Risk Of Inappropriate Use Research Articles

Prevalence of Self-Medication with Antibiotics amongst Clients Referred to Outpatient University Dental Clinics in Iranian Population: A Questionnaire-Based Study.

One thousand and two hundred of dentistry patients, who were referred to dental school clinics in ten major provinces of Iran, participated in this study. A valid self-administered questionnaire regarding self-medication with antibiotics in case of dental pain was used to collect data. Data were analysed using descriptive statistics and Logistic regression analysis. In our study population, the prevalence of self-medication was 42.6%. Amongst the Iranian cities, the highest prevalence of self-medication with antibiotics belonged to the city of Bandar Abbas (64%) and the lowest was seen in the city of Kerman (27.3%). Men were more likely to take antibiotics. Amoxicillin was the mostly used antibiotic. Severe pain, previous self-medications and high costs of dental visits were the most common reasons for self-medication with antibiotics in the investigated population. In addition, the present study showed that marriage, acceptable financial status and high level of education could decrease self-medication with antibiotics. In the current investigation, an alarming fact was that self-medication for dental problems seemed very common amongst the studied population. One of its most important consequences was bacterial resistance. Therefore, there should be plans to promote and prioritize public health awareness and encourage general public's motivation to reduce the practice of self-medication.

Knowledge, attitudes and practices relating to antibiotic use among community members of the Rupandehi District in Nepal

BackgroundThe development of antibiotic resistance is one of the biggest threats to global public health. Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. The aim of this study was to explore the knowledge, attitudes and practices (KAP) towards antibiotic use among adults in Nepal.MethodsA quantitative survey was conducted with 220 community members of the Rupandehi district of Nepal, with cluster sampling techniques applied to select households. Interviews were carried out face-to-face using a structured questionnaire. Responses were presented using descriptive analysis, with chi-squared tests and regression analysis applied to identify factors associated with KAP about antibiotic use and the Spearman’s rank order correlation coefficient calculated to examine the relationship between responses to the KAP questions.ResultsThe sample comprised more females (54%) than males, the average age of respondents was 38.5 years and almost 60% of respondents lived in rural areas. Respondents had relatively good knowledge about aspects of antibiotic use other than identifying antibiotics. The concept of antibiotic resistance was well known but imperfectly understood. Half of respondents (50.9%) were unsure whether skipping doses would contribute to the development of antibiotic resistance, 88.2% indicated they would go to another doctor if not prescribed an antibiotic when they thought one was needed and nearly half (47.7%) believed antibiotics helped them get better more quickly if they had a fever. Most respondents reported correct practices accessing and using antibiotics, however, 84.6% at least sometimes preferred an antibiotic when they have a cough and sore throat.Logistic regression showed respondents with higher levels of education tended to have better knowledge, more appropriate attitudes and better practices about antibiotic use. Rural respondents were less likely to have better knowledge about antibiotic use, while females were more likely to report better practices.ConclusionThe study provides baseline evidence about the knowledge, attitudes and practices regarding antibiotic use among the population of the Rupandehl district. Its findings will be useful in designing effective and targeted interventions to decrease misconceptions about antibiotic use and to increase awareness about the risks of inappropriate use of antibiotics in the community.

How general practitioners would deprescribe in frail oldest-old with polypharmacy \u2014 the LESS study

BackgroundMany oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe for this population.MethodsGPs took an online survey that presented case-vignettes of a frail oldest-old patient with and without history of cardiovascular disease (CVD) and asked if they would deprescribe any of seven medications. We calculated percentages of GPs willing to deprescribe at least one medication in the case with CVD and compared these with the case without CVD using paired t-tests. We also included open-ended questions to capture reasons for deprescribing and asked which factors could influence their decision to deprescribe by asking for their agreement on a 5-point-Likert-scale.ResultsOf the 282 GPs we invited, 157 (56%) responded: 73% were men; mean age was 56. In the case-vignette without CVD, 98% of GPs deprescribed at least one medication (usually cardiovascular preventive medications) stating it had no indication nor benefit. They would lower the dose or prescribe pain medication as needed to reduce side effects. Their response was much the same when the patient had a history of CVD. GPs reported they were influenced by ‘risk’ and ‘benefit’ of medications, ‘quality of life’, and ‘life expectancy’, and prioritized the patient’s wishes and priorities when deprescribing.ConclusionSwiss GPs were willing to deprescribe cardiovascular preventive medication when it lacked indication but tended to retain pain medication. Developing tools for GPs to assist them in balancing the risks and benefits of medication in the context of patient values may improve deprescribing activities in practice.

