Gender influence in the quantity of drugs used in primary care.
Gac Sanit. 2008 Jan;22(1):11-19
Authors: Sanfélix J, Palop V, Pereiró I, Rubio E, Gosalbes V, Martínez-Mir I
OBJECTIVE: To analyze whether for an equal health problem there are gender differences in the drugs used in an adult population attended in the Health Care Centers of the Valencian Community (Spain). METHODS: A cross-sectional analytical study was carried out between February-August 1997. The independent variables were: socio-economic parameters, frequency of visits, and self-perceived or diagnosed health problems, and the dependent one the number of drugs consumed. RESULTS: Of the 812 patients considered, 801 consumed medication. Eighty percent of the health problems for which drugs were used involved 5 apparatuses and systems (mean: 3.3 health problems/patient). The 5 most consumed therapeutic groups accounted for 81% of the total (mean: 4.5 drugs/patient). Significant differences were recorded, with greater female consumption in the central nervous system and genitourinary tract therapeutic groups, and with greater male consumption in relation to the respiratory system and systemic anti-infectious therapy. Drug use increased with age, lowest educational level, lowest professional categories, and with the highest frequency of visits to the physician. Significant differences were also recorded in drug use by occupational status, marital status and family structure. The multivariate analysis showed the number of health problems and the frequency of visits accounted for 82.2% of the variability of the variable <<number of drugs consumed>>. The variability accounted for by gender was explained by the variable health problems, the main factor underlying drug consumption among women and men. CONCLUSION: The main finding is probably that women do not use larger numbers of drugs than men if health problems and frequency of visits are controlled.
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Minimizing adverse drug events in older patients.
Am Fam Physician. 2007 Dec 15;76(12):1837-44
Authors: Pham CB, Dickman RL
Adverse drug events are common in older patients, particularly in those taking at least five medications, but such events are predictable and often preventable. A rational approach to prescribing in older adults integrates physiologic changes of aging with knowledge of pharmacology. Focusing on specific outcomes, such as the prompt recognition of adverse drug events, allows the family physician to approach prescribing cautiously and confidently. Physicians need to find ways to streamline the medical regimen, such as periodically reviewing all medications in relation to the Beers criteria and avoiding new prescriptions to counteract adverse drug reactions. The incorporation of computerized alerts and a multidisciplinary approach can reduce adverse drug events.
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Family practice nurses supporting self-management in older patients with mild osteoarthritis: a randomized trial.
BMC Fam Pract. 2008 Jan 28;9(1):7
Authors: Wetzels R, van Weel C, Grol R, Wensing M
ABSTRACT: BACKGROUND: Supporting self-management intends to improve life-style, which is beneficial for patients with mild osteoarthritis (OA). We evaluated a nurse-based intervention on older OA patients’ self-management with the aim to assess its effects on mobility and functioning. METHODS: Randomized controlled trial of patients (>= 65 years) with mild hip or knee OA from nine family practices in the Netherlands. Intervention consisted of supporting patients’ self-management of OA symptoms using a practice-based nurse. Outcome measures were patients’ mobility, using the Timed Up and Go test (TUG), and patient reported functioning, using an arthritis specific scale (Dutch AIMS2 SF). RESULTS: Fifty-one patients were randomized to the intervention group and 53 to the control group. Patient-reported functioning improved on four scales in the intervention group compared to one scale in the control group. However, this result was not significant. Mobility improved in both groups, without a significant difference between the two groups. There were no differences between the groups regarding consultations with family physicians or physiotherapists, or medication use. CONCLUSION: A nurse-based intervention on older OA patients’ self-management did not improve self-reported functioning, mobility or patients’ use of health care resources.
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