Susan D. Schaffer

Promoting Adherence Effects of Theory-Based Asthma Education

This study compared the effects of a the oretically focused audiotape and a standard educational booklet on asthma preventive medication adherence and other asthma outcomes. Forty-six adult asthmatics were randomly assigned to receive either an experimental audiotape incorporating components of protection motivation theory, a standard asthma management booklet, both, or no educational materials. Outcomes were assessed at baseline, 3 months, and 6 months. Mean pharmacy-verified adherence improved 15% to 19% in the intervention groups and declined 22% in the control group at 6 months. Using analysis of covariance (ANCOVA) to control for baseline adherence, these changes were significant between the control and booklet group (t = 2.47; p = .02) and between control and combined group (t = 2.07; p = .04). Providing a minimal educational intervention can have a beneficial effect on asthma medication adherence that persists at least 6 months.

Improving wait times and patient satisfaction in primary care.

&NA; A strong and inverse relationship between patient satisfaction and wait times in ambulatory care settings has been demonstrated. Despite its relevance to key medical practice outcomes, timeliness of care in primary care settings has not been widely studied. The goal of the quality improvement project described here was to increase patient satisfaction by minimizing wait times using the Dartmouth Microsystem Improvement Curriculum (DMIC) framework and the Plan‐Do‐Study‐Act (PDSA) improvement process. Following completion of an initial PDSA cycle, significant reductions in mean waiting room and exam room wait times (p = .001 and p = .047, respectively) were observed along with a significant increase in patient satisfaction with waiting room wait time (p = .029). The results support the hypothesis that the DMIC framework and the PDSA method can be applied to improve wait times and patient satisfaction among primary care patients. Furthermore, the pretest–posttest preexperimental study design employed provides a model for sequential repetitive tests of change that can lead to meaningful improvements in the delivery of care and practice performance in a variety of ambulatory care settings over time.

Evidence-based Methods to Enhance Medication Adherence

Medication adherence problems prevent 50% of patients with chronic disorders from receiving the full benefit of prescribed regimens. These problems are consistent regardless of disease, symptom, regimen, or age-group. This article discusses evidence-based recommendations for assessing and improving adherence. The recommendations are categorized into affective, behavioral, and cognitive (ABC) domains. Using ABC strategies, clinicians and patients can work together to improve treatment outcomes.

The sexual addict: a challenge for the primary care provider.

Sexual compulsion is now recognized as a true addictive process that may manifest itself through a wide range of behaviors. Recognition of this disorder in primary care settings may be difficult because of the ego defenses of denial and rationalization that characterize this disorder. Cues in the medical and sexual history as well as behavioral cues may suggest the presence of sexual addiction. The alert primary care provider should play a significant role in the recognition of sexual addiction.

A review of smoking cessation: potentially risky effects on prescribed medications.

AIMS AND OBJECTIVES To identify prescription drugs that require dosage adjustment or monitoring in patients who quit smoking and to provide recommendations for dosage adjustment based on available evidence. BACKGROUND Health care providers are urged to facilitate smoking cessation for patients who smoke, but the effects of smoking cessation on the metabolism of some drugs is not routinely considered. DESIGN A comprehensive literature review. METHODS The review was conducted in 2008 using a computerised drug interaction program and multiple PubMed and CINAHL searches to identify prescription drugs with clinically significant pharmacokinetic or pharmacodynamic changes caused by smoking cessation. RESULTS Although much of the evidence is case report, dosage adjustments are clearly indicated for warfarin, olanzapine, clozapine and theophylline since they are metabolised by cytochrome P450 CYP1A2 and also have narrow therapeutic ratios. Careful monitoring is recommended for other CYP1A2 metabolised drugs, including those for hypertension and Alzheimers disease. For many affected drugs, smoking cessation reverses smoking-induced CYP1A2 hepatic enzyme levels to normal, increasing plasma concentrations in patients whose dose was established while smoking. Because the effect on hepatic microsomal enzymes is not related to the nicotine component of tobacco, nicotine replacement will not alter the effect. CONCLUSIONS The effects of smoking cessation on drugs metabolised by CYP1A2 have been under-appreciated by health care providers. Smoking cessation may increase plasma levels of some drugs to potentially toxic levels. Further research is warranted to clarify this effect. RELEVANCE TO CLINICAL PRACTICE When patients stop smoking, providers should carefully review prescribed drug regimens and adjust or monitor drugs whose metabolism is affected by smoking cessation. This is particularly important for patients who abruptly stop smoking due to hospitalisation and for older patients who are likely to be taking multiple medications.

