scholarly journals Safer Prescribing and Care for the Elderly (SPACE): feasibility of audit and feedback plus practice mail-out to patients with high-risk prescribing

2017 ◽  
Vol 9 (2) ◽  
pp. 145 ◽  
Author(s):  
Katharine Wallis ◽  
Rebecca Tuckey
Keyword(s):  
General Practice ◽  
High Risk ◽  
The Elderly ◽  
Audit And Feedback ◽  
Structured Interviews ◽  
Medicines Information ◽  
Care For The Elderly ◽  
Increased Risk ◽  
Information Brochure ◽  
Practice Methods

ABSTRACT INTRODUCTION High-risk prescribing in general practice is common and places patients at increased risk of adverse events. AIM The Safer Prescribing and Care for the Elderly (SPACE) intervention, comprising audit and feedback plus practice mail-out to patients with high-risk prescribing, was designed to promote medicines review and support safer prescribing. This study aims to test the SPACE intervention feasibility in general practice. METHODS This feasibility study involved an Auckland Primary Health Organisation (PHO), a clinical advisory pharmacist, two purposively sampled urban general practices, and seven GPs. The acceptability and utility of the SPACE intervention were assessed by semi- structured interviews involving study participants, including 11 patients with high-risk prescribing. Interviews were audio-recorded, transcribed verbatim and analysed using a general inductive approach to identify emergent themes. RESULTS The pharmacist said the SPACE intervention facilitated communication with GPs, and provided a platform for their clinical advisory role at no extra cost to the PHO. GPs said the feedback session with the pharmacist was educational but added to time pressures. GPs selected 29 patients for the mail-out. Some GPs were concerned the mail-out might upset patients, but patients said they felt cared for. Some patients intended to take the letter to their next appointment and discuss their medicines with their GP; others said there were already many things to discuss and not enough time. Some patients were confused by the medicines information brochure. DISCUSSION The SPACE intervention is feasible in general practice. The medicines information brochure needs simplification. Further research is needed to test the effect of SPACE on high-risk prescribing.

scholarly journals Safer Prescribing and Care for the Elderly (SPACE): a pilot study in general practice

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101594
Author(s):  
Katharine A Wallis ◽  
C Raina Elley ◽  
Simon Moyes ◽  
Ngaire Kerse
Keyword(s):  
General Practice ◽  
Pilot Study ◽  
High Risk ◽  
Controlled Trial ◽  
Randomised Trial ◽  
The Elderly ◽  
Multiple Chronic Conditions ◽  
Outreach Visit ◽  
Care For The Elderly ◽  
Increased Risk

BackgroundHigh-risk prescribing places patients at increased risk of adverse drug events (ADEs). High-risk prescribing and ADE hospitalisations are increasingly common as people are living longer and taking more medicines for multiple chronic conditions. The Safer Prescribing and Care for the Elderly (SPACE) intervention is designed to foster patient engagement in medicines management and prompt medicines review.AimTo pilot the SPACE intervention in preparation for a larger cluster randomised controlled trial (RCT).Design & settingA pilot study in two general practices. Study participants were all patients at increased risk of an adverse drug reaction (ADE) from non-steroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet medicines. The primary outcome was the proportion of participants receiving high-risk prescribing at 6 months and 12 months compared with baseline.MethodThe SPACE intervention comprised automated practice audit to identify and generate for each GP a list of patients with high-risk prescribing for these medicines; an outreach visit by clinical advisory pharmacist to deliver education and to go through with each GP their list of at-risk patients and indicate in a tick-box the intended action for each patient; and a mail-out from GPs to selected patients containing a medicines information brochure and a letter encouraging patients to discuss their medicines when they next see their GP.ResultsSPACE can be delivered within existing primary care infrastructure. The rate of high-risk prescribing was reduced at 6 months following the delivery of the intervention, but these improvements were not evident at 12 months.ConclusionSPACE prompts medicines review and shows promising signs of supporting safer prescribing in general practice in the short term. A randomised trial of SPACE started in 2018.

scholarly journals Training of nursing students in integrated care for the elderly

