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Biomedical subjects

D B Christensen

Publications and source records attributed to D B Christensen.

At least 19 recordsLinked to original sources
PubMed1991

The Health of the Public Program at the University of Washington: a new role for academic medical centers.

The University of Washington Health of the Public Program has convened a consortium composed of the region's academic medical center, the two largest managed care plans in Washington, and representatives of the state's major private and public purchasers of health care. The consortium's purpose is to test the feasibility of collaboratively collecting cross-system data, assessing variations in practice, and implementing site-specific interventions to improve the management of common illnesses and encourage preventive care. Changes under way in the ambulatory training environment and in the undergraduate curriculum as a result of the consortium's initial efforts are described. In today's climate of cost consciousness and concerns about quality, academic medical centers can play an important role in helping to improve community-wide outcomes of care.

Academic Medical Centers↗
PubMed1990

Medical and psychosocial factors predictive of psychotropic drug use in elderly patients.

The purpose of this study was to investigate medical and psychosocial factors that may be used to identify patients at risk of psychotropic drug use. Population-based surveys were completed by 278 elderly health maintenance organization (HMO) patients in August 1984. Physical and mental health status and social support were measured in the survey. Automated prescription records from the year prior to and the year after the survey were linked to data from the survey. Patients received 737 prescriptions for psychotropic drugs during the two-year period under study. Doxepin (20.2 percent), flurazepam (15.2 percent), and diazepam (14.8 percent) were dispensed most frequently. Nearly 30 percent of the patients received a prescription for at least one psychotropic drug during the two-year period, and 14 percent received at least one prescription during both years. Three significant predictors of subsequent psychotropic drug use were: prior use (odds ratio = 17.2, 95% CI = 6.25, 47.33), the number of physical impairments (OR = 1.73, 95% CI = 1.05, 2.84), and the respondent's rating on the Alameda Health Scale (OR = 1.65, 95% CI = 0.99, 2.75). Patients' self-reported mental health status and sociodemographic characteristics were not significant predictors of subsequent use.

Age Factors↗
PubMed1990

Prospective comparison of patient tolerance to enteric-coated vs nonenteric-coated erythromycin.

Erythromycin base and its salts are frequently used in clinical practice. The most frequent side effects of oral erythromycin preparations are gastrointestinal. Various salts and enteric coatings have been developed without adequate comparison in regard to gastrointestinal side effects. The overall incidence of gastrointestinal side effects (abdominal pain and cramps, nausea, vomiting, diarrhea, and gas) of two common erythromycin base formulations, Erythromycin Base Filmtab (Abbott), a nonenteric-coated base tablet, and Eryc (Parke-Davis), a pelletized, encapsulated, enteric-coated base capsule, were compared in 368 adults at two dosage levels (1 g/d and 2 g/d). Minimal differences were found when target symptoms were compared by preparation coating. In contrast, subjects receiving erythromycin at the 2-g/d dosage level reported higher incidence rates for each of the target symptoms, regardless of product coating, than did those patients treated at the 1-g/d dosage level. Enteric coating of erythromycin base offers little protection from the common dose-related gastrointestinal adverse effects of oral erythromycin.

Administration, Oral↗
PubMed1989

Use and misuse of metered-dose inhalers by patients with chronic lung disease. A controlled, randomized trial of two instruction methods.

