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Inappropriate use of emergency services: a study in a provincial hospital in Morocco  [PDF]
Berraho M,Boly A,Tachfouti N,Elmajjaoui A
Pratiques et Organisation des Soins , 2012,
Abstract: Summary Aim: The inappropriate use of emergency department decrease the quality of services allowed in this service. The main objective of this study was to determine the determinant of inappropriate use of the emergency department. Methods: The study was conducted in emergency department of the Nador Provincial Hospital, over a period of three weeks. The information gathering was done through a questionnaire. The definition of adequate consultation or not was based on the urgency or not, the day and time of consultation (day/night) and the length of symptoms. Results: Four hundred ten patients were recruited. The proportion of inappropriate consultants was 30.7%. The inappropriate consultants had social security coverage in 9.9% vs 18.3% for appropriate consultants (p = 0.02), the proportion of patients “worried to agitated” was greater among inappropriate consultants (62.3% vs 31.7%)(p < 10–6), the majority (88.9%) of inappropriate consultants felt their condition medium to very urgent vs. 45.2% in others (p < 10–6), the time to onset of symptoms was shorter in appropriate consultants (within less than 24 hours was observed in 71% of appropriate consultants vs. 6.3% in others) (p < 10–6), the proportion of consultants for traumatic lesions was significantly greater among appropriate consultants than other (59.2% vs 0.8%)(p < 10–6). Conclusion: This study identified several predictors of inappropriate consultation in the emergency department. Communication activities and public education are to be undertaken to promote the proper use of the emergency department. Further studies are necessary to take into account regional and hospital specificity. Prat Organ Soins. 2012;43(3):197-204
Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya
Charles Opondo, Philip Ayieko, Stephen Ntoburi, John Wagai, Newton Opiyo, Grace Irimu, Elizabeth Allen, James Carpenter, Mike English
BMC Pediatrics , 2011, DOI: 10.1186/1471-2431-11-109
Abstract: Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention.9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7%) were diagnosed with diarrhoea, with 130 of these being bloody (dysentery) therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7%) of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02).We found some evidence that the multi-faceted, sustained intervention described in this paper led to a reduction in the inappropriate use of antibiotics in treating children with non-bloody diarrhoea.International Standard Randomised Controlled Trial Number Register ISRCTN42996612Diarrhoea remains one of the leading causes of mortality in childhood, accounting for 15% of the approximately 8.7 million deaths of under-5 year olds worldwide in 2008 alone [1]. Current best-practice guidance for treatment of diarrhoea is contained within the World Health Organisation's strategy for Integrated Management of Childhood Illness (IMCI), a strategy adopted by over 100 countries worldwide [2]. This strategy is intended to foster correct diagnosis and treatment of common childhood illnesses in ou
Clasificación de las causas que determinan estadía inadecuada útil para la gestión hospitalaria Usefulness of the classification of causes of inappropriate lengths of stay for the hospital management
María Eugenia Elorza,Nadia Vanina Ripari,Franco Cruciani,Nebel Silvana Moscoso
Revista Cubana de Salud Pública , 2012,
Abstract: Introducción: la búsqueda de eficiencia en la gestión hospitalaria motiva el empleo de indicadores de gestión que detecten y evalúen la presencia de estancias hospitalarias inadecuadas. Objetivo: dise ar una clasificación de las causas que determinan una estadía hospitalaria inadecuada adaptada al contexto del sistema de salud argentino. Métodos: se revisaron 25 artículos publicados entre los a os 1990 y 2009 en revistas argentinas y de otras nacionalidades, en idioma inglés y espa ol. Para la exploración se incluyeron buscadores genéricos de Internet y las bases de datos bibliográficos: Medline, Cochrane y Lilacs. Las palabras clave empleadas fueron: inappropriateness, inappropriate hospital days, the appropriateness evaluation protocol, factors associated with inappropriate hospitalization days, uso inadecuado de la hospitalización, lenght of stay. Sintesis de los datos: es necesario distinguir entre ingresos y estadías inadecuadas. Las causas de estas últimas, según la clasificación dise ada, pueden deberse a la responsabilidad de: 1. La planificación y gestión hospitalaria. 2. El médico. 3. La familia del paciente. 4. El sistema de salud. Conclusiones: el dise o de esta clasificación es una herramienta útil para la implementación de indicadores de gestión hospitalaria que involucren los días de estadía. Introduction: the search for the hospital management efficiency encourages the use of management indicators that detect and assess inappropriate lengths of hospital stay. Objective: to design a classification of the causes that determine inappropriate lengths of hospital stay, adjusted for the Argentinean health system setting. Methods: twenty five articles, both in English and Spanish, published from 1990 to 2009 in Argentinean journals and in those of other nations, were reviewed. For this search, the generic Internet's searchers and the main databases such as Medline, Cochrane, Lilacs, and others were consulted. The key words were inappropriateness, inappropriate hospital stays, the appropriateness evaluation protocol, factors associated with inappropriate hospitalization days, uso inadecuado de la hospitalización, length of stay. Results: it is necessary to differentiate incomes from inappropriate lengths of stay. The designed classification included the following causes: 1. Difficulties in hospital planning and management, 2. The physician's responsibility, 3.The responsibility of the patient's family, 4. The responsibility of the health care system. Conclusions: the design of this classification is a useful tool to implement hospital management
Different Patterns of Inappropriate Antimicrobial Use in Surgical and Medical Units at a Tertiary Care Hospital in Switzerland: A Prevalence Survey  [PDF]
Alexia Cusini,Silvana K. Rampini,Vineeta Bansal,Bruno Ledergerber,Stefan P. Kuster,Christian Ruef,Rainer Weber
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0014011
Abstract: Unnecessary or inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance, drug toxicity, increased morbidity and health care costs. Antimicrobial use has been reported to be incorrect or not indicated in 9–64% of inpatients. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription.
Use of potentially inappropriate medicines in elderly: A prospective study in medicine out-patient department of a tertiary care teaching hospital  [cached]
Zaveri H,Mansuri S,Patel V
Indian Journal of Pharmacology , 2010,
Abstract: Objective: The present study was undertaken with the aim to detect extent of drug use in elderly at medicine outpatient department at tertiary care hospital and to evaluate inappropriate prescribing with the help of Beers′ criteria 2002. Materials and Methods: The study was carried out at medicine out patient department of our hospital. 407 geriatric patients were included during the study period of three and half months. The data was collected in a proforma which included the patients′ details and the prescriptions. Results: The results reveal that 7.42% of total drugs were prescribed in an inappropriate manner and 23.59% of total patients received at least one inappropriate drug prescription. Administration of a drug which is avoided in elderly forms a common category of inappropriate drug use. Antihistamines, anticholinergic, sedatives and hypnotics and cardiac glycosides are the most common drug groups prescribed in inappropriate manner. Conclusion: To conclude, this study shows high prevalence of inappropriate use of drugs in geriatric practice suggesting urgent need for sincere efforts to improve the situation.
Prescribing Patterns and Inappropriate Use of Medications in Elderly Outpatients in a Tertiary Hospital in Nigeria
UIH Eze, AO Olowu
Tropical Journal of Pharmaceutical Research , 2011,
Abstract: Purpose: To determine the prescribing patterns and occurrence of potentially inappropriate medications (PIM) among elderly outpatients visiting a tertiary hospital in Nigeria. Methods: A retrospective study was carried out among elderly subjects (age 60 years) who were issued prescriptions in the outpatients department of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria. Data were obtained on demographics, prescribing indicators and potentially inappropriate medications using Beer’s criteria. Results: Of the 1000 prescriptions consecutively selected, 546 (54.6 %) were for women and 454 were for men, giving a female to male ratio of 1:0.83. The mean age of the subjects was 68.9 ± 7.3 years. Analgesics (756, 75.6 %) were the most commonly prescribed medicines. Prescription of antimalarials was low 127 (12.7 %).The total number of medications prescribed was 3979 while the mean number of medications per encounter was 3.9. The medications prescribed by generic name were 1945 (48.9 %). Encounters with antibiotic and injection prescriptions were 203 (23 %) and 8 (0.8 %), respectively, while the proportion of medications prescribed that were on Nigeria’s essential medicines list or formulary was 95.4 %. Four hundred and fifty six (45.6 %) prescriptions had one or more potentially inappropriate medicine. Medicines with high and low severity for potentially adverse events occurred in 82.7 % and 17.3 % of the cases, respectively. Conclusion: Medication prescribing among the elderly is still suboptimal. Appropriate interventions are required from all stakeholders.
Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital
Fadare JO, Agboola SM, Opeke OA, Alabi RA
Therapeutics and Clinical Risk Management , 2013, DOI: http://dx.doi.org/10.2147/TCRM.S40120
Abstract: escription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital Original Research (213) Total Article Views Authors: Fadare JO, Agboola SM, Opeke OA, Alabi RA Published Date March 2013 Volume 2013:9 Pages 115 - 120 DOI: http://dx.doi.org/10.2147/TCRM.S40120 Received: 09 November 2012 Accepted: 04 January 2013 Published: 13 March 2013 Joseph O Fadare,1 Segun Matthew Agboola,2 Olumide Augustine Opeke,3 Rachel A Alabi4 1Department of Medical Pharmacology and Therapeutics, Obafemi Awolowo University, Ile-Ife, Nigeria; 2Department of Family Medicine, 3Department of Internal Medicine, 4Pharmacy Department, Federal Medical Centre, Ido-Ekiti, Nigeria Introduction: Polypharmacy and inappropriate prescriptions are prominent prescribing issues with elderly patients. Beers criteria and other guidelines have been developed to assist in the reduction of potentially inappropriate medications prescribed to elderly patients. The objectives of this study were to assess the prescribing pattern for elderly Nigerian outpatients and estimate the prevalence of potentially inappropriate medications among them using the Beers criteria. Methodology: This was a prospective cross-sectional study of elderly patients (65 years and above) who were attending the general outpatients clinic of a rural Nigerian hospital. For the drug utilization aspect of the study, drug-use indicators were assessed using established World Health Organization guidelines, while the Beers criteria was used to screen for potentially inappropriate medications. Result: The medical records of 220 patients aged 65 years and above were utilized for the study. A total of 837 drugs were prescribed for the patients, giving an average of 3.8 ± 1.3 drugs per person. Antihypertensive drugs accounted for 30.6% of the prescriptions, followed by multivitamins/food supplements (11.5%) and analgesics (10.8%). A review of the prescribed medications using the 2012 Updated Beers Criteria by the American Geriatric Society identified 56 patients with at least one potentially inappropriate medication prescribed giving a rate of 25.5%. The drug groups identified were nonsteroidal anti-inflammatory drugs, antihistamines, and amitriptyline. Conclusion: Polypharmacy and prescription of potentially inappropriate medications are major therapeutic issues in Nigeria. There is a need for prescriber training and retraining with emphasis on the geriatric population.
Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital  [cached]
Fadare JO,Agboola SM,Opeke OA,Alabi RA
Therapeutics and Clinical Risk Management , 2013,
Abstract: Joseph O Fadare,1 Segun Matthew Agboola,2 Olumide Augustine Opeke,3 Rachel A Alabi41Department of Medical Pharmacology and Therapeutics, Obafemi Awolowo University, Ile-Ife, Nigeria; 2Department of Family Medicine, 3Department of Internal Medicine, 4Pharmacy Department, Federal Medical Centre, Ido-Ekiti, NigeriaIntroduction: Polypharmacy and inappropriate prescriptions are prominent prescribing issues with elderly patients. Beers criteria and other guidelines have been developed to assist in the reduction of potentially inappropriate medications prescribed to elderly patients. The objectives of this study were to assess the prescribing pattern for elderly Nigerian outpatients and estimate the prevalence of potentially inappropriate medications among them using the Beers criteria.Methodology: This was a prospective cross-sectional study of elderly patients (65 years and above) who were attending the general outpatients clinic of a rural Nigerian hospital. For the drug utilization aspect of the study, drug-use indicators were assessed using established World Health Organization guidelines, while the Beers criteria was used to screen for potentially inappropriate medications.Result: The medical records of 220 patients aged 65 years and above were utilized for the study. A total of 837 drugs were prescribed for the patients, giving an average of 3.8 ± 1.3 drugs per person. Antihypertensive drugs accounted for 30.6% of the prescriptions, followed by multivitamins/food supplements (11.5%) and analgesics (10.8%). A review of the prescribed medications using the 2012 Updated Beers Criteria by the American Geriatric Society identified 56 patients with at least one potentially inappropriate medication prescribed giving a rate of 25.5%. The drug groups identified were nonsteroidal anti-inflammatory drugs, antihistamines, and amitriptyline.Conclusion: Polypharmacy and prescription of potentially inappropriate medications are major therapeutic issues in Nigeria. There is a need for prescriber training and retraining with emphasis on the geriatric population.Keywords: drug utilization pattern, elderly patients, rational use of medicines, adverse drug reactions, Beers criteria
Demand for emergency health service: factors associated with inappropriate use
Maria LV Carret, Anaclaudia G Fassa, Ichiro Kawachi
BMC Health Services Research , 2007, DOI: 10.1186/1472-6963-7-131
Abstract: We conducted a cross-sectional study in a medium-sized city in southern Brazil. The urgency of the presenting complaint was defined according to the Hospital Urgencies Appropriateness Protocol (HUAP). Multivariable Poisson regression was carried out to examine factors associated with inappropriate ER use.The study interviewed 1,647 patients over a consecutive 13-day sampling period. The prevalence of inappropriate ER use was 24.2% (95% CI 22.1–26.3). Inappropriate ER use was inversely associated with age (P = 0.001), longer stay in the waiting room, longer duration of symptoms and morning shift. However, the determinants of inappropriate ER use differed according age groups (P value for interaction = 0.04). Within the younger age-group (15–49 years), inappropriate ER use was higher among females, patients who reported visiting the ER because there was no other place to go, patients reporting that the doctor at the regular place of care refused to attend to them without a prior appointment, and individuals who reported that the PHC clinic which they use is open for shorter periods during the day. Among older patients (50+ years), those with highest level of education, absence of self-reported chronic diseases and lack of social support were more likely to engage in higher inappropriate ER use.Efforts should be made to redirect inappropriate ER demand. Besides expanding access to, and improving the quality of primary and secondary care, it is important to mobilize social support for older patients, to enhance the relationship between different levels of care, as well as to develop campaigns to educate the public about the appropriate use of medical services.The inappropriate use of emergency room (ER) service by patients with non-urgent health problems is a worldwide problem, both in countries with publicly funded health systems as well as in those with private security systems [1-7].The inappropriate use of theses services makes it difficult to guarantee access for r
Evaluación de la adecuación de las estancias en un hospital de tercer nivel
Pérez-Rubio,A.; Santos,S.; Luquero,F. J.; Tamames,S.; Cantón,B.; Castrodeza,J.J.;
Anales del Sistema Sanitario de Navarra , 2007, DOI: 10.4321/S1137-66272007000100003
Abstract: background: the appropriateness evaluation protocol (aep) has proved to be a useful tool for reviewing the utilisation of hospital resources. the aim of this article is to determine the proportion of inappropriate admissions and stays, as well as their causes, in patients hospitalised in the hospital clínico universitario de valladolid (hcuv). material and methods: a retrospective, analytical, observational, cohort study. the period of study was one year (2004). a sample of 1,630 admissions was gathered. case definition, variables of interest and the model of data gathering were carried out in accordance with the aep. the principal variables were analysed by means of a basal analysis and the possible relations between them. results: fifty-four percent of the admissions showed at least one day of inappropriate stay, with the global rate of inappropriateness being 34.17%. amongst the causes responsible for inappropriateness, 68.9% of admissions showed at least one criterion falling under the responsibility of the doctor or the hospital, and 51.3% were due to delays in the development of study or treatment. conclusions: the utilisation of methods of identification of inappropriate use such as aep show applications both in planning and in hospital management, by making it possible to identify hospital problems causing delays, principally problems of an organisational type, making it possible to develop interventions aimed at reducing inappropriate use.
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