Home Medicines Research Articles

Sustaining practice change in health care: the impact of a national quality improvement program on the uptake of collaborative medicines reviews

AbstractAimWe evaluated the impact of quality improvement interventions at different time points on the uptake of collaborative Home Medicines Reviews (HMRs).MethodsNational interventions to promote HMRs, comprising patient‐specific prescriber feedback and tailored educational materials for patients and clinicians, were conducted in 2004, 2006 and 2011 through the Veterans’ Medicines Advice and Therapeutics Education Services (Veterans’ MATES) program. Primary care patients taking multiple medicines were targeted in each intervention, while primary care patients taking multiple medicines who did not receive the intervention served as comparisons. Monthly HMR rates among targeted patients and a comparison group in the 9 months post‐intervention were determined using health claims data from the Australian Government Department of Veterans’ Affairs and compared using log binomial regression models. Overall trends in the rate of HMRs between November 2001 and December 2016 were also determined.ResultsOver 40 000 patients were targeted in each HMR intervention. Relative increases in HMR uptake were observed among patients targeted in the 2004 intervention (rate ratio (RR) 1.76 (1.39, 2.22), p < 0.0001), the 2006 intervention (RR 1.45 (1.19, 1.76), p = 0.0002) and the 2011 intervention (RR 2.81 (2.34, 3.37), p < 0.0001) compared to the comparison group. Overall, the monthly HMR rate increased from 0.2 per 1000 patients in November 2001 to 2.7 per 1000 patients in December 2012.ConclusionRegular repetition of quality improvement messages has led to sustained increases in HMR uptake among Australian veterans over the last decade.

Quality Use of the Pathology Data in Home Medicines Reviews: A Retrospective Evaluation.

Laboratory tests can be important tools for the assessment of pharmacotherapy. Nonetheless, there are no previous studies that have explicitly focused on the role of pathology data in Home Medicines Reviews (HMR), an Australian medication review program. Evaluate pharmacists' recommendations regarding laboratory testing in the medication review process. This retrospective review of HMRs assessed the prevalence of the pathology data provided by general practitioners. Additionally, the pharmacists' recommendations based on these laboratory data were compared with national and international guidelines. In total, 580 reports were evaluated. Of these, 179 reports did not contain any pathology data. Pharmacists commented on provided laboratory values in 324 reports and recommended further testing in 473 reports. Not all suggestions were related to previous values or were in line with guidelines. Most recommendations were regarding vitamin D and lipids (69% and 62% of medication review reports, respectively). Particularly, regarding renal impairment, pharmacists used their knowledge on dose adjustments and contraindications. In relation to full blood count, vitamin B12, and thyroid function, unjustified screenings were often recommended. In 26% of all reports, the pharmacists requested an array of tests without explaining the necessity for these tests. Conclusion and Relevance: Pharmacists provided useful advice based on the pathology data, which was concordant with national and international guidelines; however, in some cases, there was no rationale for the test recommendations provided. The outcome of the HMR program might be further enhanced if pharmacists had direct access to the patients' pathology data.

Improving medication safety for home nursing clients: A prospective observational study of a novel clinical pharmacy service-The Visiting Pharmacist (ViP) study.

Polypharmacy, medication errors and adverse events are common in older people receiving home nursing medication management support. Access to clinical pharmacists is limited. In Australia, few home nursing clients receive a general practitioner (GP)-initiated pharmacist-led Home Medicines Review, despite their eligibility and community nurses' (CN) efforts to facilitate this. An integrated home nursing clinical pharmacy service, in which CNs directly referred clients to a pharmacist, was therefore developed and piloted. The aim was to explore the number and type of medication-related problems (MRPs) and medication treatment authorization (medication order) discrepancies identified and addressed by clinical pharmacists. Two part-time clinical pharmacists were employed. They reviewed and reconciled clients' medications, educated clients/carers about their medicines, provided advice and support to CNs and worked with clients' GPs and other prescribers to optimize medication regimens and revise/update nurses' medication treatment authorizations. Evaluation involved review of clients' medicines data, including treatment authorizations and pharmacist medication review reports. Eighty-four clients (median 86years, 6 health conditions, 13 medications) were reviewed. The pharmacists identified 334 MRPs (median 4 per client) and 307 medication discrepancies in treatment authorizations (median 2 per client). The pharmacists made 282 recommendations to prescribers to address MRPs; 148 (52.5%) recommendations were acted on, resulting in 190 medication changes for 60 (71.4%) clients (median 2 per client). The pharmacists prepared, or assisted GPs to update, treatment authorizations for 68 (81%) clients. Integrating pharmacists into a home nursing service identified and addressed MRPs and medication treatment authorization discrepancies, hence contributing to enhanced medication safety.

