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1
Clifford, Rhonda Marise. "Pharmaceutical care in diabetes mellitus." Curtin University of Technology, School of Pharmacy, 2004. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=14951.
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People with diabetes mellitus are more likely to die from cardiovascular causes than those without diabetes, and modifiable risk factors, such as hyperglycaemia, dyslipidaemia and hypertension can be targeted in intervention programs to decrease this risk. In addition to tertiary care for patients with diabetes, there is a need for simple programs to be implemented in the community that allow the benefits of improved metabolic and blood pressure control to be realised more widely. Pharmaceutical care comprises the detection, prevention and solution of drug-related problems in a quantifiable form, so that outcomes of care can be easily reviewed and monitored. Previous studies of pharmaceutical care programs in patients with diabetes do not provide conclusive evidence of the benefit of pharmaceutical care. The aim of this research was to evaluate the impact of the provision of pharmaceutical care to patients with diabetes mellitus in an Australian context. In order to develop a pharmaceutical care program, the characteristics of an Australian cohort of patients with diabetes were reviewed. The Fremantle Diabetes Study (FDS), was a community-based prospective observational study of diabetes care, control and complications in a postcode-defined region of 120 097 people surrounding the port city of Fremantle in Western Australia. It was intended that the FDS annual reviews would provide important local information in order to design and implement a prospective pharmaceutical care program. A pilot pharmaceutical care program was subsequently developed for use in a diabetes outpatient clinic. This program was then modified for use in a community-based sample of type 2 diabetes mellitus patients, drawn from the FDS cohort.Demographic parameters, including ethnicity and treatment details, were reviewed at study entry for the full FDS cohort and then over time for a subset of patients that returned for four subsequent annual assessments. Insulin use was more common in patients of Southern European origin compared with the Anglo-Celt group irrespective of the level of glycaemia, at baseline. This difference persisted during subsequent follow-up but was not associated with improved glycaemic control. These findings demonstrated that there are important ethnic differences in the management of patients with type 2 diabetes mellitus. The pilot pharmaceutical care program was carried out in high-risk diabetes mellitus patients attending a hospital outpatient clinic. The patients had poor glycaemic control, dyslipidaemia, hypertension and/or were on three or more prescription medications. In the pharmaceutical care arm, a clinical pharmacist reviewed and monitored all aspects of the patients' drug therapy in collaboration with other health care professionals at six weekly intervals for six months. The control patients received usual outpatient care. Seventy-three patients were recruited into the study, of whom 48 (66%) were randomised to receive pharmaceutical care. One in six patients was taking complementary medicines. The pharmaceutical care program provided patients with important medication information that resulted in changes to drug therapy. However, the six-month program did not lead to an improvement in glycaemic control. The next phase of the study adapted the pilot hospital-based pharmaceutical care program to a community-based setting.
Two hundred and two type 2 diabetes mellitus FDS patients were recruited, of whom 101 (50%) were randomised to the pharmaceutical care program, and all were followed for 12-months. There were significant reductions in risk factors associated with coronary heart disease in the case but not the control group over time, specifically glycaemic control, lipid levels, and blood pressure. Glycosylated haemoglobin fell from 7.5% to 7.0% (P<0.0001), total cholesterol fell from 5 mmol/L to 4.6 mmol/L (P<0.0001), systolic blood pressure fell from 158 mmHg to 143 mmHg (P<0.0001) and diastolic blood pressure fell from 77mmHg to 71mmHg (P<0.0001). Multiple linear regression analysis confirmed that pharmaceutical care program involvement was an independent predictor of benefit after adjustment for key variables. The 10-year coronary heart disease risk for patients without a previous coronary event was reduced by 4.6% over the 12-month study period in the pharmaceutical care group (P<0.0001), while there was no change in the controls (P=0.23). This phase of the study showed that medium-term individualised pharmaceutical care reduced vascular risk factors in a community-based cohort of patients with diabetes and that provision of a multifactorial intervention can improve health outcomes in type 2 diabetes mellitus. As part of the pharmaceutical care program, a high level of complementary medicine use was found. As a result, a study of complementary medicine use was undertaken in 351 patients from the FDS. A convenience sample of FDS patients was interviewed regarding their use of complementary medicines. A literature search was conducted to assess the potential impact of these medicines on diabetes, concomitant medications or diabetes-related co-morbidities.
Eighty-three of 351 (23.6%) patients with diabetes had consumed at least one complementary medicine in the previous year and 42% (77/183) of the products potentially necessitated additional patient monitoring or could be considered potentially inappropriate for a diabetic patient. The data indicated the need for patient disclosure of complementary medicine use and adequate monitoring for complementary medicine-related adverse events, as part of the pharmaceutical care process. The pharmaceutical care model was established to provide a framework by which drug use could be improved to enhance patients' clinical and health-related quality of life outcomes. For the present study, a straightforward pharmaceutical care program was adapted from a hospital setting to a community setting, where the principal requirement was a clinical pharmacist who had completed a self-directed diabetes-training program. In this context, clinically relevant parameters improved over the course of the study period. Pharmaceutical care programs such as this can begin the process of translating the findings of large and expensive clinical trials into standard clinical practice.
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Clifford, Rhonda. "Pharmaceutical care in diabetes mellitus." Thesis, Curtin University, 2004. http://hdl.handle.net/20.500.11937/1907.
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People with diabetes mellitus are more likely to die from cardiovascular causes than those without diabetes, and modifiable risk factors, such as hyperglycaemia, dyslipidaemia and hypertension can be targeted in intervention programs to decrease this risk. In addition to tertiary care for patients with diabetes, there is a need for simple programs to be implemented in the community that allow the benefits of improved metabolic and blood pressure control to be realised more widely. Pharmaceutical care comprises the detection, prevention and solution of drug-related problems in a quantifiable form, so that outcomes of care can be easily reviewed and monitored. Previous studies of pharmaceutical care programs in patients with diabetes do not provide conclusive evidence of the benefit of pharmaceutical care. The aim of this research was to evaluate the impact of the provision of pharmaceutical care to patients with diabetes mellitus in an Australian context. In order to develop a pharmaceutical care program, the characteristics of an Australian cohort of patients with diabetes were reviewed. The Fremantle Diabetes Study (FDS), was a community-based prospective observational study of diabetes care, control and complications in a postcode-defined region of 120 097 people surrounding the port city of Fremantle in Western Australia. It was intended that the FDS annual reviews would provide important local information in order to design and implement a prospective pharmaceutical care program. A pilot pharmaceutical care program was subsequently developed for use in a diabetes outpatient clinic. This program was then modified for use in a community-based sample of type 2 diabetes mellitus patients, drawn from the FDS cohort.Demographic parameters, including ethnicity and treatment details, were reviewed at study entry for the full FDS cohort and then over time for a subset of patients that returned for four subsequent annual assessments. Insulin use was more common in patients of Southern European origin compared with the Anglo-Celt group irrespective of the level of glycaemia, at baseline. This difference persisted during subsequent follow-up but was not associated with improved glycaemic control. These findings demonstrated that there are important ethnic differences in the management of patients with type 2 diabetes mellitus. The pilot pharmaceutical care program was carried out in high-risk diabetes mellitus patients attending a hospital outpatient clinic. The patients had poor glycaemic control, dyslipidaemia, hypertension and/or were on three or more prescription medications. In the pharmaceutical care arm, a clinical pharmacist reviewed and monitored all aspects of the patients' drug therapy in collaboration with other health care professionals at six weekly intervals for six months. The control patients received usual outpatient care. Seventy-three patients were recruited into the study, of whom 48 (66%) were randomised to receive pharmaceutical care. One in six patients was taking complementary medicines. The pharmaceutical care program provided patients with important medication information that resulted in changes to drug