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Biomedical subjects

F M Haaijer-Ruskamp

Publications and source records attributed to F M Haaijer-Ruskamp.

At least 37 records · Page 2Linked to original sources
PubMed1999

GPs' treatment of uncomplicated urinary tract infections--a clinical judgement analysis in four European countries. DEP group. Drug Education Project.

BACKGROUND: Non-adherence to recommendations for treatment of uncomplicated urinary tract infections (UTI) is common, but the reasons are not sufficiently understood. OBJECTIVES: We aimed to assess and compare the influence of specific patient characteristics on GPs' treatment decisions for UTI in four European countries. METHODS: GPs in The Netherlands, Norway, Sweden and Germany were presented 18-26 case vignettes of UTI. Linear regression models were used to determine which patient characteristics predicted non-optimal decisions. RESULTS: Adherence to national recommendations varied both within and between countries, but there were remarkable similarities in the case characteristics predicting non-optimal decisions: a history of UTI and the patient's age were strongly related to prescription of second-choice antibiotics and longer treatment courses. CONCLUSION: In all countries many GPs were reluctant to follow the recommendations in UTI cases that they might perceive as being more complicated.

Adult↗
PubMed1999

Intervention research in rational use of drugs: a review.

Many studies have been done to document drug use patterns, and indicate that overprescribing, multi-drug prescribing, misuse of drugs, use of unnecessary expensive drugs and overuse of antibiotics and injections are the most common problems of irrational drug use by prescribers as well as consumers. Improving drug use would have important financial and public health benefits. Many efforts have been undertaken to improve drug use, but few evaluations have been done in this field. This article provides an overview of 50 intervention studies to improve drug use in developing countries. It highlights what type of interventions exist and what is known about their impact. It reveals that commonly used interventions, such as an essential drug list and standard treatment guidelines, have rarely been systematically evaluated so far. The majority of intervention studies are focused on prescribers in a public health setting, while irrational use of drugs is also widespread in the private sector. Furthermore, the magnitude of inappropriate drug use at community level is often overlooked and few interventions address drug use from a consumer's perspective. More research on different types of intervention strategies in various health care settings is needed to draw conclusions on the effectiveness of a specific intervention strategy. Also more research is needed on socio-cultural factors influencing the impact of drug use interventions, particularly from a user perspective. To enhance evaluative research, more technical support will be needed for researchers in developing countries. The design of available studies from developing countries is generally weak, only six of the 50 studies included in this overview were randomized controlled studies. In order to provide technical support and coordination of future intervention research the establishment of an international resource centre for drug use intervention research is recommended.

Developing Countries↗
PubMed1999

Evaluating an educational intervention to improve the treatment of asthma in four European countries. Drug Education Project Group.

In the international Drug Education Project, a new educational program for peer groups of doctors was developed and tested to improve the treatment of asthma patients in The Netherlands, Norway, Sweden, and Slovakia. Individualized feedback on prescribing and the underlying decision strategy was presented and discussed within the group of doctors, in relation to existing guidelines. In a parallel, randomized controlled design the effect on competence and actual prescribing was tested. Results were related to national guidelines. In general, the program improved the doctors' attitudes as well as some of their prescribing behavior. The proportion of patients treated with inhaled corticosteroids significantly improved in The Netherlands (effect size 1.27), and the proportion of oral corticosteroid use for exacerbation treatment increased both in The Netherlands and in Norway (effect sizes 1.99 and 0.87, respectively). Overall attitudes of Dutch and Norwegian doctors also improved significantly (effect sizes 1.06 and 0.87, respectively), as did both knowledge (effect size 1.06) and attitudes (effect size 1.49) concerning exacerbation treatment in Slovakia. In Sweden no significant improvements could be measured. Conclusively, improvements in asthma treatment are possible with an educational program based on self-learning in small peer groups, although effects in one health care setting may not occur in another health care setting. Possible explaining factors may be different attitudes to and experiences with guidelines as well as with continuing medical education programs, and differences in the opportunities for change, including prevailing trends in prescribing behavior.

Adult↗
PubMed1998

Prescription changes and drug costs at the interface between primary and specialist care.