Nursing Home Physicians Discuss Caring for Elderly Residents: An Exploratory Study.

ABSTRACTDespite the increasing complexity of nursing home care, the role of physicians caring for residents is largely unexplored. This international, exploratory study sought to learn about physicians' roles, responsibilities, and tasks as well as investigate the unique qualities of medical practice in nursing homes. We conducted interviews with 18 physicians, who reported making important contributions to the quality of resident care, including clarifying the goals of care, working to reduce unnecessary medication and hospitalization, as well as contributing to staff education. Nursing home practice involved physicians in networks of relations that were instrumental to the quality of medical care and physicians' job satisfaction. The importance of these relationships disrupts the oft-drawn boundary between the medical and the social, suggesting that good medical practice depends on good social practice. Reflecting the exploratory nature of the study, we recommend research to better understand and support the relational dimensions of nursing home medicine.

A CASE OF LOPERAMIDE INDUCED CARDIAC SYNCOPE

Loperamide is a nonprescription medication commonly used to treat diarrhea. If consumed in large amounts, it can cause QRS widening accompanied by QT interval prolongation and torsades de pointe arrhythmia. 25 year old female presents with syncopal episode. Home medicines included quetiapine,

Traditional healing practices in rural Bangladesh: a qualitative investigation

BackgroundTraditional healing practice is an important and integral part of healthcare systems in almost all countries of the world. Very few studies have addressed the holistic scenario of traditional healing practices in Bangladesh, although these serve around 80% of the ailing people. This study explored distinctive forms of traditional healing practices in rural Bangladesh.MethodsDuring July to October 2007, the study team conducted 64 unstructured interviews, and 18 key informant interviews with traditional healers and patients from Bhabanipur and Jobra, two adjacent villages in Chittagong district, Bangladesh. The study also used participatory observations of traditional healing activities in the treatment centers.ResultsMajority of the community members, especially people of low socioeconomic status, first approached the traditional healers with their medical problems. Only after failure of such treatment did they move to qualified physicians for modern treatment. Interestingly, if this failed, they returned to the traditional healers. This study identified both religious and non-religious healing practices. The key religious healing practices reportedly included Kalami, Bhandai, and Spiritual Healing, whereas the non-religious healing practices included Sorcery, Kabiraji, and Home Medicine. Both patients and healers practiced self-medication at home with their indigenous knowledge. Kabiraji was widely practiced based on informal use of local medicinal plants in rural areas. Healers in both Kalami and Bhandari practices resorted to religious rituals, and usually used verses of holy books in healing, which required a firm belief of patients for the treatment to be effective. Sorcerers deliberately used their so-called supernatural power not only to treat a patient but also to cause harm to others upon secret request. The spiritual healing reportedly diagnosed and cured the health problems through communication with sacred spirits. Although the fee for diagnosis was small, spiritual healing required different types of treatment instruments, which made the treatment implicitly expensive.ConclusionsTraditional healing was widely practiced as the means of primary healthcare in rural areas of Bangladesh, especially among the people with low socioeconomic status. The extent of services showed no decline with the advancement of modern medical sciences; rather it has increased with the passage of time.

