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A total of 124 patients were admitted with a primary diagnosis of exacerbation of CHF or COPD during the study period (Table 1). Of these, 67 were excluded, most because of active anticoagulation before or at the time of admission to hospital. The demographic characteristics and risk factors of the 57 patients included in the study are reported in Table 2. The baseline characteristics of the patients with CHF were similar to those of the patients with COPD.
Educational interventions were conducted in November 2001 in conjunction with 2 physicians (R.M., a respirologist, and M.B., an internal medicine specialist) and consisted of written memos sent to all physicians, nurse clinicians, and pharmacists and presentations at departmental and committee meetings (e.g., meetings of hospital department heads, family practice and internal medicine departments, the Pharmacy and Therapeutics Committee, joint pharmacy and nursing committees, and pharmacy staff). Both the memos and the presentations reported on use of VTE prophylaxis for patients with COPD and CHF admitted to the institution and described current practice guidelines for VTE prophylaxis in medical patients. Following the educational intervention, a chart review was conducted of consecutive patients with exacerbation of CHF or COPD (or both) who were admitted over the 5-month period between December 1, 2001, and April 30, 2002.
INTRODUCTION
The incidence of venous thromboembolism (VTE) is predicted to escalate as the population ages, and complications of VTE, such as pulmonary emboli, are a significant cause of in-hospital morbidity and mortality. It has been reported that 10% of the deaths observed in hospitals are related to pulmonary embolism and that 75% of these deaths occur in nonsurgical patients. General medical patients admitted to hospital may have multiple risk factors putting them at risk for VTE. Exacerbations of congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have been identified as independent risk factors for a venous thromboembolic event1 and have accounted for the majority of general medicine patients admitted to the authors’ institution. The 2001 guidelines of the American College of Chest Physicians (ACCP) recommended the use of low-dose unfractionated heparin (LDUH) or low-molecular-weight heparin (LMWH) for VTE prophylaxis in general medical patients with risk factors for VTE (including cancer, bed rest, heart failure, and severe lung disease) (grade 1A recommendation).
Patient satisfaction is a subjective measure and depends on the patient’s preferences and perceived expectations. In this small survey, the patients demonstrated an overall high level of satisfaction with counselling services provided by both pharmacists and nurses. Patients expressed greater satisfaction with the information about medication side effects that was provided by pharmacists, and there was a trend toward greater satisfaction with information about side effect management provided by nurses.
Subject selection was nonrandom, but was probably unbiased because subjects for both groups were drawn from the same sample population according to the same inclusion criteria. In addition, recall bias, a common criticism of data obtained by questionnaire, can be discounted because there was a high level of patient recall (see Table 3), and insignificant time lapse between events (2 to 4 weeks). This short data collection period assisted in limiting recall bias but might not have been sufficient in duration to represent patients’ knowledge retention over the long term. An increase in the number of subjects would have maximized the statistical power for the satisfaction survey and knowledge assessment (i.e., by decreasing the chance of type II errors). With regard to the survey format, despite the fact that simple language was used, the participants for whom English was not their first language had more difficulty in completing the questionnaire.
- In: Disease
- Tags: counselling, patient satisfaction, pharmacists, questionnaires, tuberculosis
A total of 100 subjects were recruited, 50 of whom were counselled by pharmacists and 50 by nurses. All participants completed the initial interviews over a period of 1 month. The overall mean scores for the level of satisfaction with counselling were not significantly different between patients counselled by pharmacists and those counselled by nurses (4.2 ± 0.68 and 4.3 ± 0.73, respectively; p = 0.48) (Table 1). Satisfaction scores for pharmacists and nurses were similar with regard to giving instructions on medication dose and schedule, providing information about adverse reactions, and courtesy and respect. However, there was a trend toward greater satisfaction with advice provided by nurses regarding appropriate action to be taken by the patient should a side effect occur.
Pharmacists used the written pamphlet information as a counselling aid more than nurses, and patients counselled by pharmacists had significantly greater satisfaction with the written information given to them as a take-home reference (4.1 ± 0.90 and 3.7 ± 0.84, respectively; p = 0.03).
- In: Disease
- Tags: counselling, patient satisfaction, pharmacists, questionnaires, tuberculosis
Patient Selection
Ambulatory patients with latent TB infection and active extrapulmonary disease with Mycobacterium tuberculosis, as well as those with atypical mycobacterial disease, were surveyed for satisfaction with counselling services. Patients with active pulmonary TB were excluded because air exchange in the pharmacy was inadequate (as defined by the Canadian Standards Association). Each patient was receiving at least one antituberculosis medication (rifampin, isoniazid, ethambutol, pyrazinamide, levofloxacin, ciprofloxacin, or pyridoxine).
Data Collection
Once a physician at the BCCDC prescribes antituberculosis medication, the patient is given a 1-month supply, either by the nurse at the TB Clinic (on Mondays and Tuesdays) or by the pharmacist in the BCCDC pharmacy (on Wednesdays through Fridays). Counselling about TB medications is conducted at that time. Thus, during this study, patients receiving their drugs on Monday or Tuesday received medication counselling from a nurse and those who received their drugs on Wednesday, Thursday, or Friday were counselled by a pharmacist. Patients normally return for a follow-up visit with the physician within 2 to 4 weeks. The nurses in the TB Clinic administered the satisfaction questionnaire to the patients at the time of follow-up.
- In: Disease
- Tags: counselling, patient satisfaction, pharmacists, questionnaires, tuberculosis
INTRODUCTION
Although overall rates of tuberculosis (TB) in Canada are low, the previous gradual decline in disease rates has reached a plateau. In both the United States and Canada certain groups remain at high risk for TB, most notably foreign-born residents, who represent over 50% of cases. Other groups at high risk include Canadian-born Aboriginal people, high-risk inner-city groups (including injection drug users and homeless people), and those with HIV infection.
Control of TB in Canada includes administering antituberculosis medication to those with active disease and preventive treatment to those with latent TB infection. The most serious problem hindering TB treatment and control is noncompliance with therapy, which delays sputum conversion to smear negativity, increases relapse rates, and increases the emergence of drug-resistant mutant strains.
- In: Disease
- Tags: counselling, patient satisfaction, pharmacists, questionnaires, tuberculosis