Biomedical subjects

Sture Rognstad

Publications and source records attributed to Sture Rognstad.

4 recordsLinked to original sources

PubMed2006

Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice--the Prescription Peer Academic Detailing (Rx-PAD) Study [NCT00272155].

BACKGROUND: More than half of all antibiotic prescriptions in general practice are issued for respiratory tract infections (RTIs), despite convincing evidence that many of these infections are caused by viruses. Frequent misuse of antimicrobial agents is of great global health concern, as we face an emerging worldwide threat of bacterial antibiotic resistance. There is an increasing need to identify determinants and patterns of antibiotic prescribing, in order to identify where clinical practice can be improved. METHODS/DESIGN: Approximately 80 peer continuing medical education (CME) groups in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, evidence-based recommendations of antibiotic prescriptions for RTIs will be presented and software will be handed out for installation in participants PCs, enabling collection of prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Main outcomes are baseline proportion of inappropriate antibiotic prescriptions for RTIs and change in prescription patterns compared to baseline one year after the initiation of the tailored pedagogic intervention. DISCUSSION: Improvement of prescription patterns in medical practice is a challenging task. A thorough evaluation of guidelines for antibiotic treatment in RTIs may impose important benefits, whereas inappropriate prescribing entails substantial costs, as well as undesirable consequences like development of antibiotic resistance. Our hypothesis is that an educational intervention program will be effective in improving prescription patterns by reducing the total number of antibiotic prescriptions, as well as reducing the amount of broad-spectrum antibiotics, with special emphasis on macrolides.

Anti-Bacterial Agents↗

PubMed2006

A cluster-randomized educational intervention to reduce inappropriate prescription patterns for elderly patients in general practice--The Prescription Peer Academic Detailing (Rx-PAD) study [NCT00281450].

BACKGROUND: Age-related alterations in metabolism and excretion of medications increase the risk of adverse drug events in the elderly. Inappropriate polypharmacy and prescription practice entails increased burdens of impaired quality of life and drug related morbidity and mortality. The main objective of this trial is to evaluate effects of a tailored educational intervention towards general practitioners (GPs) aimed at supporting the implementation of a safer drug prescribing practice for elderly patients > or = 70 years. METHODS/DESIGN: Approximately 80 peer continuing medical education (CME) groups (about 600 GPs) in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. The control group will not receive any intervention towards prescription patterns in elderly, but will be the target of an educational intervention for prescription of antibiotics for respiratory tract infections. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, a set of quality indicators (QIs), i.e. explicit recommendations for safer prescribing for elderly patients, will be presented and discussed. Software will be handed out for installation in participants' practice computers to enable extraction of pre-defined prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Feedback reports will include QI-scores on individual- and group levels, before and after the intervention. The main outcome of this trial is the change in proportions of inappropriate prescriptions (QIs) for elderly patients > or = 70 years following intervention, compared to baseline levels. DISCUSSION: Improvement of prescription patterns in medical practice is a challenging task. Evidence suggests that a thorough evaluation of diagnostic indications for drug treatment in the elderly and/or a reduction of potentially inappropriate drugs may impose significant clinical benefits. Our hypothesis is that an educational intervention program will be effective in improving prescribing patterns for elderly patients in GP settings.

Aged↗

PubMed2006

[The withdrawal of Vioxx: how did the patients react?].

BACKGROUND: The withdrawal of rofecoxib (Vioxx) from the global market because of adverse cardiovascular effects affected many patients and created a lot of publicity. MATERIAL AND METHODS: 287 patients from four general practices who had received prescriptions for rofecoxib in 2004 were identified from the medical records of their general practitioner (GP) and mailed a questionnaire addressing their reactions and their expectations of their GP in this respect. RESULTS: 140 out of 287 patients returned the questionnaire. More than half were scared by the media frenzy about the withdrawal. 15% had received information from their GP after the withdrawal, whereas 70% wanted this kind of information. 42% had received prescriptions for rofecoxib, even if the patients could not confirm the presence of the diagnostic criteria. INTERPRETATION: The media frenzy gave rise to concern among patients, who want their GP to be more active in informing them about their use of unsafe medication. Better routines and data tools are needed for GPs to better identify and inform patients when needed.

Attitude to Health↗

PubMed2004

[Do general practitioners know what medication community nurses give their shared patients?].

BACKGROUND: Frail elderly outpatients often receive medicines from community nurses. There is little knowledge of how general practitioners (GPs) and nurses update and coordinate their medication lists for their shared patients. MATERIAL AND METHODS: Lists of regular medication for 90 randomly selected shared patients from GPs as well as community nurses were assessed with respect to agreement. An agreement score was calculated for number of medicines and for each drug: total daily dosage and dose regimen. Routines for updating medication lists were addressed in a questionnaire to GPs and community nurses. RESULTS: For three out of four patients, discrepancies were found between physicians' and nurses' lists of regular medication. 52% of the discrepancies were in relation to cardiovascular drugs and psychotropic drugs. Only 41% of the GPs reported explicit routines for updating their medication lists. INTERPRETATION: The GPs' lack of knowledge of what their patients actually receive may contribute to medication errors and adverse drug reactions.

Aged↗