A/Prof Bajorek is a registered clinical pharmacist, having practiced in community & hospital and is the inaugural Academic Pharmacist at Royal North Shore Hospital. Previously she has been a Research Fellow at the Clinical Practice Advancement Centre, University Health System Consortium (Chicago, USA), followed by 9 years in academia in the Faculties of Pharmacy and Nursing, University of Sydney (Australia).
She is a highly experienced clinical educator, having supervised countless clinical placements, served as education coordinator for the Society of Hospital Pharmacists of Australia (NSW) and authored over 125 educational articles for clinical practice journals. A/Prof Bajorek has been recognised through awards and nominations for Outstanding Teaching, Support for the Student Experience, and Research Supervision.
She also teaches specialised topics for the University of NSW and College of Nursing and has been an expert speaker/reviewer for various professional organisations including the National Prescribing Service, Pharmaceutical Society of Australia, Australian College of Pharmacy Practice, NSW Therapeutic Assessment Group and National Stroke Foundation. Her clinical research spans the Quality Use of Medicines (QUM), Cardiovascular Health, Medication Safety and pharmacist-led interventions.
She has been a member of teams that have been competitively awarded just over $3 million for research, and is one of a rare few Pharmacy Practice researchers to have been awarded NHMRC Project Grants as a Chief (Lead) Investigator. She has supervised over 35 research students and over 30 QUM research students from a range of national and international universities.
A/Prof Bajorek is an experienced doctoral supervisor and welcomes research degree enquiries via a formal expression of interest (please do not email directly).
Can supervise: YES
A/Prof Bajorek is an experienced doctoral supervisor and welcomes research degree enquiries via a formal expression of interest (please do not email directly).
Professional practice and communication skills
Data handling and statistics
Clinical practice and residencies
Applied pharmacology for health care professionals and prescribers
Yiu, AWP, Bajorek, BV, Lee, VW & Ng, KK 2020, 'Patient Feedback on a Warfarin Action Plan Used in a Local Australian Physician Practice Setting', Therapeutic Innovation and Regulatory Science.View/Download from: Publisher's site
© The Author(s) 2019. Background: Warfarin is a high-risk medicine, and older persons (those aged 65 years and older)1,2 who take this therapy need medicines information about it that is at a level which is both understandable and comprehensive to improve their knowledge about the risks and benefits of warfarin therapy.3,4 Therefore, the primary objective of this study was to report patient feedback on a Warfarin Action Plan (WAP) (leaflet) and identify patients' preferences regarding its content and format. The secondary objective was to canvass in-depth feedback regarding the participants' information needs and current information-seeking practices with respect to warfarin therapy. Method: In an Australian General Practice medical centre setting, a qualitative study comprising 34 individual interviews was conducted. Emergent themes were elicited via a qualitative analysis using manual inductive coding. Results: The majority of participants gave very positive feedback on the WAP leaflet, stating that it was a useful and concise resource. In canvasing this feedback, 4 themes emerged: (1) the need for information about warfarin therapy, (2) reliance on doctors and/or pharmacists for information, (3) the need for information to normalize their daily life, and (4) patients and carers acting on the new information. Conclusion: The WAP is a simple and well-received tool that meets the knowledge and education needs about warfarin therapy for older people and their carers.
Bajorek, B, Gao, L, Lillicrap, T, Bivard, A, Garcia-Esperon, C, Parsons, M, Spratt, N, Holliday, E & Levi, C 2020, 'Exploring the Economic Benefits of Modafinil for Post-Stroke Fatigue in Australia: A Cost-Effectiveness Evaluation', Journal of Stroke and Cerebrovascular Diseases, vol. 29, no. 11.View/Download from: Publisher's site
© 2020 Elsevier Inc. Background: In stroke survivors, post-stroke fatigue predicts dependency in daily living and failure to return to work. Modafinil shows promise as a pharmacotherapy to reduce post-stroke fatigue and related sequelae, e.g., poorer functional and clinical outcomes. Aims: This study explored the cost-effectiveness of modafinil in treating post-stroke fatigue in the Australian context, by determining its incremental cost-effectiveness ratio (ICER) and by simulating the potential cost-savings on a national scale, through a re-analysis of MIDAS trial data. Methods: A post hoc cost-effectiveness analysis was undertaken. Part A: patient-level cost and health effect data (Multidimensional Fatigue Inventory (MFI) scores) were derived from the MIDAS trial and analysis undertaken from a health-system perspective. Part B: a secondary analysis simulated the societal impact of modafinil therapy in terms of national productivity costs. Results: Part A: Mean cost of modafinil treatment was AUD$3.60/day/patient for a minimally clinically important change (10 points) in total MFI fatigue score, i.e., AUD$0.36/day/unit change in fatigue score per patient. For the base case scenario, the ICER of using modafinil (versus placebo) was AUD$131.73 ($90.17 – 248.15, for minimum and maximum costs, respectively). Part B: The potential productivity cost-savings to society were calculated as nearly AUD$467 million over 1 year, and up to $383,471,991,248 over 10 years, from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors, representing a significant societal benefit. Conclusions: Modafinil is a highly cost-effective treatment for post-stroke fatigue, offering significant productivity gains and potential cost-savings to society from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors.
Donovan, J, Al Hamarneh, YN, Bajorek, B, Papastergiou, J & Tsuyuki, RT 2020, 'Community pharmacist identification of chronic kidney disease using point-of-care technology: A pilot study.', Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC, vol. 153, no. 2, pp. 84-87.View/Download from: Publisher's site
Leung, KL, Fong, W, Freedman, B, Bajorek, B & Lee, VWY 2020, 'Association between beta-blocker use and obesity in Hong Kong Chinese elders: a post-hoc analysis.', Hong Kong medical journal = Xianggang yi xue za zhi, vol. 26, no. 1, pp. 27-34.View/Download from: Publisher's site
INTRODUCTION:Studies of Caucasian populations have shown that beta-blockers may exacerbate weight gain, a risk factor for many chronic diseases. Still, beta-blockers are the most prescribed antihypertensives in the Chinese population in Hong Kong. We aimed to explore the association between beta-blocker use, hypertension, and weight status of this population. METHODS:A post-hoc analysis regarding body mass index (BMI) and the use of beta-blockers was performed based on the medication profile of community-dwelling older adults. Participants' BMI, hypertension diagnosis, name, dose, frequency, route of administration of beta-blockers, and other drugs that may alter body weight were recorded. RESULTS:Of 1053 Chinese individuals aged ≥65 years (mean age 76.9±7.2 years, 80% female) from 32 elderly centres in Hong Kong, 18% (185/1053) of them consumed beta-blockers. That group also had a significantly larger proportion of obese individuals (45.9% vs 32.1%, P=0.002). After adjusting for other weight-altering drugs, beta-blockers remained a significant predictor of overweight and obesity (P=0.001). As the hypertensive population had significantly higher BMI than the normotensive population (24.3±3.6 vs 22.9±3.5, P<0.001), a sub-analysis on those with hypertension diagnosis confirmed that only the hypertensive population taking atenolol had a significantly larger population of obese individuals (BMI ≥25) compared with those who took metoprolol (58.9% vs 38.5%, P=0.03) and those who did not take any beta-blockers (58.9% vs 38.4%, P=0.007). CONCLUSIONS:Our findings taken together with other guideline reservations cast doubt on whether beta-blockers, particularly atenolol, should be the major drug prescribed to older adults with hypertension.
Yiu, A, Ng, KK, Lee, VW & Bajorek, BV 2020, 'Evaluating the Understandability and Actionability of Web-Based Education Materials for Patients Taking Non-vitamin K Oral Anticoagulants.', Therapeutic innovation & regulatory science, vol. 54, no. 2, pp. 476-483.View/Download from: Publisher's site
BACKGROUND:More patients are now taking high-risk medicines such as non-vitamin K oral anticoagulants (NOACs). Hence, patient education materials need to be in an understandable format so that they can be empowered to act on their knowledge. Factors such as health literacy and the design of the medicine information material may influence the patient's ability to understand and act on key information. METHOD:The PRISMA checklist was used to inform the study design. A structured search was conducted to obtain all freely accessible online educational resources designed for patients about the non-vitamin K antagonists (NOACs) during August 2018. Three search engines were used: Google, Yahoo! and Bing, using the search terms "NOAC" and "anticoagulant" combined with "patient/consumer information and patient/consumer resources."We applied the Patient Education Materials Assessment Tool (PEMAT) to evaluate web-based patient education materials in terms of understandability and actionability for patients taking NOACs. RESULTS:Of the 35 materials included, the majority of the materials (n = 32, 91%) were rated as highly understandable (PEMAT score ≥70%), and more than three-quarters of all the materials (n = 29, 83%) were rated as poorly actionable (PEMAT score <70%). For understandability, the majority of materials neither provided a summary of the key points nor used visual aids for several items such as simple tables, illustrations, and photographs. For actionability, few materials provided a tangible tool, such as a checklist, to prompt the user into action (n = 4). Few used visual aids such as nonverbal cues to the written instructions (n = 4). CONCLUSION:To improve the understandability and actionability of most of the NOAC patient education materials, there is a need to include more summaries of information, visual aids, and tangible tools such as checklists. Further research is warranted where patients are involved in providing feedback on the design of medicine in...
Yiu, AWP, Lee, VW, Ng, KK & Bajorek, BV 2020, 'Patient Feedback on a Warfarin Action Plan Used in a Local Australian Physician Practice Setting', Therapeutic Innovation and Regulatory Science, vol. 54, pp. 605-612.View/Download from: Publisher's site
© 2020, The Author(s). Background:: Warfarin is a high-risk medicine, and older persons (those aged 65 years and older)1,2 who take this therapy needmedicines information about it that is at a level which is both understandable and comprehensive to improve their knowledgeabout the risks and benefits of warfarin therapy.3,4 Therefore, the primary objective of this study was to report patient feedbackon a Warfarin Action Plan (WAP) (leaflet) and identify patients' preferences regarding its content and format. The secondaryobjective was to canvass in-depth feedback regarding the participants' information needs and current information-seekingpractices with respect to warfarin therapy. Method:: In an Australian General Practice medical centre setting, a qualitative study comprising 34 individual interviews wasconducted. Emergent themes were elicited via a qualitative analysis using manual inductive coding. Results:: The majority of participants gave very positive feedback on the WAP leaflet, stating that it was a useful and conciseresource. In canvasing this feedback, 4 themes emerged: (1) the need for information about warfarin therapy, (2) reliance ondoctors and/or pharmacists for information, (3) the need for information to normalize their daily life, and (4) patients and carersacting on the new information. Conclusion:: The WAP is a simple and well-received tool that meets the knowledge and education needs about warfarin therapy forolder people and their carers.
Yiu, A, Ng, KK, Lee, VW & Bajorek, BV 2019, 'Evaluating the Understandability and Actionability of Web-Based Education Materials for Patients Taking Non–vitamin K Oral Anticoagulants', Therapeutic Innovation and Regulatory Science.View/Download from: Publisher's site
© The Author(s) 2019. Background: More patients are now taking high-risk medicines such as non–vitamin K oral anticoagulants (NOACs). Hence, patient education materials need to be in an understandable format so that they can be empowered to act on their knowledge. Factors such as health literacy and the design of the medicine information material may influence the patient's ability to understand and act on key information. Method: The PRISMA checklist was used to inform the study design. A structured search was conducted to obtain all freely accessible online educational resources designed for patients about the non–vitamin K antagonists (NOACs) during August 2018. Three search engines were used: Google, Yahoo! and Bing, using the search terms "NOAC" and "anticoagulant" combined with "patient/consumer information and patient/consumer resources." We applied the Patient Education Materials Assessment Tool (PEMAT) to evaluate web-based patient education materials in terms of understandability and actionability for patients taking NOACs. Results: Of the 35 materials included, the majority of the materials (n = 32, 91%) were rated as highly understandable (PEMAT score ≥70%), and more than three-quarters of all the materials (n = 29, 83%) were rated as poorly actionable (PEMAT score <70%). For understandability, the majority of materials neither provided a summary of the key points nor used visual aids for several items such as simple tables, illustrations, and photographs. For actionability, few materials provided a tangible tool, such as a checklist, to prompt the user into action (n = 4). Few used visual aids such as nonverbal cues to the written instructions (n = 4). Conclusion: To improve the understandability and actionability of most of the NOAC patient education materials, there is a need to include more summaries of information, visual aids, and tangible tools such as checklists. Further research is warranted where patients are involved in providing feedback o...
Donovan, J, Tsuyuki, RT, Al Hamarneh, YN & Bajorek, B 2019, 'Barriers to a full scope of pharmacy practice in primary care: A systematic review of pharmacists' access to laboratory testing.', Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC, vol. 152, no. 5, pp. 317-333.View/Download from: Publisher's site
Objectives:To describe primary care pharmacists' current scope of practice in relation to laboratory testing. Method:A 2-tiered search of key databases (PubMed, EMBASE, MEDLINE) and grey literature with the following MeSH headings: prescribing, pharmacist/pharmacy, laboratory test, collaborative practice, protocols/guidelines. We focused on Canada, the United States, the United Kingdom, New Zealand and Australia for this review. Results:There is limited literature exploring primary care pharmacists' scope of practice in relation to laboratory testing. The majority of literature is from the United States and Canada, with some from the United Kingdom and New Zealand and none from Australia. Overall, there is a difference in regulations between and within these countries, with the key difference being whether pharmacists access and/or order laboratory testing dependently or independently. Canadian pharmacists can access and/or order laboratory tests independently or dependently, depending on the province they practise in. US pharmacists can access and/or order laboratory tests dependently within collaborative practice agreements. In the United Kingdom, laboratory testing can be performed by independent prescribing pharmacists or dependently by supplementary prescribing pharmacists. New Zealand prescribing pharmacists can order laboratory testing independently. Most publications do not report on the types of laboratory tests used by pharmacists, but those that do predominantly resulted in positive patient outcomes. Discussion/Conclusion:Primary care pharmacists' scope of practice in laboratory testing is presently limited to certain jurisdictions and is often performed in a dependent fashion. As such, a full scope of pharmacy services is almost entirely unavailable to patients in the United States, the United Kingdom, New Zealand and Australia. Just as in the case for pharmacists prescribing, evidence indicates better patient outcomes when pharmacists can access/orde...
Krzyzaniak, N, Pawłowska, I & Bajorek, B 2019, 'Pharmaceutical Care in NICUs in Australia and Poland: Attitudes and Perspectives of Doctors and Nurses.', The Journal of perinatal & neonatal nursing, vol. 33, no. 4, pp. E27-E37.View/Download from: Publisher's site
A multidisciplinary and collaborative team network is essential in ensuring positive health outcomes for critically ill neonatal patients. The objective of this study was to investigate the perceptions of neonatal intensive care unit (NICU) doctors and nurses in Australia and Poland toward pharmaceutical care services in the NICU. A cross-sectional, anonymous, electronic-based survey was distributed between January and April 2017 among a sample of NICU doctors, nurses, and midwives. A total of 77 participants from Australia and 93 from Poland completed the survey. Overall, from the perspectives of medical and nursing staff, it is apparent that clinical pharmacy practice on the NICU is more established in Australia than in Poland. Only 8.6% of Polish participants reported that a pharmacist worked directly on the NICU in comparison with 87% of Australian participants (P < .001). The main roles performed by pharmacists in Polish NICUs related to the provision of medicines, whereas Australian pharmacists were highly involved in all aspects of pharmacotherapy, particularly in the clinical and education domains. Future efforts should focus on how practice is structured in each country and what support can be implemented from educational, cultural, and legislative levels to enable better pharmacist integration into the NICU therapeutic team.
