Browsing by Subject "Medication"

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    Open Access
    Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial
    (BioMed Central Ltd, 2007) Zwarenstein, Merrick; Bheekie, Angeni; Lombard, Carl; Swingler, George; Ehrlich, Rodney; Eccles, Martin; Sladden, Michael; Pather, Sandra; Grimshaw, Jeremy; Oxman, Andrew
    BACKGROUND:Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice. METHODS: This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices.Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention. RESULTS: Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms. CONCLUSION: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting.
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    Open Access
    MIMS Handbook of Psychiatric Medication
    (Arena Holdings, 2022) Stein, Dan; Hoffman, Jacob; Kadenge, Betty; Stein, Dan; Hoffman, Jacob; Kadenge, Betty
    There is general agreement on the value of evidence-based medicine in general practice. And there is growing acknowledgement that the treatment of psychiatric disorders is an important component of primary care. This volume addresses the logical conclusion from these two premises; there is a need for an evidence-based approach to the use of psychiatric medications in general practice. While the evidence base of psychopharmacology grows annually, there are relatively few attempts to synthesise this literature for general practitioners. Lengthy and cumbersome guidelines are unlikely to be read, much less implemented. Our aim here was to synthesise the evidence in a readable and easy-to-use format, using pharmacotherapy algorithms. The current volume updates previous attempts to meet this aim. The approach here draws in part on our experience with Continuing Medical Education courses for general practitioners. To that extent, we are grateful to the many GPs who have attended these courses, and who have advised us on how to improve them. We are also grateful to our colleagues who have helped us with this teaching, and to those in the pharmaceutical industry who have supported such teaching over the years. It would perhaps be remiss if we did not end by emphasising that psychiatry is concerned not only about brain circuitry and neurotransmitters, but also about the patient-doctor relationship, and the broader intersections between society and the individual. Arguably, psychopharmacology is both a science and a humanity. We hope that the treatment algorithms provided here are implemented with good clinical judgement. To purchase a physical copy of the handbook and for access to CPD points, please visit subs.mims.co.za