Writing and dispensing safe prescriptions

Writing and dispensing safe prescriptions

The aging methadone maintenance patient: Treatment adjustment, long-term success, and quality of life

To evaluate the features and modes of adaptation to aging among Methadone Maintenance Treatment (MMT) enrollees. Beth Israel Medical Center in New York City. A sample of 156 MMT enrollees (103/66 percent males and 53/34 percent females) age 24-68 years. Twenty-nine percent of participants were aged 55 or older. A cross-sectional, multivariate, correlational design. Participants were administered the MMSE, ASI, BSI, as well as measures of impulsiveness and quality of life (QOL). Older adults were more likely to have had longer periods of treatment (p < 0.01), less likely to report current heroin use (p < 0.05) and overall drug use (p < 0.05), but were more likely to have a history of comorbid alcohol misuse (p < 0.01). Advanced age was also associated with less impulsiveness, hostility, paranoia, and interpersonal sensitivity (p < 0.01), more chronic medical problems (p < 0.05), greater use of medication for medical problems (p < 0.05), and more liberal take home medicine schedules (p < 0.01). However, no differences were found between older and younger participants with respect to their scores on the Overall Social Support scale (p > 0.05), the Personal Well-Being Index (p > 0.05) and the Satisfaction with Life Scale (p > 0.05), suggesting comparable levels of QOL. Furthermore, the rate of contact for older participants with medical professionals did not differ significantly from that of younger participants (p > 0.05). Only 7.1 percent of older participants reported regular contact with a primary care physician; a rate that is slightly lower than the rate in the overall population. The findings from the present study highlight at least two underappreciated challenges that clinicians are increasingly likely encounter in their work with the aging MMT population. These challenges are: (1) that despite numerous medical and psychiatric complaints, only a small proportion of MMT patients have regular contact with a primary care physician and the rate of contact does not appear to increase with age and (2) even with age-related declines in psychiatric comorbidity and illicit substance use, the suboptimal level of QOL that is characteristic of the MMT population as a whole does not improve with aging and length of tenure in MMT.

Two Centuries of Policing Swindles and Humbugs

Two Centuries of Policing Swindles and Humbugs Anne Fleming (bio) Edward J. Balleisen. Fraud: An American History from Barnum to Madoff. Princeton, N.J: Princeton University Press, 2017. xiv + 496 pp. $35.00. In 1865, P.T. Barnum observed that "there is no sort of object which men seek to attain … in which humbug is not very often an instrumentality."1 As the self-described Prince of Humbug, Barnum knew well the art of deception and its commercial value; his sales tactics often straddled the line between showmanship and fraud. Today, almost one hundred and fifty years later, Barnum's statement still rings true. Although much has changed in the way that commercial deception is policed, humbug remains an important tool for some modern American capitalists. Indeed, the American marketplace has never been nor will ever be entirely cleansed of fraud, as Edward Balleisen reports in his exciting new book Fraud: An American History from Barnum to Madoff. "No capitalist society will ever rid itself of clever, beguiling, charismatic flim-flammers, nor established firms that, in the face of new challenges, turn to deceptive marketing or dishonest accounting," Balleisen concludes (p. 383). He finds that commercial innovation and fraud have always been closely linked; new industries without established norms and standards of conduct consistently provide fertile ground for swindles and humbugs. Fraud chronicles the history of business fraud and its regulation over the past two hundred years, beginning in the early nineteenth century. Unlike previous works that focus on particular fraudsters or incidents of fraud, Balleisen casts a wide net that draws in examples from many corners of the world of commerce, including from the sale of securities, lightning rods, and other home improvement services, appliances, and medicine. An array of "capsule stories" illustrate the many varieties of business fraud and range of antifraud policing efforts over the past two centuries, as well as the similarities in approaches to fighting fraud across different domains of business within each era (p. 12). Although this method does not yield "clean plotlines" or deep explorations of central figures and events, it serves Balleisen's purpose well, which is to find the enduring patterns and "key inflection points" in the fight against business fraud, in addition to explaining the value of this history for [End Page 217] present-day policymaking (p. 12). Without lingering for long on the question of how we define "fraud," Balleisen provides historians and policymakers with a rich history of the machinery designed to stop and prevent it. Aside from the first two chapters, which offer an introduction and overview of the world of fraud, the remainder of the book explores the history of fraud policing in four parts. Each part corresponds to a different "phase" in the history of antifraud regulation: "A Nineteenth-Century World of Caveat Emptor (1810s to 1880s)," "Professionalization, Moralism, and the Elite Assault on Deception (1860s to 1930s)," "The Call for Investor and Consumer Protection (1930s to 1970s)," and "The Market Strikes Back (1970s to 2010s)." The first three phases chart a gradual shift away from the nineteenth century ethos of caveat emptor, "buyer beware," toward the mid-twentieth century mantra of caveat venditor, "seller beware." Over this period, reformers from within the state, the business community, and the "quasi-public domains between the two" fashioned new institutions and initiatives that became part of the "expanding web of antifraud regulation" that appeared between the 1860s and the 1970s (pp. 6–7). The final part then describes the "partial resurgence" of the caveat emptor ethos beginning in the mid-1970s, fueled by criticisms of excessive regulation from across the political spectrum and a "resurgent American antistatism" (p. 360). Within each part, most chapters proceed thematically, rather than chronologically. Part II chapter three, for example, maps the legal landscape of antifraud laws in the period from the end of the War of 1812 through Reconstruction, which corresponds to the lifespan of P. T. Barnum. The next chapter then describes private strategies for preventing fraud deployed during the same period, including the creation of new institutions for the collection and dissemination of information about commercial trickery for the business community and general public. The resulting chronology of fraud...

