Base de dados : MEDLINE
Pesquisa : E02.183.875 [Categoria DeCS]
Referências encontradas : 4 [refinar]
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[Au] Autor:Barnard JG; Dempsey AF; Brewer SE; Pyrzanowski J; Mazzoni SE; O'Leary ST
[Ad] Endereço:Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; General Academic Pediatrics, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO. Electronic addre
[Ti] Título:Facilitators and barriers to the use of standing orders for vaccination in obstetrics and gynecology settings.
[So] Source:Am J Obstet Gynecol;216(1):69.e1-69.e7, 2017 Jan.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many young and middle-aged women receive their primary health care from their obstetrician-gynecologists. A recent change to vaccination recommendations during pregnancy has forced the integration of new clinical processes at obstetrician-gynecology practices. Evidence-based best practices for vaccination delivery include the establishment of vaccination standing orders. OBJECTIVES: As part of an intervention to increase adoption of evidence-based vaccination strategies for women in safety-net and private obstetrician-gynecology settings, we conducted a qualitative study to identify the facilitators and barriers experienced by obstetrician-gynecology sites when establishing vaccination standing orders. STUDY DESIGN: At 6 safety-net and private obstetrician-gynecology practices, 51 semistructured interviews were completed by trained qualitative researchers over 2 years with clinical staff and vaccination program personnel. Standardized qualitative research methods were used during data collection and team-based data analysis to identify major themes and subthemes within the interview data. RESULTS: All study practices achieved partial to full implementation of vaccine standing orders for human papillomavirus, tetanus diphtheria pertussis, and influenza vaccines. Facilitating factors for vaccine standing order adoption included process standardization, acceptance of a continual modification process, and staff training. Barriers to vaccine standing order adoption included practice- and staff-level competing demands, pregnant women's preference for medical providers to discuss vaccine information with them, and staff hesitation in determining HPV vaccine eligibility. CONCLUSIONS: With guidance and commitment to integration of new processes, obstetrician-gynecology practices are able to establish vaccine standing orders for pregnant and nonpregnant women. Attention to certain process barriers can aid the adoption of processes to support the delivery of vaccinations in obstetrician-gynecology practice setting, and provide access to preventive health care for many women.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Cuidado Pré-Natal
Prescrições Permanentes
[Mh] Termos MeSH secundário: Pessoal Administrativo
Pessoal Técnico de Saúde
Difteria/prevenção & controle
Vacinas contra Difteria, Tétano e Coqueluche Acelular/uso terapêutico
Seres Humanos
Vacinas contra Influenza/uso terapêutico
Influenza Humana/prevenção & controle
Enfermeiras e Enfermeiros
Infecções por Papillomavirus/prevenção & controle
Vacinas contra Papillomavirus/uso terapêutico
Preferência do Paciente
Diretores Médicos
Pesquisa Qualitativa
Tétano/prevenção & controle
Coqueluche/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Diphtheria-Tetanus-acellular Pertussis Vaccines); 0 (Influenza Vaccines); 0 (Papillomavirus Vaccines)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170531
[Lr] Data última revisão:
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161001
[St] Status:MEDLINE

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[Au] Autor:De Rijdt T; Spriet I; Willems L; Blanckaert M; Hiele M; Wilmer A; Simoens S
[Ad] Endereço:1 University Hospitals Leuven, Belgium.
[Ti] Título:Appropriateness of Acid Suppression Therapy.
[So] Source:Ann Pharmacother;51(2):125-134, 2017 Feb.
[Is] ISSN:1542-6270
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The inappropriate startup of long-term acid suppressive therapy (AST) can have clinical and pharmacoeconomic impacts on ambulatory care. OBJECTIVE: To assess the proportion of patients with appropriate initiation of long-term AST in non-critically ill patients. To describe possible risk factors for nonappropriate AST. To calculate the potential savings when eliminating the nonappropriate startup of AST. METHOD: This observational, retrospective study evaluated the appropriateness of startup of long-term AST in medical records using a broad variety of international criteria and guidelines and using a validated screening instrument. RESULTS: A sample of 597 patients was included in the analysis. In 57% of them, AST was appropriately initiated. No specific risk profile could be defined. There was some indication that the availability of a clinical pharmacist and the use of standing orders were correlated to the outcome. Extrapolation to the total population (ie, 2836 patients) led to a total cost of €8880 during hospital stay plus an extra €40 391 per month after discharge. Avoiding inappropriate initiation of AST could lead to a saving of €3805 plus €17 441 per month. CONCLUSION: In all, 43% of initiation of long-term AST in the hospital was inappropriate. The potential savings from avoiding this could be substantial from a health care payer perspective. No patient characteristics that could predict for inappropriate initiation of AST were identified. A correlation between inappropriate initiation and medical disciplines using standing orders that include AST was seen.
[Mh] Termos MeSH primário: Antagonistas dos Receptores Histamínicos H2/economia
Prescrição Inadequada
Inibidores da Bomba de Prótons/economia
[Mh] Termos MeSH secundário: Adulto
Antagonistas dos Receptores Histamínicos H2/efeitos adversos
Antagonistas dos Receptores Histamínicos H2/uso terapêutico
Seres Humanos
Prescrição Inadequada/economia
Prescrição Inadequada/estatística & dados numéricos
Tempo de Internação
Alta do Paciente
Inibidores da Bomba de Prótons/efeitos adversos
Inibidores da Bomba de Prótons/uso terapêutico
Estudos Retrospectivos
Fatores de Risco
Prescrições Permanentes
Resultado do Tratamento
[Nm] Nome de substância:
0 (Histamine H2 Antagonists); 0 (Proton Pump Inhibitors)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170816
[Lr] Data última revisão:
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160922
[St] Status:MEDLINE
[do] DOI:10.1177/1060028016670414