Krzyżaniak, N, Pawłowska, I & Bajorek, B 2019, 'Quality pharmaceutical care in the neonatal intensive care unit: identification of essential pharmacy services and key performance indicators for the Australian setting', Journal of Pharmacy Practice and Research, vol. 49, no. 4, pp. 331-340.View/Download from: Publisher's site
© 2019 The Society of Hospital Pharmacists of Australia Background: When considering subspecialties of clinical pharmacy practice such as the neonatal intensive care unit (NICU), no key performance indicators (KPIs) or practice standards have been published by national or international pharmacy organisations. Aim: The aims of this study were to identify: (1) a list of essential pharmacist roles that should be performed in the NICU; and (2) a set of clinical pharmacy KPIs that can be used to benchmark the quality of pharmaceutical care provided to patients in Australian NICU settings. Methods: A modified Delphi technique was used to send 65 indicators and 30 proposed roles to an expert panel of doctors, pharmacists and nurses. The indicators and roles were compiled from a previously conducted literature review. An online survey sent in two consecutive Delphi rounds in August and September 2017 asked experts to rank the indicators and roles against specific criteria. Results: Fifteen healthcare professionals from Australia participated as expert panellists. Overall, 75% consensus was reached for 31 indicators and 23 roles by Australian panellists. Experts particularly valued the following roles: pharmacists being a source of medication information (100%; median = 1.00), assisting in off-label prescribing (100%; median = 1.00), documenting medication errors (100%; median = 1.00), medication chart review (100%; median = 1.00) and writing medication protocols for the NICU (100%; median = 1.00). Conclusion: Further investigations are needed to formalise a set of NICU-specific clinical pharmacy KPIs and a practice model to form the foundations of national and international standardised practice guidelines for this subspecialty.
Krzyżaniak, N, Pawłowska, I, Pawłowski, L, Kocić, I & Bajorek, B 2019, 'Pharmaceutical care in the neonatal intensive care unit: Perspectives of Polish medical and pharmacy students.', Currents in pharmacy teaching & learning, vol. 11, no. 4, pp. 361-372.View/Download from: Publisher's site
INTRODUCTION:The concepts of ward-based pharmaceutical care as well as collaborative practice are still relatively novel in Poland, particularly in specialty areas of practice such as the neonatal intensive care unit (NICU). The purpose of this study was to identify the opinions and perceptions of Polish medical and pharmacy students towards the provision of pharmaceutical care services in the NICU as well as pharmacist integration into the ward-based multi-disciplinary NICU treating team. METHODS:A cross-sectional, mixed-method survey was distributed among medical and pharmacy students at a large Polish medical university. RESULTS:A total of 147 students completed the survey (74 pharmacy and 73 medical). Overall, there were statistically significant differences between the perspectives of medical and pharmacy students towards the provision of pharmaceutical care services in the NICU. For 11 out of 15 proposed clinical roles, a significantly lower proportion of medical students (M) agreed that pharmacists should perform these in the NICU compared to pharmacy students (P). These roles included participation in ward rounds (P = 82.4%, M = 38.4%, p < 0.001), therapeutic drug monitoring (P = 98.6%, M = 78.1%, p < 0.001), and monitoring total parenteral nutrition (P = 87.8%, M = 37%, p ≤ 0.001). CONCLUSIONS:Further investigation is needed to develop educational strategies directed at clinical, patient-centered, collaborative roles, particularly for specialty areas of practice such as the NICU, that have the potential to facilitate the provision of a more advanced and comprehensive level of pharmaceutical care.
Lucas, C, Williams, K & Bajorek, B 2019, 'Virtual Pharmacy Programs to Prepare Pharmacy Students for Community and Hospital Placements.', Am J Pharm Educ, vol. 83, no. 10.View/Download from: Publisher's site
Objective. To explore and evaluate pharmacy students' perceptions of the value and relevance of virtual community and virtual hospital on-campus placement programs. Methods. Students enrolled in a Master of Pharmacy program completed the required Virtual Community Placement (VCP) program and/or the Virtual Hospital Placement (VHP) program. A six-item questionnaire was administered to students after completion of each of the virtual programs to elicit students' perceptions of the value and relevance of the virtual programs. Additional data related to the relevance of specific workshops were collected, including students' self-reported confidence levels to undertake placement in a real-world setting following completion of the virtual programs. Results. Surveys were completed by 61 students in the VCP program and 50 students in the VHP program. Students perceived the virtual programs to be beneficial, with the majority (84% of the VCP students and 98% of the VHP students) reporting that the programs should be an essential component of any pharmacy degree. The majority of students (72%) self-reported an increase in their confidence levels in undertaking a real-world experiential placement after they completed their virtual hospital placement. Conclusion. Completing virtual placement programs prior to pharmacy students beginning their first "real world" pharmacy placements had a positive effect on student learning and confidence levels. Pharmacy students' feedback from this study regarding the relevance of specific learning modules and laboratory sessions will inform future curriculum development of the virtual placement programs.
Mostaghim, M, Snelling, T & Bajorek, B 2019, 'Agreement between units of measure for paediatric antibiotic utilisation surveillance using hospital pharmacy supply data.', Pharmacy Practice, vol. 17, no. 3.View/Download from: Publisher's site
Background:Drug utilisation studies from paediatric hospitals that do not have access to patient level data on medication use are limited by a lack of standardised units of measures that reflect the varying daily dosage requirements among patients. The World Health Organization's defined daily dose is frequently used in adult hospitals for benchmarking and longitudinal analysis but is not endorsed for use in paediatric populations. Objective:Explore agreement between standard adult-based defined daily doses (DDD) and paediatric estimates of daily injectable antibiotic use in a Paediatric Intensive Care Unit that does not have access to individual patient-level data. Methods:Hospital pharmacy antibiotic use reports and age-specific occupied bed-day data from 1 January 2010 to 31 May 2016 were extracted. Paediatric reference dosages and frequencies for antibiotics were defined and applied to three paediatric units of measure. Measures were applied to extracted data, agreement between antibiotic use measured in the adult DDD and each of the paediatric measures was assessed visually via Bland-Altman plots and linear regression for each antibiotic. Results:Thirty one different antibiotics were used throughout the study period. Despite varying daily dosages in grams, the daily use of vials was unchanged from birth to 18 years for thirteen antibiotics. Agreement between DDD and vial-based measures was closer than the total recommended daily dose that did not account for wastage during preparation and administration. Vial-based measures were unaffected by vial size changes due to drug shortage. Conclusions:Agreement between the DDD and vial-based measures of use supports the use of DDD for select antibiotics that may be targeted by antimicrobial stewardship programs. Vial based measures should be further explored in hospitals with single vial policies; detailed understanding of hospital practice is needed before inter-hospital comparisons are made.
Mostaghim, M, Snelling, T & Bajorek, B 2019, 'Factors associated with adherence to antimicrobial stewardship after-hours.', International Journal of Pharmacy Practice, vol. 27, pp. 180-190.View/Download from: Publisher's site
OBJECTIVES:Assess restricted antimicrobials acquired after standard working hours for adherence to antimicrobial stewardship (AMS) and identify factors associated with increased likelihood of adherence at the time of acquisition, and the next standard working day. METHODS:All documented antimicrobials acquired from a paediatric hospital after-hours drug room from 1 July 2014 to 30 June 2015 were reconciled with records of AMS approval, and documented AMS review in the medical record. KEY FINDINGS:Of the 758 antimicrobial acquisitions from the after-hours drug room, 62.3% were restricted. Only 29% were AMS adherent at the time of acquisition, 15% took place despite documented request for approval by a pharmacist. Antimicrobials for respiratory patients (OR 3.10, 95% CI 1.68-5.5) and antifungals (2.48, 95% CI 1.43-4.30) were more likely to be AMS adherent. Half of the acquisitions that required review the next standard working day were adherent to AMS (51.8%, 129/249). Weekday acquisitions (2.10, 95% CI 1.20-3.69) and those for patients in paediatric intensive care (2.26, 95% CI 1.07-4.79) were associated with AMS adherence. Interactions with pharmacists prior to acquisition did not change the likelihood of AMS adherence the next standard working day. Access to restricted antimicrobial held as routine ward stock did not change the likelihood of AMS adherence at the time of acquisition, or the next standard working day. CONCLUSION:Restricted antimicrobials acquired after-hours are not routinely AMS adherent at the time of acquisition or the next standard working day, limiting opportunities for AMS involvement.
Mostaghim, M, Snelling, T, McMullan, B, Ewe, YH & Bajorek, B 2019, 'Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia.', Journal of Paediatrics and Child Health, vol. 55, pp. 305-311.View/Download from: Publisher's site
To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community-acquired pneumonia (CAP).Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre-CDSS) and 1 October 2012 and 30 September 2014 (post-CDSS) determined the sequence of case assessment by two independent investigators. Initial antibiotic therapy, associated CDSS approvals and documented signs of clinical deterioration prior to antibiotic decision-making were recorded.Statistically significant differences between cases pre- and post-CDSS implementation were minimal. High fever was observed in 57.5% (77/134) cases pre-CDSS and 45.8% (49/107) cases post-CDSS (P = 0.07). Supplemental oxygen was used in 30.6% pre-CDSS and 54.2% post-CDSS cases (P < 0.001). Narrow-spectrum penicillins were prescribed most often, with no statistically significant change post-CDSS implementation (81.3% pre-CDSS, 77.6% post-CDSS, P = 0.47). Macrolides were used consistently throughout the study period (53.7% pre-CDSS, 61.7% post-CDSS; P = 0.21).CDSS implementation did not reduce already low rates of broad-spectrum antibiotic use for uncomplicated CAP.
Yiu, A & Bajorek, B 2019, 'Patient-focused interventions to support vulnerable people using oral anticoagulants: a narrative review.', Therapeutic advances in drug safety, vol. 10.View/Download from: Publisher's site
The aim of this review was to identify patient-focused interventions that have been trialed to support vulnerable patient populations taking oral anticoagulants (warfarin and the direct-acting oral anticoagulants (DOACs)) such as older persons (65 years and over), those with limited health literacy, and those from culturally and linguistically diverse (CALD) backgrounds. This review also aimed to report on the effects of these interventions on outcomes relevant to the use of anticoagulant therapy. Original articles published between 1 January 1995 and 30 June 2017 were identified using several electronic databases such as Medline, Ovid, Embase, Scopus, Cochrane, and Google Scholar. The following terms were used for the three-tiered search: Tier 1, elderly, aged, older adult, geriatrics; Tier 2, health literacy, literacy, low health literacy, low English proficiency, patient literacy; and Tier 3, ethnicity, ethnic, ethnic groups, CALD, culturally and linguistically diverse, NESB, non-English speaking background, race, racial groups, religion, religious groups, and minority groups. The terms for each tier were combined with the following terms: anticoagulants, anticoagulation, warfarin, apixaban, dabigatran, rivaroxaban, DOACS, new oral anticoagulants, novel oral anticoagulants, patient care, patient knowledge, comprehension, patient education, patient participation, and communication. A total of 41 studies were identified. Most of the interventions identified included older persons taking warfarin who were monitored using the international normalized ratio (INR) and who received patient education. Many interventions reported a significant positive impact on patients' knowledge, reduction in the number of adverse events caused by hemorrhage, and better INR control. More research on patient-focused interventions is needed that includes patients with limited health literacy, those from CALD backgrounds, and family members and caregivers of patients taking oral antico...
Ferguson, C, Hendriks, J, Gallagher, C, Bajorek, B & Inglis, SC 2019, 'Clinical service organisation for adults with atrial fibrillation', Cochrane Database of Systematic Reviews, vol. 2019, no. 8.View/Download from: Publisher's site
© 2019 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of different clinical service interventions for AF versus usual care for people with all types of AF.
Ferguson, C, Hickman, LD, Phillips, J, Newton, PJ, Inglis, SC, Lam, L & Bajorek, BV 2019, 'An mHealth intervention to improve nurses' atrial fibrillation and anticoagulation knowledge and practice: the EVICOAG study.', European Journal of Cardiovascular Nursing, vol. 18, no. 1, pp. 7-15.View/Download from: Publisher's site
There is a need to improve cardiovascular nurses' knowledge and practices related to stroke prevention, atrial fibrillation and anticoagulation therapy.The aim of this study was to evaluate the efficacy of EVICOAG - a novel mHealth, smartphone-based, spaced-learning intervention on nurses' knowledge of atrial fibrillation and anticoagulation.Nurses employed in four clinical specialties (neuroscience, stroke, rehabilitation, cardiology) across three hospitals were invited to participate. In this quasi-experimental study, 12 case-based atrial fibrillation and anticoagulation learning scenarios (hosted by an mHealth platform) were delivered to participants' smartphones over a 6-week period (July-December 2016) using a spaced timing algorithm. Electronic surveys to assess awareness and knowledge were administered pre (T1) and post (T2) intervention.From 74 participants recruited to T1, 40 completed T2. There was a 54% mean improvement in knowledge levels post-intervention. The largest improvement was achieved in domains related to medication interaction and stroke and bleeding risk assessment. Post-intervention, those who completed T2 were significantly more likely to use CHA2DS2-VASc (2.5% vs. 37.5%) and HAS-BLED (2.5% vs. 35%) tools to assess stroke and bleeding risk, respectively ( P<0.01).The EVICOAG intervention improved nurses' knowledge of atrial fibrillation and anticoagulation, and influenced their uptake and use of stroke and bleeding risk assessment tools in clinical practice. Future research should focus on whether a similar intervention might improve patient-centred outcomes such as patients' knowledge of their condition and therapies, medication adherence, time in the therapeutic range and quality of life.