therapy. However, the six-month program did not lead to an improvement in glycaemic control. The next phase of the study adapted the pilot hospital-based pharmaceutical care program to a community-based setting.Two hundred and two type 2 diabetes mellitus FDS patients were recruited, of whom 101 (50%) were randomised to the pharmaceutical care program, and all were followed for 12-months. There were significant reductions in risk factors associated with coronary heart disease in the case but not the control group over time, specifically glycaemic control, lipid levels, and blood pressure. Glycosylated haemoglobin fell from 7.5% to 7.0% (P<0.0001), total cholesterol fell from 5 mmol/L to 4.6 mmol/L (P<0.0001), systolic blood pressure fell from 158 mmHg to 143 mmHg (P<0.0001) and diastolic blood pressure fell from 77mmHg to 71mmHg (P<0.0001). Multiple linear regression analysis confirmed that pharmaceutical care program involvement was an independent predictor of benefit after adjustment for key variables. The 10-year coronary heart disease risk for patients without a previous coronary event was reduced by 4.6% over the 12-month study period in the pharmaceutical care group (P<0.0001), while there was no change in the controls (P=0.23). This phase of the study showed that medium-term individualised pharmaceutical care reduced vascular risk factors in a community-based cohort of patients with diabetes and that provision of a multifactorial intervention can improve health outcomes in type 2 diabetes mellitus. As part of the pharmaceutical care program, a high level of complementary medicine use was found. As a result, a study of complementary medicine use was undertaken in 351 patients from the FDS. A convenience sample of FDS patients was interviewed regarding their use of complementary medicines. A literature search was conducted to assess the potential impact of these medicines on diabetes, concomitant medications or diabetes-related co-morbidities.Eighty-three of 351 (23.6%) patients with diabetes had consumed at least one complementary medicine in the previous year and 42% (77/183) of the products potentially necessitated additional patient monitoring or could be considered potentially inappropriate for a diabetic patient. The data indicated the need for patient disclosure of complementary medicine use and adequate monitoring for complementary medicine-related adverse events, as part of the pharmaceutical care process. The pharmaceutical care model was established to provide a framework by which drug use could be improved to enhance patients' clinical and health-related quality of life outcomes. For the present study, a straightforward pharmaceutical care program was adapted from a hospital setting to a community setting, where the principal requirement was a clinical pharmacist who had completed a self-directed diabetes-training program. In this context, clinically relevant parameters improved over the course of the study period. Pharmaceutical care programs such as this can begin the process of translating the findings of large and expensive clinical trials into standard clinical practice.
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Al, Mazroui Nadia. "Pharmaceutical care of type 2 diabetic patients." Thesis, Queen's University Belfast, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.431401.
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Bronkhorst, Elmien. "An Assessment of the need of pharmaceutical services in the intensive care unit and high care unit of Steve Biko Academic hospital." Thesis, University of Limpopo (Medunsa Campus), 2012. http://hdl.handle.net/10386/1081.
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Thesis (MSc(Med)(Pharmacy)) -- University of Limpopo, 2012.The role of the pharmacist has evolved over the last two decades beyond the traditional functions of dispensing and stock control. The focus has shifted toward patient-oriented functions, in which the pharmacist assumes responsibility for the patient’s drug- and healthcare needs as well as the outcome of treatment. The aim of this research was to assess the need for pharmaceutical care to the Surgical Intensive Care Unit of Steve Biko Hospital. The surgical and trauma ICU is a 12 bed unit to which the researcher rendered pharmaceutical care over an eight week period, from 14 February to 26 March 2011. Interventions to assess drug therapy and achieve definite outcomes to improve patients’ quality of life were documented for 51 study patients according to the system developed by the American Society of Health-System Pharmacists (1992). Of the 51 patients, 35 were male and 16 were female. The age of the patients ranged from 12 years to 86 years, with most patients admitted to the unit in the age groups 21 to 30 years, and 51 to 60 years. The patients’ estimated weights ranged from 40kg to 120kg with older patients, from age 41 upwards, weighing more. The average stay in the unit was 8.7 days, with the minimum stay for one patient being only one day, and the maximum stay for one patient was 26 days. In the study, the HIV status of only 13 of the 51 patients was tested. Of the 13 patients, six were HIV positive, while seven tested negative. All the patients admitted to the unit were not tested for HIV, because they were not admitted to the unit for HIV-related causes, and test results would not have had an effect on their outcome. Diagnoses encountered most frequently in the unit were trauma (21 patients), skeletal involvement or fractures (16 patients), infections or sepsis (15 patients) and gastro-intestinal bleeds (14 patients). In most cases more than one diagnosis applied to the same patient, since patients admitted with trauma also had skeletal or gastro-intestinal involvement. An Assessment of the need of Pharmaceutical Services in the Intensive Care Unit and High Care Unit of Steve Biko Academic Hospital viii The medications prescribed most frequently were enoxaparin (49 patients), sucralfate (41 patients) and multivitamin syrup (47 patients); in accordance with the standard ward protocol for prophylactic regimens. The drug class most often used was the anti-infectiveshaving124 items prescribed during the study period. Of these, the broad spectrum antibiotics were used most frequently, e.g. piperacillin/tazobactam (22 patients), meropenem (11 patients) and imipenem (11 patients). An average of 12 medications was prescribed for each patient in the ward. A total of 181 interventions were suggested for the 51 patients during the study period, of which 127 (70%) were accepted and implemented by the medical and nursing staff. The average number of interventions per patient ranged from 0 to 13 with a median of 3.5 interventions per patient. The four most frequent problem types were untreated medical conditions (15.5%), length or course of therapy inappropriate (13.8%), investigations indicated or outstanding (12.2%) and prescribed doses and dosing frequency appropriate (11%). Interventions were also made regularly to address system errors or non-compliance and factors hindering achievement of therapeutic effect. The perceived need for pharmaceutical care by healthcare professionals in the SICU was measured by questionnaires before and after the study period. The feedback by staff regarding the pharmacist working in the ward was very positive. They appreciated the researchers input on ward rounds, as well as assistance with problems encountered with the pharmacy. Of the total time spent in the ward, the researcher spent 28% of her time on patient evaluation. Ward rounds also took up a great deal of time (21.7%), since ward rounds were done with different members of the multidisciplinary team. Most interventions were suggested during ward rounds. The costs saved during the study period were enough to justify the appointment of a pharmacist to the ward on a permanent basis, albeit for limited hours daily. The researcher designed an antibiotic protocol for the unit. The protocol was designed according to international standards, and after discussion with the microbiologists, adapted for use in the specific unit. An Assessment of the need of Pharmaceutical Services in the Intensive Care Unit and High Care Unit of Steve Biko Academic Hospital ix In conclusion, the study results have demonstrated that a pharmacist’s contribution to patient care at ward level in a surgical ICU resulted in clinical outcomes that improved the patient’s quality of life. Drug-related problems were identified and addressed. Medical staff in the S-ICU accepted the pharmacist’s interventions and even welcomed her contribution to other ward functions, for instance managing medication and providing education. Pharmaceutical care should be rendered on a permanent basis to the Surgical ICU and the pharmacist should increasingly become a key part of the multidisciplinary team, taking responsibility for patients’ medication needs.
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Varma, Sumanthra. "Pharmaceutical care of elderly congestive heart failure patients." Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.388199.
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Sturgess, Ian K. "Pharmaceutical care provision to community dwelling elderly patients." Thesis, Queen's University Belfast, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268313.
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Sadik, A. S. "Pharmaceutical care of patients with congestive heart failure." Thesis, Queen's University Belfast, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269178.
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Scanlan, Justine Claire. "Pharmaceutical care for cancer patients : a multidisciplinary approach." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289814.
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Stern, Philip. "Patterns of pharmaceutical prescribing." Thesis, London Business School (University of London), 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309363.
