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  • 1
    Electronic Resource
    Electronic Resource
    Predictors for prophylactic antithrombotic prescribing in ischaemic heart disease and the impact of national guidelines (2000)
    Springer
    European journal of clinical pharmacology 56 (2000), S. 739-746 
    Details
    ISSN: 1432-1041
    Keywords: Ischaemic heart disease Angina pectoris Myocardial infarction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract. Objectives: Assessment of predictors for initiating prophylactic antithrombotic prescribing for patients newly diagnosed with ischaemic heart disease (IHD) and the impact of the introduction of national guidelines. Design and setting: A retrospective case control study was performed using pharmacy prescription data from 120,000 Dutch patients over a 5-year period. IHD patients were identified using as a marker multiple nitrate prescriptions [anatomical–chemical–therapeutic (ATC) code C01D] indicating chronic use. Initiation of antithrombotic therapy was likewise identified using ATC codes B01AA and B01AC (oral anticoagulants and thrombocyte aggregation inhibitors), prescribed within 6 months following the first nitrate prescription. Statistically significant (P〈0.05) predictors were assessed using multivariable analysis considering patient, prescriber and medication characteristics. Results: Of the 2598 patients who met specified inclusion criteria for newly diagnosed IHD, approximately 35% was not prescribed any type of antithrombotic therapy. Male patients [odds ratio (OR) 2.4, 95% confidence interval (CI) 2.0–2.9], patients with cardiovascular (other than IHD) and diabetic co-morbidity (OR 6.4, 95% CI 4.8–7.9 and OR 1.6, 95% CI 1.1–2.1, respectively) and patients using isosorbide mononitrate rather than isosorbide dinitrate as anti-ischaemic main therapy (OR 2.1, 95% CI 1.3–2.5) were most likely to be prescribed antithrombotic therapy. Furthermore, initiating antithrombotic prescribing was more likely after the introduction of national guidelines (OR 1.4, 95% CI 1.1–1.7). Conclusions: Initiating antithrombotic prescribing in newly diagnosed IHD patients can be predicted by patient gender, certain co-morbidity and main type of nitrate therapy. The introduction of national guidelines has resulted in an increase of prophylactic antithrombotic prescribing in accordance with their contents.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280000221
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  • 2
    Electronic Resource
    Electronic Resource
    Rational pharmacotherapy in The Netherlands: formulary management in Dutch hospitals (1999)
    Springer
    Pharmacy world & science 21 (1999), S. 74-79 
    Details
    ISSN: 1573-739X
    Keywords: Pharmacotherapy ; Hospital pharmacists ; Formulary management ; Formulary agreements ; Formularies ; Prescribing restriction ; The Netherlands ; D&T committees ; Antibiotic policies ; Drug management ; Disease management ; Treatment guidelines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract A survey regarding the management of rational pharmacotherapy was conducted among all Dutch general hospitals in 1998. The response was 99% (n = 120). The presence of a drugs and therapeutics committee and antibiotic policies in Dutch general hospitals appears independent of hospital characteristics. However, formulary agreements and treatment guidelines are less likely to be present in hospitals that employ only 1 pharmacist or those served by community pharmacies. More than half of the hospitals claim to have restrictive formulary agreements. Large hospitals, hospitals in the eastern and southern provinces and those served by hospital pharmacies more often tend to have restrictive agreements compared to small hospitals, hospitals in the northern, central, and western provinces, and those served by community pharmacies. Various methods to impose restriction and ensure formulary compliance are mentioned. It must be noted that hospitals tend to operate rather solely regarding the large number of different formularies. Surprisingly just a small majority of pharmacists evaluates formulary agreements positively as a management tool. Many drawbacks appear to be present. The results of this survey indicate that in the future Dutch hospitals will favour disease management (treatment guidelines) over drug management (formulary agreements) in the management of rational pharmacotherapy and that information technology will be used to influence clinicians' prescribing behaviour.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008654609916
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  • 3
    Electronic Resource
    Electronic Resource
    Prescription data as a tool in pharmacotherapy audit (I) general considerations (1999)
    Springer
    Pharmacy world & science 21 (1999), S. 80-84 
    Details
    ISSN: 1573-739X
    Keywords: Feedback ; Prescription data ; Audit ; Prescribing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract This article discusses how prescription data that are available from pharmacies can be used as a tool to support the improvement of prescribing behaviour. For the optimal use of prescription data in pharmacotherapeutic audit, the specific aim of the audit meeting must be clear. Next, appropriate measures (quality of drug choice, volume, cost) have to be selected for the presentation and discussion of prescribing. For several aims of audit meetings, suggestions for adequate measures are given. For each stage of behavioural change the article describes why and how prescription data can provide a useful contribution. Finally, recommendations are given regarding prerequisites for the optimal use of prescription data. Important factors are that the prescription data should sufficiently cover the physicians' patient population, information regarding the extent of repeat prescribing is needed, and the prescribing of drugs with multiple indications can cause difficulties with the interpretation of the graphs. With this information in mind, feedback on prescribing can be tailored to the audit groups' needs and targeted to the intervention that is pursued.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008617832536
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  • 4
    Electronic Resource
    Electronic Resource
    Antidepressant drug choice for first users in two regions in the Netherlands (1999)
    Springer
