Abstract:
OBJECTIVE:To use structured implicit review following large-scale explicit audit of antipsychotic polyprescribing to: (1) determine the true rate of antipsychotic polytherapy that deviated from best practice for schizophrenia treatment; and (2) assess whether explicit antipsychotic polytherapy criterion was appropriate for identifying patients at risk for medication problems and assessing quality of care. METHODS:Antipsychotic prescribing was reviewed for outpatients in four public health services in Auckland, New Zealand on 31 October 2004 (T1). Schizophrenia patients in one service (n = 794) prescribed antipsychotic polytherapy (n = 84, 10.6%) were followed up 10 months later (T2). Historical medication summaries were prepared for those remaining on polytherapy, including diagnosis, clinical problems and treatment plan. Criteria for structured implicit review and rating form for quality of antipsychotic management were piloted. All medication summaries were independently rated by two reviewers, and a third independent rater reviewed summaries where disagreement was found. RESULTS:Forty-nine patients remained on long-term polytherapy at T2 (6.2% of original population). All but two cases included a second-generation antipsychotic. At T2, average polytherapy duration was 35.8 months, and average antipsychotic dose was 699 mg day(-1) chlorpromazine equivalents. Two raters achieved agreement for 24/49 summaries, and the remaining 25 were rated independently by a third reviewer. Consensus agreement of antipsychotic management (by two raters) was reached for 44/49 cases (89.8%). Polytherapy was rated 'well-justified' in 32.7%, 'some justification' in 10.2% and 'lacked justification' in 46.9% cases. The final rate of polytherapy deviating from best practice reduced from 10.6% to 3.5% when short-term polytherapy was excluded, and details of the clinical situation and care plan were included in implicit review. CONCLUSIONS:Audit of prescribing in routine practice using explicit guideline-based criteria may be a useful baseline performance indicator. It does not provide an accurate measurement of quality of care because it overestimates the deviation rate from good practice. It may also identify complex patients at risk for poor treatment outcomes who may benefit from structured treatment review.
journal_name
J Eval Clin Practjournal_title
Journal of evaluation in clinical practiceauthors
Wheeler Adoi
10.1111/j.1365-2753.2008.01084.xsubject
Has Abstractpub_date
2009-08-01 00:00:00pages
685-91issue
4eissn
1356-1294issn
1365-2753pii
JEP1084journal_volume
15pub_type
杂志文章abstract:OBJECTIVE:We investigated whether providing participants in an exercise programme with regular feedback on their exercise progress affected their adherence to the programme regimen. METHOD:We conducted a randomized controlled trial. Adult men and women with borderline hypertension and a body mass index ≥ 25.0 were ran...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1365-2753.2009.01342.x
更新日期:2011-02-01 00:00:00
abstract:OBJECTIVE:The purpose of the current study was to assess, in patients scheduled for primary total knee replacement (TKR), the effects of pre-surgery waiting time on pain and functional limitations related to the knee joint undergoing surgery, on health-related quality of life (HRQoL) and on contralateral knee pain 6 mo...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01541.x
更新日期:2012-02-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:Current meta-analysis was conducted aiming to assess the efficacy and safety of recombinant human interleukin-11 (rhIL-11) in the treatment of acute leukaemia (AL) patients with chemotherapy-induced thrombocytopenia (CIT). METHODS:We searched PubMed, Embase, Chinese National Knowledge I...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13152
更新日期:2020-02-01 00:00:00
abstract:RATIONALE, AIM AND OBJECTIVE:Factors influencing doctors in prescribing of drugs have mostly been studied in primary care. Studies performed in hospital care have primarily focused on new drugs, not prescribing in general. An in-depth understanding of the prescribing process in the more specialized secondary care is no...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00751.x
更新日期:2007-10-01 00:00:00
abstract:AIMS AND OBJECTIVES:We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs' views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1365-2753.2006.00653.x
更新日期:2007-02-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:We developed a novel Internet-based blended learning programme that allows busy health care professionals to attain core competency in clinical research. This study details the educational strategies and learning outcomes of the programme. METHOD:This study was conducted at Kyoto Univers...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2011.01808.x
更新日期:2013-04-01 00:00:00
abstract::Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themse...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00617.x
更新日期:2006-08-01 00:00:00
abstract::According to Sackett, evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. In this article, clinical reasoning is depicted as multilayered processes of evidence construction by means of social interaction and hum...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.2002.00353.x
更新日期:2002-05-01 00:00:00
abstract::The aim of this study was to evaluate the impact of a program of training, education and awareness on the accuracy of the data collected from hospital discharge abstracts. Four random samples of hospital discharge abstracts relating to four different periods were studied. The evaluation of the impact of systematic tra...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.2000.00265.x
更新日期:2000-11-01 00:00:00
abstract::Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervised weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, mul...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.2002.00320.x
更新日期:2002-02-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:The American College of Cardiology and American Heart Association (ACC/AHA) statin guidelines recommend that people with risk of cardio-vascular disease (CVD) ≥7.5% over 10 years should be treated with statins. This recommendation ignores individual patient CVD risks and preferences. We c...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12473
更新日期:2017-04-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:Clinical studies show equivalent health outcomes from interventional procedures and treatment with medication only for stable angina patients. However, patients may be subject to overuse or access barriers for interventional procedures and may exhibit suboptimal adherence to medications....