Alomari, A, Wilson, V, Solman, A, Bajorek, B & Tinsley, P 2018, 'Pediatric Nurses' Perceptions of Medication Safety and Medication Error: A Mixed Methods Study.', Comprehensive Child and Adolescent Nursing, vol. 41, no. 2, pp. 94-110.View/Download from: Publisher's site
This study aims to outline the current workplace culture of medication practice in a pediatric medical ward. The objective is to explore the perceptions of nurses in a pediatric clinical setting as to why medication administration errors occur. As nurses have a central role in the medication process, it is essential to explore nurses' perceptions of the factors influencing the medication process. Without this understanding, it is difficult to develop effective prevention strategies aimed at reducing medication administration errors. Previous studies were limited to exploring a single and specific aspect of medication safety. The methods used in these studies were limited to survey designs which may lead to incomplete or inadequate information being provided. This study is phase 1 on an action research project. Data collection included a direct observation of nurses during medication preparation and administration, audit based on the medication policy, and guidelines and focus groups with nursing staff. A thematic analysis was undertaken by each author independently to analyze the observation notes and focus group transcripts. Simple descriptive statistics were used to analyze the audit data. The study was conducted in a specialized pediatric medical ward. Four key themes were identified from the combined quantitative and qualitative data: (1) understanding medication errors, (2) the busy-ness of nurses, (3) the physical environment, and (4) compliance with medication policy and practice guidelines. Workload, frequent interruptions to process, poor physical environment design, lack of preparation space, and impractical medication policies are identified as barriers to safe medication practice. Overcoming these barriers requires organizations to review medication process policies and engage nurses more in medication safety research and in designing clinical guidelines for their own practice.
Bajorek, B, Saxton, B, Anderson, E & Chow, CK 2018, 'Patients' preferences for new versus old anticoagulants: a mixed-method vignette-based study.', European Journal of Cardiovascular Nursing, vol. 17, no. 5, pp. 429-438.View/Download from: Publisher's site
For both patients and clinicians, differences between older and new anticoagulants have major implications for treatment selection, day-to-day management of therapy and adherence.To explore patients' preferences for warfarin versus direct oral anticoagulant (DOAC) therapy.Mixed-method study involving anticoagulated older patients admitted to hospital. Part A comprised a vignette-based questionnaire; patients were asked whether they preferred Medicine A (warfarin) or Medicine B (DOAC). Part B interviews explored patients' satisfaction with their current anticoagulant. Responses were thematically analysed.Forty patients participated: 23 warfarin-treated, 17 DOAC-treated. Collectively, Parts A and B identified that most patients were satisfied with their current therapy (warfarin or DOAC), expressing reluctance to change to alternatives. Among patients who were able to numerically rate their satisfaction with therapy, most were 'satisfied' with their current anticoagulant, although warfarin-treated patients were slightly less 'satisfied' (median score 3.5) than those on DOACs (median score 5.0). Despite this, warfarin-treated patients still preferred their current therapy (over DOACs) due to familiarity and the security of regular international normalised ratio (INR) monitoring; those who preferred DOACs cited previous warfarin-related bleeding and unstable INRs as key reasons. DOAC-treated patients who preferred warfarin perceived regular monitoring as a major advantage; only those having had negative experiences with warfarin clearly preferred DOACs.Most patients accepted their currently prescribed anticoagulant, be it warfarin or DOACs. Features of specific anticoagulants, such as regular monitoring with warfarin, were perceived variably - some patients cited them as advantages and others as disadvantages. The clearest preference identified was for the agent already being taken.
Krzyzaniak, N, Pawlowska, I & Bajorek, B 2018, 'Quality pharmacy services and key performance indicators in Polish NICUs: a Delphi approach', INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, vol. 40, no. 3, pp. 533-542.View/Download from: Publisher's site
Krzyzaniak, N, Pawlowska, I & Bajorek, B 2018, 'The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice', EUROPEAN JOURNAL OF HOSPITAL PHARMACY-SCIENCE AND PRACTICE, vol. 25, no. E1, pp. E7-E16.View/Download from: Publisher's site
Krzyżaniak, N, Pawłowska, I & Bajorek, B 2018, 'Pharmacist perceptions on the need for a quality guidance resource for pharmacy service provision in the neonatal intensive care unit: comparison between Poland and Australia', Journal of Pharmaceutical Health Services Research, vol. 9, no. 3, pp. 245-257.View/Download from: Publisher's site
© 2018 Royal Pharmaceutical Society Objectives: There is no global consensus on services and roles that should be performed by a clinical pharmacist in the neonatal intensive care unit (NICU). Furthermore, there are no quality guidance resources or key performance indicators (KPIs) available to guide pharmacist practice in this setting. The purpose of this research was to explore pharmacist perceptions on the need for, and development of, a NICU-specific quality guidance resource containing KPIs for pharmacy service provision. Methods: Semi-structured interviews were conducted with directors of pharmacy as well as neonatal pharmacists in Poland and Australia. The interviews were conducted between February and August 2017. Key findings: Overall, three key themes were categorised around the study objectives: (1) Lack of guidance in the provision of NICU pharmaceutical care services, (2) Embracing a pharmacist-specific, quality guidance resource for the NICU and (3) Constraints limiting the use of quality guidance resource. None of the participants from either country were able to identify any readily available NICU-specific quality guidance resources for pharmacists. However, the majority of participants from both countries were open towards the development of a quality guidance resource and felt that this would be useful. Differences between countries were noted when considering the type of pharmacy practice models functioning in each country and the perceived barriers to implementing the proposed quality guidance resource into practice. Conclusion: Although there are significant differences in the type of pharmacist practice systems functioning in each country, pharmacists in both Australia and Poland demonstrated significant support for the development of a quality measurement tool to guide and structure practice in the NICU and recognised benefits to its implementation. Future efforts should focus on the development of quality measures that can be adapted to di...
Krzyżaniak, N, Pawłowska, I & Bajorek, B 2018, 'Pharmacist perspectives towards pharmaceutical care services in neonatal intensive care units in Australia and Poland', Drugs and Therapy Perspectives, vol. 34, no. 12, pp. 573-582.View/Download from: Publisher's site
© 2018, Springer Nature Switzerland AG. Objectives: The purpose of this study was to, first, investigate the perceptions of neonatal intensive care unit (NICU) pharmacists and directors of pharmacy in Australia and Poland regarding their level of preparation to perform pharmaceutical care services in the NICU, and second, identify practice barriers and ways to improve services. Method: A cross-sectional, electronic-based survey was distributed among NICU pharmacists and directors of pharmacy working in hospitals with a NICU in Australia and Poland. The survey comprised 12 items, and the majority of questions were fixed binary 'agree/disagree' answers, supplemented by open-ended questions. Results: A total of 29 participants from Australia and 20 from Poland completed the survey. Overall, it is apparent that Australian pharmacists felt more competent in clinical and educational roles than Polish participants. For 14 of the 15 clinical roles listed, more than 70% of Australian participants felt that pharmacists had a 'good' level of preparation to provide services to the NICU, including performing medication chart reviews (93.1%) and pharmaceutical interventions (96.6%), and collaborating with medical and nursing staff (93.1%). A significantly higher proportion of Polish than Australian pharmacists agreed that changes were needed to improve pharmacist practice in the NICU (90 vs. 53.6%; p = 0.007). Conclusion: Future efforts should focus on developing guidelines and practice standards for sub-specialties of pharmacist practice, such as neonatology, to promote the standardization of practice.
Krzyzaniak, N, Singh, S & Bajorek, B 2018, 'Physicians' perspectives on defining older adult patients and making appropriate prescribing decisions', Drugs and Therapy Perspectives, vol. 34, no. 4, pp. 174-185.View/Download from: Publisher's site
© 2018, Springer International Publishing AG, part of Springer Nature. Background: Older patients are major users of pharmacotherapy due to a higher incidence of health issues. However, there is evidence of age-biased prescribing, leading to over- or underprescribing of medication, and suboptimal clinical outcomes. Although many guidelines provide cautionary statements about the use of medicines in older patients, they fail to identify what this means in practice. There is no accepted definition of an older adult that appropriately characterises this patient group. As a result, there is potential for physicians to have variable interpretations of individuals within this patient population, leading to potential inconsistencies when making pharmacotherapeutic decisions. Objective: The aim of this study was to explore how Australian medical physicians practically defined an older adult patient in the context of providing pharmacotherapeutic care to this population. Methods: This was a two-stage study comprising a scenario-based questionnaire (quantitative phase) and semi-structured individual interviews (qualitative phase) with Australian physicians. Qualitative data was thematically analysed and manual inductive coding was used to generate core themes. Results: A total of 15 physicians participated in the study. Overall, in regard to providing care to their older patients, the three key themes that emerged from physicians' discussions were (1) using a number-based versus health status-based definition of an older patient; (2) patient 'red flags' influence prescribing decisions; and (3) lack of guideline support in prescribing for older patients. Most physicians ultimately defined older adult patients using a number-based description (i.e. age between 65 and 90 years) because they felt they needed some sort of 'cut-off' point to guide their decision making. However, in assessing an older patient, physicians considered a multitude of patient factors as influencers of...
Krzyżaniak, N, Singh, S & Bajorek, B 2018, 'Defining an 'older' patient in the context of therapeutic decision making: perspectives of Australian pharmacists and nurses', Drugs and Therapy Perspectives, vol. 34, no. 8, pp. 392-401.View/Download from: Publisher's site
© 2018, Springer International Publishing AG, part of Springer Nature. Objective: Our aim was to explore Australian nurses and pharmacist's perspectives on defining an 'older' patient in the context of decision making around pharmacotherapy. Design: A qualitative study was conducted using semi-structured interviews, facilitated by a purpose-designed interview guide. Setting: Practitioners were recruited from the primary care (i.e. registered community pharmacists, registered community nurses, general practice nurses) and tertiary care settings (i.e. referral hospitals, specialist clinics). Participants: Non-prescribing health professionals directly involved in medication management (i.e. nurses, pharmacists) with experience in caring for older patients. Results: This exploratory study identified three key themes: (1) defining 'older' patients is difficult, given the heterogeneity of the population; (2) age is more than a number and, therefore, cannot be used alone for tailoring and managing a patient's treatment; and (3) a contemporary definition of an 'older' patient needs to be integrated into guidelines for treating aged patients. Overall, Australian nurses and pharmacists shared similar perspectives about defining an 'older' patient, favouring holistic assessments of individual patients. Conclusions: Non-prescribing health practitioners, such as nurses and pharmacists, advocate an individualised approach, rather than a number-based approach, to decision making in older patients.
Mostaghim, M, Snelling, T, Katf, H & Bajorek, B 2018, 'Paediatric antimicrobial stewardship and safe prescribing: An assessment of medical staff knowledge and behaviour', Pharmacy Practice, vol. 16, no. 2.View/Download from: Publisher's site
© 2018, Grupo de Investigacion en Atencion Farmaceutica. All rights reserved. Objective: Determine baseline knowledge of antimicrobial stewardship, and safe prescribing among junior medical officers, monitor their level of participation in interactive education during protected teaching time and assess day-to-day prescribing behaviours over the subsequent 3-month period. Methods: A voluntary and anonymous survey of all non-consultant level medical officers was conducted with the use of an audience response system during mandatory face-to-face orientation sessions at a tertiary paediatric hospital. Routine prescribing audits monitored compliance with national and locally derived quality use of medicines indicators. Results: Eighty-six percent of medical officers participated by responding to at least one question (171/200). Response rate for individual questions ranged between 31% and 78%. Questions that addressed adverse drug reactions, documentation and monitoring for empiric antibiotics and the error-prone abbreviations IU and U were correctly answered by over 90% of participants. Other nonstandard and error-prone abbreviations were less consistently identified. In practice, 68% of patients had complete adverse drug reaction documentation (113/166). Error-prone abbreviations were identified on 5% of audited medication orders (47/976), approximately half included a documented indication and intended dose. Conclusions: Participants demonstrated a good understanding of safe prescribing and antimicrobial stewardship. Audits of prescribing identified potential discrepancies between prescribing knowledge and behaviours.
Pandya, E, Masood, N, Wang, Y, Krass, I & Bajorek, B 2018, 'Impact of a Computerized Antithrombotic Risk Assessment Tool on the Prescription of Thromboprophylaxis in Atrial Fibrillation.', Clinical and Applied Thrombosis/Hemostasis, vol. 24, no. 1, pp. 85-92.View/Download from: Publisher's site
The computerized antithrombotic risk assessment tool (CARAT) is an online decision-support algorithm that facilitates a systematic review of a patient's stroke risk, bleeding risk, and pertinent medication safety considerations, to generate an individualized treatment recommendation. The CARAT was prospectively applied across 2 hospitals in the greater Sydney area. Its impact on antithrombotics utilization for thromboprophylaxis in patients with nonvalvular atrial fibrillation was evaluated. Factors influencing prescribers' treatment selection were identified. The CARAT recommended a change in baseline therapy for 51.8% of patients. Among anticoagulant-eligible patients (ie, where the risk of stroke outweighed the risk of bleeding) using "nil therapy" or antiplatelet therapy at baseline, the CARAT recommended an upgrade to warfarin in 60 (30.8%) patients. For those in whom the bleeding risk outweighed the stroke risk, the CARAT recommended a downgrade from warfarin to safer alternatives (eg, aspirin) in 37 (19%) patients. Among the "most eligible" (ie, high stroke risk, low bleeding risk, no contraindications; n = 75), the CARAT recommended warfarin for all cases. Discharge therapy observed a marginal increase in anticoagulation prescription in eligible patients (n = 116; 57.8% vs 64.7%, P = .35) compared to baseline. Predictors of warfarin use (vs antiplatelets) included congestive cardiac failure, diabetes mellitus, and polypharmacy. The CARAT was able to optimize the selection of therapy, increasing anticoagulant use among eligible patients. With the increasing complexity of decision-making, such tools may be useful adjuncts in therapy selection in atrial fibrillation. Future studies should explore the utility of such tools in selecting therapies from within an expanded treatment armamentarium comprising the non-vitamin K antagonist oral anticoagulants.
Pandya, EY, Anderson, E, Chow, C, Wang, Y & Bajorek, B 2018, 'Contemporary utilization of antithrombotic therapy for stroke prevention in patients with atrial fibrillation: an audit in an Australian hospital setting', THERAPEUTIC ADVANCES IN DRUG SAFETY, vol. 9, no. 2, pp. 97-111.View/Download from: Publisher's site
Rahmawati, R & Bajorek, B 2018, 'Factors affecting self-reported medication adherence and hypertension knowledge: A cross-sectional study in rural villages, Yogyakarta Province, Indonesia.', Chronic Illness, vol. 14, no. 3, pp. 212-227.View/Download from: Publisher's site
Objectives This study assessed medication adherence and hypertension knowledge, and their predictive factors, in people with hypertension, living in rural communities in Indonesia. Methods Data were acquired from 384 people living in eight rural villages via a researcher-administered questionnaire, a validated adherence scale, and a standardized hypertension knowledge survey. Multivariate analysis was used to identify the predictors of adherence and knowledge. Results Fifty-nine (15%) participants had good hypertension knowledge (score ≥ 8 out of 10). Compared to participants with poor knowledge, these participants had higher formal education (odds ratio = 2.7, 95% confidence interval = 1.5-4.7), and lived closer to a community health center (odds ratio = 1.8, 95% confidence interval = 1.0-3.3). Knowledge gaps about the need for long-term medication, hypertension complications, and the target blood pressure were identified. Good hypertension knowledge predicted good adherence to medication (odds ratio = 7.1, 95% confidence interval = 3.3-15.2). Only 42 (11%) participants were considered to have good adherence. Reasons for intentional nonadherence were beliefs that medicines should be taken only when symptoms are evident, limited access to healthcare services, and a preference using traditional medicines. Conclusion Strategies for addressing knowledge gaps and misconceptions about hypertension medication are needed, particularly for people with a low educational level and those living some distances from healthcare facilities.
