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Biomedical subjects

F M Haaijer-Ruskamp

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

48 records · Page 3Linked to original sources
PubMed1992

[Agreement between specialists' care and family practitioner's intention in patient referral].

The interaction between the general practitioner (GP) and the medical specialist during the referral process was studied in 309 referrals by GPs to medical specialists in eight hospitals in the north of the Netherlands, notably the extent of agreement between the specialist care and the intention of the GP. Furthermore the influence of two factors on the referral process was investigated: 'the clarity of the question in the referral letter' and 'the view of each other's professional tasks'. In most of the cases the GPs allowed the specialists a free hand. In the few cases the GP wanted a restricted consultation the specialist did more than the GP wanted him to do. In one of five referrals the GP or the specialist thought that the specialist had not done what the GP had asked. In most of these cases this impression was not confirmed by the objective evaluation by independent doctors. According to these the referral question was ambiguous. The GP's would like to have more influence on specialist care than the specialists were prepared to allow. The two factors each had an influence on several moments in the referral process. The main conclusion of the study is: the behaviour of the GP does not fit his attitude.

Attitude of Health Personnel↗
PubMed1992

Handling of risk-bearing drugs during pregnancy. Do we choose less risky alternatives?

The drug use of nearly 2,000 pregnant women was evaluated at the level of the individual patient for the drugs belonging to the Australian risk categories B3, C and D. The pattern of changes in the use of these drugs is studied in terms of women who discontinue (d), continue (c) or begin (b) using the drug during pregnancy. The ratios d/(c+b) and d/b were the highest for the drugs belonging to the high-risk groups and the lowest for drugs from the low-risk categories. This suggests a congruence between theoretical knowledge and daily practice. Patients who had already been using a drug for a long time before pregnancy, more frequently continued using that drug than patients who had been using the drug only incidentally before. The described daily dose for the riskful drugs was approximately 20% lower in patients who started to use a drug during pregnancy compared to those who continued drug use. The data from this analysis indicate that the prescribing physician is generally aware of the possible risks of drug use during pregnancy. The d/(b+c) and d/b ratios are shown to be a good measure of prescribing behaviour in relation to pregnancy and can be used to compare knowledge of theory and daily practice.

Female↗
PubMed1992

Therapeutic decision making of physicians.

In this review the therapeutic decision-making process of physicians is described. This process is divided into two steps: the generation of a limited set of possible options (the 'evoked set') and the selection from this evoked set of a treatment for a specific patient. Factors that are important in both steps are reviewed. Behavioural and decision-making theories in general and decision-making analysis of physicians in particular are discussed to identify possible shortcomings in their decision-making process. Based on this information a model of the drug choice process is presented. With reference to this model possible ways of influencing drug choices of physicians are discussed.

Decision Making↗
PubMed1991

Investigating drug use in pregnancy. Methodological problems and perspectives.

In this study the use of prescribed drugs before, during and after pregnancy is described. The study is based on data obtained from pharmacy records of 1,948 women who delivered a live-born infant. Different measures to evaluate drug exposure are used. During the nine months of pregnancy 86% of the women used on average 4.2 prescriptions. During the course of pregnancy the use of gastro-intestinal and blood-forming drugs increased, whereas the use of cardiovascular, antiphlogistic and central nervous system drugs decreased. Anti-emetics were predominantly used in the first trimester, and antacids in the last trimester, whereas laxatives were especially used after delivery. The percentage of women who used a treatment for vaginal infections increased from 2 to 7 during pregnancy. Most of the women (73%) received one or more iron prescriptions during the course of pregnancy, however, the prescribed daily dose was low (prescribed daily dose/defined daily dose = 0.6). At least 1% of the women filled a new prescription for anticonceptives in the first trimester of pregnancy. Most likely, our data reflect the general prescribing pattern for Dutch pregnant women who delivered a live-born baby. Therefore, they form a good and detailed base for further studies, for instance, on the exposure to drugs with known or suspected risks or on the use of drugs in patients with chronic concomitant diseases. Such studies may lead to recommendations that may improve prescribing behaviour.

Adult↗
PubMed1991

Impact of clinical trials on the adoption of new drugs within a university hospital.

To assess the influence that clinical trials may have on the introduction of new drugs into prescribing routines, the adoption of drugs has been studied in a university hospital in the Netherlands. A significant relation was found between the testing of semi-innovative drugs in clinical trials in the hospital and the introduction of these drugs into general use in the same hospital. No such relationship was found for innovative drugs. Employment in clinical trials only affected the frequency of adoption of semi-innovative drugs. It did not influence the quantity of their use once they had been adopted. The idea that the stimulating effect of clinical trials on the adoption of semi-innovative drugs is only due to acceleration of the adoption process was not confirmed. These findings support the idea that clinical trials can lower the barriers for adoption of semi-innovative drugs.

Clinical Trials as Topic↗
PubMed1991

Prescribing pattern in a Dutch university hospital.

