Background: Guidelines, policies, and warnings have been applied to reduce the use of medications for behavioral and psychological symptoms of dementia (BPSD). Because of rare dangerous side effects, antipsychotics have been singled out in these efforts. However, antipsychotics are still prescribed "off label" to hundreds of thousands of seniors residing in nursing homes and communities. Our objective was to evaluate how and why primary-care physicians (PCPs) employ nonpharmacologic strategies and drugs for BPSD.Methods: Semi-structured interviews analyzed via template, immersion and crystallization, and thematic development of 26 PCPs (16 family practice, 10 general internal medicine) in full time primarycare practice for at least 3 years in Northwestern Virginia.Results: PCPs described 4 major themes regarding BPSD management: (1) nonpharmacologic methods have substantial barriers; (2) medication use is not constrained by those barriers and is perceived as easy, efficacious, reasonably safe, and appropriate; (3) pharmacologic policies decrease the use of targeted medications, including antipsychotics, but also have unintended consequences such as increased use of alternative risky medications; and (4) PCPs need practical evidence-based guidelines for all aspects of BPSD management.Conclusions: PCPs continue to prescribe medications because they meet patient-oriented goals and because PCPs perceive drugs, including antipsychotics and their alternatives, to be more effective and less dangerous than evidence suggests. To optimally treat BPSD, PCPs need supportive verified prescribing guidelines and access to nonpharmacologic modalities that are as affordable, available, and efficacious as drugs; these require and deserve significant additional research and payer support. Community PCPs should be included in BPSD policy and guideline development. (J Am Board Fam Med 2018;31: 9 -21.)
Purpose -This paper's aim is to examine how long established ad valorem taxation systems can be adapted so they remain relevant and equitable in the more complex contemporary property environment. Design/methodology/ approach -The research methodology involves a review of national and international literature and structured interviews with key informants from the public and private sectors, particularly Queensland, Australia, but also with the Valuer Generals and others of all mainland states and New Zealand. Findings -Ad valorem taxation systems continue to provide an important and sound base for the raising of government revenue. While it is essential that the long-standing fundamental techniques of mass appraisal be protected, a number of relatively simple modifications in policy and operational areas can enhance the effectiveness and robustness of the valuation systems.Research limitations/implications -Despite its importance in the form of taxation in practically all countries, existing research is quite limited and largely descriptive rather than analytical. Limitations also exist because of the very significant variations in law across jurisdictions in Australia and internationally. Practical implications -The findings can be readily applied in valuation systems particularly as regards the consideration of national markets for certain complex properties, proposals for the better sharing of information and the introduction of improved mediation processes in the case of objections. All of these can lead to more efficient and effective application. Originality/value -Difficulties have been experienced in a number of jurisdictions where relatively simple valuation provisions are applied to highly complex property types. This paper provides some innovative ideas as to how, even within existing legislation, these problems can be addressed while protecting the well-established, mass appraisal practices.
The approaches used by valuers in assessing the market value of investment property are explained with reference to a survey of practising valuers in Australia. The survey examined the profile of the valuers, their interpretation of market value in a volatile market and details of the valuation methodology used for urban investment property. Identifies the cross‐tabulations between valuation qualifications, experience and methodology. The need for greater market research and a specialist group of valuers with sound cash flow analysis skills to undertake major urban investment valuation are proposed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.