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Govind Rao

7 new things your pharmacist can do Starting in September Quebec pharmacists will take ... - 1 views

www.cbc.ca/...-health-care-new-services.html

from heather pharmacists Quebec

shared by Govind Rao on 14 Aug 13 - No Cached
  • Govind Rao on 14 Aug 13
     
    Starting Sept. 3, pharmacists across the province will expand their role and provide a bundle of new services. Quebec's association of pharmacist owners (AQPP) is meeting with the Ministry of Health today to determine which of the services will be covered by medicare. Here's the run-down of tasks your pharmacist will be able to perform after Labour Day: Extend a prescription. Adjust a prescription. Switch one medication for its equivalent in case of a shortage. Administer medication to show a patient its proper usage. Prescribe and interpret laboratory analyses. Prescribe medication for a mild condition when the diagnostic is known. Prescribe medication when a diagnosis is not required.
Govind Rao

Murder trials begin in US against two high opioid prescribers | The BMJ - 0 views

www.bmj.com/...bmj.h4827

from heather us drugs pharmacare court

shared by Govind Rao on 11 Sep 15 - No Cached
  • BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4827 (Published 08 September 2015) Cite this as: BMJ 2015;351:h4827
  • A new stage in the US authorities’ crackdown against high prescribers of opioids has opened with the murder trials in California and Florida of doctors who are directly accused of killing patients who died of overdoses after taking prescribed drugs.Hsiu-Ying “Lisa” Tseng, a Los Angeles area physician, is charged with three counts of second degree murder over the deaths in 2009 of three male patients aged 21, 25, and 28, alongside several felony counts of prescribing drugs to people unnecessarily.
  • Owen Dyer
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  • Gerald Klein, 81, is charged in Florida with first degree murder in the overdose related death of Joey Bartolucci, 24, who died in bed after taking Xanax and hydromorphone prescribed at Klein’s East Coast Pain Clinic in West Palm Beach. Klein is one of 13 doctors and 19 others charged with various offences after a 2010 federal operation against a “pill mill” empire run by twin brothers, Jeffrey and Christopher George, which prescribed over 20 million oxycodone …
Govind Rao

Four things needed to make pharmacare work - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20150228|215426928

from heather pharmacare drugs

shared by Govind Rao on 04 Mar 15 - No Cached
  • Times Colonist (Victoria) Sat Feb 28 2015
  • A growing number of health professionals, patients, community groups and even politicians are calling for national pharmacare. But many Canadians likely wonder what pharmacare is and whether Canada is ready for it. Let's start at the beginning. Affordable access to safe and properly prescribed prescription medicines is so critical to patient health that the World Health Organization has declared governments are obligated to ensure such access for all of their citizens.
  • Unfortunately, Canada is the only developed country with a universal health-care system that does not include universal coverage of prescription drugs. The negative consequences for our health and economic well-being are significant. Without universal coverage of prescription drugs, one in 10 Canadians cannot afford to fill the prescriptions their doctors prescribe. When patients don't fill prescriptions they need, it hurts them and our economy because they end up needing more health care in the long run.
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  • But pharmacare is about more than just drug coverage. Insurance companies can do that. What national pharmacare must do is to ensure sustainable, equitable and affordable access to medicines that are safe and appropriately prescribed. In the Canadian context, this is a public responsibility. And, to be clear in this election year, it will require federal engagement - and not just in the form of cutting cheques for provincial pharmacare programs, but real leadership. More so than other aspects of health policy in Canada, the federal government has responsibility for matters that affect the safety, availability, use and cost of prescription drugs. Here are four things the federal government could do to make national pharmacare work for Canadians:
  • Commit to a clear and comprehensive pharmacare plan, not a patchwork of private and public insurance and not income-based or "catastrophic" drug coverage. Research has consistently shown those systems don't work well and are unnecessarily costly. Canada needs a universal, public and comprehensive pharmacare system that will meaningfully integrate medicines into medicare in ways that lead to safer, more affordable use of medicines for all Canadians. We've known this since the 1960s. It's time for a government to commit to make it its legacy for Canada. Get on with the task of improving prescribing in Canada. About one in three seniors receives prescriptions known to pose health risks for older adults. The preventable problems of overuse, underuse and misuse of medicines cause one in five hospitalizations in Canada. Cutting these problems in half would save Canadians billions.
  • The federal government should fund the development and implementation of a national strategy to improve prescribing. Done in partnership with patients, professionals and the provinces, this national strategy should aim to establish a culture of safety and appropriateness, to put an end to questionable drug-marketing practices, and to put credible and usable information in the hands of patients, prescribers and policy-makers. Quit applying antiquated drugprice regulations. We live in a world where most comparable health systems have abandoned the blunt instrument of price regulation in favour of more sophisticated tools of price-and-supply contract negotiation. When done well, negotiations with suppliers lead to more competitive prices and more assurances of a secure supply of the medicines the country needs.
  • The federal government should take the $11 million spent enforcing antiquated price regulations and invest it in joint capacity for negotiating, monitoring and enforcing contracts on behalf of public drug plans and hospitals from coast to coast. This would not only level the playing field within Canada, it would also make Canada much stronger on the world market. Sustainability of any system to encourage access to medicines depends to a great extent on timely and vigorous generic competition. Yet Canadian regulations create unnecessary barriers to generic drugs entering our market.
  • The federal government should create a clearer, faster and fairer path to generic entry following required periods of market exclusivity for patented drugs. This would save Canadians millions - and wouldn't cost the federal government a dime. If done right, a pharmacare plan would effectively integrate medicines into Canadian medicare and ensure that the Canadian principles of universal access to highquality, affordable healthcare do not end when doctors give patients prescriptions to fill. It is within reach with the right plan - and leadership.
  • Steve Morgan is a professor in the University of British Columbia's school of population and public health and an expert adviser with EvidenceNetwork.ca.
Govind Rao

