Article based on presentation at FIP 2013 in Dublin: ' The medication use process in people a... more Article based on presentation at FIP 2013 in Dublin: ' The medication use process in people ageing with intellectual disabilities and behaviour disorders. What is quality? A modified Delphi technique to develop quality indicatorsc '
The Chairman’s Statement in the Annual Report of the National Intellectual Disability Database (N... more The Chairman’s Statement in the Annual Report of the National Intellectual Disability Database (NIDD) Committee 2008,1 states that “the objective of the NIDD is to ensure that information is available to provide appropriate services to people with intellectual disability and their families in Ireland”. The report (p 75) identifies, rightly, that there was substantial demand for new services and enhanced services relating to all therapeutic inputs in 2008. Two of the services most commonly availed of by adults with intellectual disability were medical services (6,322 adults) and psychiatry (6,096 adults).1 Both of these services are strongly associated with the prescription and use of medication. Speech and language therapy was one of the most commonly availed of multidisciplinary supports (7,839)1 and the influence of medication on the swallowing process is an area of growing concern for the population ageing with intellectual disability. The Annual Report of the NIDD Committee 2008...
Background Behaviour disorders in adults with intellectual disabilities burden the person, increa... more Background Behaviour disorders in adults with intellectual disabilities burden the person, increase strain on families and caregivers , impair social interactions, increase the risk of restrictive practices being used, increase the risk of out of home placements and they are costly for the service provider . Psychotropic medication is commonly used but this is one of the most controversial areas in current mental health. The experience of quality medication use by any adult with intellectual disabilities is shaped, directly and indirectly, by organisational and human factors interacting in dynamic and complex ways. Medication use provides an opportunity for monitoring quality of care. Methodolgy A 2 round Modified Delphi Technique with a 32 member multidisciplinary panel, which included a geriatrician, identified quality indicators [QIs] for medication use in adults with intellectual disabilities and behaviour disorders. Panel members were asked to rate the candidate QIs on a 9 poin...
Diabetes Research and Clinical Practice, Mar 1, 2016
AIMS To measure the costs associated with the use of antidiabetic agents, monitoring materials an... more AIMS To measure the costs associated with the use of antidiabetic agents, monitoring materials and cardiovascular disease (CVD) agents in the management of newly treated type 2 diabetes, and to investigate the factors associated with these costs. METHODS A population-based retrospective cohort study was conducted using the Irish national pharmacy claims database. Newly treated patients were identified for 2012 and followed for one year post treatment initiation. Factors associated with costs were assessed using a generalised linear model with gamma family and log-link function. Cost ratios (CR) and 95% CIs were used to determine the contributors of prescription costs. Adjusted odd ratios (OR) and 95% CIs were used to investigate factors associated with high frequency self-monitoring of blood glucose (SMBG). RESULTS Mean prescription costs for the 12,941 subjects was €871, while total costs were €11 million. CVD agents accounted for 58% of total costs; 22% of costs were for SMBG; antidiabetic agents accounted for 17% of costs. SMBG resulted in costs that were 80% higher than those without, CR 1.80 (95% CI 1.76-1.84). No significant differences were observed between initiation on metformin or sulphonylureas and high frequency SMBG (OR 1.01 95% CI 0.97-1.04 vs reference). Initiation on newer antidiabetic agents was a significant positive predictors of prescription costs (CR 2.36 95% CI 2.21-2.51 vs metformin). CONCLUSIONS Type of initial antidiabetic agent, and SMBG were significant predictors of prescription costs. SMBG represent a major proportion of total costs; however, its use in combination with antidiabetic agents that do not cause hypoglycaemia is questionable.
An observational study of prescription dispensing in 40 community pharmacies in Dublin found that... more An observational study of prescription dispensing in 40 community pharmacies in Dublin found that the mean number of prescriptions dispensed per hour was 7.7. Differences in the hourly dispensing rate were found between days of the week and parts of the day. Pharmacies with computerised dispensing dispensed a mean of 11.8 items per hour compared to 6.0 items per hour for those without computers. Prescriptions dispensed free to eligible patients accounted for 39% of all prescriptions.