Home Medication Cabinets and Medication Taking Behavior of the Staffs in a University in China

Background: A growing sum of medicines is stored in home medication cabinets in China, with the behavior of self-medication increasing. Although responsible self-medication can help prevent and treat ailments that do not need professional consultation, it bears the risk of misuse of medicines issued on prescription due to inadequate prescription medicine administration. Objective: The objective of this study was to investigate the condition and safety of medication storage and intended self-medication in a University in China. Method: The study was conducted over 10 month period (May 2015–March 2016) and involved a random sample of households. The questionnaire survey and personal insight into household medicine supplies was performed by a team of trained pharmacy staffs. Interviewees (N = 398, aged 16–88 y) were visited door to door and the home medication cabinets were catalogued after the participants were interviewed. Results: The majority (89.71%) households have home medicine cabinets. The total number of medicine items in the 398 households was 5600, with a median of 14 per household. The most frequently encountered categories of registered medicines were cough and cold medcines (47.8%), antibacterials for systemic use (30.0%), topical products for joint and muscular pain(26.1%), vitamins (23.2%), medication for functional gastrointestinal disorders (23.2%), oral and external forms have not kept separately(55.1%). The most treatment related problems recorded were curative effect not ideal (57.9%). 68% of the sample population would choose doctors as medication consultation object about medicines purchased. Conclusion: Large sum of medicines were found per household, with a high prevalence of cough and cold medcines. Public services in China, mainly government and health organizations, need put more effort on educating people on how to store medicines, as well as finding a way to raise awareness of the public in promoting behavioral change about medication use.

Clinical Update on Nursing Home Medicine: 2017

This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.

Medicines education at home – A case study in Finland

Background: Educating children about medicines and medicine use is part of health education and is often seen as parents’ responsibility. However, to date, little research has been conducted on medicines education as provided in the home. Objective: To explore (1) parents’ attitudes towards medicines, (2) medicines education practices in the home and (3) the interaction in medicines education between the home and at school. Design: Mixed-methods case study. Setting: Pupils and their parents in one comprehensive school in Finland. Method: Before an educational intervention with Year 4 (aged 10–11 years) and Year 7 (aged 13–14 years) students, parents completed a background survey concerning their perceptions, beliefs and knowledge of medicines ( n = 250). Following the intervention, interviews with 12 mothers and 12 children, and medicine cabinet studies ( n = 10) were conducted. Quantitative data were analysed using K-mean cluster analysis to see whether respondents could be divided into different clusters based on their attitudes towards medicines. Qualitative data were analysed using theory-guided content analysis to obtain a picture of home medicines education. Results: Participants, mostly mothers, were divided into different types of medicine educators, whose attitudes towards medicines were either positive or neutral. Medicine consumption practices varied between families, but medicines were usually discussed when the child, a family member, a relative or a friend had a long-term illness; when a family member was suffering from a sickness; and while taking a medicine. In general, interaction between the home and the school was rather limited. Conclusion: The majority of mothers exhibited a strong reliance on public systems of health care. Greater interaction between schools and the home is needed in Finnish medicines education.

