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L Pereles

Publications and source records attributed to L Pereles.

12 recordsLinked to original sources
PubMed2000

Home visits. An access to care issue for the 21st century.

OBJECTIVETo review trends and current practices in delivery of medical care at home.QUALITY OF EVIDENCEA MEDLINE search from January 1989 to March 2000 yielded 65 articles. Most articles are descriptive; analytical studies are rare.MAIN MESSAGEThe number of home visits made by physicians has consistently declined in the last 30 years. The most common reasons cited are lack of efficiency, the time required, and poor reimbursement. Home visits, reserved mainly for frail elderly people and palliative patients, are seen as valuable for preventing unnecessary visits to emergency rooms and hospitalizations. Home visits are also useful for reducing caregivers' stress, monitoring chronic illnesses, and assessing need for institutionalization. Home visiting requires special skills; these must be taught to current trainees.CONCLUSIONWith the shift to more community-based care, the demand for physicians to make home visits will increase. Physicians must be adequately prepared to deliver home care and be reimbursed appropriately.

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PubMed1996

Evaluation of a self-medication program.

OBJECTIVE: To determine the effect of an inpatient self-medication program (SMP) on the ability to self-medicate, patient medication knowledge, compliance, and patient morale. DESIGN: Randomized controlled clinical trial. POPULATION: One hundred seven consecutive patients admitted to a geriatric assessment and rehabilitation program were randomized to either participate in the SMP or to receive standard care. INTERVENTION: The SMP was a three-stage program in which patients were given increasing responsibility for the administration of their own medications. MEASUREMENTS: Ability to self-medicate on discharge from hospital; medication compliance at 1 month; patient medication knowledge; Philadelphia Morale Scale. MAIN RESULTS: Participation in the self-medication program did not increase the proportion of patients who were able to self-medicate on discharge from hospital. Compliance was improved by the program. On a proportional basis, the self-medication group made significantly fewer medication errors than the control group at 1-month follow-up (0.045 vs 0.086, P < .001). There were no significant differences in morale or medication knowledge between the SMP and control groups, although both groups made significant gains in knowledge about the names, administration times, and purposes of their medications from admission to follow-up (P < .001). CONCLUSIONS: A SMP can improve compliance in geriatric patients who are discharged to the community. Participation in a SMP does not improve patients' morale nor does it improve their medication knowledge more than pharmacy counselling alone. Participation in a SMP is unlikely to increase the probability that patients will be able to self-medicate on discharge. Cognitive factors limit patients' ability to self-medicate.

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PubMed1996

Needs for CME in geriatrics. Part 1: Perceptions of patients and community informants.

OBJECTIVE: To describe the needs of physicians for continuing education in geriatrics as perceived by patients and community informants. DESIGN: Cross-sectional survey by mail and in-person interviews. SETTING: Organizations working with the elderly in the community and patients in a primary care population in Calgary. PARTICIPANTS: Key informants working with the elderly in the community, including managers and providers of physical, psychosocial, educational, or mental health services to the elderly, and the first two geriatric patients visiting physicians after telephone contact from study investigators were surveyed. Twenty-five of 27 key community informants and 32 of 61 geriatric patients responded. MAIN OUTCOME MEASURE: Potential topics for continuing medical education. RESULTS: The 10 most frequently identified topics were communication, time management, attitudes to the elderly, medication, continuity of care, mental health, medical management of complicated cases, knowledge of community resources, health promotion, and compassion. Patients were more concerned than key informants about the process of care. Key informants were concerned about the technical aspects of care. CONCLUSIONS: The process of care as well as technical aspects of care must be addressed in continuing education in geriatrics for physicians.

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PubMed1992

An evaluation of pharmacy assessment for geriatric patients.

Evaluation of a pharmacy assessment for geriatric patients on a geriatric assessment and rehabilitation unit is described. The assessment has been developed to identify functional, comprehension and therapeutic problems affecting an elderly patient's ability to self-medicate. The pharmacy assessment identified more obstacles to self-medication than the nursing and medical assessments. The detection of obstacles was particularly apparent in the areas of medication knowledge deficit, complicated medication regimes and the inability to follow directions. The pharmacist made more recommendations than the other health professionals for improving the safety and efficacy of drug therapy and medication compliance (p less than .01). Recommendations included simplification of medication regimes, requesting drug levels or specific lab tests, and the use of compliance aids. Seventy-seven percent of the recommendations made by the pharmacist were acted upon by the physician or nurse. Results of the study demonstrate the pharmacy assessment was the most significant predictor of self-medication success.

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PubMed1992

Geriatric nutrition assessment: comparison of a screening tool to a dietitian assessment.

A priority in nutrition care is early identification of patients at risk of developing nutrition disorders. Simple identification measures such as nutrition screening on admission must be demonstrated to be as effective as the more lengthy traditional nutrition assessment. This study compares a nutrition screen to a clinical assessment in a geriatric setting. Seventy-two consecutive admissions to a geriatric assessment unit were both screened and individually assessed by different staff dietitians. Results of the assessment and the screen corresponded in classifying those at nutrition risk 92% of the time and those not at nutrition risk 77% of the time. The screen was found to be highly sensitive (88%) and specific (83%). A geriatric nutrition screen that has a high degree of agreement with a lengthier assessment may be a useful tool for the clinical practitioner in early identification of patients at nutritional risk.

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