"National Checkup" panel debates the pros, cons and questions surrounding a universal d... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|bcbc|20150319|216801470

from heather pharmacare drug

shared by Govind Rao on 20 Mar 15 - No Cached
  • THE NATIONAL Thu Mar 19 2015,
  • WENDY MESLEY (HOST): All that medicine isn't cheap either. Canadians spent an estimated 22 billion dollars a year on prescriptions in 2013, almost twice what they spent in 2001. One in ten struggle to afford it. It's big business and big drug companies know it, spending billions marketing it right back to you. VOICE OF UNIDENTIFIED WOMAN (ANNOUNCER): (Advertisement) Ask your doctor if Lunesta is right for you. WENDY MESLEY (HOST):
  • So are we over- or under-medicated? Is the high cost of prescription drugs failing to help Canadians in need? And what should we be watching for next? So we'll start with that middle question, like, who is not covered? Who is falling through the cracks? You must all see this in your practices? Danielle, what are you seeing? DANIELLE MARTIN (FAMILY PHYSICIAN, WOMEN'S COLLEGE HOSPITAL): In fact, millions of Canadians have no drug coverage whatsoever and millions more don't have adequate coverage for their needs. In my practice I see it all the time among the self-employed, people who are working in small businesses, people who are working part-time and don't have employer-based coverage. It's the taxi drivers, it's the people who are working in a part-time job, but it's also middle-income people who are consultants or working in small businesses who don't have coverage. So this isn't just a problem for the poor. It's a problem for people across socioeconomic lines.
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  • DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): Well, I think it's probably not divided properly and I also think that we need to be very mindful of the ways in which advertising and marketing, whether it's direct to patients or consumers as we often consume from the American media on our television screens, or whether it's direct to physicians. So, you know, in fact, even in the U.S. under the Affordable Care Act, physicians are now required to declare any amount of money that they take from the pharmaceutical industry. We have no such sunshine law here in Canada. Don't Canadian patients want to know if your doctor has had their vacation or their last meal or their speakers' fees paid by the company that makes the drug they have just prescribed for you? WENDY MESLEY (HOST): Well, we saw in those ads they'll say: Ask your doctor. Is there a lot of pressure and is that contributing to the number of pills on the market? SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK):
  • WENDY MESLEY (HOST): What are you seeing, David? DAVID HENRY (PROFESSOR, DALLA LANA SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF TORONTO): I think this is right and it's a surprise to somebody from outside of Canada to find that in a country with a good comprehensive care system, there is not drug coverage. So patients with chronic disease, for instance diabetics, ironically in the city where insulin was discovered, are relying on free handouts from their physicians to provide what is really an essential medication; it's keeping them alive. WENDY MESLEY (HOST): Who do you think is falling through the cracks? What are you seeing?
  • CARA TANNENBAUM (GERIATRIC PHYSICIAN, PHARMACY CHAIR, UNIVERSITÉ DE MONTRÉAL): The vulnerable population in my mind are older adults with multiple medical conditions who are taking 5, 10, 15 medications at the same time and have to pay the deductible on that. And that adds up for a lot of them who don't have a lot of money to begin with, so they start making choices about will I take my drugs until the end of the month? Will I take every single medication that I have to? Do I really need those three medications for my high blood pressure, or can I let one go? And that could have effects on their health. WENDY MESLEY (HOST): Well, you mentioned diabetes, David. We heard earlier on "The National" this week from a woman in B.C. She has diabetes. That's a life-threatening disease if it's not looked after. This is what she said.
  • SASHA JANICH (PHON.) (DIABETES PATIENT): Roughly about 600 to 800 bucks a month. I don't get any help until I spend at last 3500 a year and then they'll kick in, you know, whatever portion they decide to cover. WENDY MESLEY (HOST): So, David, that's really common? People on diabetes aren't fully covered?
  • DAVID HENRY (PROFESSOR, DALLA LANA SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF TORONTO): Well, they're covered to a degree in B.C., but it's what we call the co- payment level that they have to make even under an insurance program. In Ontario, they don't have any insurance at all. They're going to pay the full market price if they don't have insurance through their employer, and they may lose that if they're out of work. WENDY MESLEY (HOST): What are you seeing? What's not covered? Give me an example. DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL):
  • Well, actually, one thing that I think is surprising to a lot of people is the variability in coverage among public drug plans in Canada. So something that's covered, even if you're covered under a public drug plan, for example if you have cancer and you have to take chemotherapy outside of the hospital, in many Canadian provinces that's taken care of. In Ontario, for example, it's not. And I think that many Canadians are surprised to discover, imagine the, you know, enormous stress of a cancer diagnosis, that on top of that you're going to have to pay out of pocket at least to very… sometimes to very, very high levels, in fact. WENDY MESLEY (HOST): Samir? SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): And even just the other day, I just was debating with a pharmacy about the cost of some vitamin D. I have a person who's under house, he's on social assistance, and they said: We'll give you a free blister pack, you know, so he can sort his meds. We'll give you this. And we were actually, you know, working out a pricing system so this guy could even afford something so that he wouldn't break bones and actually have a fracture down the road. So it's amazing how some of the basic things we think are important aren't even covered. WENDY MESLEY (HOST):
  • Well, we saw that the drug costs have almost doubled in the last 11, 12 years. Is part of the problem… there's only so much, it seems, money to go around for prescription drugs. Is part of the problem that there's too many… some drugs are too easily available while people who really need them are not getting them? And there's marketing playing into that. We see a lot of ads in the last ten years. Check this out. VOICE OF UNIDENTIFIED WOMAN (ANNOUNCER): (Advertisement) We know a place where tossing and turning have given way to sleeping, where sleepless nights yield to restful sleep. And Lunesta can help you get there.
  • UNIDENTIFIED MAN #1: (Advertisement) Anyone with high cholesterol may be at increased risk of heart attack. I stopped kidding myself. VOICE OF UNIDENTIFIED MAN #2 (ANNOUNCER): (Advertisement) Talk to your doctor about your risk. VOICE OF UNIDENTIFIED WOMAN (ANNOUNCER): (Advertisement) Ask your doctor if Lunesta is right for you.
  • WENDY MESLEY (HOST): It's funny, you know, we hear our health plan discussed in the United States and now you talk about our socialized medicine and it's sort of until you have a health problem, you assume everything is covered. But who falls through the cracks that you see, Samir? SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): Yeah, I mean, I treat a lot of older patients and those who are 65 and older generally are covered by a provincial drug plan. But, you know, I'm seeing more and more, especially after the recent recession, we have people who are closer to that age who lose their jobs and if they lose their jobs and they were relying on private drug coverage plans, they are not covered. And then they find themselves they can't afford their medications, they get sicker and they literally have to wait and be sick until they can actually get their medications.
  • Well, it's a huge amount of pressure, I think, you know, for… you know, if you're a doctor that relies on information or supports from pharmaceutical representatives, for example, then there is that pressure that you're put under, there is that influence that you have. But also, we know that if your patient asks you specifically and says, you know, what about this medication, you may say, well, it's easier to prescribe you that medication if that's what you really want. But there's actually five things you can do to improve your sleep and actually avoid being on that medication, but we don't get asked for that. WENDY MESLEY (HOST): But I want to be like the lady with the wings.
  • SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): And that's what I hear: Why can't I be like that? But I think it's important to think about the other options. WENDY MESLEY (HOST): David, what do you think? DAVID HENRY (PROFESSOR, DALLA LANA SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF TORONTO): I would like to focus a little bit on the prices that are being paid. We talked about usage and whether drug use is appropriate. There's also the price that is paid. Canada is paying too much. And if we can just return for a second or two to the idea of a national program, there's a huge advantage in being the sole purchaser on behalf of 35 million people, as it would be with a national program in Canada. And we know from experience you can reduce drug prices by 30, 40 percent. That's billions of dollars a year. WENDY MESLEY (HOST):
  • That's a political debate that you have launched and I hope that it gets taken up by the politicians. Who is buying these drugs? We have seen that there are more people having trouble getting drugs, more people using drugs. Who is it? DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): That are taking prescription drugs in Canada? WENDY MESLEY (HOST): Yeah. DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL):
  • Well, you know, interestingly over the last decade, we have seen an increase in prescription drug use in every single age category. So the answer is we all are. We're all taking more drugs than our equivalent people did a decade ago and I think… WENDY MESLEY (HOST): Teenagers? DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): Absolutely, teenagers and the elderly and everybody in between. And so the question really becomes: Are we any healthier as a result? You know, in some cases we're talking about truly life-saving treatment that are medical breakthroughs and, of course, we all want to see every Canadian have unfettered access to those important treatments. In other cases we may actually be talking about overdiagnosis, overprescription and as you say, Cara, sort of chemical coping of all different kinds. And I think that's what we need to kind of get at and try to tease out. WENDY MESLEY (HOST):
  • Well, and the largest group of all on prescription drugs right now, Cara, are the seniors. CARA TANNENBAUM (GERIATRIC PHYSICIAN, PHARMACY CHAIR, UNIVERSITÉ DE MONTRÉAL): The seniors, yes, and I'm very passionate about this topic because sometimes I see patients come into my office on 23 different drug classes, and that's when we don't talk about what drugs should we add but what drugs can we take away, and the concept of de-prescribing. And imagine if we could get people who are on unnecessary drugs, because as you get older you get added this drug and a second drug and this specialist gives you this and that specialist gives you that, but then there starts to be interactions between the different drugs that could cause side effects and hospitalization. And maybe it's time to start asking, well, what's the right drug for you at this time, at this age, with these medical conditions? And personalized medicine is something that we have been talking about. It would be nice if we could introduce that conversation into therapy and not just drug therapy, but all therapy. Maybe the drug isn't needed. Maybe physiotherapy is needed or a psychologist or better exercise or nutrition. So I think it's really a bigger question. WENDY MESLEY (HOST): Samir?
  • SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): Exactly. I mean, in my clinic the other day I had a patient who was on eight medications when she came with me, and… WENDY MESLEY (HOST): This is a senior? You deal with seniors as well. SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): Absolutely. And when she left my office, she was thrilled because she was only on two medications, mainly because some of the medications are prescribed to treat the side effects of other medications, for example, or the indications for those medications were no longer valid in her. But we added some vitamins and we just balanced things out appropriately. And she was thrilled because, as Cara was saying before, the co-pays, the other payments that one needs to pay for medications you don't want to take, that's a problem as well. WENDY MESLEY (HOST): We're going to take a short break, but we have one more discussion area which is: What are the next challenges that Canadians might face with prescription drugs? We'll be right back.
  • (Commercial break) WENDY MESLEY (HOST): Welcome back to our "National Checkup" panel. Danielle Martin, Samir Sinha, Cara Tannenbaum and David Henry are all here to talk about the next frontier. So we're hearing all of this exciting new science marches on and there's all of these new drugs, new treatments. Everyone wants them or everyone who needs them wants them, but they're expensive, right, Danielle? DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): They can be extremely expensive. So, you know, what we call these blockbuster drugs coming onto the market, some of them truly do represent breakthroughs in medical treatment and in some cases they can cost tens or hundreds of thousands of dollars a year. So they really are very expensive. But what I think many people may not realize is that the number of drugs coming out, even the expensive ones that are truly breakthroughs, is still a very small portion of the drugs coming out on the market. Many, many drugs that are being released and are expensive are marginally, if at all, really any better than their predecessor. So just because it's new and fancy and costs a lot doesn't necessarily mean that it's all that much better.
  • WENDY MESLEY (HOST): So what's going to happen, David? DAVID HENRY (PROFESSOR, DALLA LANA SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF TORONTO): We need to find a plan. These drugs may cost hundreds of thousands of dollars. Nobody can afford that individually. Tens of thousands, rich people can afford them but the average person cannot. So there's really no way we can cope with these unless we've got a plan and, in my view, it has to be a national plan. And the advantage of that are that when you're buying or you're subsidizing on behalf of 35 million people, you're going to get better prices and your insurance pool that covers these costs is much greater. So the country can afford drugs that individuals can't.
  • WENDY MESLEY (HOST): Samir, what do you see as the new frontier here? SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): I think the new frontier is going to be more personalized treatments in terms of how do we actually treat cancers, how do we treat certain rare conditions with more personalized treatments. WENDY MESLEY (HOST): Because it's very exciting, right? You have this cancer that's not that common and then you hear that there's a treatment for it and you want it. SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): And it has the possibility of alleviating a lot of suffering from unnecessary treatments that may not actually be… you know, be effective. But I think this is the challenge. If we want to be able to afford these, if we actually work together we're actually more able to afford them when we bulk-buy these medications. But the key is going to be that, you know, this is where the future is going and we're going to have to figure out a way to pay for them.
  • WENDY MESLEY (HOST): What are you looking forward to? CARA TANNENBAUM (GERIATRIC PHYSICIAN, PHARMACY CHAIR, UNIVERSITÉ DE MONTRÉAL): I'm really looking forward to seeing all these new treatments that we have spent decades researching. You know what the investment in health research has been in order to find new targets for drugs, in order to increase quality of live, in order to cure cancer, and then to send a message, oh, sorry, we're not going to give them to you or you can't afford to pay for them, then I think there is a lack of consistency in the messaging that we're giving to Canadians around equity for health care. So you could get your diagnosis and you could see a physician, but we way not be able to afford treating you. So I think this is something we need to think about it. It's very exciting, I think we live in exciting times, and looking at different funding strategies to make sure that people get the appropriate care that they need at the right time to improve their health is really what we're going to be looking forward to. WENDY MESLEY (HOST):
  • Tricky, though. It's a provincial jurisdiction, you've got to get all the provinces to agree to a list, and the list is getting longer. DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): Absolutely. I mean, I think actually one of the big myths out there about drug plans is that higher-quality plans are the ones that cover everything. And, in fact, that's not true. You know, we can use a national plan or a pan- Canadian plan or whatever you want to call it to target our prescribing and guide our prescribing in order to make it more appropriate, and that's another way that we're going to save money in the long run. WENDY MESLEY (HOST): Well, I learned a lot tonight. I hope our audience did too. Thanks so much for being with us. DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): Thank you.
Govind Rao

