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Biomedical subjects

L D MacKeigan

Publications and source records attributed to L D MacKeigan.

10 recordsLinked to original sources
PubMed1999

Effects of perceived patient demand on prescribing anti-infective drugs.

BACKGROUND: Although patient demand is frequently cited by physicians as a reason for inappropriate prescribing, the phenomenon has not been adequately studied. The objectives of this study were to determine the prevalence of perceived patient demand in physician-patient encounters; to identify characteristics of the patient, physician and prescribing situation that are associated with perceived demand; and to determine the influence of perceived demand on physicians' prescribing behaviour. METHODS: An observational study using 2 survey approaches was conducted in February and March 1996. Over a 2-day period 20 family physicians in the Toronto area completed a brief questionnaire for each patient encounter related to suspected infectious disease. Physicians were later asked in an interview to select and describe 1 or 2 incidents from these encounters during which perceived patient demand influenced their prescribing (critical incident technique). RESULTS: Perceived patient demand was reported in 124 (48%) of the 260 physician-patient encounters; however, in almost 80% of these encounters physicians did not think that the demand had much influence on their decision to prescribe an anti-infective. When clinical need was uncertain, 28 (82%) of 34 patients seeking an anti-infective were prescribed one, and physicians reported that they were influenced either "moderately" or "quite a bit" by perceived patient demand in over 50% of these cases. Of the 35 critical prescribing incidents identified during the interviews, anti-infectives were prescribed in 17 (49%); the reasons for prescribing in these situations were categorized. INTERPRETATION: This study provides preliminary data on the prevalence and influence of perceived patient demand in prescribing anti-infectives. Patient demand had more influence on prescribing when physicians were uncertain of the need for an anti-infective.

Adolescent↗
PubMed1995

Cost of providing pharmaceutical services to hospice patients.

The cost to a hospital pharmacy department of providing pharmaceutical services for a hospice program was studied. Drug acquisition costs were tabulated for all prescriptions dispensed to patients in the hospice program from April 1, 1992, to March 31, 1993. Direct time studies were conducted to determine the average personnel time involved in dispensing a prescription for a hospice patient. To determine the personnel time associated with auxiliary activities, self-reporting and work-sampling techniques were used. Indirect and delivery costs were also calculated. Relevant resource inputs were identified, measured, and valued by using both observation and pharmacy records. A total of 5640 hospice prescriptions were dispensed by the outpatient pharmacy; these represented 30% of all prescriptions dispensed. The average cost of dispensing a hospice prescription was $14.91 (total annual costs less drug acquisition costs). The total annual cost of providing pharmaceutical services to the hospice's patients was $196,607, and the total annual reimbursement received from the hospice program and self-paying patients was $155,623; therefore, costs exceeded revenues by $40,984. The cost to a pharmacy department of providing pharmaceutical services to patients in a hospice program substantially exceeded revenues. Greater efficiencies, a change in the pricing structure, or both may be necessary.

Contract Services↗
PubMed1993

Time preference for health gains versus health losses.

The purpose of this research was to determine whether people devalue further health gains differently from future health losses. 108 subjects in various states of health were randomised to groups that rated their preference for a hypothetical health gain or loss of variable duration and delay, in the condition of arthritis. Direction and duration of the hypothetical future health change had an interactive effect on time preference (p less than 0.001). For the health gain, devaluation due to delay was consistent across durations. For the health loss, devaluation depended on duration; the long-duration loss was devalued with delay while the fleeting loss was inflated. These findings cast doubt on the assumptions of positive time preference and constant rate discounting that underlie the classical model of discounting. They provide support for a theory of intertemporal choice which posits that vivid, fleeting, future events engender 'anticipation utility' which attenuates positive time preference. Our findings suggest that standard practices for discounting future health outcomes in economic evaluations of arthritis and possibly other conditions may need to be re-examined.

Adult↗
PubMed1992

Overview of health-related quality-of-life measures.

