages. This behaviour is recognised by medical researchers and government health authorities as a potential risk factor in adverse drug events across the community. Objective This article discusses prescription medication borrowing and sharing and identifies populations more likely to participate in this behaviour. It also focuses on the classes of drugs identified in the research literature as those being more likely to be borrowed or shared. Discussion Prescription medication borrowing and sharing behaviours have been associated with several risk factors such as polypharmacy and multiple chronic comorbidities. General practitioners and health professionals are therefore encouraged to counsel patients, at the time of issuing prescriptions and following discharge from hospital, on the risks of borrowing and sharing prescription medications and the safe disposal of ‘left over’ prescription medications.

Patient Education

Judy Mullan — Mon, 10 Oct 2011 20:02:31 PDT

Strategies to Improve Student Reaction to Group Work

L. Kriflik et al. — Mon, 10 Oct 2011 20:02:27 PDT

After receiving negative feedback from students and tutors about their group work experiences in a health subject, strategies to resolve these collaborative learning issues were considered. The objectives were to facilitate student ability to resolve group work issues, highlight group work as an important graduate attribute and to improve perceptions of the benefits of group work. A literature review assisted in identifying several strategies that had been used elsewhere to resolve issues similar to those raised by the students in this study. Consequently a number of support resources were designed for the revised delivery of the subject to the next cohort of students. These included a structured introduction to elements of group work and several strategies to improve the group work experience. At the conclusion of the subject students indicated that the group work experience was of value. The overall response suggested that active tuition in the elements of group work contributes positively to student understanding of both the process and group dynamics.