Antibiotics overused with elderly: study; Nursing homes in U.S. advised to do more to p... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|vitc|20151022|231941173

from heather us ltc continuing care infectious disease drugs

shared by Govind Rao on 22 Oct 15 - No Cached
  • Times Colonist (Victoria) Thu Oct 22 2015
  • Antibiotics are prescribed incorrectly to ailing nursing home residents up to 75 per cent of the time, a U.S. public-health watchdog says. The reasons vary - wrong drug, wrong dose, wrong duration or just unnecessarily - but the consequences are scary, warns the Centers for Disease Control and Prevention. Overused antibiotics over time lose their effectiveness against the infections they were designed to treat. Some already have. And some antibiotics actually cause life-threatening illnesses on their own.
  • The CDC last month advised all nursing homes to do more - immediately - to protect residents from hard-to-treat superbugs that are growing in number and resist antibiotics. Antibiotic-resistant infections threaten everyone, but elderly people in nursing homes are especially at risk because their bodies don't fight infections as well. The CDC counts 18 top antibioticresistant infections that sicken more than two million people a year and kill 23,000. Those infections contribute to deaths in many more cases.
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  • The CDC is launching a public education campaign for nursing homes aimed at preventing more bacterial and viral infections from starting and stopping others from spreading. A similar effort was rolled out for hospitals last year.
  • "One way to keep older people safe from these superbugs is to make sure antibiotics are used appropriately all the time and everywhere, particularly in nursing homes," said CDC Director Tom Frieden in announcing the initiative. Studies have estimated antibiotics are prescribed inappropriately 40 per cent to 75 per cent of the time in nursing homes. Here's why that worries the CDC: Every time someone takes antibiotics, sensitive bacteria are killed but resistant bacteria survive and multiply - and they can spread to other people. Repeated use of antibiotics promotes the growth of antibiotic-resistant bacteria. Taking antibiotics for illnesses the drugs weren't made to treat - such as the flu and common colds - contributes to antibiotic resistance.
  • Antibiotics also wipe out a body's good infection-fighting bacteria along with the bad. When that occurs, infections like Clostridium difficile can get out of control. C. diff. leads to serious diarrhea that each year puts 250,000 people in the hospital and kills 15,000. If precautions aren't taken, it can spread in hospitals and nursing homes. Health-care facilities already have infection-control procedures in place, such as providing private rooms and toilets for infected individuals. But the CDC is pushing them to do more on the prescribing side, advising nursing homes to track how many and what antibiotics they prescribe monthly and what the outcomes were for patients, including any side-effects.
  • Other recommendations include placing someone, such as a consulting doctor or a pharmacist, in charge of antibiotics policies and training other staff in following them. Some of the CDC's suggestions could challenge nursing homes' culture and how staffs, residents and their families interact. While nursing home residents and staff are among the people most at risk for the flu, annual shots aren't mandatory. Nor do homes always track who gets them.
  • That's starting to change at Evangelical Lutheran Good Samaritan Society, a nonprofit that provides a spectrum of senior care services in many states. Starting this year, it will collect data on staff vaccinations at one of its 167 nursing homes and share the pilot project's results with other homes, said Victoria Walker, chief medical officer. But better handling of antibiotics in nursing homes may also require tactful communication with residents' families and nursing home doctors accustomed to treating antibiotics as a default remedy.
  • "There's a real fear of undertreatment and that it is better to err on the safe side, and that means treating with antibiotics but forgetting about all the harms. But giving antibiotics can be just as harmful as not," said Walker. Family members may push for an antibiotic treatment when they visit a loved one in a nursing home who seems sick, even if they don't know precisely what's wrong. Doctors and nurses may go along because they don't know either and it's easier to treat than not. "The family will check in and ask what the doctor did and the nurse will say 'nothing' because they don't see monitoring as doing anything," said David Nace, director of long term care at the University of Pittsburgh, who contributed to the CDC guidelines.
  • "Practitioners are guilty of saying, 'it's just an antibiotic.' ... We don't appreciate the real threat," he said. Antibiotics are routinely prescribed to treat urinary tract infections, which are common in nursing homes, but too often when a UTI is only suspected, not confirmed, studies have found. The Infectious Disease Society of America is developing guidelines to help institutions implement programs to better manage antibiotics. In addition to fostering antibiotic resistant bacteria and causing C. diff infections, antibiotics also can produce allergic reactions and interfere with other drugs a nursing home resident is taking. Those risks aren't always fully considered, says researcher Christopher Crnich, who has published articles on antibiotic overuse. He is a hospital epidemiologist at William S. Middleton Veterans Hospital in Madison, Wisconsin. "Bad antibiotic effects don't come until weeks or months later, and frankly all we [prescribers] see is the upside when we're dealing with a sick mom or dad," Crnich said.
  • The Centers for Disease Control in the United States has raised concerns about the use of antibiotics in nursing homes.
Doug Allan