In many countries, including The Netherlands, little is known about the overall prescribing patterns within hospitals. While individual hospitals have some data available, these are not pooled on a regional or national level. The available data consist of dispensing data that are neither patient-linked nor diagnosis-linked. We report the results of a study in a Dutch university hospital which show that despite the limitations, such data can be used for a general evaluation of prescribing patterns. Using three categories of undesirable or irrational drug prescribing the dispensing data were screened. The categories were 'inferior or dubious' drugs, 'semi-innovative' drugs, and 'inappropriately used' drugs. The results show that most problems are seen with the use of new drugs. In the first instance, this involves the use of semi-innovative drugs whose adoption may be stimulated by clinical trials in the hospital concerned. Secondly, innovative drugs seem to be used on too large a scale, i.e., for indications for which their use is not warranted. Based on these findings, a follow-up study has been initiated to study some of these suboptimal drug choices in detail.

Drug Prescriptions↗
PubMed1991

Drug utilization studies and drug monitoring in The Netherlands.

Drug utilization research is a research area of increasing importance, as well in the Netherlands as elsewhere. In this article on overview is given of the situation in the Netherlands. Three types of studies are distinguished, descriptive studies, studies of the determinants of drug use and studies of the impact of drug use. Descriptive studies are needed to understand the present situation and to detect problems. If these problems are to be solved it is important to understand the factors that determine drug use. By looking what the impact is, the value of drug use for health care can be assessed. It is also an important tool for developing systems for drug monitoring at a patient level. At present community pharmacists play an important role in drug monitoring at the patient level. A problem still awaiting a solution is how to implement such systems effectively.

Adverse Drug Reaction Reporting Systems↗
PubMed1990

Drug-utilization studies in The Netherlands.

Drug-utilization research is a research area of increasing importance, both in the Netherlands and elsewhere. In this article an overview of the situation in the Netherlands is given. Three types of studies are distinguished: descriptive studies, studies of the determinants of drug use and studies of the impact of drug use. Descriptive studies are needed to understand the present situation and to detect problems. If these problems are to be solved it is important to understand the factors that determine drug use. In the Netherlands research in the latter area is focused on the influence of policy measures and of educational measures for physicians, as well as for the general public. The main body of research into the impact of drug use is the study of adverse effects, but increasingly attention is paid to the effect on quality of life in a broader sense. A number of data bases exist that enable drug-utilization research. At present one of the main problems concerning the data bases is the absence of adequate diagnosis-related drug-utilization data. Despite the existence of a number of shortcomings and problems, the general impression of drug-utilization research in the Netherlands is one of a flourishing field of study.

Drug Utilization↗
PubMed1990

Impact of a drug bulletin on the knowledge, perception of drug utility, and prescribing behavior of physicians.

The impact of a drug bulletin was tested in a randomized controlled trial that included 186 family physicians. The length of the trial was six months. It was hypothesized that printed information, such as in drug bulletins, influences physician prescribing behavior by changing their knowledge of drug efficacy and adverse effects and their perceptions of drug utility. Therefore, the impact of a drug bulletin was evaluated on these domains of influence. Interview data were used to assess changes in knowledge, perceived drug utility, and stated prescribing. Health insurance funds' records were used to collect actual prescribing data. Information in the bulletin on the treatment of renal colic changed physicians' knowledge as well as perceived utility of drugs used for renal colic (p less than 0.05). Significant changes in stated prescribing were also found. On the other hand, advice in the same bulletin on the treatment of the irritable bowel syndrome (IBS) had no impact at all. It did not even improve the knowledge of the physicians about the drugs used for IBS. Apparently, the message about the treatment of IBS failed to gain the attention of the physicians. It is suggested that some messages are sufficiently transmitted through written information, and others that are seen as less relevant or too difficult to implement need more intensive strategies.

Adult↗
PubMed1988

How physicians choose drugs.

A drug choice model which includes the physician's attitudes, norms and personal experiences with drugs, was tested. One hundred and sixty-nine physicians were asked to estimate the model's components for the treatment of irritable bowel syndrome (IBS) and of renal colic. Given three drugs for both indications, the physicians gave their expectancies about the treatment outcomes, professional acceptability, patient demand and their personal experiences with the drugs. They also stated the value they assign to each of these components when choosing a drug for IBS and for renal colic. The influence of patient demand on the choice of a specific drug appeared to be negligible. The combined effect of the other three elements of the model predicted the stated drug of first choice correctly in 74% (for IBS) and 78% (for renal colic) of the cases, but further analysis showed that only the drug choices for renal colic were as reasoned as the model assumed. Expectancies and values about treatment outcomes determined the drug choice only in part. For choosing a drug for renal colic, the professional environment was more important. Moreover it was found that drug preferences were more related to expectancies about efficacy than to expectancies about side effects for both disorders. The findings can be useful when trying to change prescribing behaviour. Only a limited effect can be expected from the provision of technical drug information. Especially information about costs is unlikely to change prescribing easily, unless values and norms are changed as well. The importance of the professional environment implies that educational programmes in groups might be more effective than individual approaches.

Choice Behavior↗
PubMed1987

Does indirect consultation lead to overprescribing in general practice?

Indirect consultations (by telephone or receptionist) are of increasing importance in general practice and may result in more prescribing than during direct (face to face)-consultations. We analysed prescribing data for 14,660 disorders, presented in one week in 52 general practices. In general, a significant, but hardly relevant increase in prescribing during indirect consultations was observed. The effect varies strongly for different disorders and was especially relevant for repeat-prescriptions for the following conditions: musculoskeletal- and connective tissue diseases, endocrine, nutritional and metabolic disorders and disorders of the female genital tract.

Drug Prescriptions↗