Descripciones mejoradas de Syndetics:

Read this book in order to learn:

Why medicines often fail to produce the desired result and how such failures can be avoided

How to think about drug product safety and effectiveness

How the main participants in a medications use system can improve outcomes and how professional and personal values, attitudes, and ethical reasoning fit into drug therapy

What a properly designed and managed medications use system would look like --nbsp;specific components, how the components fit together into a system, and how the system can be maintained and improved

Ways to evaluate medications use systems, how to recognize ineffective systems operations, how to identify missing system components and how to correct them

How the environment of medications use affects systems operations and patient outcomes, and why standards must change to improve drug safety and effectiveness

Drug-related illnesses and complications cost the health care system billions of dollars each year. Medical errors account for approximately 100,000 deaths each year, and drugs are the most common cause of medical errors in hospitals. Synthesizing research studies from seven nations, Preventing Medication Errors and Improving Drug Therapy Outcomes: A Management Systems Approach explores medications use from a social perspective. It identifies and describes the preventable adverse outcomes of drug therapy, discusses the safety, cost-effectiveness, and quality of medications use from a management systems perspective, and proposes systematic solutions.

Tabla de contenidos provista por Syndetics

• 1 The Second Drug Problem(p. 1)
• Why Do These Problems Persist?(p. 4)
• Thesis--A Systems Approach(p. 7)
• The Way Forward(p. 8)
• References(p. 10)
• 2 Morbidity and Mortality from Medication Use(p. 11)
• Review of Research Data on Adverse Outcomes of Drug Therapy(p. 12)
• Adverse Drug Reactions(p. 13)
• Preventable Adverse Outcomes(p. 13)
• Medical Record Review(p. 13)
• Selected Examples(p. 15)
• Hospitalization(p. 15)
• Emergency Department Visits(p. 18)
• Inpatient Studies(p. 18)
• Drug-Related Deaths(p. 19)
• Indicator (Large Sample) Studies(p. 20)
• Possible Significance of PDRM(p. 22)
• Cost of PDRM(p. 22)
• Summary(p. 24)
• References(p. 25)
• 3 Understanding Adverse Drug Therapy Outcomes(p. 29)
• Changing Attitudes toward Adverse Outcomes of Drug Therapy(p. 29)
• Causal Attributions of DRM: From the Four Bads to System Failure(p. 31)
• The Medicines Use Process Causes Adverse Outcomes(p. 33)
• A Model of the Medications Use Process(p. 35)
• The Adverse Outcome(p. 39)
• Adverse Drug Reactions(p. 39)
• Drug-Related Morbidity and Adverse Drug Event(p. 40)
• Errors, Drug Therapy Problems, and System Failures(p. 42)
• Errors(p. 42)
• Drug Therapy Problems(p. 47)
• System Failures(p. 49)
• Preventability(p. 53)
• Preventability in Medical Record Reviews(p. 53)
• Proposed Definition of Preventability(p. 54)
• PDRM Indicators(p. 56)
• Summary (Preventability Definition)(p. 57)
• Preventability Depends on Assumptions and Paradigm(p. 58)
• Active Errors and Theoretically Perfect Systems(p. 60)
• Summary of the Preventable DRM Model(p. 61)
• Where Do Medications Use Systems Fail?(p. 63)
• Hospital Admissions Studies(p. 63)
• Inpatient Studies(p. 66)
• Chapter Summary(p. 67)
• Conclusion: Looking Forward to Systematic Medications Use Management(p. 67)
• References(p. 69)
• 4 People and Purpose in Medication Use(p. 73)
• Introduction(p. 74)
• The People in Medication Use(p. 75)
• Environment of Medication Use(p. 76)
• Objectives of Medication Use(p. 76)
• Professional Objectives(p. 77)
• Personal Objectives(p. 78)
• Medicines as Instruments(p. 79)
• Quality of Life(p. 79)
• Three Basic Relationships(p. 83)
• Paternal Relationship(p. 83)
