Biomedical subjects

Kurt E Hersberger

Publications and source records attributed to Kurt E Hersberger.

9 recordsLinked to original sources

PubMed2007

Management of potential drug interactions in community pharmacies: a questionnaire-based survey in Switzerland.

OBJECTIVE: To analyze the current drug-interaction management in Swiss community pharmacies, with a particular focus on electronic systems, and to compare the results with those expressed by German general practitioners in a recent survey. METHODS: Data were collected with a postal questionnaire which was randomly sent to 500 out of 833 community pharmacies in the German part of Switzerland. RESULTS: The response rate was 57.4%, and only 24.7% pharmacists reported that they were confronted less than daily with potential drug interactions. Use of computer software to identify potential drug interactions was widespread in community pharmacies (90.2%), and the software was the primary source of information (81.2 +/- 29.6%). The quality of the interaction software was judged sensitive (identifying all dangerous interactions) by 80.5 +/- 21.5%, but specific (identifying only relevant interactions) by only 38.3 +/- 32%. Pharmacists declared a low override rate (14%) of drug interaction alerts, although unjustified alerts were reported by 60.6 +/- 33.1%. In contrast to general practitioners, pharmacists opted less often for information on the mechanism of the interaction, and more frequently for details for dose adjustment. Both groups complained about deficient information on non-interacting alternatives. CONCLUSION: The information needs of community pharmacists differed considerably from general practitioners, and pharmacists were overwhelmed by inappropriate alerts because of a lack of specificity of their drug-interaction systems. Substantial improvement of drug-interaction software systems is thus required at least in two important aspects, the suppression of inappropriate alerts and the tailoring to the needs of the user.

Adult↗

PubMed2007

Risk factors associated with a high velocity of the development of hyperkalaemia in hospitalised patients.

BACKGROUND/OBJECTIVE: Drugs have been recognised as a primary or contributing cause of hyperkalaemia, especially when administered to patients with underlying risk factors. The objective of this study was to analyse the influence of the known risk factors for hyperkalaemia on the velocity of the development of hyperkalaemia. STUDY DESIGN/METHODS: Clinical characteristics, laboratory data and medication profiles of patients developing hyperkalaemia (serum potassium>or=5.0 mmol/L) hospitalised between 2000 and 2004 in the University Hospital Basel, Switzerland, were recorded. Factors associated with a high velocity of the development of hyperkalaemia were detected using a multiple logistic regression model. Subsequently, the velocity during a defined observation period was compared between patients with one risk factor and patients with two or more risk factors. Finally, the dose effects of drugs identified as risk factors for a high velocity of the development of hyperkalaemia were analysed using two sample comparisons. RESULTS: A random sample of 551 hospitalised patients was analysed. Compared with the drug treatment at entry, significantly more patients during the hospitalisation were treated with drugs associated with hyperkalaemia, such as heparins (p<0.001), ACE inhibitors or angiotensin receptor blockers (ARBs) [p=0.002], potassium supplements (p<0.001), potassium-sparing diuretics (p<0.001) and/or NSAIDs or selective cyclo-oxygenase (COX)-2 inhibitors (p<0.001). Risk factors associated with a high velocity of the development of hyperkalaemia were use of potassium supplements (adjusted odds ratio [OR] 3.386; 95% CI 2.251, 5.091), severe renal impairment (OR 3.119; 95% CI 2.007, 4.850), use of ACE inhibitors or ARBs (OR 2.642; 95% CI 1.742, 4.006), use of potassium-sparing diuretics (OR 2.065; 95% CI 1.310, 3.254), and diabetes mellitus (OR 1.525; 95% CI 1.005, 2.313). The velocity of the development of hyperkalaemia significantly increased in patients with two or more risk factors. Dose effects could be found for potassium supplements (p=0.006) and potassium-sparing diuretics (p=0.007), but not for ACE inhibitors or ARBs (p=0.289). In contrast, the use of kaliuretics (loop diuretics or thiazides) was associated with a decreased velocity of the development of hyperkalaemia in patients with serious renal impairment (p=0.016) and in patients treated with two or more drug classes associated with a high velocity of the development of hyperkalaemia (p=0.001). CONCLUSIONS: Risk factors associated with a high velocity of the development of hyperkalaemia are use of potassium supplements>severe renal impairment>use of ACE inhibitors or ARBs>use of potassium-sparing diuretics>diabetes mellitus. The presence of two or more of these risk factors is associated with an even faster development of hyperkalaemia. Clinicians should be aware of these risk factors in order to avoid a rapid development of potentially life-threatening hyperkalaemia.