Article based on presentation at FIP 2013 in Dublin: ' The medication use process in people a... more Article based on presentation at FIP 2013 in Dublin: ' The medication use process in people ageing with intellectual disabilities and behaviour disorders. What is quality? A modified Delphi technique to develop quality indicatorsc '
The Chairman’s Statement in the Annual Report of the National Intellectual Disability Database (N... more The Chairman’s Statement in the Annual Report of the National Intellectual Disability Database (NIDD) Committee 2008,1 states that “the objective of the NIDD is to ensure that information is available to provide appropriate services to people with intellectual disability and their families in Ireland”. The report (p 75) identifies, rightly, that there was substantial demand for new services and enhanced services relating to all therapeutic inputs in 2008. Two of the services most commonly availed of by adults with intellectual disability were medical services (6,322 adults) and psychiatry (6,096 adults).1 Both of these services are strongly associated with the prescription and use of medication. Speech and language therapy was one of the most commonly availed of multidisciplinary supports (7,839)1 and the influence of medication on the swallowing process is an area of growing concern for the population ageing with intellectual disability. The Annual Report of the NIDD Committee 2008...
Background Behaviour disorders in adults with intellectual disabilities burden the person, increa... more Background Behaviour disorders in adults with intellectual disabilities burden the person, increase strain on families and caregivers , impair social interactions, increase the risk of restrictive practices being used, increase the risk of out of home placements and they are costly for the service provider . Psychotropic medication is commonly used but this is one of the most controversial areas in current mental health. The experience of quality medication use by any adult with intellectual disabilities is shaped, directly and indirectly, by organisational and human factors interacting in dynamic and complex ways. Medication use provides an opportunity for monitoring quality of care. Methodolgy A 2 round Modified Delphi Technique with a 32 member multidisciplinary panel, which included a geriatrician, identified quality indicators [QIs] for medication use in adults with intellectual disabilities and behaviour disorders. Panel members were asked to rate the candidate QIs on a 9 poin...
Diabetes Research and Clinical Practice, Mar 1, 2016
AIMS To measure the costs associated with the use of antidiabetic agents, monitoring materials an... more AIMS To measure the costs associated with the use of antidiabetic agents, monitoring materials and cardiovascular disease (CVD) agents in the management of newly treated type 2 diabetes, and to investigate the factors associated with these costs. METHODS A population-based retrospective cohort study was conducted using the Irish national pharmacy claims database. Newly treated patients were identified for 2012 and followed for one year post treatment initiation. Factors associated with costs were assessed using a generalised linear model with gamma family and log-link function. Cost ratios (CR) and 95% CIs were used to determine the contributors of prescription costs. Adjusted odd ratios (OR) and 95% CIs were used to investigate factors associated with high frequency self-monitoring of blood glucose (SMBG). RESULTS Mean prescription costs for the 12,941 subjects was €871, while total costs were €11 million. CVD agents accounted for 58% of total costs; 22% of costs were for SMBG; antidiabetic agents accounted for 17% of costs. SMBG resulted in costs that were 80% higher than those without, CR 1.80 (95% CI 1.76-1.84). No significant differences were observed between initiation on metformin or sulphonylureas and high frequency SMBG (OR 1.01 95% CI 0.97-1.04 vs reference). Initiation on newer antidiabetic agents was a significant positive predictors of prescription costs (CR 2.36 95% CI 2.21-2.51 vs metformin). CONCLUSIONS Type of initial antidiabetic agent, and SMBG were significant predictors of prescription costs. SMBG represent a major proportion of total costs; however, its use in combination with antidiabetic agents that do not cause hypoglycaemia is questionable.
An observational study of prescription dispensing in 40 community pharmacies in Dublin found that... more An observational study of prescription dispensing in 40 community pharmacies in Dublin found that the mean number of prescriptions dispensed per hour was 7.7. Differences in the hourly dispensing rate were found between days of the week and parts of the day. Pharmacies with computerised dispensing dispensed a mean of 11.8 items per hour compared to 6.0 items per hour for those without computers. Prescriptions dispensed free to eligible patients accounted for 39% of all prescriptions.
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