effect of an interprofessional pain service on nonmalignant pain control.
chronic pain; chronic pain; DISCHARGE planning; HEALTH literacy; HEALTH occupations students; INTERDISCIPLINARY education; LENGTH of stay in hospitals; MEDICAL appointments & schedules; MEDICAL care; MEDICAL personnel & patient; MEDICAL protocols; MEDICAL records; MEDICAL referrals; MEDICALLY underserved persons; medication therapy management; MORPHINE; opioid; pain management; pain management; PAIN measurement; PATIENT education; PATIENT satisfaction; pharmacist; pharmacists; RETROSPECTIVE studies; SUBSTANCE abuse; SURVEYS; TELEPHONES; THERAPEUTIC use of narcotics
Purpose The primary objective of this project was to evaluate an existing interprofessional, nonmalignant pain service by measuring the difference in patient pain scores (numeric rating scale-11) before and after a pharmacist-led pain education class and medication therapy management (MTM) visit. Secondary objectives included determining the percentage of pharmacist recommendations approved, patient satisfaction, and difference in immediate release (IR) and extended release (ER) opioid use before and after enrollment. Methods Baseline data were obtained from a retrospective chart review. Enrolled patients attended an educational pain class with the pharmacist. At the MTM visit with the pharmacist 3–14 days after the initial education class, the patient's pain score was assessed along with his/her medication use, and a care plan was developed and forwarded to the referring provider for implementation. Three months after the pain class and participation in the MTM visit, patients were contacted via telephone to complete a survey. The survey questions assessed patient satisfaction with the pain education program, their current pain score, and their knowledge of information covered during the pain class. Results Patients reported an average preenrollment pain score of 8.3/10 (n = 39) and a post-survey pain score of 5.6/10 (n = 39). The IR opioid use averaged 19.7 morphine equivalent daily dose (MEDD) at enrollment and decreased by 40% to 11.8 MEDD. The provider approval rate of the pharmacist-recommended interventions ranged from 80% to 92%, depending on the predesignated disease state category. Conclusion An interprofessional, nonmalignant-pain service including a pharmacist-led class resulted in a decrease in average pain scores and MEDD in an underserved population. [ABSTRACT FROM AUTHOR]
Coffey Cory P; Ulbrich Timothy R; Baughman Kristin R; Awad Magdi H
American Journal of Health-System Pharmacy
2019
2019-06
<a href="http://doi.org/10.1093/ajhp/zxy084" target="_blank" rel="noreferrer noopener">10.1093/ajhp/zxy084</a>
Assessment of the Clinical Use of Intravenous and Oral N-Acetylcysteine in the Treatment of Acute Acetaminophen Poisoning in Children: A Retrospective Review.
United States; Patient Selection; Medical Records; Descriptive Statistics; Retrospective Design; Intravenous; Administration; Oral; Cost Benefit Analysis; Acetaminophen – Adverse Effects; Acetylcysteine – Therapeutic Use; Overdose – Drug Therapy; Poisoning – Drug Therapy
Abstract: Background: N-acetylcysteine (NAC) is the most effective therapy for acetaminophen (APAP) toxicity and is currently available for oral and intravenous (IV) administration. Although both routes are effective, use of the IV formulation has been increasing since becoming available in the United States in 2004, raising questions about cost/benefit comparisons between the 2 formulations. Decreased length of treatment and hospital stay have been used to justify the use of IV NAC; however, some patients may receive extended therapy of either NAC regimen. Objective: This retrospective review assessed the clinical use of oral and IV NAC in pediatric patients with APAP intoxication from June 1, 2004 through May 31, 2008. Methods: Electronic medical charts for patients aged ≤21 years were identified with International Classification of Diseases, Ninth Revision (ICD-9) codes for APAP overdose. Descriptive statistics were used to describe the overall patient population and route of NAC administration. The primary outcome variable was the length of treatment with IV and oral NAC therapy. Results: A total of 62 charts for patients with APAP toxicity were reviewed; 37 patients (60%) received IV NAC and 25 patients (40%) received oral NAC. The average lengths of treatment and stay for IV dosing were 23.5 hours (range, 17.6–54.9 hours) and 1.6 days (range, 1–3 days), respectively; those for oral dosing were 69.5 hours (range, 33–133 hours) and 1.95 days (range, 1–5 days), respectively. Of 16 patients who received oral NAC and were admitted for \textless3 days, 14 were transferred to an inpatient psychiatric unit and completed the 72-hour therapy. A total of 3 patients received extended NAC dosing—2 with IV dosing and 1 with oral dosing. Conclusions: Based on our review, the majority of patients received recommended dosing of NAC therapy; however, 3 patients received extended NAC therapy. Patient-specific factors should be considered when assessing whether NAC therapy should be extended and if one route of administration may be preferred. ClinicalTrials.gov identifier: NCT00725179.
Blackford Martha G; Felter Thomas; Gothard M David; Reed Michael D
Clinical Therapeutics
2011
2011-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.clinthera.2011.08.005" target="_blank" rel="noreferrer noopener">10.1016/j.clinthera.2011.08.005</a>
Importance of Culture for Group A Strep Pharyngitis after a Negative Rapid Test.
Adult; Incidence; Sensitivity and Specificity; Medical Records; Multicenter Studies; Adolescence; Retrospective Design; Washington; Diagnosis; Differential; Microbial Culture and Sensitivity Tests; Patient Care – Standards; Pharyngitis – Etiology; Streptococcal Infections – Complications; Streptococcal Infections – Diagnosis
Watkins Richard R
Infectious Disease Alert
2014
2014-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Family practice residents' identification and management of obesity.
Adult; Female; Humans; Male; Middle Aged; Risk Factors; Prevalence; Body Mass Index; Motivation; Age Factors; Sex Factors; *Primary Health Care; *Family Practice; Medical Records; Self Care; Obesity/epidemiology/*therapy
This study, involving 25 family practice residents and 2746 patients in a family practice residency programme, addressed four hypotheses regarding the identification and management of obesity in the primary care setting: (i) the physician-identified prevalence of obesity is significantly lower than the actual prevalence in the population, (ii) obesity is more likely to be addressed with management actions when it is recorded on the medical record problem list than when it is not recorded, (iii) physician actions dealing with obesity are influenced by the patient's age, sex, level of motivation, and body mass index (BMI) value, and (iv) the type of physician management actions taken are affected by the patient's age, sex, level of motivation, and level of BMI value. Obesity was identified as a risk factor by physicians for 51.6% of all patients with a BMI greater than or equal to 30. Obesity was recorded on the medical record problem list for 70.6% of the physician-identified obese patients. When obesity was recorded on the problem list, management actions were taken for 92.9% of patients. However, when obesity was recorded on a risk factor evaluation form but not on the problem list, management actions were taken for only 56.6% of patients. Self-care strategies were selected as the management strategy more frequently than return visits. Demographic characteristics, BMI value and level of patient motivation did not influence the selection of follow-up management strategies. Given the potential for significant improvement in a patient's health status through early recognition and aggressive management of obesity, the barriers to physician identification and involvement in clinical management of obesity deserve further investigation.
McArtor R E; Iverson D C; Benken D; Dennis L K
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity
1992
1992-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures.
*Culture; *Medical History Taking; *Professional-Family Relations; *Seizures/diagnosis/drug therapy/psychology; Female; Humans; Infant; Medical Records; Thailand; United States
Wear D; Nixon L L
Academic medicine : journal of the Association of American Medical Colleges
2001
2001-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00001888-200106000-00012" target="_blank" rel="noreferrer noopener">10.1097/00001888-200106000-00012</a>