Age Factors↗

PubMed2006

Sequential screening for diabetes--evaluation of a campaign in Swiss community pharmacies.

OBJECTIVE: For early detection of persons at risk for type 2 diabetes, a combination of risk factor assessment and glucose measurement could be a promising approach and an opportunity for health promotion. The object of this study was to develop a sequential screening concept and to evaluate it in a national pharmacy based screening campaign. METHOD: Community pharmacies of the German speaking part of Switzerland participating in the national Self Care campaign "Stop diabetes--test now" offered a free of charge "sequential screening" with (a) diabetes risk assessment, (b) consecutive capillary blood glucose measurement and (c) assessment of the motivation for lifestyle change based on the Transtheoretical Model (TTM) of behaviour change. A 35 items data sheet served as a structured screening protocol and enabled quick and reliable documentation of all relevant data. Outcomes measures were: age, sex, cigarette smoking, total score of the ADA diabetes risk-factor questionnaire, family history of diabetes, body mass index, insufficient physical activity, blood pressure, capillary blood glucose, motivation for lifestyle change, counselling activities and triage decisions of the pharmacy team. RESULTS: During the 5 weeks of spring 2002, 530 pharmacies screened a total of 93,258 persons (33.1% male, mean age 60.9 years +/- 14.1 (SD)). Risk profile: family history of diabetes 26.4%; BMI > or = 25 kg/m(2) 49.3%; low physical activity 27.2%; elevated blood pressure 45.7%. Stratification into risk groups: < 2 risk factors 21.6%; > or = 2 risk factors 71.5%; borderline glycaemia (FG 5.3-6.1 mmol/l, confirmed in a second measurement) 2.5% and hyperglycaemia (FG > or = 6.1 mmol/1 or NFG > or = 11.1 mmol/1) 4.4%. Of all persons screened, 6.4% were referred to a physician and 73.7% got targeted advice with respect to physical activity and/or nutrition based on their specific risk profile. CONCLUSION: The screening campaign attracted an important part of Swiss German speaking adults (2.4%). The sequential screening could successfully be implemented into pharmacy practice. Of the generally elderly persons screened, 6.9% were detected with suspicion for diabetes type 2 and 71.5% had at least two risk factors. This provided an opportunity to initiate targeted counselling regarding therapeutic lifestyle change.

Adult↗

PubMed2006

Prevalence and influence of diagnostic tests for acute respiratory tract infections in primary care.

BACKGROUND: General practitioners (GPs) use diagnostic tests to help distinguish between viral and bacterial acute respiratory tract infections (ARTI). We investigated the prevalence of these tests, and how tests are associated with diagnosis, treatment and patient satisfaction. METHODS: As part of a clinical trial, 45 GPs screened 1108 patients with ARTI and collected information on signs and symptoms, diagnostic test results, and subsequent diagnosis and treatment. A sample of 636 patients was interviewed after 7 days and their opinions recorded. We used multivariate mixed models to estimate associations between the use of tests and (1) baseline characteristics, (2) subsequent antibiotic treatment, and (3) patient satisfaction. RESULTS: GPs carried out at least one test in 42% of the 1108 patients screened. The tests used were (percentage of patients): CRP (35%), leucocyte count (17%), rapid Strep A (9%), chest X-ray (5%), sinus X-ray (1%), and throat culture (1%). The use of tests was associated with increasing patient age, education, and degree of discomfort. Antibiotic therapy was strongly associated with a positive test, with odds ratios of 26 (95% CI, 10-67) for a CRP above 50 mg/l; 9.6 (95% CI, 3.6-26) for a leucocyte count above 10,000/microl; and 122 (4.4-3435) for a positive StrepA test. There was no evidence of an association between the use of tests and patient satisfaction. CONCLUSIONS: Nearly half of these patients with ARTI received a diagnostic test. Older patients, those with higher education and those in more discomfort were more likely to get tests. A positive test was strongly associated with antibiotic treatment.

Acute Disease↗

PubMed2006

Sleep and wakefulness disturbances in Swiss pharmacy customers.