2018 ◽  
Vol 21 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Wanderson Carneiro Moreira ◽  
Ana Raquel Batista de Carvalho ◽  
Eliana Campêlo Lago ◽  
Fernanda Cláudia Miranda Amorim ◽  
Delmo de Carvalho Alencar ◽  
...  
Keyword(s):  
Nursing Students ◽  
Integrated Care ◽  
Exploratory Study ◽  
Holistic Approach ◽  
The Elderly ◽  
Qualitative Approach ◽  
Training Process ◽  
Structured Interviews ◽  
University Center ◽  
Care For The Elderly

Abstract Objective: To analyze training in integrated health care for the elderly from the perspective of nursing students. Method: A descriptive and exploratory study with a qualitative approach was carried out using the action research method with the participation of 24 nursing students from a university center in Piauí, Brazil. Data were obtained through semi-structured interviews and submitted to content analysis. Results: Two thematic categories emerged: Perspectives on aging, violence and sexuality and A holistic approach to the elderly: integrating training and care. Conclusion: The perspective of the students on integrated care for the elderly is fragmented, stemming from the limitations of the training process for such care.

scholarly journals Public, private or hybrid? Providing care services under austerity: the case of Italy

2020 ◽  
Vol 40 (11/12) ◽  
pp. 1279-1300
Author(s):  
Lisa Dorigatti ◽  
Anna Mori ◽  
Stefano Neri
Keyword(s):  
Trade Unions ◽  
Local Governments ◽  
Industrial Relations ◽  
The Elderly ◽  
Educational Services ◽  
Structured Interviews ◽  
Term Care ◽  
Content Type ◽  
Care For The Elderly ◽  
Market Factors

PurposeThe paper examines the different trajectories of externalisation and the development of different kinds of welfare mix in three different sub-sectors of socio-educational services: long-term care for the elderly, early childhood services and kindergartens. By integrating the industrial relations and comparative public administration literatures, it analyses the different rationales underpinning contracting-out decisions of Italian local governments.Design/methodology/approachThe paper adopts a multi-method, multi-level approach: quantitative data on the provision of socio-educational services and the nature of the providers are combined with the analysis of 12 case studies of municipalities through 80 semi-structured interviews and documentary analysis.FindingsThe paper argues that differentials in labour regulation across the public/private divide and the consequent possibility to access labour markets characterised by cheaper labour and higher organisational flexibility are a key explanation in local governments' decisions to outsource. Despite labour market factors playing a prominent role, their relevance is significantly tempered by political and social factors and particularly by the strong opposition of citizens, personnel and trade unions to pure market solutions in the provision of such services. However, the centrality of these factors depends on the nature of the services: political sensibility against privatisation proved to be stronger in kindergartens, while services for the elderly were more frequently and less contentiously privatised.Originality/valueThe main contribution is the integration of the two research traditions to analyse patterns of outsourcing in the socio-educational services in Italy, showing that neither of them is able, alone, to explain the different private/public mix characterising different social and educational services.

Prevalence of Impaired Kidney Function in the German Elderly: Results from the Berlin Aging Study II (BASE-II)

Gerontology ◽  
2017 ◽  
Vol 63 (3) ◽  
pp. 201-209 ◽  
Author(s):  
Maximilian König ◽  
Maik Gollasch ◽  
Ilja Demuth ◽  
Elisabeth Steinhagen-Thiessen
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
The Elderly ◽  
Community Dwelling ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Increased Risk ◽  
Aging Study

Background: In aging populations with an ever-growing burden of risk factors such as obesity, diabetes, and hypertension, chronic kidney disease (CKD) is on the rise. However, little is known about its exact prevalence among elderly adults, and often albuminuria is not included in the definition of CKD. Moreover, novel equations for the estimated glomerular filtration rate (eGFR) have recently emerged, which have not been applied comprehensively to older adults. Data on CKD awareness among the elderly are sparse. Objectives: To determine the prevalence of CKD among older adults by eGFR and albumin/creatinine ratio (ACR), compare the performance of 6 established and novel eGFR formulas, explore risk factors, and determine the awareness of CKD in a large cohort of community-dwelling elderly from Germany. Methods: A total of 1,628 subjects from the Berlin Aging Study II (BASE-II) were included in this analysis (mean age 68.7 years; 51.2% female). Extensive cross-sectional data on sociodemographics, lifestyle, medication, and diagnoses were inquired during structured interviews and a medical examination, and blood and urine parameters were measured. Results: In all, 77.1% of the subjects had hypertension, 12.4% had diabetes, and 18.3% were obese. The prevalence of CKD strongly depended on the eGFR equations used: 25.4% (full age spectrum [FAS] equation), 24.6% (Berlin Initiative Study), 23.1% (Lund-Malmö revised), 19.3% (Cockcroft-Gault), 16.4% (Chronic Kidney Disease-Epidemiology Collaboration [CKD-EPI]), and 14.7% (Modification of Diet in Renal Disease [MDRD]). Of the subjects with an eGFRFAS <60 mL/min/1.73 m2 and/or an ACR >30 mg/g, only 3.9% were aware of having CKD. Polypharmacy, age, BMI, coronary artery disease, non-HDL cholesterol, and female sex were independently associated with CKD. Conclusions: CKD is prevalent among older adults in Germany, but awareness is low. The FAS equation detects higher rates of CKD than MDRD and CKD-EPI, which are most widely used at present. Also, when CKD is defined based on eGFR and albuminuria, considerably more people are identified than by eGFR alone. Finally, polypharmacy is associated with an increased risk for CKD in the elderly.

