HFSA 2010 Comprehensive Heart Failure Practice Guideline.

Patients with chronic illness often receive care from multiple providers in multiple settings and require coordination of their complex care. This report assesses the quality of the coordination of care, describes barriers to coordinated care, and discusses some solutions to improve care coordination in the United States.

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Coordinating Care — A Perilous Journey through the Health Care System

National policy for increasing leisure physical activity in the United States is impeded by a poor understanding of interventions that can be implemented by community and clinical medicine. To clarify the literature in this area, we conducted a quantitative, meta analysis of 127 studies that examined the efficacy of interventions for increasing physical activity among approximately 131,000 subjects in community, worksite, school, home, and health care settings; 445 effects were expressed as a Pearson correlation coefficient (r) and examined as they varied according to moderating variables important for community and clinical intervention. The mean effect was moderately large, r = 0.34, approximating three-fourths of a standard deviation or an increase in binomial success rate from 50% to 67%. The estimated population effect weighted by sample size was larger, r = 0.75, approximating 2 standard deviations or increased success to 88%. Contrasts between levels of independent moderating variables indicated that effects weighted by sample size were larger when the interventions: 1) employed the principles of behavior modification, 2) used a mediated delivery, 3) targeted groups, 4) of combined ages, 5) sampled apparently healthy people, or 6) measured active leisure, of 7) low intensity, 8) by observation. Independently of sample size, effects were larger when interventions 1) used behavior modification, 2) employed a preor quasi-experimental design, or 3) were of short duration, regardless of features of the people, setting, or physical activity. Our results show that physical activity can be increased by intervention. The optimal ways for selecting intervention components, settings, and population segments to maintain increases in physical activity and the relative contributions by community and clinical medicine toward successful physical activity intervention require experimental confirmation, warranting accelerated attention in clinical trials.

Increasing physical activity: a quantitative synthesis

Healthcare professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. The objective of this review is to determine the effectiveness of nursing-delivered smoking cessation interventions.

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Nursing interventions for smoking cessation.

Inability to read the labels on prescription medication containers is a possible reason for poor medication adherence. In this study of patients in community health centers, many were unable to und...

http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/7505f589436f625486257237006890bb/$FILE/Perscription%20Litercracy.pdf

Literacy and Misunderstanding Prescription Drug Labels

Objectives.The authors determined patients' report of prescription drug counseling activities after withdrawal of the pilot program to require patient package inserts in 1980 and implementation of Omnibus Budget Reconciliation Act of 1990 counseling requirements in 1993.Methods.Four cross-sectional

Counseling patients about prescribed medication: 12-year trends.

Objectives To develop three tools for assessing the quality of written information provided with new prescriptions in community pharmacies and to identify pharmacy, pharmacist, and patient characteristics associated with the dissemination and quality of that information Design Observational study Regression techniques were used to analyze the influence of pharmacy, pharmacist, and shopper (acting as patient) characteristics on outcome measures Participants Trained shoppers (acting as patients) visited 306 randomly selected pharmacies in 8 states Each shopper presented three prescriptions, answered questions according to a standard scenario, accepted the information offered, and paid for the prescriptions Main Outcome Measures Percentage of shoppers receiving any written information; quality of written information as judged by an expert panel using explicit criteria Results Shoppers received an information leaflet with 87% of the 918 prescriptions dispensed Although most leaflets provided unbiased information, leaflet length and quality of information varied greatly A majority of leaflets did not include adequate information about contraindications, precautions, and how to avoid harm Shoppers were more likely to receive leaflets in chain pharmacies and pharmacies with more staff Information quality also was higher in chain pharmacies Shopper and pharmacist demographic characteristics were unrelated to the level or quality of written information after controlling for other factors Conclusion The provision of patient leaflets is becoming a routine practice in the states studied However, most leaflets do not meet quality criteria It is important for pharmacists to become familiar with criteria for evaluating these leaflets and to take necessary action to improve their quality

https://www.japha.org/article/S1544-3191(15)31977-4/pdf

Evaluation of Written Prescription Information Provided in Community Pharmacies: A Study in Eight States

Characteristics of controlled studies of patient education and counseling for preventive health behaviors.

Objective Evaluate the distribution and quality of patient medication leaflets provided in U.S. pharmacies. Design Observational. Setting United States. Participants 384 randomly selected community pharmacies in 44 states. Interventions Professional shoppers (acting as patients) presented four new prescriptions to study pharmacies. Main Outcome Measures Medication leaflets obtained by shoppers were evaluated by expert and consumer raters using criteria specified in federal law mandating distribution of useful written information to 95% of individuals receiving new prescriptions by 2006. Results Leaflets were provided by pharmacies with 89% of 1,536 prescriptions presented by professional shoppers posing as patients. Leaflet quality varied: 95% of leaflets received high ratings on accuracy, but only 19% received high ratings on the specificity of directions. Fewer than 10% of all leaflets met quality criteria regarding contraindications, precautions, and how to avoid harm. One fourth of all leaflets had poor print size, according to the shoppers. Conclusion Additional efforts are needed to meet federally mandated information distribution and quality goals by 2006.

https://www.japha.org/article/S1544-3191(15)31667-8/pdf

Expert and Consumer Evaluation of Patient Medication Leaflets Provided in U.S. Pharmacies

Members of the American Academy of Family Physicians (nonfederal, continental U.S.) were surveyed regarding their involvement in health-habit modification (response rate = 70.4%, n = 903). Frequency and indications for use of specific counseling techniques were assessed in each of four health-habit areas: smoking, exercise, weight control, and stress management. Factor analysis of responses produced clusters of techniques labeled "traditional teaching," "behavioral," "interpersonal with follow-up," and "referral." The dominant style varied by health-habit area. The factors were less clear for stress than for the other three areas. Results indicated no relationships or weak relationships between counseling approaches and physician gender, year of graduation, board status, region, community size, practice type, average visit length, and selected patient characteristics. Study findings suggest that family physician counseling varies with the health habit and that background and practice variables are not associated with counseling approach.

Ellen R. Tabak

Papers

Counseling patients about prescribed medication: 12-year trends.

Evaluation of Written Prescription Information Provided in Community Pharmacies: A Study in Eight States

Characteristics of controlled studies of patient education and counseling for preventive health behaviors.

Expert and Consumer Evaluation of Patient Medication Leaflets Provided in U.S. Pharmacies

Patterns of counseling techniques used by family practice physicians for smoking, weight, exercise, and stress.