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Biomedical subjects

Albert Bakker

Publications and source records attributed to Albert Bakker.

9 recordsLinked to original sources
PubMed2005

Initial benzodiazepine use and improved health-related quality of life.

OBJECTIVE: The health-related quality of life (HRQOL) of initial benzodiazepine users was measured over time. Furthermore, benzodiazepine usage characteristics as determinants of change in mental and physical health status of the benzodiazepine users were examined. METHODS: In the only pharmacy of a Dutch community of 13,500 and during four months from November 1994, all patients with a benzodiazepine prescription and no history of benzodiazepine use over a period of 12 months before inclusion, were invited to participate. A total of 106 initial benzodiazepine users were matched for age and gender. In a six-month follow-up study, HRQOL was measured with the RAND-36. Consequently, in a nested case control design, determinants of change in mental and physical functioning over the six-month period were analysed using the Mental Component Summary and the Physical Component Summary. RESULTS: At baseline, initial benzodiazepine users showed a lower HRQOL as compared to reference subjects. After six-month follow-up, benzodiazepine users presented an absolute increase in HRQOL, while the reference subjects maintained a stable HRQOL. Diazepam and the male gender were associated with an increase in physical functioning over time. Younger age, a lower daily dose (DDD < 0.75) and a period of use between 16 and 60 days were associated with better mental functioning over time. CONCLUSION: This study is one of the first to associate improvement in HRQOL over time of starting benzodiazepine users with specific usage characteristics, such as limited duration of use and a low dosage.

Adult↗
PubMed2004

Effects of a management technician on structured working in Dutch community pharmacies.

OBJECTIVE: To study the effects of 'stepwise working with the help of a management technician' on structured working with regard to patient education in a sample of Dutch community pharmacies. METHODS: The intervention program provided the management technician with knowledge, tools and skills needed for the organisation of patient education activities in her community pharmacy. Twenty-eight pharmacies were selected for the study. After matching, each pharmacy was randomly assigned to either the experimental or control group. In the pharmacies of the experimental group, a technician was selected to become the management technician. MAIN OUTCOME MEASURES: Pharmacy technicians were assessed by means of written questionnaires at baseline and immediately after the intervention (12 months). The outcomes were the variables that were directly targeted by the intervention, and included technicians' perception of the availability of policy plans, support for patient education activities towards their implementation, evaluation, and provisions for continuity. RESULTS: After 12 months, the following indicators for structured working were noted to have increased in the experimental group compared to the control group: the technicians in the experimental group more often reported an awareness of policy plans, less lack of continuity of activities, support and evaluation for implementing patient education activities. We also observed that the control group had a higher baseline level and the effects on support and evaluation showed differences between pharmacies. The observed increases were more pronounced in pharmac higher exposure to the intervention, and in the case of support and evaluation relevant in this more exposed group. CONCLUSION: We found indications for effects of the intervention program, especially in the pharmacies with increased exposure. However, results could be influenced by regression to the mean, as the control group started with a higher mean than the experimental group. We conclude that technicians' participation in the management of patient education activities appears to be effective when she has a minimum of hours to spend on this task in her pharmacy.

Accreditation↗
PubMed2003

Initial 3-month usage characteristics predict long-term use of benzodiazepines: an 8-year follow-up.

OBJECTIVE: The aim of the study was to identify initial usage predictors for prolonged benzodiazepine use. METHODS: An 8-year pharmacy data-based study (1983-1992) was carried out on a retrospective cohort of 425 initial benzodiazepine users. The setting was the only pharmacy in a community of 13,500 people. RESULTS: Among the 425 initial users, 36% had a single initial exposure year, 50% had two to seven exposure years, and 14% had benzodiazepine use during all 8 years of follow-up. Prolonged use over more years was associated with an initial high number of prescriptions, elderly patients and initial use of hypnotics. Two patterns of irregular prolonged use were investigated: increase in use was associated with a shorter length of the first usage period and switching to another benodiazepine during the first 90 days; relapses of use were associated with a shorter length of first usage period and initial use of an anxiolytic. Gender and initial dosage were not associated with prolonged use at all. CONCLUSION: During the first 90 days after initiation of benzodiazepine use, a number of determinants of prolonged benzodiazepine use were visible. The prescribers of these drugs and the pharmacists should advise rational use not only at the start but also at the moment of the first repeat prescription in order to prevent needless prolonged use and dependence.

Adult↗
PubMed2003

The impact of attitudes and beliefs on length of benzodiazepine use: a study among inexperienced and experienced benzodiazepine users.