Inpatient Use of Insulin Pens—Eliminating Risk for Inappropriate Use of Pen on More than One Patient

Use of insulin pens for inpatient insulin administration is accurate and safe. However, if the pen is used on more than one patient, there is potential risk of infection with pathogens including hepatitis viruses and HIV. Rapid-acting insulin (RAI) is a time-critical medication, both for correctional and nutritional doses. Many hospitals using insulin pens choose to dispense them with a patient specific ID barcode from the pharmacy. This workflow ensures the correct patient ID for scanning, yet it may result in dispensing duplicates and may create time-critical delays. At UCSF, automated dispensing machines (ADM) on adult-units house time-critical medications, including RAI. In this workflow, the RN labels the insulin pen with the patient specific 3D barcode generated on the unit. Prior to insulin pen administration, 3 barcodes must be scanned: 1. Patient armband, 2. Patient label on insulin pen. (NEW) 3. Insulin pen manufacturer (confirms an active order for this type of insulin). The EMR will flash a screen size alert with a red stop sign and a warning if the patient’s armband ID and the pen label’s patient ID do not match. Implemented in 2/2017, this workflow and alert system, for the approximately 18,000 insulin pen SQ injections administered per month has triggered 10-25 alerts per month. As of 11/1/2017, all alerts have stopped the process and the correct patient’s insulin pen was retrieved and administered. Each alert is followed by an investigation. Significant factors contributing to the triggering of an alert involve RNs caring for >1 patient with RAI insulin orders, pens returned to the wrong patient specific cassette in centralized medication rooms, carrying > 1 patient’s insulin pen at a time and opening > 1 patient’s EMR in the patient’s room when scanning. We conclude that pen misuse can be avoided with compliance to our triple scanning system, in conjunction with best practices, while preserving the critical timing of rapid-acting insulin. Disclosure H.W. Macmaster: None. A. Maruoka: None. C. San Luis: None. S. Gonzalez: None. R.J. Rushakoff: None.

Effects of Diagnostic Work-Up on Medical Decision-Making for Canine Urinary Tract Infection: An Observational Study in Danish Small Animal Practices.

BackgroundClinical signs of urinary tract disease in dogs often lead to prescription of antibiotics. Appropriate diagnostic work‐up could optimize treatment and reduce the risk of inappropriate use of antibiotics.Hypothesis/ObjectivesTo describe and evaluate the impact of diagnostic work‐up on decision to treat (DTT) and choice of antibiotic treatment (COT) for dogs presenting with clinical signs of urinary tract disease.AnimalsOne hundred and fifty‐one dogs presenting to 52 Danish veterinary practices.MethodsProspective, observational study. Clinical signs, diagnostic work‐up, and prescriptions were recorded. Urine samples were submitted to a reference laboratory for quantitative bacterial culture (QBC) and susceptibility testing. The laboratory results were used as reference for assessing the appropriateness of DTT and COT.ResultsIn the majority of dogs, veterinarians performed dipstick (99%), microscopic examination of urine (80%) and bacterial culture (56%). Fifty‐one percent of dogs had urinary tract infection (UTI) based on reference QBC. Appropriate DTT was made for 62% of the dogs, while 36% were over‐prescribed and 2% under‐prescribed. Inappropriate use of second‐line agents was found in 57% of the UTI cases. Performing microscopy—but not culture—significantly impacted DTT (P = 0.039) while no difference was seen in COT (P = 0.67). The accuracy of in‐house microscopy and culture were 64.5 and 77%, respectively. Conclusions and Clinical Importance: Over‐prescription of antibiotics was common among dogs with suspected UTI, regardless of the diagnostic work‐up performed. Test inaccuracy under practice conditions and incoherence between diagnostic test results and decision‐making both explained inappropriate and unnecessary use of antibiotics.

