Meetings

FIP Congress 2006

Pamela Mason reports from a session on current issues in health care information, organised by the Pharmacy Information Section

The World Congress of Pharmacy and Pharmaceutical Sciences, the 66th International FIP Congress, was organised by the International Pharmaceutical Federation in association with the Federal Council of Pharmacy of Brazil.
It took place in Salvador da Bahia from August 26 to 31, 2006

Improving the benefits of medication

ARTICLE CONTENTS
Improving the benefits of medication

Improving patients’ understanding

Improving GPs’ understanding

Tools that help to improve patient treatment in Australia, Canada and The Netherlands

Imogen Savage

Imogen Savage: technology cannot replace hands-on teaching

Speaking at a session looking at new developments in drug and health care information, and their impact on pharmacy, medicines and public health, Imogen Savage, lecturer in patient safety, School of Pharmacy, University of London, UK. described a study whose aim was to compare metered dose inhaler (MDI) technique in patients with poor and with fluent English.

“The patient information leaflet is often the only information many UK patients get on how to how use their inhalers and we aimed to find out whether the inability to read and understand this information could contribute to poor inhaler technique,” she said.

She explained that the study involved 105 fluent English speakers and 69 Turkish speakers with poor English whose inhaler technique was videotaped and key steps (eg, shaking, quantity breathed in) rated.

The group with poor English was then randomised to receive information by a touchscreen computer program or a translated leaflet plus advocate support. Inhaler technique was videotaped before and after the provision of information.

The results showed a big difference between the two groups, suggesting that MDI users with poor English could be disadvantaged in terms of access to medicines information, said Dr Savage. Before the intervention, only 17 per cent of the poor English group had adequate technique compared with 62 per cent of the fluent English speakers.

Moreover, the poor English group were significantly less likely to report ever seeing the practice nurse about their asthma. After information, technique improved in 50 per cent of the touchscreen computer group compared with 28 per cent of those given a translated leaflet. A further 17 per cent in the leaflet group improved after subsequent oral advice in their own language. Beneficial changes were greater when a person gave advice.

However, the biggest changes occurred in the steps that mattered least (ie, shaking) with co-ordination improving in only a small number of people, and there was a clear added benefit of oral advice on breathing time. “Technology may help, but cannot replace hands-on teaching from health professionals,” she concluded.

Improving patients’ understanding

Lack of patient understanding about medication was highlighted in two further presentations, the first about the needs of pre-teenage tuberculosis patients in Moldova and Kyrgyzstan and the second about the needs of patients with HIV/AIDS in Ghana.

Describing the Moldovan study, Marja Airaksinen, of Finland, said that youngsters with TB were found to have a mixture of correct beliefs (eg, 74 per cent believed TB medicines kill TB and 63 per cent believed they recover faster if they take their medicines) and incorrect beliefs (eg, 30 per cent believed that TB medication lowers fever and 88 per cent that they should stop taking the medicine when they feel better).

Three quarters of the youngsters said they wanted to be better informed about their TB medicines and an educational programme to target patients, families and health care workers is being developed by the Moldovan drug information centre and Kyrgyz Medical University, said Ms Airaksinen.

Describing the Ghanaian study, Ms Joyce Addo-Uttuah, of Memphis, Tennessee, US, said that patients with HIV/AIDS need ongoing information and counselling about the disease, the medication (eg, mode of action, need for adherence, consequences of non-adherence, side effects and how to manage them, storage of medicines, administration in relation to food, drug interactions) and family relationships (eg, disclosure and testing of partners).

Patients also highlighted the need for information about hygiene and safe sex, diet, nutrition and exercise, and the availability of support groups. Good provider-patient interaction enhances the effectiveness of patient information. Improvement of health status may reduce the motivation to adhere strictly to antiretroviral therapy. Adherence monitors and pill counts are added tools to aid patient adherence, she said.

Improving GPs’ understanding

GPs’ information needs and prescribing practices were discussed in two presentations. First, Ingunn Bjornsdottir, of Denmark, described a study which looked at Icelandic GPs’ diagnostic behaviour in patients presenting with possible infection. There were wide variations in reported diagnostic behaviour, she said.

For example, doctors did not request cultures or ask the patient to attend the surgery if they thought it would achieve nothing, and there was a tendency to investigate patients living in town more thoroughly than those out of town. In those with urinary tract infections, children were investigated more thoroughly than adults.

GPs often balanced risk with other issues (eg, a patient’s need to work, a patient’s time, money and social life, the possibility of adverse effects on the doctor patient relationship). Perceptions of risk (eg, the possibility of microbial resistance, the possible consequences of untreated infection) also varied.

“But if changes in GPs’ diagnostic routines are considered necessary, it is not sufficient to bombard them with scientific information and technological aids. Any information and technology must be practical and reliable, as well as applicable and relevant to the individual GP,” she concluded.

Abdul Latif Sheikh, of Karachi, Pakistan, described the effect of a computerised alert system on prescribing practices in a teaching hospital in Pakistan. In this hospital, doctors prescribe medicines for inpatients using computer software, which includes an alert system for drug usage guidelines, maximum dosages, drug interactions, duplicate medicines, patient’s serum creatinine (if abnormal) and approved hospital policies regarding the use of specific drugs.

During the entry of drugs into the computer by the doctor, relevant warnings blink on the screen, allowing the doctor to proceed with prescribing only after acknowledgement of the message. This alert system has several applications, said Mr Sheikh. But it has had a particular impact on prescribing patterns of various restricted antibiotics such as vancomycin and meropenem and also in patients with abnormal creatinine concentrations.

Tools that help to improve patient treatment in Australia, Canada and The Netherlands

Tools to improve treatment were discussed by three more speakers.

First, Jonathan Dartnell, of Therapeutic Guidelines Ltd (TGL), Australia, discussed the importance of independently produced treatment guidelines. TGL is an independent not-for-profit organisation which has produced therapeutic guidelines since the first edition of its antibiotic guidelines in 1978, he explained.

Covering all common disorders seen in general practice, the organisation now publishes guidance on over 3,000 topics in both hard copy and electronic format. New topics are chosen by the board of TGL based on a clear treatment problem (eg, variations in practice, health burden, cost, existence of evidence) and an expressed need by health practitioners with an involvement in the area.

Content is produced (and updated regularly) by an expert group appointed by TGL then circulated for preview by several experts. The guidelines are used by primary care doctors, students and pharmacists both in Australia and internationally, he said.

Secondly, Janet Cooper, of the Canadian Pharmacists Association, spoke about the e-Therapeutics database developed by the CPA. e-Therapeutics is an electronic bundle of various print-based Canadian treatment information resources with links to other Canadian content including health alerts and public drug plans.

She said it is designed to provide pharmacists, doctors and other health professionals with point-of-care access to information on disease treatment. It offers not only drug product information, but a more integrated therapeutic approach, showing “what works when”, she said.

Finally, Rian Lelie van der Zande, of the Netherlands) discussed the Dutch G-Standaard medication surveillance tool. An initiative of the Dutch Association for the Advancement of Pharmacy in the 1970s, G- Standaard is a database consisting of all registered medicines and other products dispensed in Dutch pharmacies and is considered the national standard, she said.

It facilitates medication surveillance both before and after dispensing. Before dispensing, the pharmacist can check dosages, contraindications and interactions, duplicate prescriptions of identical ingredients or comparable active ingredients and allergies. After dispensing, checks can be made on medication dispensed despite pre-dispensing warnings and searches made on all the patients’ medication to check for rational prescribing (eg, morphine and laxatives).