Biomedical subjects

Ines Krass

Publications and source records attributed to Ines Krass.

16 recordsLinked to original sources

PubMed2007

Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting.

Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings.

Adult↗

PubMed2006

An educational intervention to train community pharmacists in providing specialized asthma care.

OBJECTIVES: The development, implementation, and evaluation of an educational intervention to facilitate specialized asthma care provision by community pharmacists. DESIGN: Formative evaluation and a parallel group repeated measures design were used to test the effect of an educational intervention on pharmacist satisfaction and practice behavior as well as patient outcomes. The educational intervention was based on practitioner needs and principles of adult learning using flexible delivery formats. ASSESSMENT: In the intervention area, 15 pharmacists were trained with the educational intervention, and they provided specialized asthma care to 52 patients over 6 months, while in the control area, 12 pharmacists provided "usual care" to 50 patients. The intervention pharmacists were highly satisfied with the education received and rated most aspects highly. Improvements in patient clinical, humanistic, and economic outcomes in the intervention area were obtained. CONCLUSION: The positive results of the educational intervention demonstrate the effectiveness of an educational approach grounded in the theory that inducing behavioral changes in pharmacy practitioners results in improved patient outcomes.

Asthma↗

PubMed2006

Enhancing patient education about medicines: factors influencing reading and seeking of written medicine information.

OBJECTIVE: To investigate the influence of patient factors on patients' reading and seeking of written medicine information (WMI). DESIGN: A cross-sectional questionnaire study. Main variables studied Patient's health locus of control, coping style, health literacy, demographics and disease state (independent variables) and patient's interest and likelihood in reading and seeking WMI (dependent variables). MAIN OUTCOME MEASURES: Patient factors predicting interest in reading and seeking WMI. SETTING AND PARTICIPANTS: Patients (total n = 479) from three Rheumatology/Pain clinics in teaching hospitals (n = 217) and 40 community pharmacies (n = 262) in metropolitan Sydney, Australia. RESULTS: The majority of patients were interested and likely to read WMI about their prescription medicines. However, not many were likely to seek WMI and not many frequently sought WMI. Using logistic regression, patients' interest in reading WMI was predicted by their coping style [monitor vs. blunter, odds ratio (OR) = 2.19, confidence interval (CI) = 1.17-4.10], health literacy levels (adequate vs. inadequate/marginal, OR = 2.86, CI = 1.16-7.05) and occupation (blue-collar vs. homemaker, OR = 3.42, CI = 0.09-0.88) whilst patients' interest in seeking WMI was predicted by their disease state (pain/rheumatology condition vs. hypertension, OR = 1.84, CI = 1.11-3.05), health locus of control (powerful other, OR = 0.95, CI = 0.90-0.99) and health literacy levels (adequate vs. inadequate/marginal, OR = 2.7, CI = 1.17-6.39). CONCLUSIONS: Patients' interest in reading and seeking WMI were influenced by several patient factors including disease state, health locus of control, coping style, health literacy levels and occupation. Furthermore, the results highlighted that reading and seeking WMI were regarded as distinct activities influenced by different factors. These findings may guide health professionals in assessing the utility of WMI for different patient groups and more broadly in the tailoring of patient education to meet patient needs.

Aged↗

PubMed2005

Patient characteristics influencing evaluation of written medicine information: lessons for patient education.

BACKGROUND: Written medicine information (WMI) is considered an important component of patient education. Despite the wealth of information on many aspects of WMI, there is a paucity of studies examining how patient characteristics influence use and evaluation of WMI. OBJECTIVE: To investigate the influence of patient characteristics on the evaluation and intended future use of consumer medicine information (CMI), a form of WMI. METHODS: A questionnaire was administered to patients from 3 rheumatology/pain clinics in teaching hospitals and 40 community pharmacies. The questionnaire examined patients' perceptions of CMI (comprehension, perceived usefulness, design rating) and likelihood of using CMI in the future. Information on patient characteristics (demographic data, health literacy level) was also collected. Multiple regression analysis was used to examine associations between patient characteristics and their evaluation and intended future use of CMI. RESULTS: A total of 479 patients participated. Comprehension of CMI was associated with speaking primarily English at home, having attained secondary education or higher, and having adequate health literacy levels. Perceived usefulness of CMI was influenced by age and number of medications. Design rating was influenced by type of CMI, patient age, gender, and highest level of education. Intended future use was affected by health literacy level. In addition to individual patient characteristics, overall comprehension and perceived usefulness of CMI also influenced its intended future use. CONCLUSIONS: Patient characteristics were found to influence evaluation and intended future use of CMI. These findings should be taken into consideration in future research, development of WMI, and education of patients in everyday practice.