Clinical Applications of Point-of-Care Testing in Different Conditions.

The use of point-of-care testing (POCT) in different clinical applications is justified by the fact that the time to release the result is shortened, allowing the physician to define the diagnosis and most appropriate therapy in a shorter time. However, the negative aspects must also be highlighted and studied so that we can move forward with the use of these devices. These negative aspects include greater analytical imprecision compared to laboratory automation, the variability between different equipment from different manufacturers, the risk of inappropriate use, a low level of global regulation, higher costs compared with laboratory testing and cost ineffectiveness in terms of health care. Methods and. This review presents some clinical applications of POCT in different scenarios, such as for diabetes mellitus, infectious diseases, pediatrics, and chronic kidney disease, among others. We hope to see a global consensus on an acceptable quality standard for performing POCT that is adaptable, practical, and cost effective in primary care settings, ensuring patient safety, and minimizing the risk of harm.

Predictors of Inappropriate Use of Diagnostic Tests and Management of Bronchiolitis.

Background The aim of the present study was to determine predictors of inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants. Methods In an analytical cross-sectional study, we determined independent predictors of the inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants. We defined a composite outcome score as the main outcome variable. Results Of the 303 included patients, 216 (71.3%) experienced an inappropriate use of diagnostic tests and treatment of bronchiolitis. After controlling for potential confounders, it was found that atopic dermatitis (OR 5.30; CI 95% 1.14–24.79; p = 0.034), length of hospital stay (OR 1.48; CI 95% 1.08–2.03; p = 0.015), and the number of siblings (OR 1.92; CI 95% 1.13–3.26; p = 0.015) were independent predictors of an inappropriate use of diagnostic tests and treatment of the disease. Conclusions Inappropriate use of diagnostic tests and treatment of bronchiolitis was a highly prevalent outcome in our population of study. Participants with atopic dermatitis, a longer hospital stay, and a greater number of siblings were at increased risk for inappropriate use of diagnostic tests and management of the disease.

Reliability and Validity of the Resistiveness to Care Scale Among Cognitively Impaired Older Adults

BackgroundResistiveness to care is behavior that prevents or interferes with caregivers’ performing or assisting with activities of daily living and puts residents at risk for inappropriate use of antipsychotic drugs, other restraining interventions, social isolation, and physical abuse. The purpose of this study was to establish the psychometric properties of a previously developed Resistiveness to Care measure. ProceduresThis was a descriptive study using baseline data from an ongoing randomized controlled trial testing a Function and Behavior Focused Care (FBFC) intervention. Residents were eligible to participate if they were 55 years of age or older, had a Mini-Mental State Exam (MMSE) score of 15 or less, and were not enrolled in hospice or admitted for subacute care. Descriptive information included age, race, gender, cognitive status, and marital status. In addition to the Resistance to Care Scale, the Barthel Index, the Physical Activity Survey in Long Term Care (PAS-LTC), and the Cohen-Mansfield Agitation Inventory (CMAI) were completed. Psychometric testing was done using Rasch analysis and the Winsteps statistical program. Main findingsThe participants were moderate to severely cognitively impaired (MMSE of 7.23), functionally dependent (Barthel Index 47.31, SD 27.59), and engaged in only 134.17 (SD = 207.32) minutes of physical activity daily. Reliability was supported based on a Cronbach alpha of 0.84 and the DIF analysis, as there was no difference in function of the items between male and female participants. Validity was supported as all items fit the measurement model based on INFIT and OUTFIT statistics. ConclusionsThe findings support the reliability and validity of the Resistiveness to Care Scale for use with older adults with dementia in nursing home settings. Future work with the measure may benefit from the addition of items that are easier to endorse with regard to resistiveness to care (shutting eyes or spitting out food may be useful additions).