Blame doctors for drugging of seniors, Matthews says; Health minister recognizes 'serio... - 0 views

www.fpinfomart.ca/...193899720

shared by Doug Allan on 16 Apr 14 - No Cached
  • Ontario Health Minister Deb Matthews acknowledged the drugging of seniors in provincially regulated nursing homes is a problem but suggested doctors are responsible.
  • "Let's remember, it's doctors who prescribe these drugs, not the government," Matthews told reporters in a heated scrum at Queen's Park
  • The Star article, published Monday, revealed some long-term care homes, often struggling with staffing shortages, are routinely doling out these risky drugs to calm and "restrain" wandering, agitated and sometimes aggressive patients. At more than 40 homes across the province, roughly half the residents are on the drugs. At close to 300 homes, more than a third of the residents are on the drugs.
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  • Matthews' suggestion that the government is not involved in prescribing decisions "outraged" the head of the registered nurses association, Doris Grinspun.
  • Grinspun said the province can do more to boost training and staffing levels at nursing homes so that caregivers rely less on antipsychotics to control agitation in those with dementia.
  • While doctors ultimately make the decision to prescribe, experts the Star spoke with said it is often done after consulting with long-term care home staff, including nurses and personal support workers, or PSWs.
  • Matthews, who cautioned reporters that the information the Star has is "raw data," added that her government is making investments in care plans that will provide "alternatives to that pharmaceutical solution."
  • Nursing homes and the association representing them have also acknowledged the problem and called on the province to act. A fellow member of Matthews' Liberal government, MPP Donna Cansfield, has said the province must act.
  • Several homes with high rates told the Star they are trying to get their prescribing rates down. Where possible, they want to devote resources to "behavioural" therapies, whereby caregivers are trained to identify and neutralize what triggers agitation in residents with dementia. Triggers may include hunger or physical contact in common living areas.
  • Doug Allan on 16 Apr 14
     
    LTC staffing hours become an issue again, after the Star reveals overuse of antipsychotic drugs in LTC facilities in Ontario.  This may be an issue across Canada.
Govind Rao

Ontario moves towards allowing nurses to prescribe | Toronto Star - 0 views

www.thestar.com/...owing-nurses-to-prescribe.html

from heather nursing week nursing Ontario scope

shared by Govind Rao on 08 May 15 - No Cached
  • Seniors could be saved hours of emergency room waits if nurses could prescribe drugs, order tests
  • Nurses could make the health system more efficient if they could prescribe some drugs, and order diagnostic tests.
  • May 07 2015
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  • In the middle of the night, the last thing long-term care nurse Saad Akhter wants to do is send a senior to the hospital — especially someone with dementia. But there aren’t many other options available if a resident’s blood sugar is soaring, or she’s suffering from a urinary tract infection and the nurses can’t reach a physician to prescribe medication. That means the nurse must call an ambulance to take the woman to the nearest emergency department where she could wait hours for care, and potentially develop a bed sore or pick up an infection.
Irene Jansen

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Inc... - 1 views

www.plosmedicine.org/...10.1371%2Fjournal.pmed.1001244

privatization quality costs excellent

shared by Irene Jansen on 31 Mar 13 - No Cached
  • Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector
  • Irene Jansen on 31 Mar 13
     
    Summary by Anna Marriott, Oxfam Access and responsiveness * Studies that measured utilization by income levels tended to find the private sector predominately serves the more affluent. In Colombo, Sri Lanka, where a universal public health service exists, the private sector provided 72% of childhood immunisations for the wealthiest, but only 3% for the poorest. * Waiting times are consistently reported to be shorter in private facilities and a number of studies found better hospitality, cleanliness and courtesy and availability of staff in the private sector. Quality * Available studies find diagnostic accuracy, adherence to medical management standards and prescription practices are worse in the private sector. * Prescribing subtherapeutic doses, failure to provide oral rehydration salts, and prescribing of unnecessary antibiotics were more likely in the private sector, although there were exceptions. * Higher rates of potentially unnecessary procedures, particularly C-sections, were reported at private facilities. In South Africa for example, 62% of women delivering in the private sector had C-sections, compared with 18% in the public sector. * Two country studies found a lack of drug availability and service provision at public facilities, while surveys of patients' perceptions on care quality in the public and private sector provided mixed results. Patient outcomes * Public sector provision was associated with higher rates of treatment success for tuberculosis and HIV as well as vaccination. In South Korea for example, TB treatment success rates were 52% in private and 80% in public clinics. Similar figures were found for HIV treatment in Botswana. Accountability, transparency and regulation * While national statistics collected from public sector clinics vary considerably in quality, private healthcare systems tended to lack published data on outcomes altogether. Public-private partnerships also lacked data. * Several reports ob
Irene Jansen

TheSpec - The cemetery may be easier to access than a long-term care bed. - 1 views

www.thespec.com/...cess-than-a-long-term-care-bed

ontario home care ltc prescribing safety waits restraints

shared by Irene Jansen on 13 Mar 12 - No Cached
  • the Spectator’s comprehensive report card of LHIN health performance
  • It took 209 days on average for Champlain LHIN residents to be placed in a long-term care home, nearly double the provincial average of 113 days.
  • When it came to the amount of time it took to move patients specifically from acute-care hospitals to a long-term care bed, the Hamilton-area LHIN had the second-longest waits in Ontario at 107 days, nearly twice as long as the provincial average of 58 days.
  • ...8 more annotations...
  • About one in four home care clients in Ontario reported that their pain is not well-controlled
  • One in six long-term care residents in Ontario was physically restrained at least once in the previous three-month period.
  • more than double the rates found in other countries, such as the U.S. and Switzerland
  • About one in five long-term care residents in 2009-10 was being prescribed drugs that should be avoided in the elderly
  • About one in four newly admitted long-term care residents in Ontario was being prescribed a class of sedatives known as benzodiazepines.
  • One in seven newly admitted long-term care residents was being prescribed antipsychotic drugs without a clear reason for using them.
  • “assess/restore” bed in a long-term care facility
  • short-term rehabilitation for three months or less
Govind Rao

