Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. [Review]. Cochrane database of systematic reviews [online], Issue 11, article number CS011227.
This systematic review protocol forms part of research that has been funded by _____________________________. The protocol document was originally hosted by _______________________________________ and made publicly available at ____________________________________________________________________________________. This work is made freely available under open access. The first version of this protocol was originally made available on ________________________________________. This version of the protocol was originally made available on ____________________________________________. In total, there have been ____________ known revisions of the protocol. This protocol is distributed under a CC ____________ license.
While community-based palliative care is an essential aspect of meeting the health care demands of an ageing society, the current model has several gaps and limitations. An appropriately qualified and skilled pharmacist within the palliative care team may help to address some of the gaps in relation to medication access and appropriateness.
Aim
To determine whether pharmacist‐initiated electronic discharge prescribing would decrease discharge times for selected cardiology patients and improve the accuracy of prescribing by limiting deviations from the intended therapeutic plan.
Method
A cardiology project team identified system issues impeding patient flow through the ward, including the discharge medication pathway. The stages of the medication pathway were mapped before and after the intervention of pharmacist‐initiated electronic discharge prescribing. The accuracy of prescribing in both phases of the study was measured against evidence‐based standards agreed by the cardiology unit.
Results
39 patients were recruited in phase 1 (usual practice) and 35 patients in phase 2 (pharmacist‐initiated discharge prescriptions). The time from a decision to discharge a patient to the completed prescription reaching the patient was significantly reduced from a median of 190 minutes to 50 minutes in the intervention arm (p < 0.0001). However, this result did not translate into patients leaving the hospital earlier. In phase 1, 26% of prescriptions (n = 39) contained at least one error, including 19 clinically significant omissions. In phase 2, no omissions were made but the signing doctor made two changes to the pharmacist‐initiated prescriptions that were unrelated to the evidence‐based standards.
Conclusion
This pilot study has shown that an experienced pharmacy specialist using an electronic discharge prescribing system can significantly reduce the time elements of the discharge medication pathway. In addition, errors of omission that deviate from evidence‐based practice are reduced. This practice model can be extended to other specialist areas.
This paper uses an unbalanced panel dataset to evaluate how repeated job search services (JSS) and personal characteristics affect the employment rate of the prime-age female welfare recipients in the State of Washington. We propose a transition probability model to take into account issues of sample attrition, sample refreshment and duration dependence. We also generalize Honoré and Kyriazidou's [Honoré, B.E., Kyriazidou, E., 2000. Panel data discrete choice models with lagged dependent variables. Econometrica 68 (4), 839-874] conditional maximum likelihood estimator to allow for the presence of individual-specific effects. A limited information test is suggested to test for selection issues in non-experimental data. The specification tests indicate that the (conditional on the set of the confounding variables considered) assumptions of no selection due to unobservables and/or no unobserved individual-specific effects are not violated. Our findings indicate that the first job search service does have positive and significant impacts on the employment rate. However, providing repeated JSS to the same client has no significant impact. Further, we find that there are significant experience-enhancing effects. These findings suggest that providing one job search services training to individuals may have a lasting impact on raising their employment rates. We propose a transitional probability model of finding employment or staying on employment as a means to take into account issues arising from sample attrition, sample refreshment and duration dependence. Being state dependent, employment or nonemployment, a transition probability model accommodates dynamics in a simple format. We estimate our transitional probability model under the assumptions of (1) conditional independence (CIA) (namely, participation in JSS can be considered exogenous conditional on the confounding variables) and (2) no individual-specific effects. We also generalize Honoré and Kyriazidou's (2000) conditional maximum likelihood estimator to allow for the presence of individual-specific effects. A limited information test is suggested to test for selection issues in non-experimental data. The specification tests indicate that the assumptions of no selection due to unobservables and/or no unobserved individual-specific effects are not violated.
HHS Public AccessAuthor manuscript J Econom. Author manuscript; available in PMC 2015 June 04.We find that only the first Job Search Services had positive and statistically significant impacts on employment rates. The probabilities of employment are increased by about 3.6% for the non-employed and by 3.4% for the employed. Repeating JSS does not appear to raise the probability of employment. We also find that each additional quarter of non-employment reduces the probability of employment by 2.9% and each additional quarter of employment raises the probability of employment by 2.3%. The "experience-enhancing" effect together with the finding that the first JSS does raise the probability of employme...
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