A qualitative study exploring medicines use pattern and practice among general public in Malaysia.

Objective:The objective of this study is to explore the pattern and practice of medicine use among the general public; and to explore the key factors influencing medicine use among medicine users.Methods:A qualitative approach using focus group discussions was conducted to get in-depth information about medicines use pattern and practice from the general public. Adult people who reported using medicines at the time of study or in the previous month were approached. Two focus group discussions were audio-recorded and transcribed verbatim. The obtained data were analysed using thematic content analysis.Results:This study found that there are some misunderstanding about the appropriate use of medicines. The majority of the participants reported that they were complying with their medication regimen. However, forgetting to take medicines was stated by 4 participants while 2 participants stopped taking medicines when they felt better. In addition, 10 participants reporting using medicines according to their own knowledge and past experience. Whereas 4 participants took medicines according to other informal resources such as family, friends or the media. Seven participants have experienced side effects with using medicines, 4 of them informed their doctor while 3 participants stopped taking medicines without informing their doctor.Conclusion:There was a misunderstanding about medicines use in terms of medication compliance, self-management of the illness and the resources of information about using medicines. Many efforts are still needed from health care professionals to provide sufficient information about medicines use in order to decrease the risk of inappropriate use of medicines and to achieve better therapeutic outcome.

Pharmacist-Led Home Medicines Review and Residential Medication Management Review: The Australian Model.

Older people are often prescribed multiple medicines and have a high prevalence of polypharmacy. Polypharmacy is associated with an increased risk of inappropriate use of medicines and drug-related problems. As experts in pharmacotherapy, pharmacists are well placed to review complex medication regimens and identify causes of drug-related problems and recommend solutions to prevent or resolve them. Involvement in medication review services represents a major philosophical shift and paradigm change in the way pharmacists practice, in that the focus is shifted away from the dispensing of prescription medicines to the provision of a professional service for a patient, in collaboration with their general practitioner (GP). In Australia, there are two established medication review programs: Home Medicines Review (HMR) and Residential Medication Management Review (RMMR). The objectives of this article were to describe the process of government-funded medication review services in Australia and to evaluate the contribution of pharmacists to HMR and RMMR, using evidence-based measures, such as the Drug Burden Index (DBI) and the Medication Appropriateness Index (MAI). This review found that there is good evidence to support the role of pharmacists in delivering medication review services across different settings. Although the positive impact of such services has been demonstrated using a variety of validated measures (DBI, MAI), there remains a need to also evaluate actual clinical outcomes and/or patient-reported outcomes.

Exploring the Contractors’ Qualification Process in Public Works Contracts

Public contracting authority may award contracts only to contractors who meet certain qualification criteria for participation in tenders. Such requirements can vary between countries; this paper therefore introduces basic legislation governing this process both in the Czech Republic and Poland. The verification of compliance of these requirements should be made individually for each public procurement procedure which is associated with the need to submit corresponding documents.The aim of the article is to analyse and compare current practice in using qualification criteria for public works contracts in both countries.Information about qualification criteria have been studied on the sample of 345 tenders for public works contracts, in particular for road structures, schools and water and sewage facilities and equipment. Analytical part focuses on the extent of qualification criteria use and discusses their application in the context of ensuring fairness of the competition with regard to non-discriminatory nature of the qualification. Research findings reveal significant disparity between the Czech Republic and Poland in the area of 1) professional and 2) economic and financial qualifications.It has been concluded that the reintroduction of economic and financial qualification criteria in the Czech Republic is justified if used appropriately and according to methodological guidelines. In Poland, the risk of inappropriate use of criteria lies especially in excessive requirements in relation to the volume and nature of contract. Contracting entity is not obliged to describe and demand all the requirements, it is crucial to require just the fulfilment of those criteria which are necessary to assess the ability of contractors to perform the contract. The criteria of an environmental nature are hardly used.