OBJECTIVE: To explore the relevance of prescription changes and related drug costs when patients are referred from primary to secondary care. PATIENTS AND METHODS: Secondary analysis of data derived from a study on the quality of referrals, which was performed in 1989-1990. New and non-acute referrals of ambulatory patients were studied for internal medicine, neurology, and dermatology. Diagnoses were coded according to the ICPC, and drug names were coded according to the ATC. Prescription data were collected from referral letters and questionnaires. Drugs were also coded as generic or brand name products. Cost of treatment was calculated on the basis of information in the 1989 edition of the Dutch Public Health Care Drug Compendium taking into account the price of the drug and the duration of the prescription. Potential savings were calculated for those brand name products for which substitution by a similar drug was possible. RESULTS: Data on 289 referrals, representing 289 patients, were available for analysis. In 126 out of the 289 patients (43.6%), specialists added to or changed prescriptions initiated by the general practitioner (GP). Specialist prescribing tended to shift to more chronic use. The costs of specialist prescribing are on average 23% higher than for GP prescriptions. Although specialists had fewer opportunities for generic substitution, the potential for savings was greater than for GPs. In many cases, the specialists changed the diagnosis. Only in neurology was the relative risk of receiving a prescription increased when the diagnosis changed. CONCLUSION: Specialists have considerable influence on prescribing to outpatients. The number of prescriptions and the related costs increased greatly when patients were referred from primary to secondary care. The opportunities for generic substitution, and therefore for possible savings, are not fully exploited by GPs or specialists.

Costs and Cost Analysis↗
PubMed1996

The use of drug information sources by physicians: development of a data-generating methodology.

The aim of this study was: (1) to develop and evaluate a methodology to determine hospital physician's use of personal drug information sources; (2) a preliminary insight into the use personal drug information sources. Written case simulations appeared to be the most appropriate method. To construct the written case simulations a step-wise procedure was developed. In the first stage 5 internists formulated 35 complex cases from their daily practice in which they consulted drug information sources; after an evaluation by experts 20 cases were left over. Next, using a written questionnaire, these 20 cases were evaluated in a random sample of 50 internists according to criteria concerning aspects of the process, the contents and the context. Finally, we analyzed these ratings using an elimination-by-aspects decision rule, with the dominant criterion 'need for consultation'. After this selection programme, two cases for each stage in the decision-making process of hospital physicians were selected which met the criteria. In general the colleague internist was the most frequently mentioned information source. Subspecialists and supporting specialists were considered less often and varied per stage in the decision-making process of physicians. The hospital pharmacist was hardly mentioned as a possible information source. The representatives of the pharmaceutical industry were not mentioned at all by the respondents.

Decision Making↗
PubMed1995

Information about drugs in family magazines.

Family magazines can play an important role in the diffusion of medical information and information regarding drugs to a 'lay audience'. We describe what kind of drugs are discussed in the family magazines and which information regarding these drugs is given. Furthermore, we look into the information sources for journalists; special attention is paid to the role of the pharmacist: is (s)he recognized by journalists as one of the experts on drugs? Two approaches were used in order to answer the above described research questions: a content analysis of family magazines and in-depth interviews of journalists. Gynaecological products as well as drugs for the central nervous system receive much attention in family magazines. The kind of information given about drugs is limited. Only part of the publications pays attention to side-effects. Patients asking questions about drugs in response to publications in family magazines know the name of a drug but are rarely informed about other aspects of the therapy, such as side-effects. In the provision of information physicians and medical specialists play an important role as sources of information for journalists. There is, however, until now no role for the pharmacist as a source of information on drugs in family magazines.

Drug Therapy↗
PubMed1995

Setting the agenda: does the medical literature set the agenda for articles about medicines in the newspapers?

The source of ideas and information on medicines most important to journalists in the Netherlands, and most commonly consulted by them, is known to be the scientific medical literature. In this study we therefore, explored the relation between the kind of medicines discussed in the scientific medical literature and those discussed in newspapers. A content analysis of scientific medical journals was combined with a content analysis of Dutch daily newspapers. The results show an agreement in the main groups of medicines discussed in the scientific medical literature and newspapers. In both the newspapers and the professional journals anti-infective medication and drugs for the central nervous system are the groups of medicines most frequently discussed. Although it has been suggested that 'bad news' is more newsworthy then 'good news', the negative consequences of the use of medicines received proportionally more attention in the professional literature than in the newspapers.

Drug Therapy↗
PubMed1994

Questions about drugs: how do pregnant women solve them?

In this study the need for information about drugs among pregnant women and the use of available sources was explored. The women participating in this study were well aware of the risks of the use of drugs. Health professionals were considered to be important sources of information and they should therefore use up-to-date information concerning this topic. Health professionals should also bear in mind in their counseling activities that the beliefs of pregnant women on the safety and need of drugs might lead to reasoned non-compliance.

Decision Making↗
PubMed1994

Journalists and their sources of ideas and information on medicines.

In this article we describe from which sources science writers who write about medicines in daily newspapers get their ideas and information. This study was undertaken because mass media, and therefore newspapers, can play an important role in the diffusion of information about medicines. Two approaches, interviews and a content analysis, were used to answer the research questions. Both methods show the importance of professional medical journals and information from universities and their hospitals as sources of ideas and information. Although the pharmaceutical industry did not seem to play a role as source of ideas and information according to the journalists, it is the third most frequently cited source of information in the newspaper articles. To gain a better insight in the role of the pharmaceutical industry as source of ideas and information for newspaper journalists further research is necessary.