Retraction statement: ‘Psychotropic drug usage characteristics amongst people with severe and profound disability undergoing home medicines review’ by Fares Al‐Sarawi and Chris Alderman

The above article, published online in Wiley Online Library (wileyonlinelibrary.com), and in Volume 46:4 pp 312–315, has been retracted by agreement between the journal Editor in Chief, the authors, and John Wiley and Sons, Australia Ltd. The article has been removed in Wiley Online Library.At the time of publication, the South Australian Department of Communities and Social Inclusion (DCSI) had no knowledge of and did not give approval for the use of the data sample in this publication. No relationship has or can be claimed between the specific data referred to in the article and the sample population as the data used is incorrect. Conclusions were not drawn from clean data over a sufficient period &amp; are therefore incorrect as the results may not be properly representative. Additionally, Michael Auciello should not have been listed as an author as he did not write, review or authorise the publication.

Interdisciplinary model of care (RADICALS) for early detection and management of chronic obstructive pulmonary disease (COPD) in Australian primary care: study protocol for a cluster randomised controlled trial

IntroductionUp to half of all smokers develop clinically significant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence-based guidelines for managing COPD in primary care....

Bariatric Care Requires Much More Than Just Bigger Beds

LOS ANGELES — More than a third of people in the United States older than 65 are estimated to be obese, and the percentage may be higher than 40% among those 65 to 74. These numbers could translate to millions of seniors who will need bariatric care when they arrive in American nursing homes. The problem: Many nursing facilities aren’t ready to meet the special needs of the extremely obese. It’s not just a matter of seeking heavy-duty walkers, wheelchairs, and Hoyer lifts. A huge variety of extra-large devices and supplies are needed, ranging from slippers, incontinence pads, and toilets to armchairs, stretchers, shower chairs, and much more. The key is to understand and meet the unique needs of obese individuals, said Traci Clark, RN, director of nursing at Creekside Rehabilitation & Behavioral Health in Santa Rosa, CA. And that’s not all. Nursing staff must also understand how the size of residents affects their medical care in unexpected ways. “There’s no way to do CPR on someone who’s bariatric,” Ms. Clark said at the California Association of Long-Term Care Medicine’s annual meeting.Similarly, the Heimlich maneuver may require more than one person. “You can’t do a Heimlich maneuver if you can’t get your arms around them,” she said. “My arms will not go around a 56-inch chest. You need to have two people do it. These are some of the things that no one thinks about.” Five years ago, the Centers for Disease Control & Prevention examined statistics from 2007–2010 and estimated that 35% of adults 65 and older were obese — about 13 million people. The CDC estimated that 41% of those 65 to 74 years old were obese, as were 28% of those 75 and older. Researchers noted that several groups were at higher risk of obesity as seniors: black women (49% of those 75 and older were obese) and women with less than a high school education. Over time, from 1999 to 2010, senior men saw a major jump in obesity levels, including a remarkable rise from 18% in 1999–2002 to 27% in 2007–2010 (NCHS Data Brief, no. 106, September 2012). Although bariatric patients may need extra nursing care because of their comorbid conditions, there is a major gap in one area of nursing home medicine — hospice. Ms. Clark pointed to a 2017 study that looked at 5,677 Medicare beneficiaries who died from 1998 to 2012. Of those, 117 had BMIs of at least 40; only 23% of them received care in hospice compared with 34% of all beneficiaries (Ann Intern Med 2017;166:381–389). Ms. Clark recommended that nursing homes lease or buy these supplies and devices to serve a bariatric population: •Tape measures.•Extra-wide bedpans, commodes (up to 42 inches wide), beds (expandable up to 54 inches wide), armchairs and stretcher chairs (up to 32 inches wide), and wheelchairs (with widths of 26 inches, 28 inches, and larger).•Bariatric-size friction-reducing devices such as slider sheets.•Trapeze bar systems over beds.•Extra-capacity walkers, floor and ceiling lifts, slings, shower chairs (or shower stretchers), aids for standing and raising, and stepstools.•Extra-large or even larger clothing, including gowns, briefs, incontinence pads, and slippers.•Extra-wide stretchers with 1,000-pound capacity.•Appropriately sized medical tools such as longer needles and larger blood pressure cuffs. Everyone must keep in mind the Hoyer lift’s weight capacity, Ms. Clark advised, and understand that even 450 pounds may not be enough. Ms. Clark also advised nursing facilities to consider whether their rooms are large enough to handle bariatric patients. “Think about six people simultaneously turning someone, plus a lift,” she said. “Sleep apnea is almost guaranteed,” she added, so accommodations may need to include a continuous positive airway pressure (CPAP) machine and an oxygen concentrator, as well as a bedside commode. Ms. Clark pointed to other challenges such as the need for intensive skin management, and she encouraged acceptance of patients who don’t change their eating habits. “We need to support these people even though they’re bringing this on themselves. We have to honor that choice and not chastise.” Randy Dotinga is a San Diego-based freelance writer.