• Consumer Relationship(p. 84)
• Therapeutic Relationship(p. 85)
• Authority(p. 85)
• Caring(p. 85)
• Competence(p. 86)
• Example(p. 86)
• Two Main Perspectives on Drug Therapy: Illness and Disease(p. 88)
• Sickness and Legitimization(p. 90)
• Models of Disease and Therapy(p. 91)
• Clinical Negotiation(p. 92)
• Summary(p. 92)
• References(p. 93)
• Appendix 1 How to Get the SF-36 and SF-12(p. 95)
• Appendix 2 How to Get the Living with Asthma Questionnaire(p. 96)
• 5 Access, Cost, and Quality Issues in Medication Use(p. 97)
• Introduction(p. 97)
• Relationship of Access, Cost, and Quality(p. 98)
• Accessibility of Care(p. 99)
• Physical Access(p. 99)
• Financial Access(p. 100)
• Costs of Drug Therapy(p. 103)
• Efficiency(p. 107)
• Calculating Efficiency(p. 109)
• Which Choice Is Optimal?(p. 111)
• Sensitivity Analysis(p. 113)
• Finding a Common Ground for Deciding(p. 114)
• Balancing Values(p. 114)
• Suboptimization and Values(p. 114)
• Finding a Common Ground(p. 115)
• Quality of Care(p. 116)
• Quality Domains(p. 117)
• Quality Components(p. 117)
• Quality Standards(p. 119)
• Joint Commission on Accreditation of Healthcare Organizations(p. 119)
• Example of Quality Improvement(p. 120)
• Coming Full Circle(p. 121)
• Quality Assessment(p. 121)
• Six Methods of Quality Assessment(p. 122)
• Two Remaining Issues in Quality Assessment(p. 125)
• Evidence vs. Professional Consensus(p. 125)
• Market Forces(p. 126)
• Summary on Quality(p. 127)
• Patient Satisfaction with Care(p. 128)
• Why the Interest in Satisfaction?(p. 128)
• Satisfaction with Drug Therapy(p. 129)
• Critique of Satisfaction Measures(p. 129)
• Consumer Focus(p. 129)
• Measurement Issues(p. 130)
• Drug Law: Quality of Drug Products as Legal Requirements for Safety and Efficacy(p. 131)
• Regulatory Perspective on Drug Product Quality(p. 131)
• Major Provisions(p. 133)
• Worthless Drugs(p. 133)
• Unsafe Drugs(p. 134)
• Unapproved and Off-Label Uses(p. 135)
• Drug Enforcement Administration(p. 136)
• Nonprescription Drugs and Nutritional Supplements(p. 136)
• State Law(p. 138)
• Drug Products vs. Drug Use(p. 138)
• Effectiveness and Efficacy(p. 139)
• Evaluating Effectiveness and Safety in Use(p. 140)
• Drug Product Withdrawals(p. 140)
• Chapter Summary(p. 147)
• References(p. 147)
• Appendix 1 Orphan Drug Law(p. 150)
• Appendix 2 Steps in Cost-Effectiveness Analysis(p. 152)
• 6 Prescribing and Prescribing Influence(p. 155)
• Prescribing in Medications Use(p. 156)
• Criteria for Prescribing Appropriateness(p. 158)
• Philosophical Basis of Prescribing Quality(p. 158)
• Proposed Criteria for Appropriate Prescribing(p. 159)
• Understanding the Prescribing Process(p. 162)
• Characteristics of Inappropriate Prescribers(p. 163)
• The Social Psychology of Prescribing(p. 163)
• Active Problem Solving(p. 165)
• Reasoned Policy and Rules(p. 168)
• Unreasoned Rules and Habit(p. 168)
• Psychological Models and Prescribing Improvement(p. 169)
• Sociology of Prescribing(p. 170)
• Networks and Relationships(p. 171)
• Stages of Adoption(p. 173)
• Issues Influencing Adoption(p. 175)
• Willingness to Adopt(p. 176)
• Sociological Models and Prescribing Improvement(p. 177)
• Methods of Influencing Prescribing(p. 178)
• Educational Approaches to Prescribing Influence(p. 178)
• Mass Communications(p. 178)
• Individual and Small Group Education(p. 179)
• Prescribing Restrictions(p. 180)
• Review of Literature on Prescribing Restrictions(p. 180)
• Conclusion from Literature Review(p. 184)
• Examining the Prescribing Influence Anomaly(p. 184)
• Is the Research Flawed?(p. 184)
• Formulary Terminology Is Vague(p. 185)
• Effectiveness May Depend on Environment(p. 185)
• Balance and Burden of Proof(p. 186)
• Suboptimality by Design?(p. 186)
• Promoting Products of a Favored Manufacturer(p. 187)