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Glynn, Caroline. "Aspects of pharmaceutical care provision by the community pharmacist." Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337033.
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Douglas, Elizabeth Catherine. "The pharmaceutical care of patients with type 2 diabetes." Thesis, University of Strathclyde, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269997.
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Winitwatjana, Winit. "A computer aided learning program for pharmaceutical care teaching." Thesis, King's College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.265079.
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Bailey, Frank. "The Pharmaceutical Industry's Effect on Rheumatologists' Patterns of Care." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2063.
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Drug makers have developed numerous techniques to influence treatment choices. Almost no information exists regarding the pharmaceutical industry's influence on rheumatologists and how these pressures could affect patient care. This phenomenological research, conducted within the framework of social exchange theory, explored the lived experiences of rheumatologists regarding their interactions with agents of the pharmaceutical industry. A researcher-designed interview protocol was used to gather feedback from 10 rheumatologists regarding how interactions with agents of the pharmaceutical industry made them feel. Using horizonalization, meaningful statements made by rheumatologists were condensed into specific themes and patterns, which provided a composite summary of their experiences with agents of the pharmaceutical industry. The experiences of rheumatologists' interactions with drug manufacturing personnel provided insights about medication access and patient financial assistance. Other key themes from rheumatologists' feedback included relationships, respectfulness, value appraisal and credibility, and authority and oversight. Rheumatologists' preferences and animosities towards the pharmaceutical industry revealed potential opportunities to both improve and curtail specific activities. Such opportunities would allow rheumatologists and the pharmaceutical industry to increase equitable exchanges and facilitate the appropriate application of medical care for the greater society.
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Pickering, William Roy. "Improved pharmaceutical information exchange with developing countries." Thesis, City University London, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.260314.
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Chtourou, Mariem. "Pharmaceutical and personal care products removal by advanced treatment technologies." Doctoral thesis, Universitat de Girona, 2018. http://hdl.handle.net/10803/664966.
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This thesis evaluates different technologies for treating wastewater with high concentrations of PPCPs.
Firstly, a state-of-art revision of advanced treatment technology for removing Triclosan (TCS) from waste water was carried out in an attempt to evaluate the most favourable technologies and discern any major limiting factors. The technological categories evaluated were: (i) adsorption, (ii) advanced oxidation processes, and (iii) membrane technology.
The results found in the second chapter are based on treating three PPCP compounds in a cyclic anoxic/aerobic membrane bioreactor. In fact, the target compounds selected for this study were specifically carbamazepine, caffeine and triclosan. The ultrafiltration membrane bioreactor process was an efficient and appropriate technology for chemical oxygen demand removal, as it achieved a removal average of 97%, removal rate for caffeine reaching up to 93.7 ± 9.7 and 89.7 ± 8.3 % for triclosan. In the case of carbamazepine, removal was lower (36.2 ± 6.8%) due to its recalcitrance. Low ammonia removal efficiencies were observed in both experimental systems suggesting that nitrification was inhibited by the presence of triclosan. The deterioration of sludge characteristics induced a fouling increment which forced several chemical cleanings to be carried out.
The last section is focused on cork and evaluates its potential as a sorbent material. The cork was firstly characterized to discern its structure. Then a fixed-bed column was chosen as the most suitable technology with which to evaluate the cork adsorption. Four pharmaceuticals (diclofenac, ketoprofen, naproxen and carbamazepine) and two cosmetic compounds (triclosan and methylparaben) were treated in wastewater effluent by using a fixed-bed column. Furthermore, a novel, simple, selective and low-cost method for the pre-concentration sample before chromatography was performed in real wastewater effluent. This methodology is based on a silicone rod micro extraction combined with HPLC-DAD to simultaneous determine the concentration levels of six compounds. The adsorption capacities of cork followed this order: TCS >CBZ and MPB> KET and NAP > DCF. This behaviour could be explained by the fact that the removal of PPCPs by cork is based on hydrophobicity and the charge of the PPCP molecules. Generally, the cork showed a much higher capacity for TCS sorption, minimizing the concentrations of triclosan and avoiding the inhibition effect into biological systems, as well as minimizing fouling in MBRsAquesta tesi ha avualuat diferents tractament per l'eliminació d'influent amb alta concentració de fàrmacs i productes cosmètics. Primerament, una estat de l’art sobre els diferents tractaments per eliminar triclosan ha permès establir quines tipologies de tractament podrien ser els més rendibles tant a nivell operacional com de costos. Els tractaments avaluats han estat a) adsorció, b) processos d’oxidació avançada, i c) tractament per filtració amb membrana. La tecnologia de membrana va ser una de les tecnologies escollides per analitzar la capacitat per eliminar els productes farmacèutics i cosmètics, així com per poder establir les causes de l’embrutiment de les membranes. Els compostos escollit en aquest estudi van ser el triclosan, la carbamazepina i la cafeïna. Els rendiments d’eliminació van ser elevats pel triclosan i al cafeïna (>90%), mentre que la carbamazepina va ser molt inferior degut a seu poder recalcitrant (<40%). En l’experimentació també es va detectar una inhibició del procés de nitrificació, degut a la presència de triclosan. Aquesta inhibició és va confirmar en un estudi complementari on es va quantificar la pèrdua de la capacitat nitrificant en un 60%. El darrer capítol es centra en l’avaluació de l’adsorció com a tecnologia de tractament. En aquest cas s’ha utilitzat el suro com a material adsorbent i s’han presentat resultats de caracterització del material i resultats de capacitat d’adsorció. Per dur a terme l’experimentació es va triar la tecnologia de llit fix per tractar quatre composts farmacèutics (diclofenac, fetoprofen, naproxen i carbamazepina) i dos productes cosmètics (triclosan i metilparaben). La metodologia d’anàlisi va ser la micro-extracció en tub de silicona amb HPLC-DAD. Els resultats obtinguts van demostrar que el triclosan era el compost amb major capacitat de ser eliminat i el diclofenac el que presentava menors rendiments. TCS> CBZ i MPB> KET i NAP> DCF
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Ihsan, Shehla. "Cultural competency in pharmaceutical care delivery for minority ethnic communities." Thesis, University of Derby, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.732602.
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Granlund, David. "Economic policy in health care : Sickness absence and pharmaceutical costs." Doctoral thesis, Umeå : Department of Economics, Umeå University, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1137.
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Bell, Heather M. "Pharmaceutical care provision in N. Ireland - a focus on asthma." Thesis, Queen's University Belfast, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268179.
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McGuire, Treasure Madeleine. "Consumer medicines call centres : a medication liaison model of pharmaceutical care /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18728.pdf.
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Cousineau, Lisa Marie. "Pharmaceutical and personal care product concentrations in the upper Susquehanna River." Diss., Online access via UMI:, 2008.
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Fujita, Kenji. "The development of quality indicators for home pharmaceutical care in Japan." Thesis, University of Sydney, 2020. https://hdl.handle.net/2123/22994.
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Taking into account the challenges posed by an ageing society, Japan, one of the most rapidly ageing countries in the world, has recently seen a shift in focus of its health delivery system for the elderly from hospital care to home healthcare. In Japan, home pharmaceutical care (HPC) is provided to home-bound elderly who have difficulties in accessing a community pharmacy, for regular medicine supplies and medication management. Although the number of HPC services provided has increased, little is known about the quality of care provided. Quality indicators (QIs) are a recognised mechanism for evaluating the quality of health services, if they have been robustly developed and their measurement properties scientifically tested. The overall aim of the research described in this thesis was to develop a set of QIs for HPC in Japan and assess their measurement properties. A 4-step QI development procedure was applied. First, the results of a qualitative study regarding what constitutes ‘quality’ in HPC revealed that multiple stages of the home care pathway should be covered in order to comprehensively evaluate the quality of HPC. Second, in line with the determined scope, 52 QIs were developed based on the following three sources; 1) national guidelines, 2) existing QIs, and 3) healthcare professionals’ experiences and opinions. Third, appropriateness of the preliminary set of 52 QIs was assessed using the RAND/UCLA appropriateness method. Of these, 45 QIs were judged as ‘appropriate’ by the expert panel. Fourth, a 6-month observational study followed by semi-structured interviews were carried out to evaluate measurement properties of each QI (feasibility, applicability, improvement potential, discriminatory capacity, sensitivity to change, acceptability and implementation issues). As a result, 9 QIs met all measurement properties. A set of QIs for HPC was rigorously developed and tested. This QI set may be useful in evaluating the quality of HPC services in Japan.