Rahmawati, R & Bajorek, B 2018, 'Potential use of a "blood pressure action sheet" for indonesian patients with hypertension living in rural villages: A qualitative study', Integrated Blood Pressure Control, vol. 11, pp. 93-103.View/Download from: Publisher's site
© 2018 Rahmawati and Bajorek. Purpose: The aim of the study was to obtain feedback on the layout, content, and potential use of a blood pressure (BP) action sheet, a purpose-designed written resource for Indonesian patients with hypertension. Methods: Telephone interviews were conducted with 13 health professionals, 12 community health workers, and 12 patients in rural Yogyakarta, Indonesia, to explore their impressions of the BP action sheet, how the sheet might affect management of hypertension, and suggestions for improvement. Results: Participants felt that the sheet presented useful information about achieving the target BP and managing hypertension. The use of the sheet could be optimized by engaging community health workers to help explain the information and to provide assistance around the stated actions for hypertension management. A more attractive design and inclusion of more details were suggested. Both patients and health care workers expressed interest in using the sheet. Conclusion: The BP action sheet has potential as a useful resource for patients with hypertension by providing information, recording target BP, and facilitating patient-centered communication. Use of the BP action sheet might provide an effective low-cost way for health professionals and community health workers to encourage patients to achieve their target BP.
Rahmawati, R & Bajorek, B 2018, 'Understanding untreated hypertension from patients' point of view: A qualitative study in rural Yogyakarta province, Indonesia.', Chronic Illness, vol. 14, no. 3, pp. 228-240.View/Download from: Publisher's site
Objectives This study aimed to explore perspectives about hypertension from patients who do not take anti-hypertensive medications. Factors that shape their perspectives as well as patients' expectations were also canvassed. Method Individual, face-to-face interviews were conducted with 30 people (≥45 years old) living in rural villages, diagnosed with hypertension, who had not taken any anti-hypertensive medications for at least one year. Interviews were audiotaped, transcribed verbatim and thematically analysed. Results Four themes emerged: (1) alternative medicines for managing high blood pressure; (2) accessing health care services; (3) the need for anti-hypertensive medications; and (4) existing support and patients' expectations. Reluctance to take anti-hypertensive medications was influenced by patients' beliefs in personal health threats and the effectiveness of anti-hypertensive medications, high self-efficacy for taking alternative medicines, the lack of recommendation regarding hypertension treatment, and barriers to accessing supplies of medicines. Conclusion Despite their awareness of being diagnosed with hypertension, patients undervalued visiting a health professional to control their high blood pressure. Health strategies need to consider patients' beliefs, concerns and expectations. Providing an accessible, affordable and adequate supply of hypertension medication is also key to any programs designed to optimise hypertension management.
Rahmawati, R & Bajorek, BV 2018, 'Access to medicines for hypertension: a survey in rural Yogyakarta province, Indonesia.', Rural and Remote Health, vol. 18, no. 3, pp. 1-13.View/Download from: Publisher's site
INTRODUCTION:Obtaining an adequate supply of medicines is an important step in facilitating medication adherence. This study aimed to determine (1) how people with hypertension in rural villages in Indonesia obtain their supply of anti-hypertensive medications, (2) the type of hypertension medication taken and (3) factors associated with where and how people obtain their medicines supplies. METHOD:Data pertaining to people with hypertension (age ≥45 years) were collected from eight rural villages in the Bantul district, Yogyakarta province, Indonesia, using a researcher-administered questionnaire. RESULTS:Of 384 participants, 203 (52.9%) obtained anti-hypertensive medications from public or private healthcare services. The most common way was by purchasing these medicines without prescription in community pharmacies (n=64, 17%). The medicines obtained this way included captopril, amlodipine, nifedipine, and bisoprolol. One-hundred and nineteen (15%) participants obtained their medicines at no cost by visiting public healthcare services such as community health centres (n=51), the Integrated Health Service Post for the Elderly (n=53), and the public hospitals (n=15). Direct dispensing from clinicians was reported by participants who visited a doctor (n=15), midwife (n=23) or nurse (n=21). Having access to an adequate medication supply (ie for an entire 30 days) was reported by 40 (10.4%) participants, who obtained the medication from a community health centre (n=18), public hospital (n=4), community pharmacy (n=5), private hospital (n=2), or multiple sources (n=11). A higher formal education level was associated with obtaining medicines from multiple sources rather than from the public or private provider only. Living near a community health centre and having government insurance were associated with obtaining medicines from the public health service. Age, gender, employment, presence of other chronic diseases, and knowledge about hypertension were not signific...
Wang, Y & Bajorek, B 2018, 'Selecting antithrombotic therapy for stroke prevention in atrial fibrillation: Health professionals' feedback on a decision support tool', HEALTH INFORMATICS JOURNAL, vol. 24, no. 3, pp. 309-322.View/Download from: Publisher's site
© 2018, Grupo de Investigacion en Atencion Farmaceutica. All rights reserved. Objectives: To 1) characterise older patients taking warfarin, 2) assess these patients' level of warfarin knowledge, and 3) describe their strengths and limitations in health literacy, and 4) explore relationships between participants' characteristics, warfarin knowledge and health literacy. Methods: A warfarin knowledge questionnaire and Health Literacy Questionnaire (HLQ) were administered to older patients (aged >65 years, N=34) taking warfarin in an Australian general practice setting. Results: Key gaps in participant knowledge pertained to the consequences of an international normalized ratio (INR) being below the target INR range and safety issues such as when to seek medical attention. A limitation for participants with a lower level of health literacy was the ability to appraise health information. Patients who needed assistance in completing the HLQs had significantly lower warfarin knowledge scores (p=0.03). Overseas-born participants and those taking 5 or more long-term medications had lower HLQ scores for specific scales (p<0.05). Conclusion: In this study warfarin knowledge gaps and a limitation of health literacy amongst a small sample of older patients were identified. The findings suggest that education and resources may need to be tailored to the needs of older patients taking warfarin and their carers to address these knowledge gaps and limitations in health literacy. Patients who may need greater support include those that need assistance in completing the HLQ, are overseas-born, or are taking 5 or more long-term medications.
Brieger, D, Amerena, J, Attia, JR, Bajorek, B, Chan, KH, Connell, C, Freedman, B, Ferguson, C, Hall, T, Haqqani, HM, Hendriks, J, Hespe, CM, Hung, J, Kalman, JM, Sanders, P, Worthington, J, Yan, T & Zwar, NA 2018, 'National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018', MEDICAL JOURNAL OF AUSTRALIA, vol. 209, no. 8, pp. 356-362.View/Download from: Publisher's site
Ferguson, C, Shaikh, F, Pasch, L, Newton, P, Inglis, S, Bajorek, B, Macdonald, P & Davidson, P 2018, 'Medication Regimen Complexity in Individuals With Heart Failure and Concomitant Atrial Fibrillation: A Secondary Analysis', Heart, Lung and Circulation, vol. 27, pp. S385-S385.View/Download from: Publisher's site
NHFA CSANZ Atrial Fibrillation Guideline Working Group, Brieger, D, Amerena, J, Attia, J, Bajorek, B, Chan, KH, Connell, C, Freedman, B, Ferguson, C, Hall, T, Haqqani, H, Hendriks, J, Hespe, C, Hung, J, Kalman, JM, Sanders, P, Worthington, J, Yan, TD & Zwar, N 2018, 'National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.', Heart, lung & circulation, vol. 27, no. 10, pp. 1209-1266.View/Download from: Publisher's site
Shaikh, F, Pasch, LB, Newton, PJ, Bajorek, BV & Ferguson, C 2018, 'Addressing Multimorbidity and Polypharmacy in Individuals With Atrial Fibrillation', CURRENT CARDIOLOGY REPORTS, vol. 20, no. 5.View/Download from: Publisher's site
Zhuo, A, Labbate, M, Norris, JM, Gilbert, GL, Ward, MP, Bajorek, BV, Degeling, C, Rowbotham, SJ, Dawson, A, Ky-Anh, N, Hill-Cawthorne, GA, Sorrell, TC, Govendir, M, Kesson, AM, Iredell, JR & Dominey-Howes, D 2018, 'Opportunities and challenges to improving antibiotic prescribing practices through a One Health approach: results of a comparative survey of doctors, dentists and veterinarians in Australia', BMJ OPEN, vol. 8, no. 3.View/Download from: Publisher's site
Bajorek, B & Krass, I 2017, 'Exploring the potential for pharmacist prescribing in the management of hypertension in primary care: An Australian survey', Journal of Pharmacy Practice and Research, vol. 47, no. 3, pp. 176-185.View/Download from: Publisher's site
© 2017 The Society of Hospital Pharmacists of Australia. Background: The management of hypertension, particularly medicines use, remains suboptimal and pharmacist-delivered models of care may assist clinicians in this regard. Aim: The primary objective of this study was to explore the potential for pharmacists to make treatment recommendations and prescribing decisions for patients with hypertension. Method: Accredited (medicines review) pharmacists working in the primary care setting within the Sydney metropolitan area (NSW, Australia) were recruited. Pharmacists completed a scenario-based survey that asked them to demonstrate a simulated prescribing function in the management of 6 patient scenarios. The management of the scenarios was assessed from the pharmacists' perspective (i.e. usefulness of prescribing, confidence in prescribing) and by an expert clinical panel (i.e. clinical appropriateness). Results: Thirty pharmacists (27.4 ±10.7 years in practice) participated. Most pharmacists indicated that a prescribing function would be useful within their scope of practice and that they would be confident in executing this as an intervention. The expert clinical panel rated the vast majority of recommendations by pharmacists to be appropriate. Ratings for usefulness of, confidence in and appropriateness of the prescribing recommendations were lowest for the 2 scenarios depicting more complex cases; here the level of agreement among the expert panel was also poor (κ ≤ 0.15). Recommendations relating to processes for assessing patients were rated relatively lower, particularly for the complex scenarios. Conclusion: Accredited pharmacists have the capacity and potential for a prescribing function to help optimise hypertension management. Simulated prescribing interventions undertaken by accredited pharmacists were assessed as clinically appropriate by medical clinicians.
Bajorek, B, Lemay, K, Magin, P, Roberts, C, Krass, I & Armour, C 2017, 'Patients' Attitudes and Approaches to the Self-Management of Hypertension: Perspectives from an Australian Qualitative Study in Community Pharmacy.', High Blood Pressure and Cardiovascular Prevention, vol. 24, no. 2, pp. 149-155.View/Download from: Publisher's site
In the management of hypertension, blood pressure (BP) monitoring and medication use are key strategies, but they are dependent on patients' motivation to practice self-care.To gauge patients' approaches to monitoring their blood pressure, as well as explore their attitudes toward, and actions relating to, high blood pressure readings, as the key components of their self-management of hypertension.This qualitative study, comprising individual telephone interviews, involved patients attending community pharmacies in Sydney (Australia). Patients' perspectives were elicited using a purpose-designed, semi-structured interview guide. The verbal responses were audio-recorded, transcribed verbatim, and thematically analysed.Three key themes arose: (1) approaches to monitoring blood pressure, (2) attitudes to variability in BP, (3) responses to high BP readings. Many patients self-regulated the frequency of monitoring based on perceived need and/or opportunity. Most were indifferent toward their readings, regarding BP fluctuations as 'normal'. When a high BP was detected, the action taken was highly variable, with no clear action plans in place. Several patients recognised a high BP to be a consequence of not taking their antihypertensive medication, triggering the resumption of short-term adherence to their preferred management strategy, i.e., self-medication with antihypertensives (i.e., restarting their medication) and/or self-management via lifestyle strategies.This study highlights patients' inappropriate self-management of hypertension. Misperceptions about hypertension, e.g., accepting BP fluctuations as normal, can produce indifferent attitudes as well as influence patients' self-management actions. This lack of insight undermines long-term adherence to antihypertensive therapy.
Bajorek, BV, LeMay, KS, Magin, PJ, Roberts, C, Krass, I & Armour, CL 2017, 'Management of hypertension in an Australian community pharmacy setting - patients' beliefs and perspectives.', The International journal of pharmacy practice, vol. 25, no. 4, pp. 263-273.View/Download from: Publisher's site
To explore patients' perspectives and experiences following a trial of a pharmacist-led service in hypertension management.A qualitative study comprising individual interviews was conducted. Patients of a community pharmacy, where a pharmacist-led hypertension management service had been trialled in selected metropolitan regions in Sydney (Australia), were recruited to the study. Emergent themes describing patients' experiences and perspectives on the service were elicited via thematic analysis (using manual inductive coding).Patients' (N = 18) experiences of the service were extremely positive, especially around pharmacists' monitoring of blood pressure and provision of advice about medication adherence. Patients' participation in the service was based on their trust in, and relationship with, their pharmacist. The perception of working in a 'team' was conveyed through the pharmacist's caring style of communication and the relaxed atmosphere of the community pharmacy. Patients felt that the community pharmacy was an obvious place for such a service because of their regular contact with the pharmacist, but was limited because the pharmacists were not able to prescribe medication.Patients were extremely positive about the role of, and their experience of, the pharmacy-based hypertension management service. Factors contributing to the patients' positive experiences provide important insights for community pharmacy practice. Good rapport with the pharmacist and a long-term relationship underpin patient engagement in such services. Restrictions on the pharmacists' scope of practice prevent their expertise, and the benefits of their accessibility as a primary point of contact, from being fully realised.
Bajorek, BV, Ruchi, B, MacPherson, RD, Clara, C & Phillip, E 2017, 'Pharmacist charting in the preadmission clinic of a Sydney teaching hospital: A pilot study', Journal of Pharmacy Practice and Research, vol. 47, no. 5, pp. 375-382.View/Download from: Publisher's site
© 2017 The Society of Hospital Pharmacists of Australia. Aim: To trial a pharmacist charting service, comprising medication charting, in the preadmission clinic (PAC) at aSydney teaching hospital. Methods: A prospective pre/post-trial was conducted comprising a 1-month baseline audit and a 1-month trial of pharmacist charting (i.e. pharmacists' preparation of patients' medication charts during routine consultations). Purpose-designed data collection forms were used to document: pharmacist and doctor consultation times, time taken by pharmacists to prepare medication charts, and completeness and accuracy of the prescribed medication charts. A semi-structured survey was used to elicit feedback from PAC staff regarding the pharmacist charting service; the data were thematically analysed using manual, inductive coding. Results: Seventy-two medication charts were completed by PAC pharmacists during the 1-month trial. Completeness of charts improved post-intervention (5.4 vs 80.6%, p < 0.001), as did the accuracy of charts (proportion of charts with inaccuracies:41.1 vs 1.4%,p < 0.001); only one (1.4%) pharmacist-prescribed medication chart was identified as having an inaccuracy. Thechanges in mean consultation times per patient for doctors and pharmacists, respectively, changed from pre- to post-intervention as follows: pharmacists 18.9 ± 6.5 min to 20.6 ± 8.3 min (p = NS); and doctors 25.0 ± 9.6 min to 19.0 ± 6.4 min(p < 0.001). A statistically significant relationship was found between pharmacist consultation time and patients' numbers of medications (p < 0.001) and age group (p = 0.004). Conclusion: Pharmacist charting in the PAC has been shown to improve medication chart completeness and accuracy, helping to ensure medication safety in the hospital setting. A further, long-term trial will help confirm the clinical benefits of such a service.