scholarly journals Host Immune Response Driving SARS-CoV-2 Evolution

Viruses ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 1095 ◽  
Author(s):  
Rui Wang ◽  
Yuta Hozumi ◽  
Yong-Hui Zheng ◽  
Changchuan Yin ◽  
Guo-Wei Wei
Keyword(s):  
Immune Response ◽  
High Risk ◽  
Gene Editing ◽  
The Elderly ◽  
Host Immune Response ◽  
Social Inequities ◽  
Increased Risk ◽  
Type C ◽  
Systemic Health ◽  
Adar Gene

The transmission and evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are of paramount importance in controlling and combating the coronavirus disease 2019 (COVID-19) pandemic. Currently, over 15,000 SARS-CoV-2 single mutations have been recorded, which have a great impact on the development of diagnostics, vaccines, antibody therapies, and drugs. However, little is known about SARS-CoV-2’s evolutionary characteristics and general trend. In this work, we present a comprehensive genotyping analysis of existing SARS-CoV-2 mutations. We reveal that host immune response via APOBEC and ADAR gene editing gives rise to near 65% of recorded mutations. Additionally, we show that children under age five and the elderly may be at high risk from COVID-19 because of their overreaction to the viral infection. Moreover, we uncover that populations of Oceania and Africa react significantly more intensively to SARS-CoV-2 infection than those of Europe and Asia, which may explain why African Americans were shown to be at increased risk of dying from COVID-19, in addition to their high risk of COVID-19 infection caused by systemic health and social inequities. Finally, our study indicates that for two viral genome sequences of the same origin, their evolution order may be determined from the ratio of mutation type, C > T over T > C.

FEATURES OF THE FORMATION OF CARE FOR THE OLDERLY IN NON-STATE RESIDENTIAL HOMES

2021 ◽  
pp. 870-878
Author(s):  
К. А. Галкин
Keyword(s):  
Nursing Homes ◽  
Older People ◽  
Rural Areas ◽  
Large City ◽  
The Elderly ◽  
Structured Interviews ◽  
Personalized Care ◽  
Care For The Elderly ◽  
Informal Rules ◽  
Care For Older People