• Cost Shifting to Consumers(p. 188)
• Summary: Toward Systematic Improvement of Prescribing(p. 188)
• Conclusion(p. 190)
• References(p. 191)
• Appendix Examples of Prescribing Studies(p. 194)
• 7 Medications Use System Performance Information(p. 197)
• Performance Database(p. 198)
• Performance Guidelines(p. 198)
• Performance Indicator(p. 200)
• Standards(p. 200)
• Types of Indicators(p. 201)
• Process and Outcome(p. 201)
• Sentinel vs. Rate Based(p. 201)
• Minimum Information Needed for an Indicator(p. 201)
• Examples of Medications Use Indicators(p. 202)
• Criteria for Indicators(p. 204)
• Reliability(p. 205)
• Validity(p. 206)
• Feasibility(p. 208)
• Medications Use System Performance Indicators(p. 209)
• Indicator Development Process(p. 209)
• Examples of Indicators(p. 210)
• Delphi Panel(p. 210)
• Data Collection and Results(p. 211)
• Further Validation(p. 211)
• Application(p. 212)
• Pharmaceutical Care and Medications Use Management(p. 213)
• Summary and Conclusion(p. 214)
• References(p. 214)
• 8 Outline of a Medications Use System(p. 217)
• Pharmaceutical Care and Pharmaceutical Care System(p. 218)
• Principles of Pharmaceutical Care(p. 219)
• Relationships Diagram(p. 223)
• Flow Diagrams: Pharmaceutical Care and Medications Management Systems(p. 224)
• Drug Therapy Process(p. 224)
• Pharmaceutical Care System(p. 225)
• Medications Management System(p. 226)
• Performance Indicators(p. 227)
• Concepts in the Systems Paradigm(p. 228)
• System Model of Error Prevention(p. 229)
• Systems and Processes(p. 232)
• System Components(p. 232)
• Inputs and Outputs(p. 233)
• Processes (Transformations)(p. 233)
• Purpose(p. 233)
• Control(p. 234)
• Environment(p. 235)
• Connective Summary(p. 235)
• References(p. 236)
• Appendix Medications Use Paradigms: Product, Process, or System(p. 238)
• 9 Effect of Pharmaceutical Care Systems on Outcomes and Costs(p. 245)
• Simulation Model of Medications Use(p. 246)
• Simulation Results: Total Cost Function and Risk of DRM(p. 249)
• Total Cost of Care(p. 251)
• Summary(p. 253)
• Review of Research Evidence(p. 253)
• Connective Summary(p. 260)
• References(p. 261)
• 10 A Pharmaceutical Care System(p. 263)
• Need for a Consistent Process(p. 264)
• Drug Therapy Problems(p. 273)
• Classification of DTPs(p. 273)
• Theoretical and Actual DTPs(p. 274)
• Documentation: Problem-Oriented Medical Records and SOAP Notes(p. 276)
• SOAP Notes(p. 276)
• Documenting the Eight Steps(p. 277)
• Professional Dialog(p. 278)
• Example(p. 279)
• Background(p. 279)
• Commentary(p. 281)
• Summary(p. 281)
• References(p. 284)
• 11 Medications Management System(p. 285)
• Pharmaceutical Care and Medications Management(p. 287)
• Elements of Systematic Improvement in the Quality of Medications Use(p. 287)
• Example of Medications Management on the Program and Practice Levels(p. 288)
• Introductory Note(p. 288)
• Acme Zenith Health Plan(p. 289)
• Goals and Objectives of Medications Management(p. 290)
• Process of QI: FOCUS(p. 290)
• Find a Process to Improve(p. 290)
• Organize a Team to Study the Problem(p. 292)
• Clarify the Team's Understanding of the Process(p. 293)
• Understand the Root Causes of Variation in the Output(p. 293)
• Organization of Causes: Ishikawa (Affinity) Diagram(p. 294)
• Select the Improvement(p. 296)
• Plan, Do, Check, Act(p. 297)
• Plan(p. 297)
• Do: Implementation of Plan(p. 298)
• Check(p. 301)
• Act(p. 304)
• Connective Summary(p. 305)
• References(p. 306)
• 12 Managed Care(p. 307)
• Introduction: Scope of Managed Care(p. 308)
• History of Managed Care(p. 308)
• Types of Managed Care Organizations(p. 309)
• Preferred Provider Organizations(p. 310)
• Health Maintenance Organizations (HMOs)(p. 310)
• Point-of-Service (POS) Plans(p. 314)
• Recent Managed Care Trends(p. 315)
• Shifting Enrollments(p. 315)