Metered-dose inhalers are often used incorrectly by patients with chronic airflow obstruction, and there is a lack of controlled studies designed to evaluate methods to teach the correct use of these devices. Therefore, we screened 100 consecutive stable outpatients for correct or incorrect inhaler use and then conducted a randomized trial of two methods to teach correct use. Patients were classified as correct or incorrect users with a modified metered-dose inhaler containing a thermistor that detected inspiration, inhaler activation, and the duration of breath-holding. Patients were classified as incorrect users if they failed to: (1) activate the inhaler once during inspiration, and/or (2) hold their breath at the end of inspiration. There were 38 correct users and 62 incorrect users. Incorrect users were randomized to one of two teaching protocols: (1) standardized verbal instruction alone, or (2) standardized verbal instruction plus an automatic visual signal during inspiration. Incorrect users were restudied 6 to 10 wk later to reassess technique. Both treatment protocols were equally effective in converting incorrect user. However, the verbal instruction alone required significantly less time than the instruction with the mechanical aid. For all subjects, the proportion using correct technique declined over time, particularly for incorrect users. We also examined a series of patient characteristics, obtained by questionnaire and spirometry, to determine whether they could be used in the clinical setting to identify incorrect users. By discriminant analysis, a group of four variables predicted correct metered-dose inhaler use: bronchodilator responsiveness, a history of additional about proper technique, verbal knowledge of the correct inhaler maneuvers, and the patient's perception of whether it is important to use an inhaler.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

A psychosocial perspective in the explanation of patients' drug-taking behavior.

The goal of this study was to examine the applicability of the Health Belief (HBM) and Theory of Reasoned Action (TRA) models in predicting drug-taking compliance behavior among female patients with uncomplicated urinary tract infections. Thirty-eight percent of the respondents were compliant, 25% finished all of their medication, but missed one or more doses during the course of therapy, and 37% did not finish all of their medication as directed. Two HBM and three TRA variables had a statistically significant relationship with compliance: barriers and benefits (HBM) and belief strength, outcome evaluation, and behavioral intention (TRA). HBM variables explained 10% of the variance in the compliance variable. Adding the TRA variables to the model explained an additional 19% of the variance. Social influence variables (normative expectations, motivation to comply, and subjective norms) had a significant influence in the prediction of behavioral intention, but not in the prediction of compliance behavior. Suggestions for improving compliance based on these findings include: simplification of drug therapy by customizing and simplifying the regimen, continued patient reminders of the therapy's value, and benchmarks for patients to evaluate the success or failure of therapy. A frank and open discussion from the start of therapy about its complexity, the medication's side effects, time and fiscal constraints, and other factors which may modify patients' perception of the likelihood of compliance is an important key to improving patients' compliance behavior.

Adolescent↗
PubMed1987

Association between type of medication instruction and patients' knowledge, side effects, and compliance.

The authors measured knowledge about medication and its side effects, impact of side effects, and compliance in 30 chronic outpatients before and after they participated in two instruction sessions about their medication held one month apart. Instruction consisted of a verbal or a written and verbal presentation and minimum or maximum information about side effects. All patients' medication knowledge increased after both sessions. Those on high doses of neuroleptics given verbal and written information gained significantly more medication knowledge than those given only verbal information. After instruction, more patients knew about specific side effects, including tardive dyskinesia, and both patients given only verbal instruction and those given minimum information about side effects had fewer problems with side effects. Instruction did not affect compliance.

Adult↗
PubMed1985

Medication usage in an elderly population.

One hundred eighty-three independently living elderly residents of two federally subsidized, urban high-rise apartment buildings were interviewed in their homes to determine the numbers and types of medications they used and stored and their utilization of pharmacy services. From these interviews and observations, the frequencies of use of medications and pharmacy services and the prevalence of potential problems were determined. Results showed that 75% of interviewees used a prescription drug regularly, and 82% used a nonprescription drug regularly. Fifty-one percent had stored noncurrent prescription drugs, while 67% had noncurrent nonprescription drugs in their homes. The most common problems encountered were discrepancies between labeled dosage and dosage actually used, potential drug interactions, and underuse of medication. Findings that may contribute to the risk of future medication problems were the prevalence of noncurrent medications stored in homes, the respondents' lack of knowledge about recognition and management of adverse drug reactions, and the underutilization of pharmacists as drug therapy consultants.

Aged↗
PubMed1985

Evaluation of a digoxin pharmacokinetic monitoring service in a community hospital.