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Brown, Stacy D. "Using Drug Stability Studies to Enhance Patient Care." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5250.
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Mikhail, May Naim. "Design And Evaluation Of Theophylline Monitoring For Home Health Care Patients." Scholarly Commons, 1987. https://scholarlycommons.pacific.edu/uop_etds/3337.
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The purpose of this study was to design, evaluate, and determine the cost benefit of a pharmacokinetic service for home-based patients. Four randomly selected patient populations were used in evaluating the service for six months. The experimental group consisted of 17 patients who were under the care of family practice physicians in private practice and who received pharmacokinetic consultation and monitoring by a pharmacist as a home health care service. The retrospective control consisted of the same 17 patients of the experimental group whose past medical history for a period of six months was used. The concurrent control consisted of 17 patients who were concurrently treated by the same family practice physicians in private practice who treated the patients in the experimental group. The fourth group consisted of 17 patients who were concurrently treated by family practice physicians in a general hospital outpatient clinic.
The service was evaluated by comparing the following variables: serum levels ordered, serum levels ordered inappropriately, physicians' office visits, hospitalizations secondary to pulmonary problems, and emergency room visits secondary to pulmonary problems. A one-way analysis of variance, Scheffe's post hoc test, and t test were used to analyze the results. There was a significant difference (P greater than 0.05) in the number of inappropriate levels ordered, physician's office visits, and emergency room visits. The cost of the service was $134 and the benefit was $218. It was concluded that a homebased pharmacokinetic service is cost beneficial in this patient population.
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Kilian, Pieter Johannes. "The treatment of asthma : a managed pharmaceutical care approach / Pieter Johannes Kilian." Thesis, North-West University, 2005. http://hdl.handle.net/10394/1610.
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EngovaÌ, Dita. "An investigation of pharmaceutical mental health care provision in a community setting." Thesis, University College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250722.
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MacLean, Fiona M. "Health informatics and the delivery of pharmaceutical care to patients with cancer." Thesis, University of Strathclyde, 2018. http://digitool.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=29532.
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This research was conducted to investigate how e-health technologies can contribute to the delivery of pharmaceutical care throughout the patient's journey and across traditional care boundaries. The hypothesis was that e-health technologies are enablers of efficient seamless delivery of pharmaceutical care. Qualitative and quantitative methods were used to examine how hospital clinical pharmacists work; to find out which toxicities were experienced by patients prescribed systemic anticancer therapy (SACT) and what their pharmaceutical care issues were; and to investigate the views of both cancer patients and community pharmacists relating to delivery of pharmaceutical care. The main findings were: access to mobile technology improved the efficiency of hospital clinical pharmacists; patients receiving SACT experienced a range of toxicity, some of which could be managed in primary care; patients would be happy to receive more from their community pharmacist; and community pharmacists should have access to electronic patient records (EPR) to safely deliver pharmaceutical care. Most patients who receive SACT experience toxicity in the community. Community pharmacists are ideally placed to support these patients but pharmacists require training and access to EPR to improve their confidence in managing SACT toxicity. Cancer care specialist pharmacists can contribute to the education and training of community pharmacists and initiatives to do so were implemented in NHS Greater Glasgow & Clyde (NHSGGC). Health and wellbeing Smartphone Apps can support patients and the Wellness Tracker, designed in this study, aimed to be an innovative technological aid for patients with cancer. Feedback from teenage patients was positive. XPost-study initiatives implemented in NHSGGC included electronic referral from hospital to GP-based pharmacists as step one. Two-way sharing of the electronic cancer pharmaceutical care plan; electronic referral to community pharmacists (step two) once access to EPR is granted; and clinical vignettes to support community pharmacists in providing advice to patients who have SACT toxicity will follow. Scottish cancer care pharmacists, in collaboration with the Scottish Directors of Pharmacy, have started development of nationally agreed pharmaceutical care bundles for community pharmacists to enable local delivery of pharmaceutical care to patients prescribed SACT.
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Lee, Amy, and Nisha Patel. "A Consumer Assessment of Pharmaceutical Care Services in a Diabetes Ambulatory Clinic." The University of Arizona, 2009. http://hdl.handle.net/10150/623965.
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Class of 2009 AbstractOBJECTIVES: To assess patients’ satisfaction with pharmaceutical care services provided in a community health center diabetes management clinic. METHODS: Patients who received diabetes-related pharmaceutical services from the clinical pharmacist at El Rio Health Center in Tucson, Arizona from November 2008 to January 2009 were contacted during a visit to the diabetes clinic and asked to complete the consumer assessment of pharmaceutical services questionnaire. The questionnaire included 14 likert-type items with response options ranging from “Never” to “Always” or “Disagree” to “Agree.” In addition, the patient’s most recent hemoglobin A1C (HgbA1C) was obtained from the electronic medical record. The survey instrument was also translated from English to Spanish to serve the Hispanic participants who could not communicate fluently in English. A descriptive cross-sectional analysis was completed in order to assess patient satisfaction. Dependent variables extracted from the survey were analyzed by Mann-Whitney U test. Interval and ratio data were analyzed by calculating means, standard deviations, and an independent t-test. Nominal data were analyzed using the Chi-Square test. RESULTS: A total of 46 patients completed the questionnaires, including 17 men and 29 women (mean age = 56, SD = 11.3, 80% Hispanic). All patients had seen the clinical pharmacist at least 3 times. Overall, this study showed that majority of the patients were satisfied with the service provided in the clinic. There was no statistically significant difference between English and Spanish patient populations in terms of satisfaction with pharmaceutical services provided about their disease management. CONCLUSIONS: Patients in this clinic were highly satisfied with the pharmaceutical care services provided by the clinical pharmacist.
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Begley, Susanne. "The establishment and evaluation of a domiciliary pharmaceutical service." Thesis, University of Brighton, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282561.
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Mostert, Zhan. "The impact of pharmaceutical care services on the management of asthma patients in a primary health care clinic." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/574.