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[Au] Autor:Litvin CB; Hyer JM; Ornstein SM
[Ad] Endereço:From the Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, South Carolina (CBL); the Department of Public Health Sciences, Medical University of South Carolina (JMH); and the Department of Family Medicine, Medical University of South Carolina (SMO).
[Ti] Título:Use of Clinical Decision Support to Improve Primary Care Identification and Management of Chronic Kidney Disease (CKD).
[So] Source:J Am Board Fam Med;29(5):604-12, 2016 Sep-Oct.
[Is] ISSN:1558-7118
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Early detection of chronic kidney disease (CKD) can lead to interventions to prevent renal failure and reduce risk for cardiovascular disease, yet adherence to treatment goals is suboptimal in the primary care setting. The purpose of this study was to assess whether clinical decision support (CDS) can be used to improve the identification and management of CKD. METHODS: This 2 year demonstration study was conducted in 11 primary care PPRNet practices. CDS included a risk assessment tool, health maintenance protocols, flow chart and a patient registry. Practices received performance reports and hosted annual half day on-site visits. RESULTS: There were statistically significant increases in screening for albuminuria (median 24 month change 30%, p < 0.0005) and monitoring albuminuria (median 24 month change 25%, p < 0.0005). An absolute 23.5% improvement in appropriate use of ACE-inhibitor or angiotensin receptor blocker and an absolute 7.0% improvement in hemoglobin measurement were not statistically significant. There were no clinical or statistically significant differences in other CKD CQMs. Facilitators to CDS use included practices' prioritization of improving CKD and staff use of standing orders. Barriers included incorporating use into existing workflow and variable use among providers. CONCLUSIONS: Use of CDS to improve CKD identification and management in primary care practices shows promise. However, other barriers must be addressed to effectively achieve improvements in CKD outcomes.
[Mh] Termos MeSH primário: Antagonistas de Receptores de Angiotensina/uso terapêutico
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico
Sistemas de Apoio a Decisões Clínicas/utilização
Atenção Primária à Saúde/organização & administração
Melhoria de Qualidade
Insuficiência Renal Crônica/diagnóstico
Insuficiência Renal Crônica/tratamento farmacológico
[Mh] Termos MeSH secundário: Albuminúria/diagnóstico
Taxa de Filtração Glomerular
Seres Humanos
Atenção Primária à Saúde/normas
Insuficiência Renal Crônica/epidemiologia
Insuficiência Renal Crônica/urina
Medição de Risco
Prescrições Permanentes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Angiotensin Receptor Antagonists); 0 (Angiotensin-Converting Enzyme Inhibitors)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160911
[St] Status:MEDLINE
[do] DOI:10.3122/jabfm.2016.05.160020

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[Au] Autor:Stewart AM; Lindley MC; Cox MA
[Ad] Endereço:Milken Institute, School of Public Health, The George Washington University, Washington, District of Columbia. Electronic address:
[Ti] Título:State Law and Standing Orders for Immunization Services.
[So] Source:Am J Prev Med;50(5):e133-e142, 2016 May.
[Is] ISSN:1873-2607
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: This study determined whether state laws permit the implementation of standing orders programs (SOPs) for immunization practice. SOPs are an effective strategy to increase uptake of vaccines. Successful SOPs require a legal foundation authorizing delegation of immunization services performed by a wide range of providers, administered to broad patient populations, in several settings. Without legal permission to administer vaccines, non-physician health professionals (NPHPs) are unable to provide preventive services. METHODS: From 2012 through 2013, researchers analyzed the legal environment in 50 states and the District of Columbia to determine whether NPHPs are authorized to (1) assess patient immunization status; (2) prescribe vaccines; and (3) administer vaccines under their own practice license or delegated authority. Laws governing the following NPHPs were included: (1) medical assistants; (2) midwives; (3) nurses in advanced practice; (4) registered, practical, and vocational nurses; (5) physician assistants; and (6) pharmacists. Additionally, the review determined which vaccines may be administered, permissible patient populations, and allowable practice settings for each category of NPHP. RESULTS: The laws are highly variable, and no state authorizes all NPHPs to conduct all elements of immunization practice for all patients. The laws frequently indicate where NPHPs may or may not administer vaccines and outline permissible vaccines, eligible patients, and required level of supervision. CONCLUSIONS: The variation in the laws could potentially present a challenge to successful implementation of public health goals to improve immunization rates. Expanded authorization of SOPs in all states could increase health practitioners' ability to deliver recommended vaccines.
[Mh] Termos MeSH primário: Imunização/legislação & jurisprudência
Prescrições Permanentes
Governo Estadual
Vacinas/administração & dosagem
[Mh] Termos MeSH secundário: Pessoal de Saúde/legislação & jurisprudência
Seres Humanos
Estados Unidos
[Nm] Nome de substância:
0 (Vaccines)
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151215
[St] Status:MEDLINE

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