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13341
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Unattended home sleep studies have been implemented to minimize the cost and delay in establishing obstructive sleep apnoea syndrome (OSAS) diagnosis and therapy. However, their accuracy and validity remain disputed. The purpose of our study is to assess their effectiveness (i.e. their technical reliability ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01365.x
更新日期:2011-02-01 00:00:00
abstract:RATIONALE, AIM AND OBJECTIVE:In Australia and New Zealand, there are no established standards for the final presentations of prepared intravenous medications in Intensive Care Units (ICUs). Variability has the potential to contribute to deficiencies in safety, efficiency and cost effectiveness. This study aimed to exam...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12574
更新日期:2016-12-01 00:00:00
abstract::Therapist self-disclosure is one of the most controversial topics in the history of psychotherapy. The controversies reflect some basic discussions regarding the nature of psychotherapy practice. In psychotherapy practice, a particular concern is the interaction between the psychotherapist and the patient. The expert-...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13289
更新日期:2020-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Chronic disorders of consciousness (CDoC) pose significant problems of understanding for both medical professionals and the relatives and friends of the patient. This paper explores the tensions between the different interpretative resources that are drawn upon by lay people and professio...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12220
更新日期:2015-06-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Patients can play an important role in reducing health care harm. Finding strategies to encourage patients to take on an active role in issues related to the quality and safety of their care is therefore essential. The aim of this study was to examine patients' and health care professiona...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2011.01688.x
更新日期:2012-08-01 00:00:00
abstract:BACKGROUND:Child psychoanalytic psychotherapy has been criticized for its reluctance to embrace evidence-based practice. This study aims to explore the historical narrative of a sample of child psychoanalytic psychotherapists about progress in developing the evidence base. METHODS:Fourteen psychotherapists were interv...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2011.01638.x
更新日期:2013-08-01 00:00:00
abstract:AIMS AND OBJECTIVE:To identify factors important in determining whether an obese child achieves significant reductions in Body Mass Index Standard Deviation Score (BMI SDS) within a UK, hospital-based paediatric obesity service aimed at lifestyle modification. DESIGN:Observational Study. SUBJECTS:137 obese children (...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00706.x
更新日期:2007-06-01 00:00:00
abstract::This article reviews the methodological limitations identified in a recent authoritative US report by the Public Health Service, which provides the theoretical background to several other guidelines on cost effectiveness, such as those of the British Medical Journal. It places each limitation in context and discusses ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1046/j.1365-2753.1999.00179.x
更新日期:1999-11-01 00:00:00
abstract::Hepatocellular carcinoma (HCC) is the commonest primary hepatic malignancy and the third most common cause of cancer-related death worldwide. Incidence remains highest in the developing world and is steadily increasing across the developed world. The majority of HCC occurs on a background of cirrhosis, principally cau...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.2010.01599.x
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:Outcome of the first-trimester Down syndrome screening in younger population was less reported before. We present the outcome of this screening in Taiwanese women younger than 35 years old. We also test whether or not the first-trimester Down syndrome screening of women <35 years of age and women >35 years o...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2008.01095.x
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of hea...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01460.x
更新日期:2010-06-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:The incidence of falls and fall-related injuries in older age is predicted to increase concomitantly with global population ageing, representing a serious challenge to health care systems. In spite of the availability of policy and practice guidelines for the prevention of falls and fall-...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2009.01307.x
更新日期:2010-12-01 00:00:00
abstract::Over the past two decades, the majority of medical schools in the USA have embarked upon curricular initiatives to enhance the teaching of ambulatory or office-based primary care. Identifying characteristics of these primary care experiences that make for the most effective learning is a top priority in medical educat...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1046/j.1365-2753.2001.00288.x
更新日期:2001-08-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:This paper is the third of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. METHODS:Here we provide a systematic literature review of contextual factors that either ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.2004.00466.x
更新日期:2004-08-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:The Australian National Heart Foundation Guidelines have been developed to guide clinicians on how to best manage chronic heart failure (CHF) patients according to the current best available evidence. The primary aim of this study is to evaluate the proportion of patients prescribed evid...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12760
更新日期:2017-12-01 00:00:00
abstract::Medicine is predicated on a view of human nature that is highly positivist and atomistic. This is apparent in the way in which its students are taught, clinical consultations are structured and medical evidence is generated. The field of medical humanities originally emerged as a challenge to this overly narrow view, ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2011.01728.x
更新日期:2011-10-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:We aim to determine the prevalence of reconciliation errors (REs) at admission to surgery departments, report their potential clinical impact and analyse possible risk factors. METHODS:Prospective observational study was conducted for 8 months in a regional public hospital in Spain. The ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12403
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Few randomized clinical trials focus on patients' symptoms of the first post-operative week following outpatient (OPS) versus inpatient (IPS) laparoscopic cholecystectomy (LC). The objective was to compare these treatment modalities with regard to patients' perceptions of pain and other post-operative sympto...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1365-2753.2007.00920.x
更新日期:2008-08-01 00:00:00