Search

Introdução: O exame citopatológico e utilizado para detecção precoce das lesões precursoras do câncer do colo uterino. Objetivo: Avaliar os indicadores de qualidade de acordo com o Manual de Gestão da Qualidade para Laboratório de Citopatologia. Método: Verificaram-se os laudos das fichas de requisição dos exames citopatológicos do laboratório clinico da Pontifícia Universidade de Goiás (LC-PUC-Goiás) entre janeiro de 2013 e dezembro de 2017. Resultados: Do total de 6.809 diagnósticos, observaram-se 99,4% (6.768/6.809) satisfatórios, sendo 91,3% (6.215/6.809) resultados negativos, 8,1% (553/6.809) diagnósticos com anormalidades citológicas e 0,6% (41/6.809) de exames insatisfatórios. O índice de positividade dos anos de 2013 a 2017 foram 10,5%, 7,9%, 8,6%, 6,8% e 5,3%, respectivamente. O percentual de exames compatíveis com lesão intraepitelial de alto grau (HSIL) entre os exames satisfatórios no ano de 2013 foi de 1,3%; 2014: 1,0%; 2015: 0,5%; 2016: 0,6%; e 2017: 0,7%, resultados dentro do estabelecido, ≥0,4%. A relação de células escamosas atípicas (ASC)/satisfatórios demostrou valores acima do estabelecido nos anos de 2013 com 6,8% e 2015 com 6,1%. Segundo o Manual de Gestão para Controle de Qualidade, espera-se que, no máximo, 4% a 5% de todos dos exames sejam classificados como ASC. Valores acima de 5% necessitam de uma atenção diferenciada. Conclusão: E de suma importância a educação continuada dos profissionais que participam de todas as etapas do processo, da fase pré-analítica a analítica, para que possíveis erros possam ser corrigidos e medidas preventivas tomadas para uma melhor qualidade na interpretação dos exames citopatológicos.

Objective: To describe the self-reported management of hypertension in general practice and how this compares to national guidelines for hypertension. Design: Analysis of self-reported cross-sectional clinical audit data. Setting: Australian general practice for the years 1999, 2001, 2003 and 2004. Study population: A total of 5247 general practitioners who voluntarily participated in one of four hypertension clinical audits and provided data for 105 086 adult patients with a previous diagnosis of hypertension. Main outcome measures: Selection of blood pressure targets consistent with recommendation of hypertension guidelines, percentage of patients achieving target blood pressure and percentage of patients with selected co-morbidities treated with the preferred class of antihypertensive medications. Results: In 2001, target blood pressures of 140/90 mmHg and 130/85 mmHg were being used for 38% and 55% of patients, respectively. In 2004, target blood pressures were 140/90 mmHg (39%), 130/85 mmHg (49%) and 125/75 mmHg (0·5%). In 2003 and 2004, 58% and 70% of patients were reported to have achieved a target blood pressure that was consistent with guidelines according to patient age and co-morbidities. However, only 54–62% of hypertensive patients with heart failure were prescribed an ACE inhibitor and 52% of patients with a history of myocardial infarction were receiving a beta-blocker or ACE inhibitor. Conclusions: The self-reported data from general practitioners participating in clinical audits show that these general practitioners are using blood pressures targets consistent with guideline recommendations for most patients and that more patients are reaching their target blood pressure. However, drug selection based on co-morbidities could improve. [ABSTRACT FROM AUTHOR]

Abstract Background Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1) hypertension (HT) and 2) chronic heart failure (CHF). The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. Methods A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI) intervention on prescribing practice among Australian general practitioners (GP) in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion) with each group undertaking the clinical topics (CHF and HT) in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups. De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. Discussion This paper describes the study protocol for a project that will contribute to the development of acceptable and sustainable methods to promote QI activities within routine general practice, enhance prescribing practices and improve patient outcomes in the context of CHF and HT. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), Trial # 320870.

Background and Aims: Opioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under-treatment of opioid dependence in these settings world-wide. This study assessed the safety of subcutaneous slow-release depot buprenorphine in custody., Design: Open-label, non-randomized trial., Setting: Correctional centres in New South Wales, Australia., Participants: Sixty-seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM-5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine; patients already stable on oral methadone treatment were recruited to the comparison arm., Intervention and Comparator: Depot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone., Measurements: Safety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self-reported diversion and substance use at baseline and weeks 4 and 16., Findings: Retention in depot buprenorphine treatment was 92.3%. Ninety-four per cent of patients reported at least one adverse event, typically mild and transient. No diversion was identified. The prevalence of self-reported non-prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007-0.018, P < 0.0001)., Conclusions: This first study of depot buprenorphine in custodial settings showed treatment retention and outcomes comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of diversion., (© 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT)., Methods: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake., Results: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners., Conclusions: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice.