Age Factors↗

PubMed2005

Actual and perceived provision of pharmaceutical care in Danish community pharmacies: the pharmacists' opinions.

OBJECTIVE: The study explores characteristics of community pharmacies with respect to implementing pharmaceutical care activities. The article addresses the provision of pharmaceutical care at reality level, perceived level and policy level. METHOD: A cross-sectional questionnaire was sent to all Danish community pharmacies to investigate the provision of pharmaceutical care (n=288). The respondents were pharmacists. Pharmaceutical care activities were operationalised by detecting and identifying medicine-related problems, setting goals to solve medicine-related problems, and documenting efforts to solve them. A non-respondent analysis was also performed. MAIN OUTCOME MEASURE: The identification of medicine-related problems (from self-report) was used as a proxy measure of pharmaceutical care activities and compared to pharmacies' self-reported provision of pharmaceutical care. RESULTS: The survey response rate was 75.7. The characteristics of pharmacies that detected medicine-related problems differed from those of pharmacies with only a perceived provision of pharmaceutical care. Pharmacies that actually detected medicine-related problems focused on external cooperation regarding their pharmacy activities. CONCLUSION: The profiles of the perceived providers of pharmaceutical care and the respondents that detected medicine- related problems were distinct, thus indicating two separate groups of pharmacies. Pharmaceutical care has only been implemented in Denmark to a limited extent. This may be explained in part by the top-down implementation strategy conceived by the proprietor organisation.

Attitude of Health Personnel↗

PubMed2005

Innovative asthma health promotion by rural community pharmacists: a feasibility study.

ISSUE ADDRESSED: Asthma awareness in a rural community and the involvement of the community pharmacist in proactive health promotion. METHODS: Between September 2002 and May 2003, seven community pharmacists from Orange, a rural town in New South Wales, were trained to provide two asthma outreach programs: one targeting adolescents in high schools (Year 11 students) using Triple A training; and a public forum on asthma for the wider community. RESULTS: There was a significant increase in the mean asthma knowledge scores of Year 11 students in each high school after Triple A training. From the multivariate analysis, although there was a significant increase in mean asthma knowledge scores over time (F=101.09, df=1, p<0.001), there were no differences between high schools (F=2.79, df=2, p>0.05). There was a significant increase in the proportion of asthma-related pharmacy visits involving requests for information on asthma and on asthma devices at the four different time points. CONCLUSIONS: The study provided a unique opportunity for community pharmacists to increase asthma awareness in a rural setting. The study demonstrated that it is feasible for rural community pharmacists to become involved in proactive health promotion and effectively provide asthma outreach programs.

Adolescent↗

PubMed2005

The validity and reliability of two asthma knowledge questionnaires.

BACKGROUND: This study aimed to develop and validate two asthma knowledge questionnaires, one for consumers (CQ) and one for health care professionals (HQ) to fill an existing gap in the literature. METHODS: Following development and pilot testing, the revised CQ and HQ were administered to respiratory physicians, pharmacists and people with asthma and without asthma. RESULTS: Both the CQ and HQ were shown to be reliable with Cronbach's alpha of 0.78 and 0.92 respectively. Both were also found to have good content, face, construct and discriminant validity. CONCLUSION: The CQ and HQ were shown to be simple, valid and reliable instruments for the assessment of asthma knowledge of consumers and health care professionals and to direct educational resources more appropriately. Future research will evaluate the utility of these instruments in clinical practice.

Asthma↗

PubMed2005

Optimizing the use of antithrombotic therapy for atrial fibrillation in older people: a pharmacist-led multidisciplinary intervention.