    Pharmacy world & science 21 (1999), S. 132-136 
    Details
    ISSN: 1573-739X
    Keywords: Antidepressant drugs ; Drug utilization ; Pharmacotherapy ; Pharmacoepidemiology ; Therapeutic decision making
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Objective: To map the prescribing habits of physicians in two different regions in the Netherlands with respect to antidepressant drug choice for first users. Design: Retrospective follow‐up study. Methods: All persons who received an antidepressant drug for the first time during October 1994 to September 1995 were identified from 29 community pharmacies situated in two regions in the Netherlands. Age, gender, type of prescriber, region and the concomitant use of certain groups of drugs as marker for certain diseases were evaluated as determinants for prescribing either a “classic” or a “second generation” antidepressant drug to first users using logistic regression analysis. Results: We identified 4,637 first users during the study period corresponding with an overall incidence density of 16 per 1,000 person‐years. For the majority of first users of both regions, the same five antidepressants were prescribed. However, the two regions differed markedly with regard to the frequency of prescription of the individual antidepressants. Region of living was identified as the most important determinant of prescribing a certain category of antidepressant drugs to first users (OR 2.9 [95%CI 2.5‐3.3]). Just a few patient characteristics were associated with antidepressant drug choice. The elderly were more likely to receive a classic antidepressant, as were patients concomitantly using anti‐epileptics (OR 0.4 [95%CI 0.3‐0.6]). Patients concomitantly using cardiac glycosides were more likely to receive a second generation antidepressant (OR 1.8 [95%CI 1.2‐2.1]). With respect to age and the other patient characteristics studied, the same pattern was observed in both regions. Conclusion: Regional differences contributed more to differences in prescribing habits than individual patient characteristics. In order to improve pharmacotherapy with antidepressant drugs relevant patient characteristics should more be taken into account.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008675402004
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  • 5
    Electronic Resource
    Electronic Resource
    Quantification of communication processes, is it possible? (1999)
    Springer
    Pharmacy world & science 21 (1999), S. 195-199 
    Details
    ISSN: 1573-739X
    Keywords: Coding patient‐questions ; Patient counselling ; PAS® system ; Pharmaceutical care consultations ; Pharmacy ; Quantification communication process
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The PAS® system (Problem‐Analysis‐Solution‐system) is developed to quantify oral communication processes during counselling in pharmacy practice. The pharmacist translates the patients' drug‐related questions into a P‐code, the analysis of the question into an A‐code and finally the given solution upon the question into a S‐code. The PAS® system has been developed for two goals. First, for the registation of drug‐related questions from patients which gives the pharmacist insight in the most common issues addressed by patients. Second, it might help the pharmacist to structure the communication with the patient during the consultation. Forty‐one pharmacists participated in the evaluation of the PAS® system. The validation of the PAS® system consisted of two phases: the external validation and the internal validation. Kappa values were calculated as a measure of agreement in the coding by the pharmacists. The kappa‐value of the external validation for the P ‐, A‐ and S‐codes for the total set of questions indicate a moderate to poor agreement. This means that pharmacists categorize drug‐related questions from patients in a different way. Therefore we conclude that the PAS system is less reliable for research purpose. The kappa‐value of the internal validation for the P‐code varies from 0.42 to 0.91. For the A‐code it varies from 0.07 to 0.35 and for the S‐code from zero to 0.68. Internal reproducibility is good for P‐code but not for the A‐code and S‐code This implies that the pharmacist can use the P‐codes for registration of patients' questions in his own pharmacy. Moreover, the usage of the PAS® system during counselling in pharmacy practice can structure the consultation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008750110130
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  • 6
    Electronic Resource
    Electronic Resource
    Patient education to users of oral hypoglycemic agents: the perspective of Dutch community pharmacists (1999)
    Springer
    Pharmacy world & science 21 (1999), S. 200-204 
    Details
    ISSN: 1573-739X
    Keywords: Adherence ; Community pharmacy ; Diabetes mellitus type 2 ; General practitioner ; Implementation ; Oral hypoglycemic agents ; Patient education ; Pharmaceutical care ; Side effects ; Pharmacy technician
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The purpose of this study was to indicate which patient education activities directed at users of oral hypoglycemic agents are desirable in Dutch community pharmacies and to explore which preconditions should be considered when implementing the desired activities. A qualitative study was conducted with a panel composed of seven pharmacists and seven technicians with considerable experience in giving advice to people with diabetes mellitus type 2. A consensus method was used, which consisted of a written questionnaire and a feedback discussion, to determine which activities were considered desirable and to identify which other health care providers should be involved. The way these activities should be implemented was explored by a focus-group discussion. The following goals of patient education activities were studied: 1) adherence to the dosage regimen, 2) adherence to lifestyle advices,3) gaining awareness of effects and 4) self-monitoring. According to the members of the panel, patient education activities should be directed primarily at stimulating adherence to the dosage regimen, increasing awareness of side effects and improving the correct technical use of blood glucose meters. Activities directed at lifestyle advice seemed to be less desirable to the pharmacy staff. Preconditions that should be considered when implementing these activities were structural cooperation with GPs and diabetic nurses and specialization of tasks of pharmacy technicians. Our results indicate that deepening of existing tasks, such as stimulating adherence to the dosage regimen is desirable in developing patient education activities at users of oral hypoglycemic agents.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008721003906