Full textAbstract:
Optimal management of a chronic disease, like asthma, requires the active participation of patients. To achieve this, patients require education about asthma. Many of the recommended components of asthma care and management might not be effective without adequate patient education. Pharmacists in community, hospital and clinic practice are well placed to provide continued information and reinforcement of key messages, in order to improve compliance with medication and the outcomes of asthma management plans. Pharmacists may be able to increase medication adherence with patient counselling and monitoring systems and by facilitating communication with physicians. However, regardless of this, it remains uncertain whether pharmacist-patient interactions improve patient outcomes, and in spite of recommendations for teamwork and a multidisciplinary approach in the education of asthma patients, medical doctors and nurses are still largely responsible for carrying out the greatest part of patient education. The objectives of this study were therefore to determine the impact of pharmaceutical care services at a primary health care level on the management and well-being of asthmatic patients; to determine the effect of complex or multi-faceted pharmaceutical interventions, in patients with asthma, on lung function, asthma knowledge, attitudes and perceived self-management efficacy, asthma related quality of life and asthma control; and to determine the extent to which pharmacotherapeutic interventions, with regards to medication changes and dosage changes, are accepted and implemented by doctors. A randomised-control study was conducted at a primary health care clinic in the Eastern Cape. A total of 120 patients were allocated to two groups of sixty patients each (a Control Group and an Intervention Group). Baseline values were measured and follow-up interviews and post-intervention data collection were conducted three months afterwards for each group. Patients in the Control Group were attended to by the clinic staff as usual. Patients in the Intervention Group were educated on their disease by a pharmacist. The use of a customised 500ml plastic bottle as a spacer was suggested and each patient’s medication was evaluated against the Standard Treatment Guidelines for the management of asthma in adults at the primary health care level and where necessary, prescribing recommendations were made. Following assessment of the medication regimens of the patients in the Intervention Group, a total of 49 prescribing recommendations were made, of which 73 percent were accepted by both the doctor and patient. After educating the patients in the Intervention Group on inhaler technique, a significant improvement in technique was observed at the 3-month follow-up assessment (p<0.05). Using a short form of the Asthma Quality of Life Questionnaire (AQLQ(S)), a significant improvement post-intervention in mean total quality of life score (p<0.05) and mean average quality of life score (p<0.05) in the Intervention Group, were demonstrated. An improvement in mean activity limitation score in the Intervention Group post-intervention was also recorded for the activity limitation subscale of the AQLQ(S) (p<0.05). On measuring changes in asthma related knowledge, attitudes and self-efficacy, using a questionnaire (KASE-AQ), a significant improvement in mean knowledge score in the Intervention Group after the intervention (p<0.05) was also shown. With regards to lung function, both vital capacity (percent FVC) and expiratory flow volumes (percent FEV1) improved significantly in the Intervention Group (p<0.05). This study therefore demonstrated that multi-faceted pharmacist interventions, including medication assessment, asthma education, education on inhaler technique and the provision of medication aids in the form of spacers, can significantly improve the management of asthma patients and improve their well-being and quality of life.
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Bopape, Susan Mothekoa. "The management of dyslipidemia in a private health care setting : a managed pharmaceutical care approach / Susan Mothekoa Bopape." Thesis, North-West University, 2004. http://hdl.handle.net/10394/483.
Full textAbstract:
The global anti-dyslipidemic market grew by 19% from 2000 to 2001, achieving sales of over
$21 billion (Smith, 2004: 2). This market is currently well sewed by a number of effective and
well-tolerated treatments. Lipid-lowering drugs are considered as the first choice drugs in control
of dyslipidemias and they are well tolerated by most patients. As with many drug therapies, there
should be a balance between the benefits of cholesterol lowering agents, increased medication
cost and the overall risk of adverse drug reactions. According to Ballesteros (2001: 514),
hypolipidemic drugs are consumed on a large scale and most consumers are elderly. This
warrants a study of expenditure incurred because of inadequate prescribing of these agents.
The general objective of this study was to determine the utilisation and cost of hypolipidemic
drugs in the private health care environment in South Africa. A quantitative retrospective drug
utilisation review was performed using a medicine claims database. Data for twenty-four
consecutive months (May 1, 2001 to April 30, 2003) were used to determine and compare the
utilisation patterns and cost of drugs associated with the management of dyslipidemia a year
before (1st May 2001 to 30 April 2002) and a year after (1st May 2002 to 30 April 2003) the
implementation of a medicine reference price system (MPL). Data analysis was done by
calculating the average value, the standard deviation, effect size, and cost-prevalence indices.
The results of this study revealed that hypolipidemic drugs constituted 2.70% (n = 21820911)
and 2.78% (n =27277825) of the total number of all medicine items for the first and the second
study years respectively. On the other hand, the total cost of all hypolipidemic drugs accounted
for 6.33% (n= R3 097 604 602) and 6.23 % (n= R 4 053 280 295) of the total cost of all
medicine items claimed during the first and the second study years respectively. The prevalence
of generic hypolipidemic drugs accounted for 0.89% (n=589036) and 4.88% (n=759675) of the
total number of hypolipidemic drugs claimed during the first and second study year respectively.
Innovator drugs, on the other hand, constituted 99.1 1% (n=589036) and 95.11% (n=759675) of
the total number of hypolipidemic drugs claimed during the first and second study years
respectively. It was found that R23 694.5 and R603 277.36 could have been saved for generic
bezafibrate and generic simvastatin respectively if they had been sold at ME'L prices. The total
cost of generic hypolipidemic drugs accounted for 0.60% and 2.94%. The total cost of innovator
hypolipidemic drugs accounted for 99.40% and 97.06% of the total cost of hypolipidemic drugs
claimed during the first (n=R 196 076 050) and second (n=R 252 919 285) study year
respectively. With respect to the prescribed daily dose, it was found that most prescriptions for
individual hypolipidemic drugs did not conform to the defined daily dose. It was, however,
found that most prescriptions whose prescribed daily dose was for one tablet once daily and
whose strength was similar to the defined daily dose conformed to the defined daily dose.
The conclusion is that there was an insignificant difference in both the prevalence and cost of
hypolipidemic drugs a year before and after the implementation of MPL. It was further
concluded that increased utilisation of generic hypolipidemic medicine items a year after the
implementation of the MPL, could have been brought about by the introduction of generic
simvastatin into the market as opposed to the implementation of the MPL. Recommendations for
further studies will be formulated.Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.
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Montgomery, Anna. "Counselling in Swedish Community Pharmacies : Understanding the Process of a Pharmaceutical Care Service." Doctoral thesis, Uppsala universitet, Institutionen för farmaci, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-108973.
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Community pharmacy practice is moving towards patient care and away from the mere dispensing of medicines. In this movement, which is guided by the philosophy of Pharmaceutical care (PC), new counselling services emerge. The purpose of the thesis was to add knowledge about the real-world provision of PC services by studying a defined PC service in Swedish pharmacies. Specific aims of this thesis were to investigate the experiences of professionals working with or close to the service and to describe the content of consultations, counselling behaviour and patterns of follow-up. Further aims were to characterise patients receiving the service and describe their perceived outcomes, in relation to standard service. Data were collected via focus groups, telephone interviews, observations, a patient medication record database and a cross-sectional survey. The practitioners reported greater use of their pharmaceutical knowledge and provision of more thorough patient support. Perceived barriers in delivering the service included difficulties in documenting and getting commitment from colleagues, managers and prescribers. Doctors working close to PC pharmacies held varying opinions about the service. Consultations dealt with issues potentially improving the outcomes of medical treatment, but the level of patient centredness varied and was limited by the practitioners’ focus on the computer screen. The rate of follow-up evaluations was modest, but was higher at pharmacies with a high volume of patients receiving the service. PC patients were mostly elderly and female, using about 10 prescription drugs. In comparison to patients receiving standard service, they were more worried, vulnerable and information-seeking. At the same time, their feelings of safety following the pharmacy visit were more pronounced than those of patients receiving standard service. They also felt better prepared for doctor visits. In order for community pharmacy to better meet patients’ needs and optimise PC services, increased attention should be given to implementation strategies, interprofessional collaboration and educational efforts focusing on patient centredness.
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Salem, Hanaa Ahmed. "Evaluation of the impact of pharmaceutical care in an Air Force pulmonary clinic." Scholarly Commons, 1996. https://scholarlycommons.pacific.edu/uop_etds/2630.