Validation of the parental knowledge and attitude towards antibiotic usage and resistance among children in Tetovo, the Republic of Macedonia

This study sought to explore the knowledge and attitudes of parents on the use of antibiotics among children that could serve as baseline data and provide further insight in planning and developing strategies for local health education purposes. A cross-sectional survey involving 500 parents who attended community pharmacies in Tetovo, Republic of Macedonia, was conducted using a self-administered questionnaire from October 2013 to January 2014. The questionnaire included demographics, knowledge and attitude statements of parents towards antibiotics. The data collected were analyzed using SPSS program, version 19.0. Descriptive statistics was used to summarize the data. In all statistical analyses, a p-value of <0.05 was considered statistically significant. Nearly 40% of the parents demonstrated a moderate level of knowledge. The highest correct response in the knowledge part was the awareness of parents in using antibiotics to treat a bacterial infection (61.2%). However, most of the parents did not know that antibiotics cannot cure viral infections (59.6%). About 48.2% of the parents were aware of the antibiotic resistance as s result of the overuse. Concerning attitudes, 60.8% reported keeping any leftover antibiotics, 77.0% agreed that taking antibiotics when having cold symptoms could help their children recover faster, while, 74.6% wrongly agreed with the statement of appropriate use of antibiotics for prophylaxis' measure. This study has documented the main areas that merit attention when parental knowledge on antibiotic use for their children is the concern, reflecting in some inappropriate attitudes as well. The findings highlight the need to devise effective interventions to decrease misconceptions regarding antibiotic use and to increase parents' awareness for the risks of inappropriate use of antibiotics in children specifically and in the community at large.

Geriatric syndromes as predictors of one-year mortality in an outpatient practice

Introduction.– Polypharmacy is a term that describes patients who receive many medications. Unfortunately, using multiple medicationsmay cause problems such as the increased risk of inappropriate use of medications, nonadherence and adverse effects. Method.– We prospectively studied patients hospitalised at Geriatric Department during September to October 2012. Diagnoses, reason for admission, prescription before hospitalisation and after discharge were recorded. Polypharmacy was defined as the concomitant use of five or more medications and high-level polypharmacywas defined as concomitant use of ten ormoremedications. Results.–Hundred and twelve patientswere included,meanpatient age was 86.34±6.27years; 63.3% were female. Cumulative Illness Rating Scale for Geriatrics (CIRS-G): total score 9.84±7.07. Mean Charlson’s index: 2.16. The number of drugs prescribed amounted to 7.25 before hospitalisation and 8.12 at discharge. Hospitalisation led to a significant increase in numbermedications (P=0.001). Polypharmacy on admission and at discharge was observed in 83.03%and91.07% respectively, existing statistically significant difference (P=0.035). High-level polypharmacy on admission and at discharge was observed in 45.53% and 49.10% respectively. We observed a significant reduction in proton pump inhibitors and benzodiazepines. On the other hand, the laxative medication was increased at discharge (34.8 vs 53.5%, P=0.001). Conclusions.– Our study shows a high prevalence of polypharmacy in older spanish. Hospitalisation led to a significant increase in the number of medications and in the prevalence of polypharmacy. It is necessary to implement strategies to identify, and use properly drugs in elderly population.

Continuing education: Advanced food composition data use in practice

Continuing education and the APD programEvery contact between a lactating woman and a health professional who is unfamiliar with current breastfeeding knowledge creates a potential barrier to breastfeeding success and increases the risk of inappropriate use of artificial baby milk.