Study Shows Association Between Pain and Depression in Dementia

Pain and depression are strongly related in dementia regardless of analgesic or antidepressant use, a large, prospective Norwegian study has shown. This study (J Affect Dis 2017;218:8–14) combined prospective data on 931 patients, two-thirds of whom were women, all with mild cognitive impairment and an average age of 85.4 years. The data were taken from two independent studies of multiple nursing homes in Norway. In the first study, 684 individuals with dementia who lived in one of 47 centers were evaluated at baseline and at 6 months between January 2012 and June 2014. In the second study 247 individuals with dementia living in one of 26 centers were analyzed for pain and depression at baseline and at 4 months between April 2014 and June 2015. In both studies, cognitive function was assessed using the Mini-Mental State Examination (MMSE). Pain was assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) pain scale. Depression was measured using the Cornell Scale for Depression in Dementia (CSDD). The Neuropsychiatric Inventory–Nursing Home version (NPI-NH) assessed neuropsychiatric symptoms; the NPI depression subscale scores were used as secondary outcome measures. Pain at baseline was statistically significantly associated with depression at the follow-up points in both studies; however, after adjusting for covariates, only the second study retained the statistically significant association. Meanwhile, unadjusted rates of depression at baseline were statistically significantly associated with pain at follow-up evaluation in both studies, but only the first study retained its statistically significant association after adjusting for covariates. In their mixed model analyses, Ane Erdal, a PhD candidate in the global public health and primary care department and Centre for Elderly and Nursing Home Medicine at the University of Bergen in Norway, and her colleagues found that the patients with more pain were statistically significantly more depressed than those with less pain, and that the reverse was also true. An increase of 1 point on the MOBID-2 scale was associated with an increase of 0.48 on the CSDD scale and also with an increase of 0.11 on the NPI depression subscale. An increase of 1 point on the CSDD scale was associated with an increase of 0.10 on the MOBID-2 scale. The use of analgesics was shown to be statistically significantly associated with both pain and depression. Residents who received an increased number of analgesics from baseline to follow-up had statistically significantly increased pain and increased depression during the same period. The number of antidepressants prescribed to a resident was statistically significantly associated with their depressive symptoms, but this was not true for pain. When pain and depression were assessed according to levels of cognitive function, pain was statistically significantly associated with increased depression in people with mild and moderate cognitive impairment. It was nearly statistically significant in residents with severe cognitive impairment, but was not statistically significantly associated in those with no impairment or whose impairment was questionable. Depression was similarly associated with pain in mild, moderate, and severe cognitive impairment, but not in those with either no impairment or questionable impairment. The authors concluded that over time, reduced pain intensity is associated with future reductions in depressive symptoms across all levels of cognitive impairment, and that consideration of the equipoise of analgesic and antidepressant prescribing in this population is particularly important. Helen Jones is a NJ-based freelance writer.

A survey of standing drugs and medical treatment behavior in urban family of Hefei city of Anhui province