Prolonged benzodiazepine use is a widespread phenomenon in medical practice. In the present article, we argue that psychological models may contribute to our understanding of benzodiazepine use. This study examined variables derived from the theory of planned behaviour and the health belief model in relation to the length of benzodiazepine use. Data were collected from a sample of all benzodiazepine users with a request for this medicine in the only pharmacy in a Dutch community (N=467). Determinants of the length of benzodiazepine use were analysed separately for inexperienced and experienced users using structural equation modelling (SEM) analyses. For both groups, results showed that the intention to use benzodiazepines was a predictor of length of use. Attitudes towards benzodiazepine use had an indirect influence on length of use, through intentions. Furthermore, a positive attitude toward using benzodiazepines was related to the perceived norm of the prescriber. Experienced users were more inclined to consume benzodiazepines when they had less control over drug taking. In this group, the belief that benzodiazepine use leads to dependence was associated with less control over drug taking and a high intention to use the drug. In addition, older experienced users reported a higher intention to use the drug. For inexperienced users, the perceived attitude of the prescriber towards use of the medicine was a strong determinant. Finally, results of SEM-analyses showed that the model accounted for far more variance in behaviour for experienced users (67%), than for inexperienced users (18%).

Adult↗
PubMed2002

Community pharmacy and patient-oriented activities: the Dutch case.

This article reviews the implementation of patient education as a new task in Dutch Community pharmacy. A search of the literature, including 'grey' (not-scientific) literature was done to find indications for the implementation of patient education. The little data available show that patient education activities are not carried out as a routine task and are therefore not implemented, despite the development of interventions on educational and pharmacy practice level. In addition, barriers were found that relate to the organisation of patient education. More sound research is necessary on criteria for implementation, on the level and amount of communication with clients and on the experienced barriers for organising and practising patient education. The opportunities for designing an intervention on the organisational level should be assessed.

Humans↗
PubMed2002

Patient oriented activities in Dutch community pharmacy: diffusion of innovations.

OBJECTIVES: To explore the implementation of patient oriented activities, the perception of an innovation aimed at implementation of patient education and the preconditions for implementation of this innovation among Dutch pharmacists. METHOD: A survey, based on Roger's theory of diffusion of innovations, was carried out among a random sample (n = 300) of Dutch managing pharmacists. MAIN OUTCOME MEASURES: Reported activities regarding patient education, medication surveillance and drug therapy meetings, as well as perception of the innovation and its perceived compatibility with pharmacy practice. RESULTS: The response rate was 49.3%. Hundred (84.7%) respondents reported to provide extra written and verbal information with first prescription medication. Medication surveillance (100% check by computer, and check of the lists by the pharmacist) was reported by 43 (36.4%), and complete participation in drug therapy meetings was reported by 57 (48.3%) respondents. Observability (or results to others) of the new strategy was perceived as important by 90 (77.6%), compatibility (perceived consistency with existing values, past experiences and needs of potential adopters) by 87 (76.4%) and trialability (degree to which an innovation may be experimented with) by 81 (69.8%) respondents. Relative advantages (perception of the innovation as being better) and complexity (relatively difficult to understand and use) of the innovation were perceived as important by less respondents. The preconditions that were met by most pharmacists were 'financial resources' (n = 70; 59.8%), 'enough workspace' (n = 61; 53.1%) and 'enough time' (n = 58; 50%). Fifty-eight (49.2%) respondents intend to adopt the innovation, but this intention would be higher when more time and money and technicians are available, as well as less situations that are experienced as barriers (rush hours, lack of support, illness of employees). CONCLUSION: Based on the definitions used, we conclude that the implementation of medication surveillance and drug therapy meetings is relatively low compared to patient education. The development of an implementation tool is justified, but should deal with the experienced preconditions, barriers and needs of pharmacists. Combined, comprehensive pharmacy interventions promise to be a good way to change pharmacy practice.

Adult↗
PubMedDate not supplied

Comparing patterns of long-term benzodiazepine use between a Dutch and a Swedish community.

BACKGROUND: There is much concern about the widespread long-term use of benzodiazepines. Utilisation data can give a foundation for interventions for appropriate use. OBJECTIVE: To compare long-term usage patterns of benzodiazepines in a Dutch and a Swedish community in different periods. METHODS: Eight-year follow-up patterns of use were investigated with respect to the characteristics of those who continued use over the whole follow-up period. In the Dutch community of 13,500, the data of a cohort of 1358 benzodiazepine users were analysed during the years 1984-1991; in the Swedish community of 20,000 people, a cohort of 2038 benzodiazepine users was followed from 1976. RESULTS: At the end of the follow-up period, 32.9% of the Dutch cohort and 33% of the Swedish cohort had continued use of benzodiazepines. The two overall survival curves showed similar patterns. Stratification for age, gender, previous versus initial use and heavy versus non-heavy use showed comparable proportions of patients continuing benzodiazepine use over time. CONCLUSION: The parallels in the results of two cohorts in different countries and different periods are striking and give support to the idea to stimulate interventions to reduce long-term benzodiazepine use.

Adolescent↗