Current controversies in dental practice : Antibiotics- to prescribe or not to prescribe

Background: As a result of greater understanding of disease processes, enhanced awareness of cost effectiveness and risk-benefit correlations, and better communication between medical and dental practitioners, the guidelines for antibiotic prophylaxis have been significantly altered. From the standpoint of surgical procedures, antibiotics are rather overrated when considering the incidence of infections. There is often confusion and misinformation concerning the indications and scientific basis for the use of antibiotics in conjunction with dental procedures. Methods: The medical and dental literature was reviewed for scientific evidence regarding the use of antibiotics to prevent local and systemic infections associated with dental treatment. Situations commonly considered by dentists for potential use of prophylactic antibiotics were reviewed to determine current evidence with regard to use of antimicrobial agents. This included prevention of distant spread of oral organisms to susceptible sites elsewhere in the body and the reduction of local infections associated with oral procedures. Results: There are relatively few situations in which antibiotic prophylaxis is indicated. Aside from the clearly defined instances of endocarditis and late prosthetic joint infections, there is no consensus among experts on the need for prophylaxis. There is wide variation in recommended protocols, but little scientific basis for the recommendations. The emerging trend seems to be to avoid the prophylactic use of antibiotics in conjunction with dental treatment unless there is a clear indication. Conclusions: Aside from the specific situations described, there is little or no scientific basis for the use of antibiotic prophylaxis in dentistry. The risk of inappropriate use of antibiotics and widespread antibiotic resistance appear to be far more important than any possible perceived benefit. Clinical Implications: Dentists should use antibiotic prophylaxis in only those specific situations in which there is a valid scientific basis for it. Changes in use of antibiotics are imperative if clinicians are to limit the resistance of bacteria to these drugs.

Cost Analysis of the Use of Emergency Departments for Primary Care Services in Charlotte, North Carolina

Patients often inappropriately seek emergency services for ambulatory care-sensitive conditions (ACSCs). The unnecessary use of emergency departments (EDs) is an expensive burden on hospitals and payers. Here, we identify factors influencing ED visits for ACSCs and analyze the costs of such visits for EDs and primary care clinics. Age, race, sex, and insurance data from 2007 for 3 primary care safety net clinics and 4 EDs in Charlotte, North Carolina, were analyzed using the New York University (NYU) algorithm to identify ACSC diagnoses. Cost analyses used hospital charge data and net margins as surrogates for payer and hospital system costs. A total of 113,730 (59.4%) of 191,622 ED visits were for ACSCs. Factors that increased the number of ACSC-related visits included lack of insurance coverage; receipt of Medicaid insurance; age of less than 2 years; African American, Hispanic, or Native American race or ethnicity; and female sex. Charges in the EDs were 320%-728% higher than those in the primary care clinics, allowing for a potential savings of 69%-86% had ACSCs been treated in primary care clinics instead of in EDs. The NYU algorithm may have inherent weaknesses in the categorization of ACSC-related visits and the accuracy of cost assignment, especially for vulnerable patients, such as those with comorbidities or those aged less than 2 years. The majority of conditions treated during outpatient ED visits are treatable in primary care clinics or even preventable. Some groups are at higher risk for inappropriate use of EDs. Solutions to this complex problem will require payers and hospital systems to design and invest in novel targeted interventions.

Intoxicação exógena por “chumbinho” como forma de autoextermínio no Estado de Goiás, 2003 - 2007

doi: 10.5216/ree.v12i4.6471 A intoxicação exógena por chumbinho é considerada importante causa de morbidade e mortalidade no Brasil devido ao fácil acesso, baixo custo e por sua eficácia frente às tentativas de suicídio, tornando-se um problema de Saúde Pública. No Estado de Goiás não existem levantamentos sobre esse tipo de intoxicação, causadas intencionalmente, designando esta investigação. Trata-se de um estudo descritivo, retrospectivo documental com abordagem quantitativa, com o objetivo de estabelecer o perfil das vitimas com tentativas de autoextermínio no Estado de Goiás no período de 2003 a 2007. Das 537 fichas registradas 296 eram casos de intoxicação exógena intencional por chumbinho. As maiores ocorrências foram, nos anos de 2006 (33,44%) e 2007 (28,4%), na zona urbana com (90,88%), o sexo feminino com (52,36%), e a faixa etária entre 19 a 25 anos com (26,35%). Permaneceram internados por mais de 24 horas 76,35% dos casos, sendo que 79,07% dos casos obtiveram cura e 5,74% evoluíram para óbito. Conclui-se, portanto, a necessidade de o enfermeiro efetivar a educação em saúde na comunidade, alertando para os riscos do uso inadequado do "chumbinho", ainda, deve haver maior conscientização por parte destes profissionais no preenchimento da ficha de notificação compulsória. Descritores: Aldicarb; Saúde Pública; Tentativa de suicídio; Praguicidas.