OBJECTIVES: To develop, implement, and evaluate a pharmacist-led multidisciplinary intervention in a hospital setting that would optimize antithrombotic use in elderly atrial fibrillation patients. The hypothesis that there would be an increase in the proportion of patients receiving antithrombotic therapy at discharge was tested. DESIGN: Evidence-based algorithms were developed to define the criteria (stroke risk vs contraindications) by which an elderly patient's requirement for antithrombotic therapy was assessed. SETTING: A major Sydney teaching hospital. PARTICIPANTS: Two hundred eighteen consecutively admitted elderly patients (mean age 85.2) were recruited over a 6-month period. INTERVENTION: A pharmacist-coordinated multidisciplinary review process was implemented to coordinate risk assessments and subsequently recommend appropriate antithrombotic therapy, as per the algorithms. MEASUREMENTS: The proportion of patients receiving antithrombotic therapy was assessed on admission (preintervention), at discharge (postintervention), and postdischarge (follow-up at 3 and 6 months). RESULTS: As a result of the intervention, 78 patients (35.8%) required changes to their existing antithrombotic therapy. Of these changes, 60 (76.9%) were "upgrades" to more-effective treatment options (e.g., from no therapy to any agent or from aspirin to warfarin). The remaining 18 (23.1%) changes were "downgrades" to less-effective, albeit safer, options. Despite a significant increase in anti thrombotic use overall (59.6% vs 81.2%, P<.001), fewer patients received warfarin postintervention, after having been assessed as inappropriate candidates (20.7% vs 17.4%, P=.39). CONCLUSION: A pharmacist-led multidisciplinary process was successfully developed and implemented within the hospital setting to increase overall antithrombotic use. Having addressed some of the known barriers and limitations to warfarin use, these algorithms may allow allied health workers, patients, and clinicians to work collaboratively to achieve optimal and, importantly, appropriate (i.e., safe and effective) antithrombotic use in at-risk elderly patients.

Aged↗

PubMed2004

Development, implementation, and evaluation of a community pharmacy-based asthma care model.

BACKGROUND: Pharmacists are uniquely placed in the healthcare system to address critical issues in asthma management in the community. Various programs have shown the benefits of a pharmacist-led asthma care program; however, no such programs have previously been evaluated in Australia. OBJECTIVE: To measure the impact of a specialized asthma service provided through community pharmacies in terms of objective patient clinical, humanistic, and economic outcomes. METHODS: A parallel controlled design, where 52 intervention patients and 50 control patients with asthma were recruited in 2 distinct locations, was used. In the intervention area, pharmacists were trained and delivered an asthma care model, with 3 follow-up visits over 6 months. This model was evaluated based on clinical, humanistic, and economic outcomes compared between and within groups. RESULTS: There was a significant reduction in asthma severity in the intervention group, 2.6 +/- 0.5 to 1.6 +/- 0.7 (mean +/- SD; p < 0.001) versus the control group, 2.3 +/- 0.7 to 2.4 +/- 0.5. In the intervention group, peak flow indices improved from 82.7% +/- 8.2% at baseline to 87.4% +/- 8.9% (p < 0.001) at the final visit, and there was a significant reduction in the defined daily dose of albuterol used by patients, from 374.8 +/- 314.8 microg at baseline to 198.4 +/- 196.9 microg at the final visit (p < 0.015). There was also a statistically significant improvement in perceived control of asthma and asthma-related knowledge scores in the intervention group compared with the control group between baseline and the final visit. Annual savings of $132.84(AU) in medication costs per patient and $100,801.20 for the whole group, based on overall severity reduction, were demonstrated. CONCLUSIONS: Based on the results of this study, it appears that a specialized asthma care model offers community pharmacists an opportunity to contribute toward improving asthma management in the Australian community.

Adult↗

PubMed2003

Pharmaceutical care in Denmark: perceived importance of medicine-related problems and participation in postgraduate training.