Improvement needed on drug regulation - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150312|216233047

from heather drugs pharmacare

shared by Govind Rao on 13 Mar 15 - No Cached
  • Toronto Star Thu Mar 12 2015
  • Prescription pharmaceuticals have saved and improved many lives, but they can also be deadly. How can we make sure Canadians get the prescription drugs they need without causing unnecessary harm? The federal government plays a vital role in pharmaceutical drug regulation. We have many reasons to be proud of the systems for drug safety already in place in Canada. Yet there's room for significant improvement. Over the course of nearly three years, the Senate standing committee on social affairs, science and technology has studied prescription pharmaceuticals in Canada, and our findings are summarized in the newly tabled report, Prescription Pharmaceuticals in Canada. We heard hundreds of hours of testimony from a wide range of experts in the field on the strengths of our regulatory systems, but there was also a strong chorus of criticism from those who believe we can do much better.
  • For example, we heard frequent testimony regarding Health Canada's passive role in drug regulation, its lack of transparency in relaying safety information to the public, its inability to conduct adequate inspections at all phases of a drug's life cycle, and we witnessed, in some cases, the department's failure to provide our Senate committee with reliable testimony. But there's room for optimism. Over the course of our study, we made a number of recommendations for updated legislation and regulations, many of which are reflected in the newly adopted Vanessa's Law (Bill C-17). Key to this new legislation are transparency provisions, including the introduction of a requirement for the public disclosure of clinical trial and drug safety information, improved mechanisms to collect post-market safety information, the power to recall unsafe products when necessary and new penalties for regulatory violations - all concerns raised during the course of our study.
  • ...1 more annotation...
  • These are very good first steps, but still more needs to be done on a number of fronts. The committee heard compelling evidence that there is an urgent need for substantially improved physician training in prescribing "off-label" and addictive pharmaceuticals. "Off-label" refers to drugs that are prescribed for use beyond the approved criteria; our report reveals that the extent of off-label prescribing is not known and, in fact, physicians are frequently unaware that they are prescribing off-label. Consequently, little is known about the most common types of off-label use. We need improved data collection and for the Drug Safety and Effectiveness Network to take an active role in assessing off-label drug uses. We also need an enforcement of the prohibition on off-label drug promotion by drug manufacturers. The report also emphasizes the need for regular and accessible "take back" programs to collect unused prescription drugs to keep them from being discharged improperly into the environment. Drug shortages are not a new phenomenon, but they have been increasing in frequency and duration over the last decade.
Govind Rao

Should registered nurses prescribe drugs? - Healthy Debate - 0 views

healthydebate.ca/...registered-nurses-prescribing

from heather rn nursing nurses drugs scope

shared by Govind Rao on 03 Mar 16 - No Cached
  • by Wendy Glauser, Sachin Pendharkar & Debra Bournes (Show all posts by Wendy Glauser, Sachin Pendharkar & Debra Bournes) March 3, 2016
  • The Ontario provincial government has said it will expand the scope of practice of registered nurses (RNs) in Ontario to allow them to prescribe medications. Currently, only doctors and nurse practitioners have the ability to prescribe medications. This is a move that could radically change health care – some say for the better, but others are concerned.
Cheryl Stadnichuk

Older women more likely to be prescribed inappropriate drugs: study - The Globe and Mail - 0 views

www.theglobeandmail.com/...article30120533

senors prescription drugs women

shared by Cheryl Stadnichuk on 25 May 16 - No Cached
  • That does not necessarily mean that doctors treat older women differently. Morgan noted that women are more likely to seek medical attention for anxiety and sleeplessness, whereas men are more likely to self-medicate with alcohol and other drugs, according to previous research.Overuse of tranquilizers in both sexes may stem from long-term prescription renewals, he said. “We suspect that many people actually started using them 10 or 15, or maybe 20 years earlier, when they were middle-aged.”
  • The study, published this month in the medical journal Age and Ageing, analyzed population-based data from British Columbia’s PharmaNet, a province-wide network that links B.C. pharmacies to central databases.Rates of inappropriate prescribing for older adults are similarly high in other parts of the country, according to a 2012 study conducted by the Canadian Institute For Health Information.
Irene Jansen

Education, guidance, and equality are needed to address problem of antipsychotic prescr... - 0 views

www.bmj.com/...bmj.e2421

prescribing uk ltc funding

shared by Irene Jansen on 12 Apr 12 - No Cached
  • antipsychotic prescribing in nursing homes
  • care homes are inadequately commissioned. I recently visited an excellent hospice whose cost was around £500 a day. Dementia care in a nursing home is often commissioned around £600 a week, and most patients are referred to care homes from hospitals whose costs are of a wholly different order.
Irene Jansen

Improve environment to reduce pressure to prescribe antipsychotic drugs in nursing home... - 1 views

www.bmj.com/...bmj.e2450

uk prescribing ltc dementia staffing funding

shared by Irene Jansen on 12 Apr 12 - No Cached
  • prescribing antipsychotic drugs to residents of nursing homes who have dementia
  • Rarely do such patients ask to be treated: requests usually come from care staff. However, such requests do not result simply from a desire for a quiet life for staff. Nurses in such establishments often work with minimal staffing and comparatively little training and specialist support.
  • social isolation, an unfamiliar environment, inactivity, and boredom are as likely to be relevant to the emergence of difficult behaviour as the underlying dementia.
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  • increase pressure on care home providers and their funders to pay more attention to the quality of the environments and the levels of care they provide.
Govind Rao

Antipsychotic drugs prescribed to nearly one-third of Etobicoke nursing home residents - 0 views

www.insidetoronto.com/...obicoke-nursing-home-residents

from heather continuing care ltc drugs safety ontario

shared by Govind Rao on 29 Apr 14 - No Cached
  • Apr 24, 2014  
  • Potentially lethal drugs are used off-label to control behaviour among residents with dementia; but prescription rates decreasing since 2010 says Ontario Long Term Care Association
  • Nearly one-third of residents in Etobicoke nursing homes are being prescribed antipsychotic drugs, despite warnings the drugs could kill elderly people with dementia.
Govind Rao

