Showing papers by "Katherine Gray-Donald published in 1992"

The prevalence of pain in hospitalized patients and resolution over six months.

Abstract: Pain was assessed in 2415 randomly selected hospitalized patients. Fifty percent of the sample reported pain at the time of the interview, and 67% had experienced pain during the past 24 h. High levels of pain were more frequent in postpartum women, patients with diseases of the musculoskeletal systems and after injury or poisoning, but in all diagnostic categories there were patients whose lowest pain level in the preceding 24 h was moderate or severe. Patients who had undergone a surgical procedure during the past 7 days were more likely to report moderate or severe pain, but 21% of non-surgical patients reported moderate or severe pain. Twenty percent of those with pain reported that it had existed for more than 6 months. Patients reported significant impairment of function and distress as a consequence of pain. Use of analgesic medications was low overall and even lower for non-surgical patients. A decrease in pain over 3 weeks was predicted by pain of shorter duration, a shorter duration of hospitalization in the past year, and if a surgical procedure had been performed. None of these variables predicted pain resolution between 3 weeks and 3 or 6 months. Impairment of function did not increase with continuing pain but distress did. Medication use remained low at follow-up. The data indicate that current strategies to improve pain management need to be critically reviewed.

Referral patterns for children with chronic diseases.

Abstract: A sample of 1377 physicians were surveyed by mailed questionnaire to study to what extent primary care physicians are involved in the long-term care of children with chronic disorders. The sample included all pediatricians practicing in the province of Quebec and a stratified random sample of general practitioners (10% sample in urban areas and 25% sample in rural areas). A response rate of 81% was achieved. Referral patterns were studied for asthma, congenital heart disease, and diabetes. Although pediatricians referred their patients less frequently than general practitioners, referral patterns depended mainly on the clinical condition. "No routine referral" was the most popular management strategy for asthma, whereas for congenital heart disease and diabetes more than 20% of physicians referred their patients for all aspects of care. Rural physicians tended to assume patient care to a greater extent than did urban physicians. Most pediatricians referred patients directly to subspecialists practicing in tertiary care centers, whereas general practitioners often sent patients to pediatricians practicing elsewhere, or to other specialists. These data suggest that the availability of medical resources in the community and accessibility to tertiary care centers also influence physicians' involvement in the long-term care of these children.

Prescription of non‐steroidal anti‐inflammatory drugs for children: A survey of Quebec physicians

Abstract: An essential step in the assessment of the relative benefits and risks of a drug's use is the monitoring of its actual utilization in specific populations. However, few studies have documented the extent to which non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed for children. We surveyed a sample of 1448 Quebec physicians by mailed questionnaire to estimate approximately how often and for which indications NSAIDs, excluding ASA and acetaminophen, had been prescribed over the past year for children under 16 years of age. The sample included all pediatricians and rheumatologists in the province, and a stratified random sample of general practitioners. A response rate of 81.5 per cent was achieved. The proportion of physicians prescribing NSAIDs varied with speciality and clinical condition. The highest proportions were recorded for dysmenorrhea and juvenile rheumatoid arthritis, followed by tendinitis/bursitis, musculoskeletal trauma and recurrent headaches. Patterns of use were also explored for conditions such as osteochondroses, chronic or recurrent limb and back pain, tooth abscess, and patent ductus arteriosus. These data indicate that NSAIDs are prescribed for conditions for which they are not currently recommended in the pediatric population. Further research is thus required regarding the implications of their use for a wider range of conditions.