Pharmacists’ acceptable levels of compensation for MTM services: A conjoint analysis

Background The Medicare Modernization Act of 2003 requires prescription drug plans to provide medication therapy management (MTM) services to Medicare beneficiaries who are at high risk for inappropriate use of medications. However, inadequate compensation has been a barrier for MTM expansion among pharmacists. Objectives The objective of this study was to determine pharmacists’ acceptable levels of compensation for MTM services. Methods A preference-based fractional factorial design of conjoint analysis was used by surveying 1524 active pharmacists in Tennessee. Pharmacists were asked to select between packages (scenarios) of MTM services that represented combinations of MTM attributes (characteristics). The MTM attributes included type of patient (new or returning), patient’s number of chronic conditions (1, 3, or 6), patient’s number of medications (4, 8, or 16), patient’s annual drug costs ($2000, $3000, or $4000), service duration (15 minutes, 30 minutes, or 45 minutes), and price of MTM services ($30, $60, or $120). A survival analysis model was used to predict pharmacists’ willingness to select 1 versus another MTM service package. Pharmacists’ acceptable level of compensation was estimated as the marginal rate of substitution between the parameter estimates of an attribute and the price attribute of MTM. Results The parameter estimates were −0.0303 ( P < .0001) for service duration and 0.0210 ( P < .0001) for price of MTM services, respectively, so pharmacists were willing to accept $1.44/min (0.0303/0.0210), or $86.4/h, for MTM services. Pharmacists’ characteristics were associated significantly with their acceptable levels of compensation: years of practice was associated with a higher need for compensation, pharmacy ownership (vs nonowner) associated with a lower need, and having provided MTM previously (vs having not provided MTM) was associated with a higher need. Conclusions Pharmacists’ acceptable level of compensation is in the higher part of current ranges from $30 to $100/h. To increase participation in MTM services, pharmacist compensation needs to be increased. Future studies might continue to corroborate the generalizability of findings from this study.

Using the internet.

As use of the internet by healthcare workers grows, the risk of inappropriate use, with potentially serious legal and professional repercussions, rises too.

Self-medication with antibiotics by the community of Abu Dhabi Emirate, United Arab Emirates

Self-medication with antibiotics may increase the risk of inappropriate use and the selection of resistant bacteria. The objective of the study was to estimate the prevalence of self-medication with antibiotics in Abu Dhabi. A validated, self-administered questionnaire was used to collect data. Data were analysed using descriptive statistics, and the chi-square test when applicable. One thousand subjects were invited to participate in the study. Eight hundred sixty questionnaires were completed, with a respondent rate of 86%, consisting of 66% males and 34% females. Among the 860 participants, 485 (56%) reported the use of antibiotics within the last year. Amoxicillin was the antibiotic most commonly used (46.3%). The survey showed a significant association between antibiotics used and age group (p < 0.001). Of the participants surveyed, 393 (46%) stated that they intentionally use antibiotics as self-medication without a medical consultation, a behavior that is significantly affected by educational levels (p<0.001). Two hundred forty-five (28%) participants stored antibiotics at home. These antibiotics were mostly acquired from community pharmacies without prescriptions (p<0.001). The results of this study confirm that antibiotic self-medication is a relatively frequent problem in Abu Dhabi. Interventions are required in order to reduce the frequency of antibiotic misuse.