Krzyzaniak, N & Bajorek, B 2017, 'A global perspective of the roles of the pharmacist in the NICU.', The International Journal of Pharmacy Practice, vol. 25, no. 2, pp. 107-120.View/Download from: Publisher's site
To describe pharmacist practice and roles performed in the neonatal intensive care unit (NICU) worldwide and to map these findings along the medicines management pathway (MMP).Quasi-systematic review.Google Scholar, Medline/PubMed and Embase were searched utilising the selected MeSH terms.Thirty sources of information were reviewed. Overall, pharmacist practice in the NICU involves a wide-range of roles, with the most commonly reported involving patient medication chart review, therapeutic drug monitoring and the provision of medication information. Studies highlight that pharmacist contribution to total parenteral nutrition (TPN) regimens and patient medication chart review is beneficial to patient outcomes. Roles beyond the regular scope of practice included involvement in immunisation programmes and research. Most of the data were collected from the USA (13 of 30), followed by the UK (6 of 30) and reports from other countries. The American, British, South African and Australian articles have reported very similar roles, with a pharmacist firmly integrated into the overall structure of the NICU team.The literature identifies that there is insufficient evidence to describe what roles are currently performed in NICUs worldwide. This is due to the lack of recently published articles leading to a large gap in knowledge in understanding what contemporary pharmaceutical services in the NICU comprise. Further research is required to address these gaps in knowledge, and identify the impact of the pharmacist's role on neonatal patient outcomes as well as to determine how to better resource NICUs to access pharmacy services.
Lloyd, GF, Singh, S, Barclay, P, Goh, S & Bajorek, B 2017, 'Hospital pharmacists' perspectives on the role of key performance indicators in australian pharmacy practice', Journal of Pharmacy Practice and Research, vol. 47, no. 2, pp. 87-95.View/Download from: Publisher's site
© 2016 The Society of Hospital Pharmacists of Australia. Background: To date, there is no national or international consensus on which key performance indicators (KPIs) should be used to measure hospital pharmacy performance. Aim: To explore hospital pharmacists' perspectives on the role of KPIs and to use their perspectives to suggest a set of KPIs for use in Australian hospital pharmacy practice. Methods: The study comprised of two parts. Part A involved semi-structured interviews with hospital pharmacists from major Sydney metropolitan hospitals; interviews were conducted until theme saturation was attained. Part B involved an online survey comprising Likert-scale responses and open-ended questions; the survey was distributed nationally to pharmacists via the Society of Hospital Pharmacists of Australia (SHPA) eNewsletter and Facebook page. Results: Part A: 19 hospital pharmacists were interviewed. Part B: 49 online surveys were received (after excluding incomplete submissions). Overall, the emergent themes identified that hospital pharmacists agreed that KPIs are a valuable tool for individual and departmental performance measurement; the use of KPIs was challenged by data collection difficulties, a lack of engagement from staff, and a lack of clarification regarding the intended use of KPIs and their relevance. The study identified a consolidated set of seven KPIs, proposed as standard measures for hospital pharmacy practice. Conclusion: There is a perceived need to develop national standardised KPIs to demonstrate the value of pharmacy services at the individual and departmental levels. However, there are challenges that will need to be addressed before the implementation of a set of consolidated KPIs that encompasses the full scope of pharmacy activities.
Mostaghim, M, Snelling, T, McMullan, B, Konecny, P, Bond, S, Adhikari, S, Chubaty, A, Lovell, C & Bajorek, B 2017, 'Nurses are underutilised in antimicrobial stewardship – Results of a multisite survey in paediatric and adult hospitals', Infection, Disease and Health, vol. 22, no. 2, pp. 57-64.View/Download from: Publisher's site
© 2017 Australasian College for Infection Prevention and Control Objectives Explore perceptions and attitudes of nurses in regard to antimicrobial stewardship (AMS), their roles as nurses, and identify differences in perceptions and attitudes across paediatric and adult settings. Methods Electronic survey administered to nursing staff across three public Australian tertiary institutions with AMS facilitated by a shared electronic approval and decision support system. Results Overall 65% (93/142) of nurses who completed the survey were familiar with the term AMS, and 75% recognised that they were expected to have a role alongside other disciplines, including ward pharmacists (paediatric 88%, adult 73%; p = 0.03). Hand hygiene and infection control (86%), patient advocacy (85%) and knowledge of antimicrobials (84%) were identified most often as AMS roles for nurses. However, 57% of nurses reported that their knowledge of antimicrobials was minimal or limited. Nurses generally agreed that requirement to obtain approval is an effective way to reduce inappropriate antimicrobial use (median scores: paediatric 2.0 [agree], adult 1.0 [strongly agree] ; p = 0.001). Only 35% of paediatric and 58% of adult nurses perceived that their role includes ensuring approval for restricted antimicrobials (p < 0.01). Most nurses identified AMS teams (85%), pharmacists (83%) and infection control teams (paediatric 68%, adult 84%; p = 0.04) as sources of AMS support. Areas of interest for support and education included appropriate antimicrobial selection (73%) and intravenous to oral antimicrobial switch (paediatric 65%, adult 81%, p = 0.03). Conclusion Nurses consider AMS activities within their roles, but are underutilised in AMS programs. Further engagement, education, support and acknowledgement are required to improve nursing participation.
Pandya, EY & Bajorek, B 2017, 'Factors Affecting Patients' Perception On, and Adherence To, Anticoagulant Therapy: Anticipating the Role of Direct Oral Anticoagulants.', The Patient: Patient Centered Outcomes Research, vol. 10, no. 2, pp. 163-185.View/Download from: Publisher's site
The role of the direct oral anticoagulants (DOACs) in practice has been given extensive consideration recently, albeit largely from the clinician's perspective. However, the effectiveness and safety of using anticoagulants is highly dependent on the patient's ability to manage and take these complex, high-risk medicines. This structured narrative review explores the published literature to identify the factors underpinning patients' non-adherence to anticoagulants in atrial fibrillation (AF), and subsequently contemplates to what extent the DOACs might overcome the known challenges with traditional warfarin therapy. This review comprised a two-tier search of various databases and search platforms (CINAHL, Cochrane, Current Contents Connect, EMBASE, MEDLINE Ovid, EBSCO, PubMed, Google, Google Scholar) to yield 47 articles reporting patients perspectives on, and patients adherence to, anticoagulant therapy. The findings from the literature were synthesised under five interacting dimensions of adherence: therapy-related factors, patient-related factors, condition-related factors, social-economic factors and health system factors. Factors negatively affecting patients' day-to-day lives (especially regular therapeutic drug monitoring, dose adjustments, dietary considerations) predominantly underpin a patient's reluctance to take warfarin therapy, leading to non-adherence. Other patient-related factors underpinning non-adherence include patients' perceptions and knowledge about the purpose of anticoagulation; understanding of the risks and benefits of therapy; socioeconomic status; and expectations of care from health professionals. In considering these findings, it is apparent that the DOACs may overcome some of the barriers to traditional warfarin therapy at least to an extent, particularly the need for regular monitoring, frequent dose adjustment and dietary considerations. However, their high cost, twice-daily dosing and gastrointestinal adverse effects may present...
Self-medication is commonly practised by patients, underpinned by health beliefs that affect their adherence to medication regimens, and impacting on treatment outcomes.This review explores the scope of self-medication practices among people with hypertension, in terms of the scale of use, types of medication and influencing factors.A comprehensive search of English language, peer-reviewed literature published between 2000 and 2014 was performed. Twenty-seven studies met the inclusion criteria; 22 of these focused on complementary and alternative medicines (CAMs).Anti-hypertensive medications are listed among the 11% of products that patients reportedly obtain over-the-counter (OTC) for self-medication. On average, 25% of patients use CAMs, mostly herbs, to lower blood pressure. Recommendations by family, friends and neighbours are the most influential factors for self-medication with CAMs. Faith in treatment with CAMs, dissatisfaction with conventional medicine and the desire to reduce medication costs are also cited. Most (70%) patients with hypertension take OTC medicines to treat minor illnesses. The concurrent use of anti-hypertensive medications with analgesics and herbal medicines is commonly practised. The sociodemographic profile of patients engaging in self-medication differs markedly in the articles reviewed; self-medication practices cannot be attributed to a particular profile. Low disclosure of self-medication is consistently reported.This review highlights a high proportion of people with hypertension practise self-medication. Further studies are needed to assess the impact of self-medication with OTC and anti-hypertensive medications on hypertension treatment. Health professionals involved in hypertension management should be mindful of any types of self-medication practices.
Wang, Y & Bajorek, B 2017, 'Pilot of a Computerised Antithrombotic Risk Assessment Tool Version 2 (CARATV2.0) for stroke prevention in atrial fibrillation.', Cardiology Journal, vol. 24, no. 2, pp. 176-187.View/Download from: Publisher's site
The decision-making process for stroke prevention in atrial fibrillation (AF) requires a comprehensive assessment of risk vs. benefit and an appropriate selection of antithrombotic agents (e.g., warfarin, non-vitamin K antagonist oral anticoagulants [NOACs]). The aim of this pilot-test was to examine the impact of a customised decision support tool - the Computerised Antithrombotic Risk Assessment Tool (CARATV2.0) using antithrombotic therapy on a cohort of patients with AF.In this prospective interventional study, 251 patients with AF aged ≥ 65 years, admitted to a teaching hospital in Australia were recruited. CARATV2.0 generated treatment recommendations based on patient medical information. Recommendations were provided to prescribers for consideration.At baseline (admission), 30.3% of patients were prescribed warfarin, 26.7% an antiplatelet, 8.4% apixaban, 8.0% rivaroxaban, 3.6% dabigatran. CARATV2.0 recommended a change of therapy for 153 (61.0%) patients. Through recommendations of CARATV2.0, at discharge, 40.2% of patients were prescribed warfarin, 17.7% antiplatelet, 14.3% apixaban, 10.4% rivaroxaban, 5.6% dabigatran. Overall, the proportion of patients receiving an antithrombotic on discharge increased significantly from baseline (admission) (baseline 77.2% vs. 89.2%; p < 0.001). Prescribers moderately agreed with CARATV2.0's recommendations (kappa = 0.275, p < 0.001). Practical medication safety issues were cited as major reasons for not accepting a desire to continue therapy with CARATV2.0's recommendations. Factors predicting the prescription of antiplatelets rather than anticoagulants included higher bleeding risk and high risk of falls. An inter-speciality difference in therapy selection was detected.This decision support tool can help optimise the use of antithrombotic therapy in patients with AF by considering risk versus benefit profiles and rationalising treatment selection. (Cardiol J 2017; 24, 2: 176-187).
Bajorek, B, Lemay, KS, Magin, P, Roberts, C, Krass, I & Armour, CL 2016, 'Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges.', Pharmacy Practice, vol. 14, no. 2, pp. 1-13.View/Download from: Publisher's site
Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension.The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges.A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service.Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening.A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.
Bajorek, B, Magin, PJ, Hilmer, S & Krass, I 2016, 'Utilization of antithrombotic therapy for stroke prevention in atrial fibrillation: a cross-sectional baseline analysis in general practice', JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS, vol. 41, no. 4, pp. 432-440.View/Download from: Publisher's site
Bajorek, BV, Magin, PJ, Hilmer, SN & Krass, I 2016, 'Optimizing Stroke Prevention in Patients With Atrial Fibrillation: A ClusterRandomized Controlled Trial of a Computerized Antithrombotic Risk Assessment Tool in Australian General Practice, 2012-2013', PREVENTING CHRONIC DISEASE, vol. 13.View/Download from: Publisher's site
Krzyzaniak, N & Bajorek, B 2016, 'Medication safety in neonatal care: a review of medication errors among neonates', Therapeutic Advances in Drug Safety, vol. 7, no. 3, pp. 102-119.View/Download from: Publisher's site
Objective: The objective of this study was to describe the medication errors in hospitalized patients, comparing those in neonates with medication errors across the age spectrum.
Method: In tier 1, PubMed, Embase and Google Scholar were searched, using selected MeSH terms relating to hospitalized paediatric, adult and elderly populations. Tier 2 involved a search of the same electronic databases for literature relating to hospitalized neonatal patients.
Results: A total of 58 articles were reviewed. Medication errors were well documented in each patient group. Overall, prescribing and administration errors were most commonly identified across each population, and mostly related to errors in dosing. Errors due to patient misidentification and overdosing were particularly prevalent in neonates, with 47% of administration errors involving at least tenfold overdoses. Unique errors were identified in elderly patients, comprising duplication of therapy and unnecessary prescribing of medicines. Overall, the medicines most frequently identified with error across each patient group included: heparin, antibiotics, insulin, morphine and parenteral nutrition. While neonatal patients experience the same types of medication errors as other hospitalized patients, the medication-use process within this group is more complex and has greater consequences resulting from error. Suggested strategies to help overcome medication error most commonly involved the integration of a clinical pharmacist into the treating team.
Conclusion: This review highlights that each step of the medication-use process is prone to error across the age spectrum. Further research is required to develop targeted strategies relevant to specific patient groups that integrate key pharmacy services into wards.
Krzyzaniak, N & Bajorek, B 2016, 'Quality use of medicines in neonatal care: a review of measures of quality used to evaluate the appropriateness and rational use of medication within the NICU', Drugs and Therapy Perspectives, vol. 32, no. 9, pp. 392-402.View/Download from: Publisher's site
© 2016, Springer International Publishing Switzerland. With medication error rates in neonatal intensive care units (NICUs) reported to be as high as 91 medication errors per 100 patient admissions, the quality use of medicines (QUM) in this setting is important. Comprising the safe, rational, appropriate and effective use of pharmacotherapy, QUM is integral to achieving medication safety and optimal patient outcomes. To improve QUM in the NICU, the medication use process needs to undergo a quality assessment, using quality measures or indicators. As such, the objectives of this quasi-systematic literature review were to identify the measures used to evaluate QUM within the NICU and to map these against Donabedian's traditional framework of structure, process and outcome. We searched EMBASE, PubMed, CINAHL, Google Scholar and Google for relevant published and grey literature. Overall, a total of 47 quality measures were identified and categorised: 17 structure, 19 process and 11 outcome measures. The most common measures related to the availability of medication safety technology in the NICU, written policies on the use of high-risk medications, medication error and adverse drug event reporting systems, and the provision of education for health professionals involved in the medication use process. However, there were no quality measures specifically designed for medication management in the NICU. The literature does not provide a comprehensive evaluation of the quality of care provided along the medication use process in the NICU. There is a need to develop a quality framework outlining measures that facilitate the appropriate use of medicines in the NICU.