BACKGROUND AND OBJECTIVE: Sleep disturbances are prevalent but often overlooked or underestimated. We suspected that sleep disorders might be particularly common among pharmacy customers, and that they could benefit from counselling. Therefore, we described the prevalence and severity of symptoms associated with sleep and wakefulness disorders among Swiss pharmacy customers, and estimated the need for counselling and treatment. METHODS: In 804 Swiss pharmacies (49% of all community pharmacies) clients were invited to complete the Stanford Sleep Disorders Questionnaire (SDQ), and the Epworth Sleepiness Scale (EPW). The SDQ was designed to classify symptoms of sleep and wakefulness into the four most prevalent disorders: sleep apnoea syndrome (SAS), insomnia in psychiatric disorders (PSY), periodic leg movement disorders/restless legs (RLS) and narcolepsy (NAR). Data were entered into an internet-linked database for analysis by an expert system as a basis for immediate counselling by the pharmacist. RESULTS: Of 4901 participants, 3238 (66.1%) were female, and 1663 (33.9%) were male. The mean age (SD) of females and males was 52.4 (18.05), and 55.1 (17.10) years, respectively. The percentages of female and male individuals above cut-off of SDQ subscales were 11.4% and 19.8% for sleep apnoea, 40.9% and 38.7% for psychiatric sleep disorders, 59.3% and 46.8% for restless legs, and 10.4% and 9.4% for narcolepsy respectively. The prevalence of an Epworth Sleepiness Scale score >11 was 16.5% in females, and 23.9% in males. Reliability assessed by Cronbach's alpha was 0.65 to 0.78 for SDQ subscales, and for the Epworth score. CONCLUSIONS: Symptoms of sleep and wakefulness disorders among Swiss pharmacy customers were highly prevalent. The SDQ and the Epworth Sleepiness Scale score had a satisfactory reliability to be useful for identification of pharmacy customers who might benefit from information and counselling while visiting pharmacies. The internet-based system proved to be a helpful tool for the pharmacist when counselling his customers in terms of diagnostic classification and severity of symptoms associated with the sleeping and waking state.

Adult↗

PubMed2005

White coat effect and white coat hypertension in community pharmacy practice.

OBJECTIVE: The aim of the present study was to investigate whether a white coat effect (WCE) can be observed and quantified in community pharmacy practice. METHODS: In five community pharmacies of Basel, Switzerland, clients asking for blood pressure (BP) measurement were recruited to participate in a free of charge study. Blood pressure was measured in four different settings: pharmacy (using mercury sphygmomanometers), outpatient clinic (measurement by a nurse using mercury sphygmomanometers), self-measurement at home (using automated wrist devices) and daytime ambulatory BP (ABP) monitoring (using SpaceLabs 90207 monitors). WCE was defined as the difference between pharmacy or outpatient and daytime ABP. RESULTS: A total of 50 subjects completed all measurements (42% male, mean age 53.7 years+/-14.0). Blood pressure values of the different settings: (means in mmHg+/-SD, systolic; diastolic): pharmacy BP 129+/-19; 82+/-10, outpatient clinic BP 127+/-15; 82+/-10, home BP 119+/-15; 73+/-9, daytime ABP 124+/-10; 79+/-8. Pharmacy BP was significantly higher (P=0.03 systolic; P=0.02 diastolic) compared with daytime ABP and differences among subjects with antihypertensive medication (n=22) were even more significant (P<0.01). Individual differences were found between pharmacy BP and daytime ABP: +4.6+/-14.8; +2.9+/-8.3. Outpatient BP was significantly higher compared with daytime ABP in diastolic (P=0.04) but not in systolic values. Individual differences between outpatient BP and daytime ABP were +2.5+/-13.1; +2.8+/-9.2. 'Clinically important WCE' (>or=20 mmHg systolic or >or=10 mmHg diastolic) was observed in 24% of all subjects in the pharmacy and in 20% in the outpatient clinic. CONCLUSIONS: Our findings show that WCE and white coat hypertension exist in community pharmacy practice and are similar to the effects in an outpatient clinic.

Adult↗

PubMed2004

Drug-related problem classification systems.