Objective To understand the types of drug use, medication habits, medical treatment behavior and drug management of urban families in Hefei, and to provide background information for drug safety education and scientific medical education. Methods The questionnaire design covers 32 issues, some teachers and parents of 2 training institutions, part of the staff of the 2 administrative institutions and the residents of the 3 residential areas were investigated.320 questionnaires were distributed, and valid questionnaires were collected from 306 copies. Results 96.1% of Hefei urban family had standing drugs, anti cold drugs was the highest proportion(87.3%), followed by antibacterial drugs(51.0%), the main channel was the purchase pharmacy(89.2%) and hospital(36.3%). When the family was ill, 65.7% of the respondents first ate home medicine; the proportion of chosing a large hospital up to 83.3%.74.5% of respondents believed that antibiotics abuse.Up to 83.3% of respondents had been performed intravenous infusion therapy when illness, 55.9% of the respondents thought intravenous infusion therapy most unnecessary, and only 5.9% of the respondents thought intravenous infusion therapy was dangerous.Consulting a doctor when they had a problem in 67.7%, followed by the internet query(44.1%) and to the pharmacy consultation(14.7%).40.2% of the respondents hoped to learn medical knowledge. Conclusion Hefei city of Anhui province has a high proportion of urban family with standing drugs, the purchase way is regular, and when the disease, first of all to eat home standing drugs, medical treatment prefers large hospital, most think most intravenous infusion is not necessary; They want to understand the medical knowledge, and hope to establish consultation channels. Key words: Urban residents; Family medication; Medical seeking behavior; Investigation

INTEGRATION OF AN ELECTRONIC MEDICATION RISK ASSESSMENT TOOL INTO HOME MEDICINES REVIEWS

The Drug Burden Index (DBI) pharmacologically measures the cumulative effect of anticholinergic and sedative medications (ACh-Sed). Increasing DBI has been associated with poorer outcomes in older adults, including those with dementia. There is a need to highlight the risks of prescribing ACh-Sed in clinical practice. This study assessed the feasibility and impact of integrating a DBI report generated by The DBI Calculator© (a reliable electronic clinical decision support tool), into the pharmacist-led Home Medicines Review service - an Australian government-funded medication review model in the primary care setting. Three-months after the intervention, the median DBI for patients (n=100) significantly decreased (p=0.014), and 36.4% of patients with DBI>0 (n=66) at baseline had a reduction in their DBI scores. This study demonstrates the feasibility of integrating The DBI Calculator© in practice to facilitate deprescribing of ACh-Sed in older adults.

Triethylene glycol, an active component of Ashwagandha (Withania somnifera) leaves, is responsible for sleep induction.

Insomnia is the most common sleep complaint which occurs due to difficulty in falling asleep or maintaining it. Most of currently available drugs for insomnia develop dependency and/or adverse effects. Hence natural therapies could be an alternative choice of treatment for insomnia. The root or whole plant extract of Ashwagandha (Withania somnifera) has been used to induce sleep in Indian system of traditional home medicine, Ayurveda. However, its active somnogenic components remain unidentified. We investigated the effect of various components of Ashwagandha leaf on sleep regulation by oral administration in mice. We found that the alcoholic extract that contained high amount of active withanolides was ineffective to induce sleep in mice. However, the water extract which contain triethylene glycol as a major component induced significant amount of non-rapid eye movement sleep with slight change in rapid eye movement sleep. Commercially available triethylene glycol also increased non-rapid eye movement sleep in mice in a dose-dependent (10–30 mg/mouse) manner. These results clearly demonstrated that triethylene glycol is an active sleep-inducing component of Ashwagandha leaves and could potentially be useful for insomnia therapy.

A qualitative study to describe patient‐specific factors that relate to clinical need for and potential to benefit from a medication management service in palliative care

AbstractBackgroundIn 2011, an advanced practice role was introduced to a specialist regional palliative care service to support an expansion of the number of palliative care home medicines reviews.AimTo gain insight into which types of community‐based palliative care patients benefit from medication management services in order to guide local service development.MethodThematic analysis of a case series of medication reviews conducted by the palliative care pharmacist.ResultsOver a 12‐week period, 15 medication reviews were conducted and analysed. Four patient categories that related to a clinical need and potential to benefit from a medication review were identified: managing a chronic disease as well as cancer; experiencing ongoing generalised symptoms; having existing or anticipated problems with swallowing or digestion; and having a recognised falls risk. Most patients fit into more than one category.ConclusionThere is significant opportunity for pharmacists to enhance the quality of life of palliative care patients through improved use of medicines; however, incorporating the existing home medicine review program does not appear to be the most appropriate method for achieving this due to the program design. Delivering best outcomes for palliative care patients requires models of care that support communication and collaboration across the entire healthcare team and facilitate trusting therapeutic relationships between pharmacists and patients. Integration of advanced generalist pharmacists into clinical care teams is a positive step toward improving patient outcomes in palliative care.