Krzyzaniak, N, Pawlowska, I & Bajorek, B 2016, 'Review of drug utilization patterns in NICUs worldwide', JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS, vol. 41, no. 6, pp. 612-620.View/Download from: Publisher's site
Krzyzaniak, N, Pawłowska, I & Bajorek, B 2016, 'An overview of pharmacist roles in palliative care: A worldwide comparison', Medycyna Paliatywna w Praktyce, vol. 10, no. 4, pp. 160-173.
Pandya, E & Bajorek, BV 2016, 'Assessment of Web-based education resources informing patients about stroke prevention in atrial fibrillation', JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS, vol. 41, no. 6, pp. 667-676.View/Download from: Publisher's site
Rahmawati, R & Bajorek, B 2016, 'Perspectives on antihypertensive medication: a qualitative study in a rural Yogyakarta province in Indonesia', Drugs and Therapy Perspectives, vol. 32, no. 2, pp. 76-83.View/Download from: Publisher's site
© 2015, Springer International Publishing Switzerland. Aim: Patients' perceptions and beliefs underpin their adherence to pharmacotherapeutic regimens and are influenced by access to appropriate information and education. This study explores the perceptions of lay persons from a low-resource community in Indonesia regarding antihypertension medication. Methodology: Individual, semi-structured interviews were conducted, transcribed and thematically analysed. Fourteen respondents (i.e. older persons with hypertension and lay health workers) from a local community-based health programme in Yogyakarta province (Indonesia) were recruited for this qualitative study. Results: Four themes emerged: (1) participants felt that medication for hypertension is unnecessary, instead preferring lifestyle changes and traditional medicines; (2) a fear of becoming dependent on medication underpinned non-adherence to antihypertensive agents—participants with hypertension wanted to achieve normal blood pressure, but without taking long-term medication; (3) symptom-based drivers for treatment led participants to rank other health problems a higher priority than hypertension; and (4) although lay health workers had an opportunity to provide information about hypertension and its management, participants themselves considered this to be currently inadequate. Conclusion: Some misconceptions regarding the role of antihypertension medication that negatively influenced adherence were identified. Beliefs that hypertension can be easily treated by lifestyle modifications can undermine motivation to take antihypertensive agents. Participants expressed their need for more targeted information about hypertension and its treatment; however, they do not expect to obtain such information from their physician. The potential role of lay health workers needs to be further explored as a strategy to enhance understanding and adherence.
Wang, Y & Bajorek, B 2016, 'Clinical pre-test of a computerised antithrombotic risk assessment tool for stroke prevention in atrial fibrillation patients: giving consideration to NOACs', JOURNAL OF EVALUATION IN CLINICAL PRACTICE, vol. 22, no. 6, pp. 892-898.View/Download from: Publisher's site
Wang, Y & Bajorek, B 2016, 'Decision-making around antithrombotics for stroke prevention in atrial fibrillation: the health professionals' views', INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, vol. 38, no. 4, pp. 985-995.View/Download from: Publisher's site
Wang, Y, Singh, S & Bajorek, B 2016, 'Old age, high risk medication, polypharmacy: a 'trilogy' of risks in older patients with atrial fibrillation.', Pharmacy Practice, vol. 14, no. 2, pp. 1-11.View/Download from: Publisher's site
The safety of pharmacotherapy in atrial fibrillation (AF) is compounded by a trilogy of risks old age, high-risk medications (e.g., antithrombotics, antiarrhythmics), polypharmacy due to multiple patient comorbidities. However, to date, scarce study has investigated the use of polypharmacy (including potentially inappropriate medication (PIM)) in AF patients, and how this may contribute to their overall risk of medication misadventure.To review the extent of polypharmacy and PIM use in older patients (65 years or older) with AF.Information was extracted from a database characterising a cohort of older AF patients treated in general practice in New South Wales, Australia. Patient characteristics, number and types of drugs, the degree of PIM use were recorded. The predictors for the use of polypharmacy in older AF patients were identified.Overall, 367 patients (mean age 77.8 years) were reviewed, among which 94.8% used 5 medications or more and over half used 10 medications or more. Cardiovascular agents were most commonly used (98.9%), followed by antithrombotics (90.7%). Among agents deemed PIMs, digoxin (30.2%) was the most frequently used, followed by benzodiazepines (19.6%), and sotalol (9.8%). AF patients using polypharmacy were more likely to have low bleeding risk (OR=10.97), representing those patients in whom high-risk antithrombotics are mostly indicated. Patients with major-polypharmacy (5-9 medications) are more likely to have obstructive pulmonary diseases (OR=2.32), upper gastrointestinal diseases (OR=2.02) and poor physical function (OR=1.04), but less likely to have cognitive impairment (OR=0.27).Polypharmacy affects oldest AF patients, comprising medications that are indicated for AF, yet regarded as PIMs. Patients with lower risk of bleeding, obstructive pulmonary diseases, upper gastrointestinal diseases and poor physical function are also at higher risk of using higher number of medications. This may lead to an increased risk for medication mis...
Bajorek, B, LeMay, K, Gunn, K & Armour, C 2015, 'The potential role for a pharmacist in a multidisciplinary general practitioner super clinic.', Australasian Medical Journal, vol. 8, no. 2, pp. 52-63.View/Download from: Publisher's site
BACKGROUND: The Australian government's General Practitioner (GP) super clinics programme aims to provide well-integrated, multidisciplinary, patient-centred care for people with chronic disease. However, there is no research into the current role of pharmacists in this setting. AIMS: To explore the perspectives of GP super clinic staff on current and potential (future) pharmacist-led services provided in this setting. METHODS: Individual interviews (facilitated using a semi-structured interview guide and thematically analysed) were conducted with purposively sampled staff of a GP super clinic in a semirural location in the state of New South Wales, until theme saturation. Participating staff included (n=9): three GPs, one pharmacist, one nurse, one business manager, and three reception staff. RESULTS: Three themes emerged conveying perspectives on: working relationships between staff; a pharmacist's current role; and potential future roles for a pharmacist. All clinic staff actively engaged the pharmacist in their "team approach". Currently established roles for home medicines reviews (HMRs) and drug information were well supported, but needed to be expanded, for example, with formalised case conferences between GPs, pharmacists, and other staff. New roles needed be explored in auditing medication use, optimising medication records, specialised drug information, dispensing, and prescribing. Although GPs had differing views about opportunities for pharmacists' prescribing in this setting, they saw several benefits to this service, such as reducing the time pressure on GPs to enable more effective consultations. CONCLUSION: Results suggest a pharmacist's services can potentially be better used within the multidisciplinary super clinic model of care to address current gaps within the semi-rural practice setting. Any future role for the pharmacist could be addressed as part of a formalised, strategic approach to creating an integrated healthcare team, with attention...
Bajorek, B, Magin, P, Hilmer, S & Krass, I 2015, 'Contemporary approaches to managing atrial fibrillation: A survey of Australian general practitioners.', Australasian Medical Journal, vol. 8, no. 11, pp. 357-367.View/Download from: Publisher's site
Recent attention to the management of atrial fibrillation (AF) and stroke prevention has emphasised the need to support the use of existing pharmacotherapy through available services and resources, in preference to using the new, more expensive, novel oral anticoagulants. In this regard, general practitioners (GPs) are at the core of care.To survey Australian GPs regarding their approach to managing AF, particularly in relation to stroke prevention therapy, and to identify the range of services to support patient care.A structured questionnaire, comprising quantitative and qualitative responses, was administered to participating GPs within four geographical regions of NSW (metropolitan, regional, rural areas).Fifty GPs (mean age 53.74±9.94 years) participated. Most (98 per cent) GPs regarded themselves as primarily responsible for the management of AF, only referring patients to specialists when needed. However, only 10 per cent of GPs specialised in "heart/vascular health". Most (76 per cent) GPs offered point-of-care international normalised ratio (INR) testing, with 90 per cent also offering patient support via practice nurses and home visits. Overall, key determinants influencing GPs' initiation of antithrombotic therapy were: "stroke risk"/"CHADS2 score", followed by "patients' adherence/compliance". GPs focused more on medication safety considerations and the day-to-day management of therapy than on the risk of bleeding.Australian GPs are actively engaged in managing AF, and appear to be well resourced. Importantly, there is a greater focus on the benefits of therapy during decision-making, rather than on the risks. However, medication safety considerations affecting routine management of therapy remain key concerns, with patients' adherence to therapy a major determinant in decision-making.
Bajorek, BV, Lemay, KS, Magin, PJ, Roberts, C, Krass, I & Armour, CL 2015, 'Preparing pharmacists to deliver a targeted service in hypertension management: evaluation of an interprofessional training program', BMC MEDICAL EDUCATION, vol. 15.View/Download from: Publisher's site
Krzyzaniak, N, Pawłowska, I, Pawłowski, L & Bajorek, B 2015, 'Rola i zadania farmaceuty w systemie ochrony zdrowia w Australii i w Polsce : analiza porównawcza', Farmacja Polska, vol. 71, no. 10, pp. 650-655.
The role of the pharmacist in the health care system is defined and governed by international standards, national laws and each individual country's established practice models. This article presents a comparison of the pharmacist in Australia and Poland, both in terms of education, the scope of their activities and the degree of involvement in the provision of pharmaceutical services. The range of roles a pharmacist is required to perform in Poland is clearly defined in legislation, however in Australia is governed by pharmaceutical practice standards. Despite this, a pharmacist in Australia performs more specialized tasks and is more involved in clinical work and educational activities. On the other hand, in both countries the law clearly defines the criteria needed in obtaining professional pharmacist qualifications and the level of tertiary education required. The regulation of pharmaceutical services is not sufficient in ensuring their development and implementation in practice. These objectives can be achieved through the provision of adequate funding which allows the pharmacist to become a significant contributor to the health care system. Performing an analysis of the differences in pharmaceutical services provided in Australia or Poland can be a starting point in determining efficient models of service and the changes required to improve current pharmacist practice. As such, this article seeks to compare the mandatory roles of pharmacists that are required to be performed in clinical practice in Polish and Australian settings as per the governing pharmaceutical laws.
Lloyd, GF, Bajorek, B, Barclay, P & Goh, S 2015, 'Narrative review: Status of key performance indicators in contemporary hospital pharmacy practice', Journal of Pharmacy Practice and Research, vol. 45, no. 4, pp. 396-403.View/Download from: Publisher's site
© 2015 Society of Hospital Pharmacists Australia. Aim:The aim of this review was to explore the status of key performance indicators (KPIs) in Australian hospital pharmacy practice. Data sources:For this narrative review, databases (MEDLINE, PubMed and EBSCO) were searched for relevant publications within the period from April 1980 to April 2014 using the following search terms: hospital pharmacy, key performance indicators, performance measures, clinical indicators and benchmarking. The inclusion criteria were as follows: full text papers (papers only available as abstracts were discarded) and English language. Reference lists of selected papers were also searched to identify additional literature. Results:While there are established competencies, standards and quality use of medicines (QUM) indicators for hospital pharmacy in Australia, there are no standardised KPIs relating to the performance and practice of hospital pharmacy. International research has demonstrated that KPIs are valuable tools for measuring pharmacy performance; the need for KPIs is highlighted in research from the UK, USA, Canada, New Zealand and Australia. Particular challenges associated with KPI implementation include: the need for relevance to all stakeholders; difficulties in measuring pharmacists' activities due to the inherent nature of their work; lack of resources for data collection; limited understanding of KPIs; and negative attitudes toward KPIs by some pharmacists. Conclusion:Before nationally standardised KPIs are introduced into Australian hospital pharmacy practice, attention must be paid to developing relevant measures through careful consultation with all relevant stakeholders, including pharmacists themselves. KPIs should provide relevant results, be easy to measure and highlight the value of hospital pharmacy services in a resource-friendly manner.
Rahmawati, R & Bajorek, B 2015, 'A Community Health Worker–Based Program for Elderly People With Hypertension in Indonesia: A Qualitative Study, 2013', Preventing Chronic Diseases: Public health research, practice, and policy, vol. 12.View/Download from: Publisher's site
Hypertension is prevalent in the elderly, but treatment is often inadequate, particularly in developing countries. The objective of this study was to explore the role of a community-based program in supporting patients with hypertension in an Indonesian rural community.
A qualitative study comprising observation and in-depth interviews was conducted in an Integrated Health Service Post for the Elderly (IHSP-Elderly) program in Bantul district (Yogyakarta province). Eleven members of IHSP-Elderly program (ie, hypertensive patients), 3 community health workers (CHWs), and 1 district health staff member were interviewed to obtain their views about the role of the IHSP-Elderly program in hypertension management. Data were analyzed using thematic analysis.
CHWs played a prominent role as the gatekeepers of health care in the rural community. In supporting hypertension management, CHWs served members of the IHSP-Elderly program by facilitating blood pressure checks and physical exercise and providing health education. Members reported various benefits, such as a healthier feeling overall, peer support, and access to affordable health care. Members felt that IHSP-Elderly program could do more to provide routine blood pressure screening and improve the process of referral to other health care services.
CHWs have the potential to liaise between rural communities and the wider health care system. Their role needs to be strengthened through targeted organizational support that aims to improve delivery of, and referral to, care. Further study is needed to identify the key factors for effective CHW-based programs in rural communities and the incorporation of these programs into the health care system.
Dominey-Howes, D, Bajorek, B, Michael, CA, Betteridge, B, Iredell, J & Labbate, M 2015, 'Applying the emergency risk management process to tackle the crisis of antibiotic resistance', FRONTIERS IN MICROBIOLOGY, vol. 6.View/Download from: Publisher's site
Alhawassi, TM, Krass, I, Bajorek, BV & Pont, LG 2014, 'A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting', CLINICAL INTERVENTIONS IN AGING, vol. 9, pp. 2079-2086.View/Download from: Publisher's site
Bajorek, B, Magin, P, Hilmer, S & Krass, I 2014, 'A cluster-randomized controlled trial of a computerized antithrombotic risk assessment tool to optimize stroke prevention in general practice: a study protocol', BMC HEALTH SERVICES RESEARCH, vol. 14.View/Download from: Publisher's site
Eissa, A, Krass, I & Bajorek, BV 2014, 'Use of medications for secondary prevention in stroke patients at hospital discharge in Australia', INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, vol. 36, no. 2, pp. 384-393.View/Download from: Publisher's site
Hanna, T, Bajorek, B, Lemay, K & Armour, CL 2014, 'Using scenarios to test the appropriateness of pharmacist prescribing in asthma management.', Pharmacy Practice, vol. 12, no. 1, pp. 1-7.
Singh, S & Bajorek, B 2014, 'Defining 'elderly' in clinical practice guidelines for pharmacotherapy.', Pharmacy Practice, vol. 12, no. 4, pp. 489-489.