В статье рассматриваются особенности заботы и ухода за пожилыми людьми в двух кейсах, которые представляют собой частные дома-интернаты для людей старше 60 лет. В частности, рассматривается создание заботы в условиях альтернативных возможностей, организация альтернативной заботы о пожилых людях в таких учреждениях и особенности формирования подобной заботы. В исследовании рассмотрены вопросы о соотношении формальных (институциональных) норм заботы о пожилых людях и неформальных правил, которые создаются сотрудниками частных домов-интернатов для пожилых людей, имеющих ограниченную профессионализацию в сфере работы с людьми старше 60 лет. Роль неформальных правил в рамках создания заботы о пожилых людях важна с точки зрения расширения агентности пожилых людей и их инклюзии в социум. В исследовании проанализировано сочетание особенностей формальных и неформальных правил по осуществлению заботы. На примере двух кейсов, полуструктурированных интервью с сотрудниками и администрацией, волонтёрами частных домовинтернатов ( n =30) автор показывает, что забота, которая формируется в частных домах-интернатах для пожилых людей, может достаточно сильно отличаться в зависимости от расположения учреждения, особенностей сотрудников и их профессионализации. Для более глобального пространства крупного города регионального значения забота о пожилых людях оказывается чётко регламентированной различными нормами и стандартами. Особенности заботы частного дома-интерната в сельской местности заключаются в персонифицированной заботе и создании больших возможностей для активности пожилых людей. The article discusses the features of care and care for the older in two cases, which are private nursing homes for people over sixty years of age. In particular, is the creation of concern in terms of great opportunities, the organization of alternative care for older people in such institutions and how such concerns. The study examines the relationship between formal (institutional) norms of social care for the older and informal rules that are created by employees of private nursing homes for the older who have limited professionalization in the field of work with people over sixty years of age. The role of informal rules in creating care for older people is important in terms of including the agency of older people and their inclusion in society. The study analyzes the combination of features of formal and informal rules for the implementation of care. Using the example of two cases, semi-structured interviews with employees and administration, volunteers of private nursing homes ( n =30), the author shows that the care that is formed in private nursing homes for the older can differ quite significantly depending on the location of the institution, the characteristics of employees and their professionalization For a more global space of a large city of regional significance care for the elderly is clearly regulated by various norms and standards. Features of care of a private nursing homes in rural areas consist in personalized care and creating greater opportunities for the activities of older people.

scholarly journals Elaborating on modular interfaces in multi-provider contexts

2020 ◽  
Vol 40 (9) ◽  
pp. 1397-1419
Author(s):  
Vincent Peters ◽  
Mervi Vähätalo ◽  
Bert Meijboom ◽  
Alice Barendregt ◽  
Levinus Bok ◽  
...  
Keyword(s):  
Patient Care ◽  
The Elderly ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Content Type ◽  
Care For The Elderly ◽  
Multiple Case ◽  
Third Dimension ◽  
Insight Into

PurposeThis study examines how modular interfaces manifest in multi-provider contexts and how they can improve coordination and customization of services. The aim of the study is to describe interfaces in multi-provider contexts and elaborate on how they support the delivery of integrated patient care.Design/methodology/approachA qualitative, multiple case study was conducted in two multi-provider contexts in healthcare services: one representing paediatric Down syndrome care in the Netherlands and one representing home care for the elderly in Finland. Data collection involved semi-structured interviews in both contexts.FindingsThis study provides insight into several types of interfaces and their role in multi-provider contexts. Several inter- and intra-organizational situations were identified in which the delivery of integrated patient care was jeopardized. This study describes how interfaces can help to alleviate these situations.Originality/valueThis study deepens the understanding of interfaces in service modularity by describing interfaces in multi-provider contexts. The multi-provider contexts studied inspired to incorporate the inter-organizational aspect into the literature on interfaces in service modularity. This study further develops the typology for interfaces in modular services by adding a third dimension to the typology, that is, the orientation of interfaces.

scholarly journals Safer Prescribing and Care for the Elderly (SPACE): Protocol of a Cluster Randomized Controlled Trial in Primary Care (Preprint)

2018 ◽  
Author(s):  
Katharine Ann Wallis ◽  
Carolyn Raina Elley ◽  
Arier Lee ◽  
Simon Moyes ◽  
Ngaire Kerse
Keyword(s):  
Primary Care ◽  
Randomized Controlled Trial ◽  
High Risk ◽  
Adverse Drug Events ◽  
Controlled Trial ◽  
The Elderly ◽  
Drug Event ◽  
Randomized Controlled ◽  
Care For The Elderly ◽  
Cluster Randomized

BACKGROUND High-risk prescribing, adverse drug events, and avoidable adverse drug event hospitalizations are common. The single greatest risk factor for high-risk prescribing and adverse drug events is the number of medications a person is taking. More people are living longer and taking more medications for multiple long-term conditions. Most on-going prescribing occurs in primary care. The most effective, cost-effective, and practical approach to safer prescribing in primary care is not yet known. OBJECTIVE To test the effect of the Safer Prescribing And Care for the Elderly (SPACE) intervention on high-risk prescribing of nonsteroidal anti-inflammatory and antiplatelet medicines, and related adverse drug event hospitalizations. METHODS This is a protocol of a cluster randomized controlled trial. The clusters will be primary care practices. Data collection and analysis will be at the level of patient. RESULTS Recruitment started in 2018. Six-month data collection will be in 2018. CONCLUSIONS This study addresses an important translational gap, testing an intervention designed to prompt medicines review and support safer prescribing in routine primary care practice. CLINICALTRIAL Australian New Zealand Clinical Trials Registry: ACTRN12618000034235 http://www.ANZCTR.org.au/ACTRN12618000034235.aspx (Archived with Webcite at http://www.webcitation.org/6yj9RImDf)

scholarly journals Safer prescribing and care for the elderly (SPACE): cluster randomised controlled trial in general practice