Measuring asthma self-management knowledge in adults

Purpose: To present the development and psychometrics of a brief asthma self‐management questionnaire for adults incorporating the five content areas considered essential for asthma self‐management by the National Asthma Education and Prevention Program. Data sources: After development of the criterion‐referenced questionnaire, determination of content validity, pilot testing, and revision, the questionnaire was administered to 305 adults with asthma. Conclusions: After exploratory principal component factor analysis, the final 24‐item questionnaire had a reliability of .69, close to the preferred reliability of .70. Implications: The questionnaire is recommended for assessing self‐management knowledge in clinical settings and for evaluation of asthma education programs.

Predictors of abnormal cervical cytology: statistical analysis of human papillomavirus and cofactors.

Reported increases in the incidence of human papillomavirus infection have generated speculation that cervical cytological abnormalities may also be increasing. A 10-year retrospective study of cervical cytology in 2,919 college women demonstrated a significant increase in the frequency and severity of cervical-cytological abnormalities (p - 0.0001). The peak year for abnormal cervical cytology coincided with the peak year for overt human papillomavirus infection. Women with papillomarivus, genital herpes and who were also smokers had mean cervical-cytology scores significantly worse than those with none of these risk factors (p - 0.00001). A stepwise regression analysis of abnormal cytology from recorded risk factors accounted for only 10 percent of the variance, with human papillomavirus accounting for 8 percent of the total. If human papillomavirus is indeed responsibile for the majority of abnormalities, this infection is not detected reliably through routine examination and cervical-cytology screening [corrected].

Managing alcohol-related problems in the primary care setting.

Although alcohol-related problems are a significant source of morbidity and mortality in the United States, denial and resistance to treatment by patients and their families make detection challenging. Primary care providers may find it difficult to confront the patient who drinks excessively; however, early intervention can lower morbidity and prevent progressive damage to family and social relationships. Routine alcohol screening of all patients may assist the primary care provider in effectively identifying and treating alcohol abuse. Although abstinence is the primary goal for patients with alcohol-related problems, decreasing intake is also beneficial and may be accomplished with brief primary care interventions. The management of outpatient alcohol detoxification is increasingly provided by primary care providers in managed care environments, but requires careful assessment of the patients support system, close provider supervision, and appropriate pharmacologic support.

The Effect of an Interprofessional Heart Failure Education Program on Hospital Readmissions.

Abstract: Heart failure (HF) is an increasing concern to public health, affecting approximately 5.1 million Americans and costing the United States over

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32 billion annually. Compounding the concern, research has exposed the significant problem of hospital readmissions for the HF population, with an estimated 25% of HF patients are rehospitalized within 30 days of discharge. This project focuses on an education-based strategy designed to decrease hospital readmissions for this at-risk population. In particular, an interprofessional outpatient educational program (Heart Failure University [HFU]) was initiated to reduce healthcare costs and increase the quality of care for HF patients at a large private hospital in Florida. A retrospective case–control study was conducted to compare 30-day hospital readmissions of patients who attended HFU to patients who received standard education. Results indicated a significant association between HFU attendance and reduced 30-day hospital readmissions (&khgr;2 [1, N = 106] = 5.68, p = .02). Strengthening this effect, the results showed patients who attended HFU had a significantly greater functional disability than those who did not attend (t(104) = 2.40, p = .018). These findings corroborate with current research on transitional care interventions and emphasize the importance of interprofessional, educational-based disease management programs for the HF population.