OBJECTIVE: To identify how 'elderly' patients are defined and considered within Australian clinical guidelines for the use of pharmacotherapy. METHOD: Guidelines pertaining to the use of pharmacotherapy, focusing on conditions described in National Health Priority Areas, were identified using databases (Medline, Google Scholar) and organisation websites (Department of Health and Ageing, National Heart Foundation, National Health and Medical Research Council). Guidelines were reviewed and qualitatively analysed to identify any references or definitions of 'elderly' persons. RESULTS: Among the 20 guidelines reviewed, 3 defined 'elderly' by chronological age (i.e., years since birth) while the remaining 17 guidelines did not define 'elderly' in any way. All 20 guidelines used the term 'elderly', whilst some guidelines provided age (chronological)-based dosage recommendations suggesting an ageist or generalist approach in their representation of 'elderly', for which rationale was seldom provided. Thematic analysis of the statements revealed five key themes regarding how 'elderly' was considered within the guidelines, broadly describing 'elderly' persons as being frail and with altered pharmacology. Some guidelines also highlighted the limited evidence base to direct clinical decision-making. A continuum of perceptions of ageing also emerged out of the identified themes. CONCLUSION: Clinical practice guidelines currently do not adequately define 'elderly' persons and provide limited guidance on how to apply treatment recommendations to older persons. The representation of 'elderly' in guidelines needs to be less based on chronological age or generic definitions focusing more on establishing a direct link between an individual patient's characteristics and the pharmacology of their prescribed medication. Clinical guidelines that do not offer any practical descriptions of the features of ageing that are specifically related to the use of pharmacotherapy, or how to asses...
Wang, Y & Bajorek, B 2014, 'New oral anticoagulants in practice: pharmacological and practical considerations.', American Journal of Cardiovascular Drugs, vol. 14, no. 3, pp. 175-189.View/Download from: Publisher's site
Although highly effective, warfarin use is complicated by its unpredictable narrow therapeutic window, genetic heterogeneity in pharmacokinetic response, numerous food and drug interactions, and the need for regular international normalized ratio (INR) monitoring. Currently, several novel oral anticoagulant (NOAC) drugs (dabigatran, rivaroxaban, apixaban) are available on the market as alternatives to warfarin. These agents all feature more predictable pharmacodynamic and pharmacokinetic properties than warfarin. Additionally, the NOACs do not require routine monitoring of coagulation parameters, and have a relatively lower potential for interactions with drug, herb, and dietary constituents, which enhances the convenience of management for both patients and health professionals alike. However, there are other considerations regarding the use of NOACs that must be taken into account during management of therapy. In contrast to warfarin, most NOACs need dosage adjustments in renal impairment and are contraindicated in severe liver impairment, and there are no specific antidotes for treating NOAC-related over-anticoagulation. The more frequent dosing needed for NOACs may reduce adherence, especially in elderly patients with polypharmacy. Furthermore, NOACs, especially dabigatran, are not as well tolerated as warfarin in patients with gastrointestinal diseases. Overall, the availability of the NOACs has expanded the treatment armamentarium, but they are not without risk. Given the limited experience with the NOACs, their limited range of indications, and their cost, the characteristics of each anticoagulant must be carefully considered to carefully select the agent that will provide the optimal risk/benefit profile in the individual patient.
Wang, Y & Bajorek, B 2014, 'Safe use of antithrombotics for stroke prevention in atrial fibrillation: consideration of risk assessment tools to support decision-making.', Therapeutic Advances in Drug Safety, vol. 5, no. 1, pp. 21-37.View/Download from: Publisher's site
Clinical guidelines advocate stroke prevention therapy in atrial fibrillation (AF) patients, specifically anticoagulation. However, the decision to initiate treatment is based on the risk (bleeding) versus benefit (prevention of stroke) of therapy, which is often difficult to assess. This review identifies available risk assessment tools to facilitate the safe and optimal use of antithrombotic therapy for stroke prevention in AF. Using key databases and online clinical resources to search the literature (1992-2012), 19 tools have been identified and published to date: 11 addressing stroke risk, 7 addressing bleeding risk and 1 integrating both risk assessments. The stroke risk assessment tools (e.g. CHADS2, CHA2DS2-VASc) share common risk factors: age, hypertension, previous cerebrovascular attack. The bleeding risk assessment tools (e.g. HEMORR2HAGES, HAS-BLED) share common risk factors: age, previous bleeding, renal and liver impairment. In terms of their development, six of the stroke risk assessment tools have been derived from clinical studies, whilst five are based on refinement of existing tools or expert consensus. Many have been evaluated by prospective application to data from real patient cohorts. Bleeding risk assessment tools have been derived from trials, or generated from patient data and then validated via further studies. One identified tool (i.e. Computerised Antithrombotic Risk Assessment Tool [CARAT]) integrates both stroke and bleeding, and specifically considers other key factors in decision-making regarding antithrombotic therapy, particularly those increasing the risk of medication misadventure with treatment (e.g. function, drug interactions, medication adherence). This highlights that whilst separate tools are available to assess stroke and bleeding risk, they do not estimate the relative risk versus benefit of treatment in an individual patient nor consider key medication safety aspects. More effort is needed to synthesize these separat...
Eissa, A, Krass, I, Levi, C, Sturm, J, Ibrahim, R & Bajorek, B 2013, 'Understanding the reasons behind the low utilisation of thrombolysis in stroke.', Australasian Medical Journal, vol. 6, no. 3, pp. 152-167.View/Download from: Publisher's site
Background Thrombolysis remains the only approved therapy for acute ischaemic stroke (AIS); however, its utilisation is reported to be low. Aims This study aimed to determine the reasons for the low utilisation of thrombolysis in clinical practice. Method Five metropolitan hospitals comprising two tertiary referral centres and three district hospitals conducted a retrospective, cross-sectional study. Researchers identified patients discharged with a principal diagnosis of AIS over a 12-month time period (July 2009July 2010), and reviewed the medical record of systematically chosen samples.
Alene, M, Wiese, MD, Angamo, MT, Bajorek, B, Yesuf, EA & Wabe, NT 2012, 'Adherence to medication for the treatment of psychosis: rates and risk factors in an Ethiopian population', BMC Pharmacology and Toxicology, vol. 12, no. 10, pp. 1-9.View/Download from: Publisher's site
Background: Medication-taking behavior, specifically non-adherence, is significantly associated with treatment outcome and is a major cause of relapse in the treatment of psychotic disorders. Non-adherence can be multifactorial; however, the rates and associated risk factors in an Ethiopian population have not yet been elucidated. The principal aim of this study was to evaluate adherence rates to antipsychotic medications, and secondarily to identify potential factors associated with non-adherence, among psychotic patients at tertiary care teaching hospital in Southwest Ethiopia. Methods: A cross-sectional study was conducted over a 2-month period in 2009 (January 15th to March 20th) at the Jimma University Specialized Hospital. Adherence was computed using both a compliant fill rate method and self-reporting via a structured patient interview (focusing on how often regular medication doses were missed altogether, and whether they missed taking their doses on time). Data were analyzed using SPSS for windows version 16.0, and chi-square and Pearsons r tests were used to determine the statistical significance of the association of variables with adherence.
Bajorek, B & Ren, S 2012, 'Utilisation of antithrombotic therapy for stroke prevention in atrial fibrillation in a Sydney hospital: then and now', International Journal of Clinical Pharmacy, vol. 34, pp. 88-97.View/Download from: Publisher's site
Objective Evidence from pivotal clinical trials conducted more than a decade ago supports the use of antithrombotic therapy, particularly warfarin, for stroke prevention in atrial fibrillation (AF). Despite the wide dissemination of this evidence since that time, there is anecdotal evidence that utilisation of therapy remains suboptimal, especially in the target elderly population, which is reflected in the development of practice tools such as the TAG Clinical Indicator ('Antithrombotics in AF' Indicator 1.6, 2007). Therefore, the objective of this study was to determine the current utilisation of antithrombotic therapy for elderly patients with AF in the local setting, and to compare this utilisation with the results of a prior audit (AUDIT 1), as well as against the recommendations of the TAG Clinical Indicator(TAG IND).
Bajorek, B, Masood, N & Krass, I 2012, 'Development Of A Computerised Antithrombotic Risk Assessment Tool (Carat) To Optimise Therapy In Older Persons With Atrial Fibrillation', Australian Journal of Ageing, vol. 31, no. 2, pp. 102-109.View/Download from: Publisher's site
Aim: To develop and evaluate a novel Computerised Antithrombotic Risk Assessment Tool (CARAT) to aid clinicians' decision making regarding the riskbenefit of antithrombotic therapy in older patients. Methods: CARAT was developed in an iterative process i
Bassett-Clarke, D, Krass, I & Bajorek, B 2012, 'Ethnic differences of medicines-taking in older adults: a cross cultural study in New Zealand', International Journal of Pharmacy Practice, vol. 20, pp. 90-98.View/Download from: Publisher's site
Objectives The literature identifies many barriers to medicines use, including bio-psycho-social issues, but less is known regarding ethno-cultural barriers, which are important in culturally diverse nations. The aim of this study was to explore ethnic differences in attitudes to medicines and medicines-taking, focusing on the main constituents of the New Zealand (NZ) population: NZ European, Maori (the indigenous people of NZ), Pacific and Asian peoples. Methods A qualitative study involving a series of focus groups was conducted. Participants (>50 years old) taking medicines were recruited from various community-based groups. The focus group discussions were transcribed verbatim and analysed for key themes via manual inductive coding and constant comparison. Key findings Twenty focus groups (n = 100 participants) were conducted. Three key common themes emerged: (1) conception of a medicine; (2) self-management of medication; and (3) seeking further medicines information. In general, NZ European participants had a very narrow view of what a medicine is, were motivated to source medicines information independently and were very proactive in medicines management.
Eissa, A, Krass, I & Bajorek, B 2012, 'Barriers to the utilization of thrombolysis for acute ischaemic stroke', Journal of Clinical Pharmacy & Therapeutics, vol. 37, pp. 399-409.View/Download from: Publisher's site
Thrombolysis is currently the only evidence-based pharmacological treatment available for acute ischaemic stroke (AIS); however, its current utilization is suboptimal (administered to <3% of AIS patients). The aim of this article was to identify the potential barriers to the use of thrombolysis via a review of the available literature. Methods: Medline, Embase, International Pharmaceutical Abstracts and Google Scholar were searched to identify relevant original articles, review papers and other literature published in the period 1995-2011. Results and Discussion: Several barriers to the utilization of thrombolysis in stroke have been identified in the literature and can be broadly classified as 'preadmission' barriers and 'post-admission' barriers.The most effective interventions appear to be those comprising several strategies and those that target more than one barrier simultaneously. Therefore, optimal utilization of thrombolysis requires a systematic, integrated multidisciplinary approach across the continuum of acute care.
Eissa, A, Krass, I & Bajorek, B 2012, 'Optimizing the management of acute ischaemic stroke: a review of the utilization of intravenous recombinant tissue plasminogen activator (tPA)', Journal of Clinical Pharmacy and Therapeutics, vol. 37, no. 6, pp. 620-629.View/Download from: Publisher's site
What is known and Objective: Thrombolysis using intravenous tissue plasminogen activator (tPA) is the only available evidence-based treatment for acute ischaemic stroke; however, its current utilization is very low. Therefore, the aim of this article is to review the literature regarding the use of intravenous tPA for the treatment of acute ischaemic stroke. The review will also compare utilization rates of thrombolysis in different centres across the world and identify key reasons for the underutilization of thrombolysis in stroke. Methods: MEDLINE, EMBASE, International Pharmaceutical Abstracts (IPA) and Google Scholar were searched for relevant original articles, review papers and other publications over the publication period 1995-2012. Results and Discussion: The National Institute of Neurological Disorders and Stroke (NINDS) (1995, N = 624 patients) and ECASS III (2008, N = 821 patients) are two pivotal randomized controlled trials providing evidence for the use of intravenous tPA within 3 h or 3-4·5 h from stroke onset, respectively. Both trials have shown that tPA administration decreases disability at 90 days from stroke. Furthermore, a recent pooled analysis of randomized controlled trials (2010, N = 3670 patients) supports these results, highlighting that early stroke treatment is associated with better outcomes, especially when treatment is started within 90 min of stroke onset (but suggesting that the benefit could be afforded within a 4·5-h time window). Three major observational trials, STARS (2000, N = 389 patients), CASES (2005, N = 1135 patients) and SITS-MOST (2007, N = 6483 patients), have reported acceptable safety and efficacy in clinical practice. However, only a small proportion of acute ischaemic stroke patients receive tPA in clinical practice, because of the limited availability of tPA-utilizing sites and suboptimal use of tPA in sites where it is available. What is new and Conclusion: tPA reduces disability in stroke patients
Nasser, S, Cecchele, R, Touma, S, Han, P, Nair, K, Vizgoft, J, Murdoch, V, Mullan, J & Bajorek, B 2012, 'Documentation of Warfarin Education provided to Hospital Patients: A Clinical Audit', Journal of Pharmacy Practice and Research, vol. 42, no. 2, pp. 129-133.
Background: Effective management of warfarin therapy is often challenged by its complex pharmacology and preventable adverse events. One strategy to ensure safe warfarin use is provision of comprehensive warfarin education to patients. Aim: To review the provision of warfarin education to hospital patients prescribed warfarin and to describe patient characteristics that may impact on warfarin education. Method: A prospective study was undertaken at 2 large Australian metropolitan hospitals. Provision of warfarin education was identified by auditing the medication charts and clinical notes of hospitalised older patients (= 65 years). Patients were also interviewed to confirm whether they recalled receiving warfarin education during their hospital stay. Results: Data were collected for 96 patients with a mean age of 74 (SD 13) years. Most patients (78%) were admitted to medical wards, were taking warfarin for atrial fibrillation (56%), and had started warfarin prior to admission (54%). 36% of patients had provision of warfarin education documented in medication charts and clinical notes, and in most cases warfarin education was provided by a pharmacist. Of the 68 patients available for interview, only 47% recalled receiving warfarin education; in the majority of cases they cited pharmacists as providers of the education. Conclusion: There is a need to improve documentation and provision of warfarin education to hospital patients
Nasser, S, Mullan, J & Bajorek, B 2012, 'Assessing the quality, suitability and readability of internet-based health information about warfarin for patients', Australasian Medical Journal, vol. 5, no. 3, pp. 194-203.View/Download from: Publisher's site
The usefulness of internet-based patient information is often limited by challenges associated with finding valid and reliable health information. Given patients' increasing access of the internet for information, this study investigated the quality, suitability and readability of patient information about warfarin presented on the internet. Method Previously validated tools were used to evaluate the quality, suitability and readability of patient information about warfarin on selected websites. Results The initial search yielded 200 websites, of which 11 fit selection criteria, comprising seven non-commercial and four commercial websites. Regarding quality, most of the non-commercial sites (six out of seven) scored at least an 'adequate' score. With regard to suitability, 6 of the 11 websites (including two of the four commercial sites) attained an 'adequate' score. It was determined that information on 7 of the 11 sites (including two commercial sites) was written at reading grade levels beyond that considered representative of the adult patient population with poor literacy skills (e.g. school grade 8 or less). Conclusion Despite the overall 'adequate' quality and suitability of the internet derived patient information about warfarin, the actual usability of such websites may be limited due to their poor readability grades, particularly in patients with low literacy skills
Nasser, S, Mullan, J & Bajorek, B 2012, 'Challenges of older patients' knowledge about warfarin therapy', Journal of Primary Care & Community Health, vol. 3, no. 1, pp. 65-74.View/Download from: Publisher's site
To review the challenges of warfarin education for older patients (aged 65 years or older) in terms of knowledge, access to warfarin education, and education resources. Methods: A quasi-systematic review of the literature was performed via electronic database searches (eg, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Meditext, and Google Scholar) from 1990 to May 2011. Results: The 62 articles reviewed found that improved patient knowledge results in better anticoagulation control. The review also found that between 50% and 80% of older patients have inadequate knowledge about the basic aspects of warfarin therapy (eg, action, benefits and risks, interactions with other drugs or foods, international normalized ratio management). Demographic factors, such as advancing age, lower family income, and limited health literacy, were found to inversely affect patients warfarin knowledge, and access to warfarin education and information resources were often suboptimal in different practice settings. Finally, a number of educational strategies and resources that could be readily incorporated to improve the effectiveness of current warfarin education programs were extracted from the review. Conclusion: This comprehensive review highlights that education about warfarin in older patients is currently suboptimal and may in part contribute to poor therapeutic outcomes. This review article also acknowledges the need to identify, target, and develop educational strategies and resources to further improve older patients knowledge about their warfarin therapy.