Background: Inter-professional learning has been promoted as the solution to many clinical management issues. One such issue is the correct use of asthma inhaler devices. Up to 80% of people with asthma use their inhaler device incorrectly. The implications of this are poor asthma control and quality of life. Correct inhaler technique can be taught, however these educational instructions need to be repeated if correct technique is to be maintained. It is important to maximise the opportunities to deliver this education in primary care. In light of this, it is important to explore how health care providers, in particular pharmacists and general medical practitioners, can work together in delivering inhaler technique education to patients, over time. Therefore, there is a need to develop and evaluate effective inter-professional education, which will address the need to educate patients in the correct use of their inhalers as well as equip health care professionals with skills to engage in collaborative relationships with each other., Methods: This mixed methods study involves the development and evaluation of three modules of continuing education, Model 1, Model 2 and Model 3. A fourth group, Model 4, acting as a control.Model 1 consists of face-to-face continuing professional education on asthma inhaler technique, aimed at pharmacists, general medical practitioners and their practice nurses.Model 2 is an electronic online continuing education module based on Model 1 principles.Model 3 is also based on asthma inhaler technique education but employs a learning intervention targeting health care professional relationships and is based on sociocultural theory.This study took the form of a parallel group, repeated measure design. Following the completion of continuing professional education, health care professionals recruited people with asthma and followed them up for 6 months. During this period, inhaler device technique training was delivered and data on patient inhaler technique, clinical and humanistic outcomes were collected. Outcomes related to professional collaborative relationships were also measured., Discussion: Challenges presented included the requirement of significant financial resources for development of study materials and limited availability of validated tools to measure health care professional collaboration over time.

Objective: The aim of the present study was to determine the duration of initial anticholinesterase treatment in veteran patients in Australia. Three anti-dementia medications were investigated (donepezil, rivastigmine and galantamine) and two different setting were compared (community and residential aged care facilities)., Method: A retrospective cohort study was performed using the Department of Veterans' Affairs pharmacy claims data. Patients were included in the cohort if they had been dispensed at least one anticholinesterase prescription (index) between 2003 and 2006, were aged 65 years or over at the time of that index dispensing, and had not been dispensed any anticholinesterase medicine in the previous 12 months. Patients were followed until discontinuation (ceased or switched), death or 1 year of follow up. Time to treatment discontinuation was analysed utilizing the Kaplan-Meier method. Cox proportional hazards models were used to compare the risk of treatment discontinuation among the three treatment groups adjusting for the effect of patients' characteristics., Results: Of the new users of anticholinesterases (n = 10088), 47% of those on donepezil, 46% of those on galantamine, and 47% of rivastigmine patients discontinued their initial therapy within 6 months. A total of 32% of patients who ceased therapy reinitiated it during the study period; 28% returned to the same index medication and 4% restarted therapy with a different anticholinesterase. The median treatment duration was: 199 days (95% CI, 182-208) for donepezil patients (n = 6705), 233 days (95% CI, 212-259) for galantamine patients (n = 2898), and 219 days (95% CI, 176-260) for rivastigmine patients (n = 394). Patients in community settings were more likely to discontinue their initial anticholinesterases earlier compared to those living at residential aged care facilities (relative risk, RR=1.21; 95% CI, 1.12, 1.31)., Conclusions: Almost half of the Australian veteran patients who initiated anticholinesterases treatment discontinued (ceased or switched) therapy within 6 months. However, one-third of those who ceased therapy reinitiated it during the study period.

Background: The aim of this study was to identify the factors that influence prescribing of new drugs among general practitioners, endocrinologists and psychiatrists., Methods: Four focus groups were conducted with GPs, endocrinologists and psychiatrists on sources of awareness and influences on prescribing of new drugs., Results: Pharmaceutical companies were the most important source for becoming aware of new drugs. There were many influences on the decision to prescribe a new drug, the most important being efficacy, safety, cost and advantage over existing therapies. Endocrinologists placed greater emphasis on evidence from clinical trials and scientific conferences, and psychiatrists and GPs placed more weight on pharmaceutical representatives, colleagues and specialists., Discussion: New drug prescribing occurs in a complex environment with many influences. Effective interventions to promote rational, safe and effective prescribing of new drugs will need to be cognisant of these factors.