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Evaluation of the Pulmonary Ambulatory Care Clinic at David Grant Medical Center was an attempt to explore several questions that surround the care of patients with chronic obstructive pulmonary disease (COPD) and to assess the role and impact of pharmacists providing pharmaceutical care in an Air Force Medical Center. Four experimental designs were implemented. Thirty-eight ambulatory patients with COPD were randomized into a control group or into a program where pharmacists resolved drug-related problems (DRPs) and educated patients about optimal drug use and management of exacerbations. The groups were evaluated prospectively at baseline, three months and six months for the presence of DRPs, quality of life (QOL) scores, and health care resource utilization (HCRU) parameters. Significant improvements in Health Status Questionnaire scores of study group were at three (F = 4.56, p = 0.04) and six months (F = 3.84, p = 0.05). Chronic Respiratory Disease Index questionnaire scores significantly improved in study group at three months in fatigue category (F = 5.35, p = 0.02). Disease State Knowledge Test scores significantly improved at three (F = 3.90, p = 0.04) and six months (F = 13.37, p = 0.001) in study group. Twenty-two DRPs were resolved. The study group realized significant reductions in mean numbers of physician visits (F = 8.12, p $<$ 0.05), and emergency room visits (F = 5.41, p $<$ 0.05) at three and six months respectively. Mean number of physician visits in study group during six-month period was significantly lower prospectively than retrospectively (T = 3.56, p = 0.003) in the single subject design study. Retrospective study of seventy patients showed that mean numbers of chronic medications (F = 6.57, p $<$ 0.05) and pulmonary hospitalizations (F = 4.08, p $<$ 0.05) were significantly lower in mild patients than severe patients. These results of this four-part study design, showed that patient education and resolution of DRPs improved patients' QOL and increased their knowledge about their disease states. Teaching patients how to manage exacerbation resulted in a decrease in health care visits in this patient population. Categorization of severity by pulmonologist coincided with patients' utilization of HCRs.
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Goldstein, Ruth. "Pharmaceutical care : the needs of elderly people and their carers in the community." Thesis, University of Derby, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.386533.
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Wickham, Cheryl E. "Government pharmaceutical subsidy policy and the demand for health care in Russia : evidence from the Russia longitudinal monitoring survey /." Thesis, Connect to this title online; UW restricted, 2000. http://hdl.handle.net/1773/7513.
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Davis, Maranda, and Sarah Terminelli. "An Assessment of the Factors Affecting Rural Pharmacists and Their Ability to Counsel Patients and Provide Pharmaceutical Care." The University of Arizona, 2005. http://hdl.handle.net/10150/624722.
Full textAbstract:
Class of 2005 AbstractObjective: To determine what factors rural pharmacists believe affect their ability to counsel patients and provide pharmaceutical care. Subjects: Pharmacy managers in retail pharmacies in rural cities in Arizona (population <30,000). Methods: Questionnaires were administered through phone conversations regarding amount of time spent on counseling, items included in a counsel, views on counseling, factors impacting ability to counsel, patient care services provided, access to educational materials, difficulty and methods of getting time off, number of vacations taken, commute time to work, years working in a rural area and as a pharmacist, and location of college that pharmacists graduated from. Results: Questionnaires were completed by 40 pharmacy managers (80% response rate). Pharmacists that spent more time counseling believed that counseling had a larger impact on patient outcomes that those that counseled less. Those that counseled more had also taken more vacations in the previous ten years. Implications: Pharmacists views on the impact that their counseling has on patient outcomes affects the amount of time they spend on counseling of patients.
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O'Hare, John D. G. "The development and function of pharmaceutical services in psychiatric hospital practice." Thesis, Queen's University Belfast, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335450.
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Hill-Smith, Ian. "Development and evaluation of a primary care drug formulary." Thesis, University College London (University of London), 2000. http://discovery.ucl.ac.uk/1349872/.
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Aim This study asks if practices can collaborate to create a shared formulary, which influences prescribing. Secondary questions If so, how long does the effect last? To what degree can such a formulary influence volume of prescribing, choice of treatment and cost? Is there a limit to the number of practices involved before the effect is lost? Are doctors more influenced by the formulary if they are closely involved with its creation? Method Controlled trial in two stages. 100 general practitioners from 20 urban and semi-rural practices and 50 community nurses worked with a small team of facilitators to create a formulary. Between 1991 and 1999, prescribing by the participating doctors was compared with the prescribing by all other general practitioners in the county. Results Collaborative work resulted in a countywide formulary for primary care. The use of information to support prescribing changed from a few practices using their own formularies, to an evidence-based formulary supported by all five Primary Care Groups in the county. Choice of treatment changed in seven out of thirteen therapeutic groups. Volume of prescribing reduced in three groups. Cost reduced by F-3000 per doctor per annum. Conclusions Sharing resources between practices to create a primary care formulary can lead to modest changes in prescribing, sustained over three years, and lower overall costs. The largest observed changes were a 14% change in the choice of drugs for musculoskeletal conditions, and a saving of £5000 per practice per year on antibiotics. Such changes, attributed to the development of a formulary, also occur in practices that have no direct involvement, but later by several years. The greatest change in prescribing is seen immediately after a formulary is created and in those involved with its development. The funding for the work is estimated to amount to 17% of the saving on prescribing. Doctors and nurses from 32 practices can work together on such an intervention.
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Gordon, Karen Joyale. "Drug related problems in cardiovascular patients in primary care." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269639.
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Soorapan, Suchada. "Assessing pharmacist's intervention in supporting the management of Type 2 diabetes in a primary care setting." Thesis, Robert Gordon University, 2002. http://hdl.handle.net/10059/1911.
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Type 2 diabetes mellitus is a chronic disease that is associated with substantial morbidity, mortality, and health care cost. All patients with diabetes require a high level of clinical care to prevent the development of diabetic complications. The aim of this study was to compare the impact of a pharmaceutical care diabetic clinic within a primary care setting to standard care on clinical, humanistic and process outcomes in Type 2 diabetes patients. A randomised controlled trial was conducted in 9 general practices in Greater Glasgow Health Board. All patients with Type 2 diabetes, aged 18 years or over, taking an oral antidiabetic drug were recruited and stratified by practice, age, and gender, and then randomised into an active or control group. The patients in both groups were invited to a pharmaceutical care diabetic clinic within their general practice for three visits at three-monthly intervals. Active patients received review and allocated intervention by the pharmacist while control patients received review only without intervention by the pharmacist. Allocation remained blind until after the first evaluation. The pharmacist evaluated the appropriateness of the medication for the individual and their overall diabetic care. The pharmacist prepared a list of drug-related problems and a referral where appropriate. GP referrals were actioned in the active group but held back until after the conclusion of the study in the control group. Patient outcome measures include changes in HbA 1 c value, systolic blood pressure, health related quality of life (HRQOL), and drug related problems (DRPs) from baseline to the end of the study for both groups.
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Visaria, Jay L. "A Model Comparing Drug Utilization and Pharmaceutical Expenditures in Community and Mail-Order Pharmacy in a Retiree Population." The Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=osu1230334711.
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Maijó, Ferré Irene. "Preconcentration strategies in capillary electrophoresis for the determination of pharmaceutical and personal care products." Doctoral thesis, Universitat Rovira i Virgili, 2012. http://hdl.handle.net/10803/84043.
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L'objectiu principal d'aquestaTesi Doctoral és el desenvolupament de diferents estratègies per disminuir els límits de detecció de l’electroforesicapil•lar per a la determinació de compostos farmacèutics i els productes de cura personal. Aquestes estratègies es basen en les tècniques de preconcentració electroforètiques i cromatogràfiques, i l'ús de l’espectrometria de masses com a sistema de detecció. Com a tècniques de preconcentració electroforètiques s'han estudiat les tècniques de samplestacking i sweeping, i com a tècnica de preconcentració cromatogràficas’ha avaluat l'acoblament en línia entre l'extracció en fase sòlida i l'electroforesicapil•lar (In-line SPE-CE). Entre elsPPCPs, aquesta tesi doctoral es centra específicament en els antiinflamatoris no esteroïdals(AINE), els parabens i els filtres ultraviolats.