OBJECTIVE: To investigate the readiness of Danish community pharmacists to provide pharmaceutical care. Special focus was on information provided to patients on medicine-related problems and participation in postgraduate training. METHOD: National cross-sectional survey distributed to all Danish community pharmacies (N = 288). Response rate 75.7%; non-responders were interviewed by telephone to establish their reasons for not participating. MAIN OUTCOME MEASURES: Prioritization of information to patients regarding medicine-related problems. Postgraduate courses selected by pharmacists during the past three years. RESULTS: In accordance with the profile of Danish community pharmacists, respondents were primarily female and half were below 45 years of age. The main reason given for not responding was lack of time. The prioritization of information to patients regarding medicine-related problems resulted in three clusters of answers. The overall topics of the clusters were: information related to the technical-practical use of medicines; information related to pharmacotherapeutic aspects of medicine use; and information related to the function of the medicine. The clusters accounted for 61.9% of the total variance. The most frequently attended postgraduate courses were on quality assurance and specific diseases. CONCLUSION: The patient information prioritized by Danish community pharmacists is primarily of a technical-practical nature. The postgraduate training pursued is primarily technical without much focus on the philosophy of pharmaceutical care. These factors contribute to the lack of proper readiness of pharmacists to practice pharmaceutical care.

Adult↗

PubMed2003

Rural community pharmacy: a feasible site for a health promotion and screening service for cardiovascular risk factors.

A pharmacist-delivered health promotion and screening service for cardiovascular risk factors in rural community pharmacy was implemented in the Upper Hunter Valley, New South Wales (NSW). We describe the development of the service and profile 204 participants at their initial screening. A standardised clinical protocol guided the pharmacist through delivery of the service. The mean age of participants was 44 years (SD +/- 13). Over half (54%) had a Body Mass Index (BMI) > 25, 54% had cholesterol > 5.0 mmol L-1 and 18% a systolic BP> or = 140 mmHg and/or diastolic BP >or = 90 mmHg. Most (80%) received lifestyle information (dietary, exercise or smoking cessation). One third required referral to a general practitioner. Provision of the service through community pharmacy increased the community's access to screening, 28% reported that they had never had their cholesterol measured. Since this new service was able to identify, educate and refer people at risk of cardiovascular disease in a rural community, we recommend a broader adoption through rural pharmacies.

Adult↗

PubMed2003

Factors influencing consumer use of written drug information.

OBJECTIVE: To provide an overview of the use and impact of written drug information (WDI) on consumers, and to review the literature on the factors influencing the use of WDI by consumers. DATA SOURCES: Relevant articles published in English since the late 1970s were identified based on searches of on-line databases, texts, and cited references in published articles. STUDY SELECTION: Articles reporting findings on the origin, use, and impact of WDI were included. Due to limited literature, articles reporting findings on factors influencing the use of written drug as well as disease information were included. DATA EXTRACTION: Due to the lack of design consistency between studies and the comparatively small volume of work, subjective assessment rather than a criteria-based objective review was deemed more appropriate. DATA SYNTHESIS: To date, research on WDI has focused on its use and impact. WDI has the potential to increase patients' knowledge, compliance, and satisfaction. However, there is also the potential for anxiety or premature cessation of therapy due to fear of possible adverse effects. Multiple factors may potentially influence the use of WDI by consumers including those associated with the written information document (readability, presentation), the patient (health literacy, role of caregiver, demographic factors, health locus of control, coping style, health belief model), and the environment (timing of provision, experience). CONCLUSIONS: WDI has the potential to impact consumers positively and negatively. Although not widely investigated, a number of factors can potentially influence the use of WDI by consumers. The findings of this review can form the basis for much needed further research.

Adaptation, Psychological↗

PubMed2002

Using alternative methodologies for evaluating patient medication leaflets.

A variety of direct and indirect methods have been used to evaluate written medication information; however, no published research has validated assessment tools or presented direct consumer assessment of patient information leaflets (PILs) provided in US community pharmacy (CP). We report on two new instruments: the medication information design assessment scale (MIDAS), an indirect measure of design quality administered by the investigators, and the consumer information rating form (CIRF), a direct measure of comprehensibility, utility, and overall design quality applied by a consumer panel. These were used to assess two types of PILs: 36 CP-PILs obtained from community pharmacies and 3 Model-PILs incorporating recommended design characteristics. The validity of the MIDAS was demonstrated in two ways. First, as predicted, the Model-PILs were rated more positively by consumers. We also found a significant positive correlation between the number of design criteria incorporated in a CP-PIL (as measured by the MIDAS score) and the consumers rating of design quality (CIRF). In conclusion, we confirmed the importance of design characteristics in the production of written medication information and have also developed and validated two easy-to-use tools for the assessment of written medication information.