Nasser, S, Mullan, J & Bajorek, B 2012, 'Educating patients about warfarin therapy using information technology: A survey on healthcare professionals´ perspectives', Pharmacy Practice, vol. 10, no. 2, pp. 97-104.View/Download from: Publisher's site
Objective: To explore healthcare professionals´ views about the benefits and challenges of using information technology (IT) resources for educating patients about their warfarin therapy. Methods: A cross-sectional survey of both community and hospital-based healthcare professionals (e.g., doctors, pharmacists and nurses) involved using a purpose-designed questionnaire. The questionnaires were distributed using a multi-modal approach to maximise response rates. Results: Of the total 300 questionnaires distributed, 109 completed surveys were received (43.3% response rate). Over half (53.2%) of the healthcare participants were aged between 40-59 years, the majority (59.5%) of whom were female. Fifty nine (54.1%) participants reported having had no access to warfarin-specific IT-based patient education resources, and a further 19 (38.0%) of the participants who had IT-access reported that they never used such resources. According to the healthcare participants, the main challenges associated with educating their patients about warfarin therapy included: patient-related factors, such as older age, language barriers, cognitive impairments and/or ethnic backgrounds or healthcare professional factors, such as time constraints.
Stafford, L, van Tienen, E, Peterson, G, Bereznicki, L, Jackson, S, Bajorek, B, Mullan, J & DeBoos, I 2012, 'Warfarin management after discharge from hospital: a qualitative analysis', Journal Of Clinical Pharmacy And Therapeutics, vol. Sept 2011, pp. 1-5.View/Download from: Publisher's site
What is Known and Objective: Warfarin is recognized as a high-risk medication for adverse events, and the risks are particularly heightened in the period immediately following a patients discharge from hospital. This qualitative study aimed to explore the experiences of Australian patients and healthcare professionals of warfarin management in the postdischarge period and identify the benefits and deficiencies of existing systems, to inform the development of a model for a new collaborative post-discharge warfarin management service. Methods: Healthcare professionals, professional organization representatives and patients recently discharged from hospital taking warfarin (consumers) were recruited via purposive, criterion-based sampling within two Australian states. Semi-structured telephone interviews were conducted between August and October 2008 using standard discussion guides. Data were manually analyzed to identify emergent themes using a phenomenological approach. Results: Forty-seven participants were involved in the telephone interviews. Three major themes emerged: (i) appropriate warfarin education is integral to effective warfarin management, (ii) problems occur in communication along the continuum of care and (iii) home-delivered services are valuable to both patients and healthcare professionals. Discussion: Although high-quality warfarin education and effective communication at the hospitalcommunity interface were identified as important in post-discharge warfarin management, deficiencies were perceived within current systems. The role of home-delivered services in ensuring timely follow-up and promoting continuity of care was recognized. Previous studies exploring anticoagulation management in other settings have identified similar themes. Post-discharge management should therefore focus on providing patients with a solid foundation to minimize future problems. What is New and Conclusion: Addressing the three identifed facets of care within a new, ...
Wright, LC, Hill, KD, Bernhardt, J, Lindley, R, Ada, L, Bajorek, B, Barber, P, Beer, C, Golledge, J, Gustafsson, L, Hersh, D, Kenardy, J, Middleton, S, Brauer, S & Nelson, MP 2012, 'Stroke Management: Updated Recommendations For Treatment Along The Care Continuum', Internal Medicine Journal, vol. 42, no. 5, pp. 562-569.View/Download from: Publisher's site
The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the
Bajorek, B 2011, 'A review of the safety of anticoagulants in older people using the medicines management pathway: weighing the benefits against the risks', Therapeutic Advances in Drug Safety, vol. 2, no. 2, pp. 45-58.View/Download from: Publisher's site
Anticoagulant drugs maintain a high potential for adverse events due to their inherent risk of haemorrhage and/or complex pharmacology. In addition, compromising the safety of these agents is the context in which they are principally used; that is, in the long-term prevention of thromboembolic diseases in an older patient population. These challenges are especially pronounced in the prevention of stroke in older persons with atrial fibrillation (AF), where the need for thromboprophylaxis is paramount and in whom the arrhythmia is most prevalent, but where the target population is simultaneously at high risk of adverse drug events. Essentially, this translates to the use of high-risk therapies on an indefinite basis, in persons who have multiple comorbidities, use polypharmacy, and who may have age-related functional and cognitive decline, culminating in a higher potential for medication misadventure. For this reason, anticoagulants mandate extra pharmacovigilance, and therefore the aim of this review is to address some of the key safety considerations in the use of anticoagulant drugs (warfarin, dabigatran, rivaroxaban), spanning the initiation of therapy to its ongoing management. Using the Medication Management Pathway (MMP) as a framework, in this review we canvas and highlight specific developments in practical strategies to facilitate the safe use of anticoagulants (particularly warfarin) in `at-risk' elderly patients including: comprehensive risk/benefit assessment using novel risk stratification tools; focused medicines review services; therapeutic drug monitoring services delivered in the primary care setting; and practical education strategies and resources targeting the older patient population.
ABSTRACT* The short-comings of current anticoagulants have led to the development of newer, albeit more expensive, oral alternatives. Objective: To explore the potential impact the new anticoagulants dabigatran and rivaroxaban in the local hospital setting, in terms of utilisation and subsequent costing. Method: A preliminary costing analysis was performed based on a prospective 2-week clinical audit (29th June - 13th July 2009). Data regarding current anticoagulation management were extracted from the medical files of patients admitted to Ryde Hospital. To model potential costing implications of using the newer agents, the reported incidence of VTE/stroke and bleeding events were obtained from key clinical trials.
Cao, B, Chow, C, Elliott, P, MacPherson, R, Crane, J & Bajorek, B 2011, 'Implementing a pharmacist charting service in the pre-admission clinic', Journal of Pharmacy Practice and Research, vol. 41, no. 2, pp. 102-107.
Aim: To implement a pharmacist charting service in the pre- admission clinic (PAC) and describe a preparatory process for the initiation of this service. Method: Stage 1: a proposal for a pharmacist charting service in the PAC was devised via an iterative process with an advisory panel. Stage 2: feedback on the proposal was obtained from key staff via a survey comprising 15 linear scale statements (0 = strongly disagree to 10 = strongly agree) and openended questions. Stage 3: baseline data were collected on existing PAC service outcomes, e.g. consultation times, accuracy of medication charts.
Castelino, R, Bajorek, B & Chen, T 2011, 'Are interventions recommended by pharmacists during Home Medicines Review evidence-based?', Journal Of Evaluation In Clinical Practice, vol. 17, no. 1, pp. 104-110.View/Download from: Publisher's site
Introduction Over the past decade medication review services have been implemented in many countries, including Australia, UK and USA. Although, the attitudes and barriers to the implementation of evidence-based medicine have been investigated, the extent to which medication review recommendations are evidence-based is not known. Objective To determine (1) the extent to which pharmacists recommendations during medication review services were consistent with the evidence-based guides at the time of the review; and (2) the nature and extent of drug-related problems (DRPs) and the actions recommended by pharmacists to resolve DRPs. Method A retrospective review of Home Medicines Review cases performed on 224 community-dwelling older people (65 years or older). The chi-squared test for categorical variables was used to compare the proportion of recommendations that were evidencebased and recommendations for which no evidence could be identified in the most common Australian information sources. DRPs and the actions recommended to resolve the DRPs were classified according to previously employed criteria. Results Pharmacists made a total of 1114 therapeutic recommendations to general practitioners, of which 964 required supporting pharmacotherapeutic evidence. The majority (94%) of the pharmacists recommendations were in accordance with the evidence-based guides, as compared with the recommendations for which no evidence could be identified (P < 0.001). Pharmacists reported that 98% of the patients had at least one problem with use of their medication detected.
Kumar, N, Knowler, C, Strumpman, D & Bajorek, B 2011, 'Facilitating medication misadventure risk assessment in the emergency medical unit', Journal of Pharmacy Practice and Research, vol. 41, no. 2, pp. 108-112.
Background: The risk of medication misadventure is heightened in emergency settings. Identifying at-risk patients is integral to minimising medication-related adverse events. Aim: To pilot a medication misadventure risk assessment tool to identify at-risk patients.
Lee, Y, Levy, R & Bajorek, B 2011, 'Restricted Antimicrobial Use At Transitions Of Care At An Australian Hospital', Journal of Pharmacy Practice and Research, vol. 41, no. 4, pp. 283-287.
Background: The emergence of antimicrobial resistance reinforces the need for antimicrobial stewardship to promote the appropriate and judicious use of antimicrobials. Aim: To quantify restricted antimicrobial use among intensive care unit (ICU) discharg
Stafford, L, Peterson, G, Bereznicki, L, Jackson, S, van Tienen, E, Angley, M, Bajorek, B, McLachlan, A, Mullan, J, Misan, GM & Gaetani, L 2011, 'Clinical Outcomes of a Collaborative, Home-Based Postdischarge Warfarin Management Service', Annals Of Pharmacotherapy, vol. 45, no. 3, pp. 325-334.View/Download from: Publisher's site
Background: Warfarin Remains A High-Risk Drug For Adverse Events, Especially Following Discharge From The Hospital. New Approaches Are Needed To Minimize The Potential For Adverse Outcomes During This Period. Objective: To Evaluate The Clinical Outcomes
Yip, A & Bajorek, B 2011, 'Prescribing of anti-arrhythmics for atrial fibrillation', Australian Journal of Pharmacy, vol. 92, no. 1091, pp. 85-87.
A retrospective clinical audit was conducted over a three-month period (August to October 2008) of the medical records of patients with AF at a large Sydney teaching hospital. The approval of the local human research ethics committee was obtained prior to study commencement.
Castelino, R, Bajorek, B & Chen, T 2010, 'Retrospective evaluation of home medicines review by pharmacists in older australian patients using the medication appropriateness index', The Annals of Pharmacotherapy, vol. 44, no. 12, pp. 1922-1929.View/Download from: Publisher's site
Background: Home Medicines Review (HMR), a community-based collaborative service provided by general practitioners (GPs) and accredited pharmacists in Australia, has demonstrated effectiveness in preventing, detecting, and resolving medication-related pr
Castelino, R, Chen, T, Guddattu, V & Bajorek, B 2010, 'Use of Evidence-Based Therapy for the Prevention of Cardiovascular Events Among Older people', Evaluation & The Health Professions, vol. 33, no. 3, pp. 276-301.View/Download from: Publisher's site
Evidence-based therapies (EBTs) for the prevention of cardiovascular disease (CVD) are reportedly underutilized in older people. The primary purpose of this study was to evaluate the use of EBTs for the prevention of CVD events in older people and secondarily whether a Home Medicines Review (HMR) service by pharmacists predicts the use of these medicines. A retrospective cross-sectional audit of HMR reports pertaining to 608 community-dwelling older people (65 years) was conducted. EBTs considered for this audit included four guideline-recommended therapies for CVD: antithrombotic therapy (warfarin+antiplatelet therapy), b-blockers, statins, and angiotensin agents (angiotensin-converting enzyme inhibitors [ACEI]+angiotensin II receptor blockers [ARBs]).
Castelino, R, Hilmer, SN, Bajorek, B, Nishtala, P & Chen, T 2010, 'Drug Burden Index and Potentially Inappropriate Medications in Community-Dwelling Older People The Impact of Home Medicines Review', Drugs & Aging, vol. 27, no. 2, pp. 135-148.View/Download from: Publisher's site
Background: A Significant Problem In Older People (Aged >= 65 Years) Is The Use Of Potentially Inappropriate Medications (Pims), Including Those With Sedative And Anticholinergic Properties. However, Effective Intervention Strategies Have Yet To Be Ident
Yip, A & Bajorek, B 2010, 'Identifying temporal changes to the prescribing of anti-arrhythmics for atrial fibrillation', Journal of Pharmacy Practice and Research, vol. 40, no. 4, pp. 285-289.
Background: There are a paucity of data on the use of antiarrhythmics for atrial fibrillation (AF), particularly in view of new treatment guidelines recommending rate control over rhythm control. Aim: To investigate the use of anti-arrhythmics for AF in the local clinical setting. Method: A retrospective clinical audit of the medical records of 174 adult patients with primary or secondary AF was conducted at a large Sydney teaching hospital. Data were collected on patients characteristics, medical history, factors affecting treatment choice and clinical outcomes.
Bajorek, B 2009, 'Reducing the burden of cardiovascular disease', Australian Journal of Pharmacy, vol. 90, no. 1066, p. 72.
Bajorek, B, Ogle, S, Duguid, M, Shenfield, G & Krass, I 2009, 'Balancing risk versus benefit: The elderly patient's perspective on warfarin therapy', Pharmacy Practice, vol. 7, no. 2, pp. 113-123.
Warfarin therapy is underused in the target at-risk elderly population. Clinicians perceive that older patients are reluctant to use this therapy, however the perspective of patients or their carers has yet to be explored. Objective: To explore in-depth the perspectives of elderly patients and/or their carers regarding the use of warfarin therapy. Method: A qualitative study, using semi-structured group interviews was undertaken. The audio-taped discussions were transcribed verbatim, then thematically analysed to identify emergent themes. Group discussions were conducted at a major Sydney teaching hospital, over a 2-month period. