Background: Computerized decision support systems (CDSSs) linked with electronic medical records ... more Background: Computerized decision support systems (CDSSs) linked with electronic medical records (EMRs) are promoted as an effective means of improving patient care. However, very few high-quality studies are set in routine, community-based clinical care, and no consistent evidence of an effect on patient outcomes has been found.
Canadian Journal on Aging / La Revue canadienne du vieillissement, 2010
Objectif : Les objectifs de cette étude étaient double : (1) d'explorer les obstacles à la gestio... more Objectif : Les objectifs de cette étude étaient double : (1) d'explorer les obstacles à la gestion de la douleur et ceux associés à la mise en oeuvre d'un programme de gestion de la douleur en soins de longue durée (SLD) et (2) de développer une approche interprofessionelle afi n d'améliorer la gestion de la douleur en soins de longue durée. Méthodes : Une étude de cas a inclus tous les deux éléments, quantitatifs et qualitatifs. Nous avons recueilli des données sur deux sites LTC à l'aide de sept groupes de discussion pour les infi rmières autorisées, fournisseurs de soins non réglementés, et médecins, et 10 entretiens avec des autres groupes de fournisseurs de soins de santé, l'administration et des résidents. Nous avons examiné les documents et administré un sondage à court aux participants à l'étude pour évaluer les perceptions des obstacles à la gestion de la douleur. Résultats : Les résultats ont révélé des obstacles à la gestion effi cace de la douleur au niveau des soins de longue durée des résidents et des familles, des fournisseurs de soins de santé, et des systèmes de santé. Nous avons ensuite élaboré un modèle à six niveaux, avec les interventions proposées pour surmonter ces obstacles. Conclusions : Ce modèle peut guider le développement d'approches novatrices pour améliorer la gestion de la douleur dans les établissements de soins de longue durée.
The prevalence of suboptimal prescribing of medications is well documented. Patients are often un... more The prevalence of suboptimal prescribing of medications is well documented. Patients are often undertreated or not offered therapeutic treatments that are likely to confer benefit. As a result, drug-related hospital admissions are common and often preventable. Improvements to the health-care system are clearly needed in order to maximize the benefits that can be derived from medications. Many countries are changing their primary health-care systems to improve the quality of health-care delivery. One main transformation is the use of multidisciplinary care teams to provide care in a coordinated manner often from the same location or by using the common medical record of the patients. It has been demonstrated that pharmacists can improve prescribing, reduce health-care utilization and medication costs, and contribute to clinical improvements in many chronic medical conditions, such as cardiovascular disease, diabetes, and psychiatric illness. However, the effect of integrating a pharm...
The Family Practice Simulator (FPS) was piloted as a teaching, learning, and assessment opportuni... more The Family Practice Simulator (FPS) was piloted as a teaching, learning, and assessment opportunity for pharmacists making the transition into primary care practice. During this one-day simulation of a typical day in a family physician's office, nine pharmacists rotated through a series of 13 OSCE stations where they interacted with physicians, patients, nurses and office staff while completing primary care activities and receiving performance evaluations. Pharmacists' performance ratings from self, physician, and standardized patient evaluations were compared using Global Rating Scales (GRS) scores and station-specific key points checklists. The mean (SD) overall GRS scores obtained by pharmacists across all stations in the FPS were 4.56 (SD ¼ 0.60) from standardized patients, 3.95 (SD ¼ 0.63) from physicians, and 3.60 (SD ¼ 0.63) from self-assessment (out of a maximum score of 5). Agreement between pharmacists' and patients' GRS ratings ranged from moderate to good (generalizability coefficient (G) ¼ 0.45 to 0.72) for all except one station. Agreement in GRS scores between pharmacists and physicians was at most fair for every station (G ¼ 0.02 -0.26). There was fair agreement on key points scores between pharmacists and patients (weighted kappa ¼ 27%; 95% CI 7%, 47%) and moderate agreement between pharmacists and physicians (weighted kappa ¼ 45%; 95% CI 21%, 70%). Although there was at best moderate agreement in rating scores between pharmacists, standardized patients, and physicians, the FPS provided an important opportunity to measure expectations regarding the professional role, responsibilities, and performance of pharmacists from a multi-professional perspective, thus better preparing pharmacists for integration into primary care practice. Differences in agreement may have been due to different preconceptions and expectations among raters. J Interprof Care Downloaded from informahealthcare.com by Mcmaster University on 05/17/12 For personal use only.
Background: Computerized decision support systems (CDSSs) linked with electronic medical records ... more Background: Computerized decision support systems (CDSSs) linked with electronic medical records (EMRs) are promoted as an effective means of improving patient care. However, very few high-quality studies are set in routine, community-based clinical care, and no consistent evidence of an effect on patient outcomes has been found.
Canadian Journal on Aging / La Revue canadienne du vieillissement, 2010
Objectif : Les objectifs de cette étude étaient double : (1) d'explorer les obstacles à la gestio... more Objectif : Les objectifs de cette étude étaient double : (1) d'explorer les obstacles à la gestion de la douleur et ceux associés à la mise en oeuvre d'un programme de gestion de la douleur en soins de longue durée (SLD) et (2) de développer une approche interprofessionelle afi n d'améliorer la gestion de la douleur en soins de longue durée. Méthodes : Une étude de cas a inclus tous les deux éléments, quantitatifs et qualitatifs. Nous avons recueilli des données sur deux sites LTC à l'aide de sept groupes de discussion pour les infi rmières autorisées, fournisseurs de soins non réglementés, et médecins, et 10 entretiens avec des autres groupes de fournisseurs de soins de santé, l'administration et des résidents. Nous avons examiné les documents et administré un sondage à court aux participants à l'étude pour évaluer les perceptions des obstacles à la gestion de la douleur. Résultats : Les résultats ont révélé des obstacles à la gestion effi cace de la douleur au niveau des soins de longue durée des résidents et des familles, des fournisseurs de soins de santé, et des systèmes de santé. Nous avons ensuite élaboré un modèle à six niveaux, avec les interventions proposées pour surmonter ces obstacles. Conclusions : Ce modèle peut guider le développement d'approches novatrices pour améliorer la gestion de la douleur dans les établissements de soins de longue durée.
The prevalence of suboptimal prescribing of medications is well documented. Patients are often un... more The prevalence of suboptimal prescribing of medications is well documented. Patients are often undertreated or not offered therapeutic treatments that are likely to confer benefit. As a result, drug-related hospital admissions are common and often preventable. Improvements to the health-care system are clearly needed in order to maximize the benefits that can be derived from medications. Many countries are changing their primary health-care systems to improve the quality of health-care delivery. One main transformation is the use of multidisciplinary care teams to provide care in a coordinated manner often from the same location or by using the common medical record of the patients. It has been demonstrated that pharmacists can improve prescribing, reduce health-care utilization and medication costs, and contribute to clinical improvements in many chronic medical conditions, such as cardiovascular disease, diabetes, and psychiatric illness. However, the effect of integrating a pharm...
The Family Practice Simulator (FPS) was piloted as a teaching, learning, and assessment opportuni... more The Family Practice Simulator (FPS) was piloted as a teaching, learning, and assessment opportunity for pharmacists making the transition into primary care practice. During this one-day simulation of a typical day in a family physician's office, nine pharmacists rotated through a series of 13 OSCE stations where they interacted with physicians, patients, nurses and office staff while completing primary care activities and receiving performance evaluations. Pharmacists' performance ratings from self, physician, and standardized patient evaluations were compared using Global Rating Scales (GRS) scores and station-specific key points checklists. The mean (SD) overall GRS scores obtained by pharmacists across all stations in the FPS were 4.56 (SD ¼ 0.60) from standardized patients, 3.95 (SD ¼ 0.63) from physicians, and 3.60 (SD ¼ 0.63) from self-assessment (out of a maximum score of 5). Agreement between pharmacists' and patients' GRS ratings ranged from moderate to good (generalizability coefficient (G) ¼ 0.45 to 0.72) for all except one station. Agreement in GRS scores between pharmacists and physicians was at most fair for every station (G ¼ 0.02 -0.26). There was fair agreement on key points scores between pharmacists and patients (weighted kappa ¼ 27%; 95% CI 7%, 47%) and moderate agreement between pharmacists and physicians (weighted kappa ¼ 45%; 95% CI 21%, 70%). Although there was at best moderate agreement in rating scores between pharmacists, standardized patients, and physicians, the FPS provided an important opportunity to measure expectations regarding the professional role, responsibilities, and performance of pharmacists from a multi-professional perspective, thus better preparing pharmacists for integration into primary care practice. Differences in agreement may have been due to different preconceptions and expectations among raters. J Interprof Care Downloaded from informahealthcare.com by Mcmaster University on 05/17/12 For personal use only.
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