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  • 7
    Electronic Resource
    Electronic Resource
    Prescription data as a tool in pharmacotherapy audit (II) the development of an instrument (1999)
    Springer
    Pharmacy world & science 21 (1999), S. 85-90 
    Details
    ISSN: 1573-739X
    Keywords: Feedback ; Prescribiog data ; Computert
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract In many countries, prescription data are used as an instrument to provide feedback on prescribing. This article describes the development and implementation of a computer program as a tool for pharmacotherapy audit meetings and it illustrates the possibilities of such a program. The program was developed to support the optimisation of prescribing in the various stages of behavioural change. It enables pharmacists to make sophisticated overviews of prescribing by physicians in their audit group and furthermore, pharmacists can conduct drug utilisation studies or pharmaco‐epidemiological studies in their own patient population. Forty percent of Dutch pharmacies have purchased the computer program since its introduction; it was distributed together with a technical handbook and a course book, which elaborated on the types of graphs available and their interpretation. An educational course was developed regarding the optimal selection and interpretation of graphs. Examples of prescription data as a tool to support various aims of audit meetings are given. The program is acknowledged as a welcome contribution to pharmacotherapy audit and to the pharmacists' advisory role in pharmacotherapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008665731627
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  • 8
    Electronic Resource
    Electronic Resource
    The quality of Dutch hospital drug formularies: Evaluation of technical features and organisational information (1999)
    Springer
    Pharmacy world & science 21 (1999), S. 120-126 
    Details
    ISSN: 1573-739X
    Keywords: Classification ; Drug and therapeutics committees ; Drug policies ; Drug selection ; Generic prescribing ; Out‐patients' prescribing ; Pharmacotherapy ; Prescribing policies ; Quality assurance ; Seamless care ; User‐convenience
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Introduction: Hospital drug formularies (HDFs) are widely used tools to help influence clinicians' prescribing behaviour. Besides the therapeutic quality of HDFs, the available information and the way in which this is presented are key factors in HDFs' success or failure to influence prescribing behaviour and enhance prescribing quality. This research evaluates the technical features and organisational information of Dutch HDFs. Methods: Seventy‐two (75%) of all Dutch HDFs were evaluated based on criteria retrieved from international literature and additional criteria drafted by occupational groups working with HDFs. Aspects that were studied were physical appearance and layout, practicability with respect to the available information and how easily this could be retrieved from the HDFs, information regarding drug choice policies such as seamless care, and the available type of therapeutic and pharmaceutical information. Results: Thirty‐three (46%) of the HDFs were less than 3 years old. Physical appearance of all HDFs was very well looked after. Two (3%) HDFs were disease‐oriented rather than drug‐oriented. Changes from pre‐admission therapy were addressed in 30 (42%) of the HDFs, but other seamless care policies were addressed in less than 20% of the HDFs. Finally, less than 50% provided therapeutic information that clinicians indicated as important. Discussion: Although Dutch HDFs are technically practicable with respect to user‐convenience, practice‐oriented features are capable of improvements. Furthermore, Dutch HDFs lack important clinical information for daily practice. To enhance seamless care across healthcare, generic prescribing and prescribing on admission from and discharge to any other sectors should be addressed more specifically.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008680021854
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  • 9
    Electronic Resource
    Electronic Resource
    Rational pharmacotherapy and clinical practice guidelines Theories and perspectives on implementing pharmacotherapeutic treatment guidelines (2000)
    Springer
    Pharmacy world & science 22 (2000), S. 152-158 
    Details
    ISSN: 1573-739X
    Keywords: Bandura's social cognitive theory ; Clinical practice guidelines (CPGs) ; Dissemination ; Fox' barriers to adoption ; Healthcare model of change ; Implementation ; Pathman's awareness‐to‐adherence model ; Pharmacotherapeutic treatment guidelines (PTGs) ; Rogers' innovation‐diffusion theory
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Several theories behind implementing clinical guidelines have been described within the literature. At first sight, these may seem different. However, there are similarities and eventually they are rather complementary than mutually exclusive. This article integrates several theoretical views on implementation of pharmacotherapeutic treatment guidelines and subsequently addresses some empirical considerations. Furthermore, specific limitations and potential harms of implementating guidelines are addressed. Several checklists are provided in order to make pharmacists, pharmacologists and clinicians aware of perspectives on dissemination, implementation, and subsequent application of pharmacotherapeutic treatment guidelines.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008727528545
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  • 10
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    Predictors for prophylactic antithrombotic prescribing in ischaemic heart disease and the impact of national guidelines (2000)
    Springer
    Details
    Publication Date: 2000-11-21
    Print ISSN: 0031-6970
    Electronic ISSN: 1432-1041
    Topics: Chemistry and Pharmacology , Medicine
    Published by Springer
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