HOW TO FIX CANADA'S MENTAL HEALTH SYSTEM; Too many patients seeking mental health diagn... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150602|221788724

from heather mental health

shared by Govind Rao on 02 Jun 15 - No Cached
  • The Globe and Mail Tue Jun 2 2015
  • OPEN MINDS How to build a better mental health care system A weary-looking single mother brought her son into the London, Ont., walk-in clinic where Christina Cookson works on a weekday evening. Her son, who recently attempted suicide in another city, was sent home from hospital with no follow-up. Now, with a doctor they had never met before, they were trying to get help. Dr. Cookson asked a few questions about his current treatment, learned of a new antidepressant that his mother said seemed to be working.
  • A system that responds nimbly to patients' needs would have clear treatment guidelines, appropriate screening and good data collection to ensure that therapies are working for patients. There should be a role, for instance, for non-profit groups on the ground to be woven into a comprehensive system to provide additional supports, particularly in areas such as housing, employment and mental health promotion - without expecting them to patch up shortfalls in services the system should provide. That should include, says Dr. Goldner, non-physicians with training in psychotherapy who are integrated into the mental health system, so that access to care is based on sound science and the best treatment plans for individual patients, rather than what happens to be available. Canada doesn't have to start from scratch. As Dr. Goldner points out, Britain and Australia have both made huge investments to expand public access for all citizens to psychotherapy, recognizing both its clinical value and cost-effectiveness over the long run. Britain's system, especially, has been designed to be accountable, to track outcomes with extensive data and to be flexible enough to incorporate changes to the system to improve results.
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  • And one to which many family doctors, struggling to help mentally ill patients, can attest. After months of research, and as detailed in our Open Minds series, The Globe and Mail identified some of the top evidence-based approaches to building a mental health system that will work for Canadians. These are changes that would move the country beyond its patchwork, fragmented mental health system in which the care patients receive is too often determined by what they can afford, or where they live or what they are savvy enough to cobble together on their own. These initiatives abide by the principals of Medicare and good science, and treat the disorders of the mind as diligently as the diseases of the body.
  • Expanding access to publicly funded therapy One in five Canadians will be affected by mental illness in their lifetimes. The cost to the country's economy is staggering: $50billion a year in health care and social services, lost productivity and decreased quality of life, estimates the Mental Health Commission of Canada. The personal costs are more devastating - unemployment, family breakup, suicide. Canadians who seek help for a mental illness will most often be prescribed medication, even though research shows that psychotherapy works just as well, if not better, for the most common illnesses (depression and anxiety) and does a better job at preventing relapse. According to a 2012 Statistics Canada study, while 91 per cent of Canadians were prescribed the medication they sought, only 65 per cent received the therapy they felt they needed. Access to evidencebased psychotherapy, which experts say should be the front-line medical treatment, is limited and wait-lists are long.
  • No provinces cover therapy delivered in private practice by a psychologist, social worker or psychotherapist, creating a twotier system, which means families without coverage through work - those more likely to be low-income - often either pay out of pocket or go without or, if they are lucky, rely on a non-profit group working to fill a gaping hole in a flawed health-care system. Even Canadians with coverage rarely have enough for a proper dose that meets treatment guidelines. This kind of inconsistent, unequal and scientifically flawed approach to care would be untenable for diabetes, cancer or heart disease. Yet it persists for some of the most debilitating illnesses suffered by Canadians. "Clearly this is the biggest gap we have, and the one that most needs to be fixed," says psychiatrist Elliot Goldner, director of the Centre for Applied Research in Mental Health and Addiction. Psychotherapy is a medically necessary treatment, he argues, that should be publicly funded. The question is not whether Canadians need it, but how to deliver it.
  • With no history of care, Dr. Cookson had no way to know for sure. She advised him to make sure he told his mom if he had suicidal thoughts again and wrote a referral to see a psychiatrist, though even an urgent request would take weeks. Other than that, she had little to offer. They had no coverage for psychotherapy, which ideally, she would have prescribed. Since the young man was a walk-in patient, there is no guarantee she will see him again. "I want to be able to give them the care they deserve, and I know will benefit him, and I have no way of arranging that," she says. "It's a pretty helpless feeling."
  • Using technology to deliver therapy into the homes of Canadians It can be hard enough to get timely treatment if you only have to drive a few blocks to find it. But what if access to care for, say, an anxiety disorder requires traversing a sprawling wilderness, for hours by car, sometimes through a blizzard? These were the stories that Fern Stockdale Winder heard often from Saskatchewan patients, as the psychologist charged with developing the province's new mental health strategy. Even when mental health care was available, reaching treatment was often one more layer of stress. It doesn't have to be this way. Chief among the strategy's recommendations: a provincewide online therapy system. The evidence for tech-delivered therapy, with support over the phone, is strong - for many patients with depression and anxiety, it can be just as effective as face-to-face sessions. It allows patients to manage care around their work and school schedules, to maintain privacy and to take control of their own recovery in a way less likely to happen with medication.
  • And it's cost-effective, says Dr. Stockdale Winder, potentially reducing appointment no-shows and cutting down on travel time for patients and therapists to and from remote communities. Canadians have ready access to medication for mental illness not because it's the best option, but because it's the easiest - even though psychotherapy works as an effective early intervention, a standalone treatment or in combination with drugs, and to prevent relapse. This front-line treatment can also be delivered in a modern and increasingly convenient way that gives patients more choice in how they receive their care.
  • It's very much about how people like to learn. Whether for reasons of stigma or personal preference, many people like to work on life challenges by themselves," says Chris Williams, a psychiatrist at the University of Glasgow, whose self-guided program is used as a first-stage treatment in Britain's publicly funded psychotherapy system. It has also been adapted in British Columbia and is being piloted in other provinces by the Canadian Mental Health Association. Self-guided therapies vary - some use DVDs or booklets, others are delivered online - but the evidence is strongest for ones that also link patients to therapists, either by e-mail or with brief phone calls.
  • A separate online program at the University of Regina has already had promising results. (Even so, the government is taking a wait-and-see attitude: Health Minister Dustin Duncan said last week that the government is keeping an eye on the project and will consider whether to expand the service after the pilot concludes next year.) What Dr. Stockdale Winder envisions is a system in which family doctors could use depression and anxiety screening to easily steer appropriate patients away from medication and toward accessible, online therapy.
  • "She clicks a button, and the patient is in," she says. Such a system would also monitor the progress of participants and direct them into more intensive care if their conditions worsened. The need for early intervention is pressing, and the evidence for online therapy is already convincing. In a country of wide open spaces, with remote communities difficult to reach even in the best weather, it's necessary. What are policy-makers waiting for? Teaching the next generation about mental health
Govind Rao