Quality of life (QOL) as a measurable health-care outcome is discussed, and an overview of the field of QOL assessment is provided. QOL assessments can be used to evaluate drugs in clinical trials, to evaluate provider performance, and to monitor the progress of patients receiving drug therapy. QOL information is most useful in evaluating drug therapy when the primary purpose of a drug is palliative rather than curative, when a drug is somewhat effective but also fairly toxic, when lifelong therapy is administered to prevent complications of a relatively asymptomatic disease, and when there are several equally effective therapies for a specific condition but the adverse-effect profiles differ. Contemporary QOL questionnaires are completed by patients, and they most commonly include dimensions of physical function, mental or cognitive function, emotional or psychological function, social and role function, disease symptoms, and perceptions of well-being. The keys to successful QOL assessment in clinical practice will be selection of instruments that are practical to administer and are capable of detecting small changes in health, selective application of those instruments to patient populations most likely to benefit from this more intensive form of monitoring, and efficient use of data management systems. The consumer of QOL literature must assess the validity of QOL data obtained in a given study and their applicability to his or her practice setting.

Disease↗
PubMed1989

Development and validation of an instrument to measure patient satisfaction with pharmacy services.

A research program was undertaken to develop and validate a multidimensional measure of patient satisfaction with pharmacy services. A self-administered questionnaire consisting of 44 Likert-type attitudinal items was adapted from the Patient Satisfaction Questionnaire developed by Ware et al. In an iterative scale development process, the adapted questionnaire and its revisions were evaluated in three successive studies conducted on convenience samples (n = 30, 313, 489) of individuals in attendance at family practice clinics in a southwestern city. Methods used to construct multi-item scales measuring separate dimensions of service included principal components factor analysis and item analyses. Acquiescent response set (ARS), the tendency to agree with statements of opinion regardless of content, was measured by the method of matched pairs of items. A partial correlation matrix which controlled for ARS was used as the data in a principal components factor analysis in an effort to reduce the biasing effect of ARS on factor analytic outcomes. Dimensions of satisfaction identified were Explanation, Consideration, Technical Competence, Financial Aspects, Accessibility, Drug Efficacy, OTC (over-the-counter) Product Availability, and Quality of the Drug Product. Questionnaire revision is suggested to confirm the validity of the latter two dimensions Future research should examine the relationship between separate dimensions of satisfaction and other patient attitudes and behaviors, and the convergence between this instrument and other measures of patient satisfaction with pharmacy services.

Adolescent↗
PubMed1988

A review of cost-benefit and cost-effectiveness analyses of clinical pharmacy services.

This paper discusses the purpose and methodology of the economic evaluation techniques of cost-benefit (CBA) and cost-effectiveness analysis (CEA). It then reviews applications of the techniques in 22 evaluative studies, published between 1978 and mid-1987, of clinical pharmacy services in organized health care settings. Major conclusions are that CBA and CEA have not been extensively adopted in the evaluation of clinical pharmacy services and that the studies which have been done are lacking in rigor.

Cost-Benefit Analysis↗
PubMedDate not supplied

Holistic versus composite preferences for lifetime treatment sequences for type 2 diabetes.

This study of patient preferences for lifetime treatment sequences for type 2 diabetes had three objectives: to assess the feasibility of obtaining holistic preference assessments using the time-tradeoff (TTO) technique; to compare composite and holistic preference scores for the same lifetime treatment paths; and to assess the validity of composite and holistic preference measures in terms of their congruence with an individual's rank-order preferences. 101 persons with type 2 diabetes provided preference ratings for hyperglycemic treatments lasting 30 years, including eight discrete treatment states and four treatment paths. Scenarios described drug and glucose-testing regimens, efficacy of glucose control, and side effects. After ranking and rating scenarios on a thermometer scale, subjects provided TTO preferences for each treatment state or path scenario. Holistic assessment of treatment paths was feasible with the TTO technique, in terms of useable data (88% of interviews) and effect on coefficients of variation. Holistic and composite preference scores were not statistically different. Agreement was poor between rankings implied by holistic and composite scores and direct rankings. The authors conclude that lifetime treatment paths with minor differences in health effects can be assessed using either composite (QALY) or holistic (HYE) measures. The validity of these TTO-based preference measures remains unknown.

Adult↗