OBJECTIVE: To provide an overview of and critically appraise classifications of drug-related problems (DRPs) for use during the pharmaceutical care process and research in pharmacy. DATA SOURCES: A literature search was conducted using MEDLINE and Yahoo (January 2003) and manually. The search terms included DRP, drug-related problem, drug-therapy problem, and medicine-related problem. STUDY SELECTION AND DATA EXTRACTION: English- and German-language articles on pharmaceutical care and DRPs were reviewed. DATA SYNTHESIS: Most classifications of DRPs were identified through searching publications on pharmaceutical care and DRPs. Fourteen classifications with different focuses were found. Some classifications were hierarchical, categorized into main groups and subgroups. Various terminologies and definitions for DRPs were revealed, as well as guidelines for an optimal DRP classification. Classifications were assessed according to a clear definition, published validation method, and results reflecting process and outcomes, usability in pharmaceutical care practice, and a hierarchical structure with main groups and subgroups. CONCLUSIONS: Finding DRP classifications by computerized search of the biomedical literature with the help of PubMed proved to be difficult. No classification could be found that met all of our criteria for an optimal system. Few classifications have been validated. Three have been tested as to their usability in practice and internal consistency. The Pharmaceutical Care Network Europe system Version 4 comes closest to the defined requirements.

Drug-Related Side Effects and Adverse Reactions↗

PubMed2004

Swiss community pharmacies' on the Web and pharmacists' experiences with E-commerce: longitudinal study and Internet-based questionnaire survey.

BACKGROUND: There are multiple ways in which community pharmacies can present themselves on the Internet, e.g., as a platform for drug information or as an advertising platform for their services. OBJECTIVE: To estimate the number of Swiss community pharmacies on the Internet over the period of 32 months (2000-2003), to describe their current e-commerce services, and to explore the experiences and plans these pharmacies have with regard to their Internet presence. METHODS: A longitudinal study was performed to determine the number of Swiss German pharmacies on the Internet by conducting Internet searches in 2000, 2001, and 2003. In April 2002, a cross-sectional Internet-based survey was administered to explore the pharmacies' experiences and plans regarding their Web sites. RESULTS: As of April 2003, 373 (44%) of 852 community pharmacies from the German speaking part of Switzerland were on the Internet. One hundred eighty four listed an e-mail address and were asked to complete a questionnaire. Of the 107 pharmacies answering the survey questions (58% response rate): 46% had been on the Internet for 1 to 2 years; 33% of the Web sites are part of a pharmacy group's Web portal; 31% of the pharmacies plan to expand their Internet appearance in the future; 74% provide e-commerce services, with 81% of those pharmacies filling five or less orders per month; and 12% plan on expanding their e-commerce services in the future. CONCLUSIONS: The number of community pharmacies offering Internet services steadily increased over 32 months. Given the importance of the Internet as a tool for information, communication, and advertising for pharmacy products and services, it can be expected that the increase will continue. Pharmacy-group portals are important promoters of pharmacies on the Internet. For many community pharmacies, Internet portals that provide an Internet presence for the pharmacies and provide regularly-updated content (e.g., health news, tips, drug information) seem to be the most effective solutions. Even though 40% of the pharmacies already offer e-commerce services, these services are still of minor importance. For many pharmacists, the current legal regulations seem to be unclear. Most pharmacies want to maintain their Internet services.

Commerce↗

PubMed2004

Needs and use of drug information sources in community pharmacies: a questionnaire based survey in German-speaking Switzerland.

OBJECTIVES: To explore the types of drug information used by pharmacists in daily practice, their needs and wishes concerning drug information and their opinions about future changes of pharmacy practice. METHODS: Postal survey to a random sample of 223 (26% out of 859) community pharmacies from the German-speaking part of Switzerland. The 48-item questionnaires were processed automatically with the Cardiff TELEform-Software. In addition, a telephone-survey to a random sample of 20 non-responders was performed in order to test for non-response bias. RESULTS: A total of 108 pharmacists (response rate 48%) reported that the official Swiss drug reference book is still the most popular source of drug information used to solve all kinds of drug related problems. The Internet as a source of drug information is of minor importance, even though 88% of the pharmacies have Internet access. Deficits in drug information were reported for paediatrics, phytotherapy, drugs during pregnancy/lactation and for therapy guidelines. According to 35% of the pharmacists, the importance of offering drug information to customers will increase in the future. Most of the pharmacists are not afraid that Internet pharmacies would replace them. CONCLUSIONS: The results show that the majority of the community pharmacists are only partially satisfied with the sources of drug information currently available. The Internet still plays a minor role for solving drug-related problems in daily practice, even though the available infrastructure makes the community pharmacies able to use the Internet more frequently. The pharmacists need more websites tailored to their needs. The pharmacists have clear visions about possible future developments. They do, however, have to adopt quickly to the changes ahead in order to remain competitive.

Drug Information Services↗