• Medicare Managed Care(p. 315)
• Medicaid Managed Care(p. 316)
• Medical Groups(p. 316)
• Costs(p. 316)
• Performance Measurement in Managed Care(p. 318)
• Conclusion(p. 319)
• References(p. 320)
• 13 Managed Care Strategies to Influence the Cost, Access, and Quality of Medicines Use(p. 323)
• Medication Carve-Outs and Pharmacy Benefit Managers(p. 323)
• Drug Formulary(p. 325)
• Critique(p. 327)
• Utilization Controls on Patient Behavior(p. 327)
• Deductibles and Copayments(p. 327)
• Tiered Copayments(p. 328)
• Rx to OTC Switch(p. 329)
• Drug Caps(p. 329)
• Improving Prescription Information Exchange between Providers(p. 330)
• Critique(p. 330)
• Utilization Controls on Physicians(p. 331)
• Promotion of Best Practices(p. 332)
• Conclusion(p. 335)
• References(p. 336)
• 14 A Market Perspective(p. 339)
• Professions as Marketing Mechanisms(p. 340)
• Stakeholders in the Market for Medications Use Systems(p. 342)
• Adoption of Medications Use Systems(p. 343)
• Recognition of Unmet Need or Problem(p. 344)
• Advantages of MUSs over the Status Quo(p. 345)
• Perceived Risk of Change(p. 347)
• Compatibility of the Innovation with Current Values, Norms, Beliefs, and Procedures(p. 349)
• Competition on Quality(p. 349)
• Emerging Concept of Value(p. 350)
• New Accreditation Standards for Medications Use(p. 350)
• Possibilities for the Future(p. 351)
• Complexity: The Ease of Understanding and Using the Innovation(p. 351)
• Divisibility: Required Degree of Commitment(p. 352)
• Communicability of Results(p. 353)
• Summary of the DoI Analysis(p. 353)
• System Learning Disabilities: Psychological Barriers to System Improvement(p. 354)
• Denial, Justification of Status Quo(p. 354)
• "I Am My Job (Profession ...)"(p. 355)
• The Root Cause Is "Out There"(p. 355)
• Proactive Reaction(p. 356)
• Acquiescence, Adjusting Expectations, Accepting the Unsatisfactory(p. 356)
• Fixation on Events(p. 357)
• Delusion of Self-Correcting Experience(p. 357)
• Myth of the Management (Health Care) Team(p. 358)
• Summary: Performance Indicators Are Crucial(p. 358)
• References(p. 358)
• 15 Finding a Way Toward Medications Use Systems(p. 361)
• Organizational and Environmental Context of PDRM(p. 362)
• Lack of Response(p. 362)
• Managed Care(p. 366)
• ERISA: A Shield for Employers and Managed Care?(p. 368)
• Getting the Problem and Solutions in the Open(p. 369)
• Managed Care Is an Essential Part of the Solution(p. 370)
• A Vision of Medication Use on the "High Plateau"(p. 370)
• Rule 1 Care Is Based on Continuous Healing Relationships(p. 371)
• Old(p. 371)
• New(p. 371)
• Rule 2 Care Is Customized according to Patients' Needs and Values(p. 371)
• Old(p. 371)
• New(p. 372)
• Rule 3 The Patient Is the Source of Control(p. 372)
• Old(p. 372)
• New(p. 372)
• Rule 4 Shared Knowledge and Free Flow of Information(p. 372)
• Old(p. 372)
• New(p. 373)
• Rule 5 Decision Making Is Based on Evidence(p. 373)
• Old(p. 373)
• New(p. 373)
• Rule 6 Safety Is a System Property(p. 373)
• Old(p. 373)
• New(p. 374)
• Rule 7 Transparency Is Necessary(p. 374)
• Old(p. 374)
• New(p. 374)
• Rule 8 Needs Are Anticipated(p. 375)
• Old(p. 375)
• New(p. 375)
• Rule 9 Continuous Decrease in Waste(p. 375)
• Old(p. 375)
• New(p. 375)
• Rule 10 Cooperation among Clinicians(p. 376)
• Old(p. 376)
• New(p. 376)
• Moving Forward(p. 377)
• Model-T Era(p. 377)
• Change at Every Level(p. 378)
• Patients(p. 379)
• What Should Physicians and Pharmacists Do?(p. 386)
• Pharmacists as Part of the Solution(p. 387)
• Managed Care(p. 389)
• Purchasers(p. 391)
• Accreditors and Regulators: Quality Standards(p. 392)
• An Incrementalist's Concerns(p. 395)
• Safety and Quality Are Different(p. 397)
• Conclusion(p. 398)
• Recommendations(p. 398)
• References(p. 401)
• Glossary(p. 403)
• Index(p. 419)