This study was done to determine the effects of a pharmacokinetic service (PKS) on digoxin concentration monitoring and patient outcomes, including length of stay and toxicity measures. Two-hundred and eighteen consecutive patients with digoxin concentrations outside a target range were studied using a prospective before and after design. Demographic, diagnostic, and digoxin monitoring data were collected. The after group received PKS intervention by a clinical pharmacist. Results showed that the number of digoxin sample obtained was reduced by 22 percent in the after group and plasma concentrations were less often in the toxic range. The after group had significantly shorter lengths of stay (15.3 vs. 11.6 d) and fewer incidences of in-hospital digoxin toxicity (11.1 vs. 2.2 percent). Clinical pharmacist intervention was found to be associated with significant changes in patient outcomes, including length of stay and morbidity. The cost of the PKS was offset by savings resulting from the reduction in digoxin assays alone.

Adult↗
PubMed1984

Monitoring a primary wholesaler depot program.

Techniques for monitoring a primary wholesaler depot program used by a university hospital pharmacy department are described. One year after the program began, data from the past four months, obtained from monthly management reports provided by the wholesaler, were reviewed. Attention was focused on the drugs and drug categories that represented the bulk of purchases (in dollar value). Summary purchase orders showed that approximately half the drugs were purchased at the most favorable prices (usually contract bid prices). Most drugs not purchased at the most favorable bid prices were accounted for by sole-source items, inadequate computer documentation by the wholesaler, and atypical orders. A study of ordering patterns revealed that 16 of the top 40 drugs ordered (by volume and dollar expenditures) were ordered less than once per month; the inventory management goal was to order a two-week supply. The wholesaler could not completely fill orders for 18% of the contract drugs, often because of back orders from manufacturers. Although the computerized management reports used in this study did not allow evaluation of all aspects of the primary wholesaler depot program, they provided a convenient mechanism for concurrent assessment of the program's effectiveness. The program appeared to be advantageous to the pharmacy department, and most problems encountered were easily remedied. Several performance measures for institutions considering depot programs are recommended.

Contract Services↗
PubMed1983

Nonmedical factors associated with the prescribing volume among family practitioners in an HMO.

The influence of selected variables on the prescribing volume of eighty family practitioners in a large HMO was quantified through multiple regression analysis. Over 70% of the variation was explained. The patient panel size and age composition were the most important determinants and accounted for 45.7% of the variance. The number of patients seen per clinic hour explained 14.3% and interclinic differences explained another 8.1% of the variance. Further, the data indicated two processes that might have affected results of earlier studies. First, female patients tend to select female physicians, as indicated by a high correlation between the sex of a physician and the proportion of females in the panels. Second, older physicians tend to have older patients. This implies that physician age does not explain higher prescribing rates, but is merely a proxy for older panels of patients who generally have more chronic illnesses and need more drugs.

Adult↗
PubMed1983

Pharmacy department costs and patient charges associated with a home parenteral nutrition program.

The pharmacy department costs of a home parenteral nutrition (HPN) program were identified, and the patient charges for HPN were compared with the charges for hospitalization for parenteral nutrition. Ten patients were randomly selected from 55 patients active in the HPN program at the University of Washington Hospital. Cost identification included quantification of supplies, personnel, equipment, freight, miscellaneous, and indirect costs. Patient charges were identified through billing documents. Charges included clinic visits and laboratory tests. Inpatient charges were identified in a similar manner and included a standard daily hospital charge. Average yearly costs to the pharmacy department were nearly +9000 per HPN patient. Patient charges for HPN were +48.19 per infusion day compared with +205.68 per infusion day for the hospitalized patient. The cost savings of HPN to the patient and the hospital were clearly demonstrated.

Costs and Cost Analysis↗
PubMed1983

Subjective assessment of patient outcomes of home parenteral nutrition.

The medical, financial and psychosocial impact of home parenteral nutrition (HPN) therapy on patients' lives was assessed. A questionnaire that solicited patient characteristics and therapeutic outcomes of HPN therapy, such as number of hospital admissions, physiological complaints, and psychosocial interferences, was sent to 49 patients currently participating in a HPN program based at a university hospital. Questionnaires were returned by 42 patients. HPN-related complications were responsible for 39% of all reported hospital admissions during the previous year; of these, 27% were related to HPN catheters. Patients reported few physiological complaints, except for cramping in the hands and feet. Patients who complained of diarrhea had significantly more physiological complaints and psychosocial interferences than those who did not. The majority of patients had medical insurance coverage, but 26% had to pay at least part of the costs of HPN therapy. Only 25% of patients who were able to work did so. Most patients believed that HPN therapy had a very positive effect on their lives. The majority of patients in this HPN program appear to have a reasonable quality of life.