Drug Labeling↗

PubMedDate not supplied

Implementation and evaluation of Australian pharmacists' diabetes care services.

OBJECTIVE: To implement and evaluate a specialized service for type 2 diabetes mellitus in the community pharmacy. DESIGN: Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible. INTERVENTION: Following training, pharmacists followed a clinical protocol over 9 months, with approximately monthly intervention site visits during which blood glucose readings were downloaded and discussed with the patient, interventions were documented, and goals set with each patient. MAIN OUTCOME MEASURES: Quality of life, well-being, risk of nonadherence, and glycosylated hemoglobin (A1C) values at the beginning and end of the study. Blood glucose levels were measured in intervention patients only. RESULTS: A total of 106 intervention and 82 control patients completed the study. Patient groups were similar at baseline. Pharmacists delivered 1,459 interventions and blood glucose levels were significantly reduced in all intervention regions. The proportion of patients with A1C values greater than 7% was similar in control sites at baseline (54%) and after 9 months (61%). In intervention sites this proportion was significantly reduced, from 72% at baseline to 53% after 9 months. Well-being and the risk of nonadherence were significantly improved in intervention patients. CONCLUSION: Implementation of a specialized service for diabetes in community pharmacy resulted in better diabetes control and health care outcomes for the patient.

Aged↗

PubMedDate not supplied

Impact on medication use and adherence of Australian pharmacists' diabetes care services.

OBJECTIVE: To assess the effect of a specialized service implemented in community pharmacies for patients with type 2 diabetes on medication use and medication-related problems. DESIGN: Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible. INTERVENTION: After initial training, pharmacists followed a clinical protocol for more than 9 months, with patient contact approximately monthly. Each patient received an adherence assessment at the beginning and end of the study, adherence support, and a medication review as part of the intervention. MAIN OUTCOME MEASURES: Risk of nonadherence using Brief Medication Questionnaire (BMQ) scores and changes to medication regimen. RESULTS: Compared with 82 control patients, 106 intervention patients with similar demographic and clinical characteristics had significantly improved self-reported nonadherence as reflected in total BMQ scores after 9 months. The mean (+/-SD) number of medications prescribed at follow-up in intervention participants decreased significantly, from 8.2+/-3.0 to 7.7+/-2.7. No reduction was observed among the control patients (7.6+/-2.4 and 7.3+/-2.4). The overall prevalence of changes to the regimen was also significantly higher in the intervention group (51%) compared with controls (40%). CONCLUSION: Community pharmacists trained in medication review and using protocols in collaboration with providers improved adherence in patients with type 2 diabetes, reduced problems patients had in accessing their medications, and recommended medication regimen changes that improved outcomes.

Australia↗

PubMedDate not supplied

Warfarin use in the elderly: the nurses' perspective.

OBJECTIVE: To explore the barriers to warfarin use from the perspective of nurses working in aged care. DESIGN: A qualitative study, involving a semi-structured group interview, during March-April 2001. SETTING AND SUBJECTS: Eleven nurses, employed within the catchment of the Northern Sydney Area Health Service, who were involved in the care of elderly warfarinised patients. MAIN OUTCOME MEASURE: Identification, via thematic analysis, of the main themes underpinning the nursing perspective on warfarin use in this setting, with regard to their perceived role/s, experiences with patients, and potential strategies for managing the therapy. RESULTS: Five main themes were identified: perceived patient attitude toward warfarin; barriers to the use of warfarin; expressed lack of confidence in the processes involved; nurses' role in warfarin use; and strategies to improve warfarin use. Nurses were concerned about warfarin use in the elderly, but felt they had a limited capacity to intervene. CONCLUSION: Nurses are potentially underutilised as a resource and support for both patients and prescribers, in the management of warfarin therapy.

Adult↗