Un altre dels objectius d'aquestaTesi Doctoral és estudiarl’aplicabilitat de les metodologies desenvolupades per a l'anàlisi de mostres ambientals per determinar PPCP.The main objective of this Doctoral Thesis is the development of different strategies to decrease the detection limits of capillary electrophoresis for the determination of pharmaceutical and personal care products. These strategies are based on electrophoretic and chromatographic preconcentration techniques, and the use of mass spectrometry as a detection system. The electrophoretic preconcentration techniques studied included sample stacking techniques and sweeping while the chromatographic preconcentration technique evaluated was in-line coupling between solid phase extraction and capillary electrophoresis. With respect to PPCPs, this Doctoral Thesis focuses specifically on non-steroidal anti-inflammatory drugs (NSAIDs), parabens and UV-filters. Another objective of this Doctoral Thesis is to study the suitability of the developed methodologies for the determination of PPCPs in environmental samples.
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Hill, Peter William. "The South African community pharmacist and Type 2 Diabetes Mellitus a pharmaceutical care intervention." Thesis, Rhodes University, 2009. http://hdl.handle.net/10962/d1003238.
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Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists.
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Gnanasan, Shubashini. "Pharmaceutical care for patients with tuberculosis and diabetes mellitus in Malaysia : a complex intervention." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/28429/.
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The increasing comorbid burden of tuberculosis (TB) and diabetes mellitus (OM) worldwide requires the management of all stakeholders including pharmacists. This raises the question whether current single disease management system fulfils patients' health needs and whether pharmacists could effectively play a role in enhancing the joint management of these two commonly associated diseases. Pharmacists have begun to provide pharmaceutical care through pharmacist-led medication therapy adherence clinics and clinical pharmacy services for several diseases and conditions (e.g. OM, asthma) in some public hospitals in Malaysia but are yet to be involved in the management of TB. The management of TB has been largely delivered through directly observed treatment (OOT) as high level of adherence to treatment is vital. However, little is known on how TB patients with OM are being managed and how these patients cope with their medication. The aim of this study was to develop a pharmaceutical care service for patients with TB and OM. The first three phases (preclinical, phase 1 and phase 2) of the UK Medical Research Council framework for the development of complex interventions to improve health was applied to develop a pharmaceutical care service for patients with both TB and DM in a tertiary hospital in Malaysia. First, literature relating to TB and OM was reviewed (preclinical). Second, the pharmaceutical care needs of TB and DM patients were explored using semi-structured interviews with twenty patients, three physicians, three nurses, and a focus-group with four pharmacists (phase 1). Third, action research was conducted to assess the feasibility of providing a pharmaceutical care service for patients with TB and OM (phase 2). This study received ethical approval from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia. Patients and health care professionals reported several medication-related issues in the phase 1 study. Patients were most inclined to discuss their concerns about their medication. Patients also tended to display different attitudes towards medication-taking, depending on their beliefs, the severity of illnesses, perceived efficacy of the treatment, and the severity of medication-related problems. The findings also revealed that many of these concerns had not been discussed with their physicians. This was also caused by the patients' and physicians' tendencies to prioritise the management of TB, and unintentionally neglecting other comorbidities especially when patients were primarily managed at the chest clinic. Other difficulties identified in comorbid management included delayed initiation of both TB and OM treatment, chest physicians' lack of confidence in managing 'difficult' OM in TB patients and the burden of attending multiple clinics for patients. Health care professionals believed that pharmacist-led medication therapy adherence clinics (MTACs) encouraged the provision of patient-centred care, enhanced pharmacist-patient communication, created opportunities for inter-professional interactions and could be used as a model to provide pharmaceutical care services. Health care professionals urged pharmacists to play a role in the management of TB and OM by providing patient education and counselling. The phase 2 study revealed that the prevalence of OM in TB patients was 15%. Action research allowed the researcher, together with a hospital pharmacist, to identify pharmaceutical care needs in TB and OM patients, and fulfilled some of them. Pharmaceutical care issues identified included lack of medication adherence, poor management of OM, the need to manage adverse drug reactions, and the lack of frequent monitoring of certain monitoring parameters for TB, OM and other comorbidities at the chest clinic. Many patients had uncontrolled OM, however, many were more likely to be adherent to TB medication than medication of OM and/or other conditions. As a follow-up action, pharmacists advised these patients to place equal importance to TB and non-TB related management. Additionally, pharmacists also made treatment recommendations and referred patients to their chest physicians for further management of medication-related problems. Nevertheless, there were barriers that impinged the provision of pharmaceutical care service. The barriers include the lack of space with privacy to provide education and counselling to patients; the unavailability of medication records and other clinical information for comorbidities at the chest clinic; and the lack of time to develop inter-professional relationship. Despite the need to address the barriers, the provision of pharmaceutical care service to TB and OM patients was feasible as pharmacists were able to integrate TB and OM management by identifying, communicating, and resolving some medication-related problems. In summary, this study provided the groundwork by conducting phase 1 and phase 2 study prior to developing a full-fledged pharmaceutical care service for TB and DM patients. Future work can be done to improve the service through critical analysis of the challenges faced in the developmental phase with the effectiveness of the service care plan assessed through a randomised controlled trial (RCT).
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Cruickshank, Gillian M. "Building the frameworks to implement the continuous quality improvement philosophy related to pharmaceutical care." Thesis, Robert Gordon University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325402.
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Reis, Henry Pablo Lopes Campos e. "Adaptation of Dader Methodology in Inpatients with Diabetic Foot: an Approach in Pharmaceutical Care." Universidade Federal do CearÃ, 2005. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=312.
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FundaÃÃo de Amparo à Pesquisa do Estado do CearÃThe podologic complications liked to Diabetes mellitus (DM) constitute a serious problem faced by the health system. Its treatment has a high social and economic cost. The pharmacist can contribute to the improvement of the quality of the proposed pharmacotherapy through the use of methodologies for the implementation and divulgation of Pharmnaceutical Care in hospital settings as well. The present study aims to carry out the Drug Therapy Follow-up, of inpatients with diabetc foot, at Dr. Waldemar de AlcÃntara General Hospital, through DÃder Pharmaceutical Care Methodology, by observing descriptive aspects of the adjustment and feasibility. Thus, a Drug Therapy Follow-up of 53 patients was carried out from November 2003 to March 2004, according to the steps suggested in the methodology (service offer, first interview, diagnostic, study phase, evaluation phase, intervention outcomes phase, new diagnostic, with appropriate adjustments to local needs. Drug-Related Problems (DRP) were classified according to the second Consensus of Granada(2002). Data set up analysis were executed using computer programs, mainly Access and SPSS. The methodological adjustments involved the structure of the Drug Therapy Follow-up record card, of the HENPA Method of codification of the non-conformities of the pharmacotherapy cicle, of the scales for the measurement of the disease perception of the caregiver and the patient, and also of the domiciliary pharmacotherapy used and the necessary forms for communications and outcomes record, and the instruments used for the follow-up. Most patients were from Fortaleza, with average age of 66 yaers, and low schooling. Hospitalization average time was 19 days. When amputation was necessary for more than half of the diabetes follwed-up. The evaluation of the degree of perception of caregiver the patients with relation to DM and its correlations showed they have little knowledge of the various aspects. A statiscally significant relation was observed (p<0,05) between the level of knowledge of the DM complications and treatment. 57,2 DRP/patien (atotal of 3030 DRP), of whom 75% were potencial. The most displayed DRP class was regular insulin. The most suggested pharmaceutical interventions were related to drug administration and prescrition, respectively, base don internal written communication. The adoption of Pharmaceutical Care, through the application of DÃder methodology contextualized an important strategy for the rational use of drugs and the revival of pharmacistâs social role.