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0129
Author(s):  
Katharine Ann Wallis ◽  
Carolyn Raina Elley ◽  
Simon A. Moyes ◽  
Arier Lee ◽  
Joanna Frances Hikaka ◽  
...  
Keyword(s):  
General Practice ◽  
High Risk ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Cluster Randomised ◽  
Increased Risk ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Automated Search

BackgroundSafer prescribing in general practice may help to decrease preventable adverse drug events (ADE) and related hospitalisations.AimTo test effect of SPACE on high-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet medicines and related hospitalisations.Design & settingPragmatic cluster randomised controlled trial in general practice. Participants were patients at increased risk of ADEs from NSAIDs and/or antiplatelet medicines at baseline. SPACE comprises automated search to generate for each general practitioner (GP)a list of patients with high-risk prescribing; pharmacist outreach to provide education and one-on-one review of list with GP; and automated letter inviting patients to seek medication review with their GP.MethodPrimary outcome was difference in high-risk prescribing of NSAIDs and/or antiplatelet medicines at 6 months; secondary outcomes included high-risk prescribing for gastrointestinal, renal or cardiac ADEs separately; 12-month outcomes; and related ADE hospitalisations.ResultsWe recruited 39 practices with 205 GPs and 191,593 patients including 21,877 (11.4%) participants, 1,479 (6.8%) with high-risk prescribing. High-risk prescribing improved in both groups at 6 and 12 months compared with baseline. At 6 months, there was no significant difference between groups (OR: 0.99 (0.87, 1.13)) although SPACE improved more for gastrointestinal ADEs (0.81 (0.68, 0.96)). At 12 months, the control group improved more (OR: 1.29 (1.11, 1.49)). There was no significant difference for related hospitalisations.ConclusionFurther work is needed to identify scalable interventions that support safer prescribing in general practice. The use of automated search and feedback plus letter to patient warrants further exploration.

scholarly journals Dukungan Keluarga Terhadap Peningkatan Kualitas Hidup Lansia Melalui Pendekatan "Bahaum Bapakat"

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Magdalena Meda Sari ◽  
Desi Desi Desi ◽  
Dennys Christovel Dese
Keyword(s):  
Quality Of Life ◽  
Family Support ◽  
Support System ◽  
Aging Process ◽  
Social Role ◽  
Negative Impact ◽  
The Elderly ◽  
Structured Interviews ◽  
Care For The Elderly

 Abstrak Background: Elderly is someone who has reached the age of 60 years and over and has experienced physical deterioration. Changes experienced in the aging process can have a negative impact or cause problems for the elderly such as feeling helpless and useless, feeling hopeless about the life they are living, feeling inferior so that the elderly isolate themselves and avoid their environment.. The aging process can have an impact on the quality of life. The quality of a person's life can be influenced by environmental aspects, physical aspects, mental aspects and social aspects. If all aspects can be fulfilled by the elderly, the quality of life they get is also good. Family support has a good function in improving the quality of life of the elderly, because family plays an important role in the social support closest to the family. Purpose: This study aims to describe family support for improving the quality of life of the elderly through the traditional "bahaum bapakat" approach. Methods: the study used a qualitative method by conducting semi-structured interviews, participants who contributed as many as 10 elderly people and were taken by purposive sampling, data was collected through audio recorders and interview guides which were analyzed with the stages of data collection, coding, selecting useful data for determination. themes, then data triangulation was carried out. Results: Environment as a support system for the quality of life of the elderly, Physical health care for the elderly in Sungai Buluh Village, Emotion, Spirituality, and Self-description of the elderly in Sungai Buluh Village, Social interaction, Family Support System, Social role: bahaum elderly in Sungai Buluh Village. Conclusion: Family support through the approach bahaum bapakat  has an influence on improving the quality of life of the elderly in Sungai Buluh Village.Keywords: the elderly, the quality of life, family support, bahaum bapakat

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