Adult↗
PubMed1981

Documenting outpatient problem intervention activities of pharmacists in an HMO.

The outpatient drug use review experiences by pharmacists at a large health maintenance organization with on-site pharmacies were investigated. Pharmacists were asked to document the nature of potential drug therapy problems encountered, drug involved, review activities undertaken, and process-outcomes. Patterns of pharmacists intervention were observed over 1 year. Results indicated that the number of problems detected increased substantially during the months immediately following the introduction of problem recording and feedback procedures. During the latter months, the number of prescriptions with problems approximated 4 per 100 dispensed prescriptions. Drug interactions of a moderate nature and drug underuse were the most frequent problem types encountered. Most were not serious and usually resulted in a cautionary or counseling message given to patients by pharmacists. The next most frequently occurring type was drug overuse problems, and, after that, problems concerning some aspect of the prescribing decision. In 9 per cent of all problem interventions and in 44 per cent of prescribing-problem interventions, the outcome of the pharmacist intervention was a change in drug, strength or directions for use. The average amount of pharmacist time per problem intervention varied from 6.0 to 7.8 minutes across problem types. This approximate a pharmacist labor cost of $0.06 per dispensed prescription, given a problem encounter rate of 4 per 100 dispensed prescriptions.

Documentation↗
PubMed1981

A comparison of patient drug regimens as viewed by the physician, pharmacist and patient.

This study sought to determine the completeness and congruence of records for drugs ordered and received by outpatients. The setting was a large outpatient medical facility that was part of a large multispecialty hospital. It was found that a listing of current drugs orders (prepared by physicians) and a listing of current prescription drugs consumed (prepared from pharmacy drug profiles) each agreed 73 per cent of the time with a list of 107 prescription drugs actually consumed by 26 study patients. Lists were compared based on drug name, strength and directions for use. Further, the physician and pharmacy lists correlated with one another 70 per cent of the time, indicating a substantial degree of inconsistent as well as incomplete drug records within the same setting. In another comparison involving medical chart drug notations and pharmacy drug profiles, a complete match or drug name, strength and directions for use occurred in 39 per cent of the cases, while a match on drug name only occurred 64 per cent of the time. The highest degree of congruence occurred between hospital discharge medication notes and outpatient drug profile records. Based on the results of this study, the common assumption that drug records in such settings are congruent and complete appears unwarranted.

Drug Information Services↗
PubMed1978

Examining physicians' drug order recording behavior.

The study reports the impact of a computer-based drug profile upon physicians' drug order recording behaviors. The drug profile system, including information about both drugs ordered and prescriptions received, was implemented for a randomly selected group of Kaiser Foundation Health Plan members during 1973. The monthly updated profile was made readily accessible to physicians. Drug order notations entered by physicians on outpatient medical records were examined to determine if the availability of the profile influenced the completeness of drug-related data being recorded by physicians. Using an experimental design, the results indicated the availability of the profile did not influence the completeness of drug-related data recorded. Also, observation of the data generated for analysis suggests caution in assuming drug notations or prescriptions reflect complete and reliable drug use data.

Drug Information Services↗
PubMed1978

Drug-taking compliance: a review and synthesis.

Patient compliance in taking prescribed drugs is still not well understood despite numerous studies. The state of knowledge through 1976 is reviewed, with some methodological criticisms of compliance studies, and patient, provider, disease, and drug factors associated with compliance are analyzed. Until recently the lack of a well-developed theory or model of compliance behavior was a major problem. Some compliance models based on the health belief model are discussed, and an alternative adaptation of the latter is developed.

Drug Therapy↗