Drug Industry↗
PubMed1993

Drug use in pregnancy: a comparative appraisal of data collecting methods.

We have compared the reliability of the information about drug therapy and pregnancy retrieved by interviewing patients with that distilled from pharmacy records. In the initial phase of each interview we used the internationally accepted open-ended technique, and extended this with an indication-oriented set of questions and then a set of specific drug-oriented questions. These data were then compared with those from pharmacy records on dispensing for the same patients during their pregnancy. The results suggest that if drug consumption during pregnancy is evaluated by interview, one should not restrict oneself to open-ended questions but should include indication-oriented and, when appropriate, drug-oriented questions. Such specific questions offer the opportunity of detecting the use of over-the-counter medication and of constructing drug use/complaint profiles. By contrast, pharmacy records will give better information in case of long recall periods and in patients with multiple and/or repeated drug use. Investigators should use the complementary elements of both techniques where appropriate.

Adult↗
PubMed1993

Towards understanding treatment preferences of hospital physicians.

Seventy-two physicians working in a university hospital in The Netherlands were interviewed to clarify their decision-making process when choosing drugs of preference. Each physician was questioned about the treatment choices for either one or two general case descriptions. The physicians considered only a limited set of different treatment options, on an average 1.7-5.0. Further, the physicians expressed their expectancies as regards various treatment alternatives, and the value or weight they attached to the principle aspects of a treatment. An analytical decision model was used as a reference to gain insight into the extent to which the physicians make decisions based on their own subjective expectancies and values. This model assumes that physicians follow a maximizing strategy by choosing the treatment they personally assess as optimal. It was found that a model including only biomedical expectancies and values predicted the preferred treatment correctly in no more than 53% of the cases. Sometimes, biomedical aspects were disregarded that should have been relevant according to the physicians themselves. Adding aspects of the social environment and experiences improved the prediction of the model substantially; 3 out of 4 treatment preferences could be understood by following an analytical maximizing strategy including biomedical aspects and social aspects and experiences. In the remaining cases, the physicians were not able to describe their decision in terms of this maximizing strategy, which points at the use of alternative decision strategies. One alternative decision strategy mentioned by the physicians was a 'follow-the-routine' decision rule.

Adult↗
PubMed1993

Drug expectations and drug choices of hospital physicians.

OBJECTIVES: To assess whether differences in drug choices of hospital physicians are related to differences in the underlying decision-making process. DESIGN: A survey study was conducted addressing drug choices in six therapeutic fields with existing interprescriber variations; prescribers and non-prescribers of drugs of which the merits were not sufficiently proven (i.e. the 'target drugs') were compared. SETTING: A 1000-bed university hospital in The Netherlands. SUBJECTS: All 85 hospital physicians working in specialities involving one of the selected fields were asked to participate; 72 physicians completed the interviews. MAIN OUTCOME MEASURES: Comparisons were made regarding three elements of the decision-making process: (1) the physicians' expectations of the target drugs and frequently used alternatives, (2) the weights attached to the principal treatment aspects, and (3) the extent to which their actual choice is based on these expectations and weights. RESULTS: In three fields, i.e. anti-emetics, vasodilators, and platelet inhibitors, the prescribers of the less desirable target drugs had higher expectations of these drugs in comparison to the non-prescribers. In the other therapeutic fields, choosing target drugs was related either to attaching less importance to side-effects and costs, or to attaching less importance to reports from clinical trials. Twenty of the 46 treatment choices of the prescribers of target drugs could not be predicted from their expressed views as opposed to 5 of the 36 choices of the non-prescribers (P < 0.05). CONCLUSIONS: Choosing less desirable drugs is not always related to having too high expectations of the drug. Assigning a different importance to certain aspects of the drug and resorting to decision strategies that do not include the weighing of all pros and cons provide alternative explanations for such treatment choices.

Decision Making↗
PubMed1992

[Placement in a nursing home does not automatically lead to increased use of drugs].

OBJECTIVE: To determine whether the use of drugs increases during a stay in a nursing home. SETTING: Fifteen nursing homes in Groningen and Haren. DESIGN: Prospective study. METHOD: In 250 persons admitted to a nursing home in the period December 1986-December 1987 the following data were determined: the mean number of different drugs, the total quantity of drugs used expressed in DDDs (Defined Daily Dose), the number of diagnosis and the functioning. RESULTS: The mean number of different drugs used per person per quarter increased significantly (4.5 in the first quarter as against 5.7 in the fourth quarter). The total quantity of drugs expressed in DDDs used per person per quarter, and the mean duration of their being prescribed did not change significantly. An exception were dermatological preparations (0.13 DDDs in the first quarter as against 0.42 DDDs in the fourth quarter), probably in connection with decubitus. CONCLUSION: A stay in a residential home does not necessarily lead to use of larger quantities of drugs (DDDs). However, there are indications that placement may lead to a greater diversity of the drugs used.

Aged↗