Ontario nursing homes should examine use of powerful drugs: report | Toronto Star - 0 views

www.thestar.com/...-of-powerful-drugs-report.html

from heather Ontario ltc drugs

shared by Govind Rao on 21 May 15 - No Cached
  • New report shows striking discrepancy in prescribing rates of antipsychotic drugs at long-term care homes across the province.
  • Benny Smith holds a photo of her late mother, Mary Bishop. She said Bishop was weaned off the antipsychotic drug quetiapine by staff at her Etobicoke nursing home and within a month the elderly woman's mood had brightened and she eventually spoke after years of silence.
  • May 20 2015
  • ...1 more annotation...
  • At some nursing homes, more than 60 per cent of residents are prescribed antipsychotic medications, while other homes are prescribing none, according to a report released Wednesday by Health Quality Ontario, which monitors the performance of the province’s health system.
Govind Rao

Partnerships: pharma is closer than you think | The BMJ - 0 views

www.bmj.com/bmj.h3688

from heather UK NHS drugs fraud corporation

shared by Govind Rao on 24 Jul 15 - No Cached
  • BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3688 (Published 23 July 2015) Cite this as: BMJ 2015;351:h3688
  • Nurses and pharmacists employed by drug companies are working in general practices to review prescribing, often without patients’ knowledge. Margaret McCartney investigates
  • “Partnerships” between the NHS and industry can be win-win. Drug companies profit from NHS prescribing but also encourage safe use by paying professionals to educate NHS staff and patients, minimising waste, diminishing harm, and promoting prescribing in line with guidelines. At least, that’s the idea.
Govind Rao

Nursing home ills tied to heavy antibiotic use - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150702|223996437

from heather ltc drugs hai

shared by Govind Rao on 06 Jul 15 - No Cached
  • The Globe and Mail Thu Jul 2 2015
  • It has been known for some time that long-term care facilities use a lot of antibiotics. Earlier studies have suggested there is a significant amount of overuse in this sector of the healthcare system, with potentially between one-third and half of all use being inappropriate or unnecessary. Residents of these facilities are typically frail, elderly people with a variety of health concerns. They are at the point in life where their immune systems cannot fight off invaders easily.
  • her risk," said Dr. Nick Daneman, first author of the study. "Unlike other medication classes, which can harm the individual recipient of that medication, antibiotics have the capacity to do harm even beyond the individual that gets the medication." Daneman is an adjunct scientist at the Institute for Clinical Evaluative Sciences and an internal medicine physician at Toronto's Sunnybrook Health Sciences Centre. The study appeared in the journal JAMA Internal Medicine, a publication of the American Medical Association.
  • ...4 more annotations...
  • Antibiotics are likely being overused in some nursing homes in Ontario - and that misuse is putting all residents of these facilities at risk, a study suggests. With most drugs, inappropriate use only threatens the health of the person who takes the medication. But with misuse of antibiotics, the problems that arise - drug-resistant bacteria, C. difficile infections - are not restricted to the people who have been taking the drugs. "[Nursing] homes with higher use put patients at hig
  • These people often live in close quarters and are cared for by staff who move from resident to resident. It's a situation that makes for efficient spread of bacteria and other pathogens that cause infections. For this study, Daneman and his co-authors looked at antibiotic use in 110,656 residents of 607 nursing homes in Ontario in 2010 and 2011. The nursing homes studied were divided into low, medium and high antibiotic-use categories. The differences were stark: antibiotic prescribing in high-use facilities was 10 times that of low-use homes. If high-use homes had residents who were significantly sicker and more frail, that might explain their heavy reliance on antibiotics. But the authors also did a comparison of the residents of the various facilities and found there were not major health differences among them. That suggests the increased use of antibiotics in the high-use homes likely is a result of the doctors who are prescribing at those facilities, said infectious diseases expert Dr. Andrew Simor, who was not involved in this study. Simor is head of microbiology at Sunnybrook.
  • He suggested this information could help change prescribing behaviours; facilities where antibiotic use is higher than the norm could be targeted with programs aimed at minimizing misuse of these critical drugs. The article, which Simor praised, also drew a line between high antibiotic use and higher rates of negative consequences of antibiotic use. Those side-effects included allergic reactions to antibiotics, developing antibiotic-related diarrhea, contracting C. difficile infection, or becoming infected with a drug-resistant bacteria. Daneman said the adverse events were generally serious enough to send these people to hospital. "If you live in a high antibiotic-use home versus a low antibiotic-use home, you had 25 per cent increased risk of one of these serious antibiotic-related adverse events," he said. Because of the way the study was designed, the authors could not tell if the antibiotics used were needed in each setting. So they cannot say that the low-use homes had hit the sweet spot for antibiotic use - not too much, but enough.
  • Still, Simor observed that when hospitals started to develop programs to cut back on unneeded use of antibiotics - it's called antibiotic stewardship - concerns were raised that some people who needed the drugs might not get them. That hasn't proven to be the case, he said. "So if you feel comfortable translating those findings into a nursing home setting, I think you'll find the same situation is true - that stewardship will not place patients at increased risk for not getting an antibiotic when they need it."
Govind Rao

Quebec nurses get new powers to prescribe meds, lab tests - Montreal - CBC News - 0 views

www.cbc.ca/...iption-birth-control-1.3261330

from heather quebec nursing nurses prescribing

shared by Govind Rao on 14 Oct 15 - No Cached
  • Quebec nurses' union pleased with new powers
  • Oct 07, 2015
  • The Quebec government is giving nurses more powers in an effort to speed up treatment for patients.
  • ...1 more annotation...
  • Quebec nurses' responsibilities will be expanded to include prescribing contraceptives, starting in January 2016.
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