As complicaÃÃes podolÃgicas (pà diabÃtico) associadas ao Diabetes mellitus (DM) constituem grave problema enfrentado pelo sistema de saÃde. Seu tratamento tem elevado custo social e econÃmico. O farmacÃutico pode contribuir na melhoria da qualidade da farmacoterapia proposta com utilizaÃÃo de metodologias para implantaÃÃo e difusÃo da AtenÃÃo FarmacÃutica tambÃm no ambiente hospitalar. O presente estudo objetivou realizar o Seguimento FarmacoterapÃutico(SFT) dos pacientes internados com pà diabÃtico, no Hospital Geral Dr. Waldemar AlcÃntara, atravÃs da Metodologia DÃder de AtenÃÃo FarmacÃutica, observando aspectos descritivos, de adequaÃÃo e operacionalizaÃÃo. Para tanto, foi feito o SFT de 53 pacientes no perÃodo de novembro de 2003 a marÃo de 2004, seguindo as etapas preconizadas na metodologia (oferta do serviÃo, primeira entrevista, estado da situaÃÃo, fase de estudo, fase de avaliaÃÃo, fase de intervenÃÃo, resultados da fase de intervenÃÃo e novo estado da situaÃÃo) com adequaÃÃes apropriadas para as necessidades locais. Os Problemas Relacionados aos Medicamentos (PRM) foram classificados de acordo com o 2 Consenso de Granada (2002). A organizaÃÃo e anÃlise dos dados foram feitas utilizando alguns pacotes computacionais, destacando utilizando alguns pacotes computacionais, destacando o Accessà e SPSSÂ, respectivamente. As adaptaÃÃes metodolÃgicas envolveram a estruturaÃÃo da Ficha de Seguimento FarmacÃutico, do MÃtodo HENPA de codificaÃÃo das nÃo conformidades do ciclo famacoterapÃutico,de escalas para mensuraÃÃo da percepÃÃo do cuidador e paciente sobre a doenÃa e para esse Ãltimo, tambÃm sobre a farmacoterapia utilizada domiciliarmente e formulÃrios necessÃrios para comunicaÃÃo e registros dos achados, bem como foram adequados instrumentos para o acompanhamento. O delineamento do perfil dos pacientes demonstrou que os mesmos tinham idade mÃdia em torno de 66 anos, com baixo grau de escolaridade, sendo a maioria proveniente de Fortaleza. O tempo mÃdio de internaÃÃo foi cerca de 19 dias, em que a amputaÃÃo foi necessÃria para mais da metade dos diabÃticos acompanhados. A avaliaÃÃo do grau de percepÃÃo dos cuidadores e pacientes quanto ao DM e suas interfaces evidenciou ser incipiente o conhecimento dos mesmos sobre esses aspectos. Observou-se uma relaÃÃo significante estatisticamente (p<0,05) entre o grau de conhecimento sobre as complicaÃÃes da DM e seu tratamento. Encontrou-se 57,2 PRM/paciente (total de 3030 PRM), dos quais 75% foram potenciais. A classe de PRM mais evidenciada foi a de necessidade (59,4%), destacando o PRM1(1756 observaÃÃes). O medicamento mais envolvido foi a insulina regular. As intervenÃÃes farmacÃuticas mais sugeridas foram as relativas aos erros de administraÃÃo e de prescriÃÃo, respectivamente, utilizando em maior proporÃÃo a comunidade interna escrita. A adoÃÃo da AtenÃÃo FarmacÃutica, atravÃs da aplicaÃÃo da Metodologia DÃder contextualizada a cada cenÃrio hospitalar especÃfico, constitui uma estratÃgia importante para o uso racional de medicamentos e a retomada do papel social do farmacÃutico.
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Pierson, Jerome F. "Health outcomes and satisfaction among asthma patients : application to a pharmaceutical care educational intervention /." The Ohio State University, 1997. http://rave.ohiolink.edu/etdc/view?acc_num=osu148794677602397.
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Newman, Robin Watson. "From direct patient care to clinical research| Transitioning to an emerging nursing specialty." Thesis, The George Washington University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10141333.
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The role of the professional nurse has evolved in numerous and unexpected ways since the founding of Nightingale’s first school of nursing in 1860. One contemporary sphere in which nurses work is the biopharmaceutical and medical device industry, but little research exists regarding how the nurse engages with and experiences this role.
This qualitative, phenomenological study was undertaken to address the research question: What is the nature and process of the transition experience from a direct patient care role to a clinical research specialist role for the professional nurse? Two subquestions were also explored: What barriers and supports are encountered during the transition process? What facilitates successful work role transition from direct patient care to clinical research?
Ten professional nurses who had transitioned to industry based careers at least two years prior to this study were identified and selected via referral sources. Each nurse participated in a series of three in-depth recorded interviews. Through an iterative process of transcript review, coding, and thematic analysis, and utilization of Ashforth’s (2001) ABCs of Role Identification and Nicholson’s (1984, 2013) Work Role Transition Theory as lenses for interpretation, seven key themes emerged. These themes include: 1) I am alone: transition can be an isolating experience, 2) I am unprepared: transition requires mastery of unfamiliar skills and knowledge, 3) I am scared and sometimes overwhelmed: transition is associated with a lack of security, structure and balance, 4) I can do it: self-reliance and resourcefulness facilitate successful work-role transition, 5) I need to build new bridges: transition requires networking and support from others, 6) I am becoming: the transition experience can be empowering and offers opportunity for growth, and 7) I am still a nurse: nursing identity and values endure through transition.
This study offers several recommendations for further research to more deeply explore identified themes and ways to facilitate success in this work-role transition. In addition, using feedback from study participants, recommendations and suggestions are offered for nurse educators, professional nursing credentialing organizations, and to other nurses considering a career in the clinical research arena.
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Hagemeier, Nicholas E., and Elvin T. Price. "Applying Patient-Centered Care in Pain Management." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5422.
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Learning Objectives: Describe the concept of patient ‐centered care from the pharmacist’s perspective. Summarize the science of patient ‐centered communication in pain management. Describe pharmacogenetic tests that are available to guide the use of opioids in pain management. Discuss research opportunities related to patient ‐centered care and genetic testing in pain management. Describe strategies used by pharmacists to implement genetic testing in clinical pharmacy practice.
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Dickerson, Candice M. "A look at bush medicine in a pharmaceutical world : three traditional healers in Belize face globalization /." View online, 2008. http://ecommons.txstate.edu/anthroptad/11.
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Sanders, Stephanie. "Exploring the Impact of Pharmaceutical Care Services on Smoking Cessation and Patient Health in a Community Setting." The University of Arizona, 2008. http://hdl.handle.net/10150/624278.
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Class of 2008 AbstractObjectives: The purpose of this study is to determine the usefulness of expanded pharmaceutical care services and pharmacist involvement in smoking cessation for patients in a community setting, to identify demographical parameters for the population which might benefit the most from pharmacist intervention, and to examine the cost benefit of such intervention. Methods: This descriptive retrospective study was conducted through a MEDLINE search for all available literature regarding the efficacy of pharmacists in a community setting and smoking cessation outcomes. The results from these studies were then analyzed in order to identify demographic factors which may be associated with higher rates of positive outcome, and the potential cost benefit of such intervention. Information examined from the various articles included: type of study, method of data anaylsis, study/intervention location, patient age, sex, race, other comorbid conditions, and success rates including p values/odds ratios when stated. Results: After the original search, 63 publications were found using MEDLINE, including 12 systematic reviews and 3 clinical trials. After filtering, a total of 28 articles were analzyed. No correlations between demographic factors and successful smoking abstinence were found. All publications, save one, found a positive correlation between higher levels of intervention and increased smoking abstinence rates. Cost effectiveness varied depending on which method of NRT was utilized, ranging from $720 to $2360 per QALY saved. Several national health organizations have published guidelines stating the role of the pharmacist as essential in smoking cessation. Conclusions: Pharmacists have begun to play an essential role in smoking cessation, as evidenced by many successful ventures that have taken place to date. Still, there is vast potential for expansion of pharmaceutical care services in this area.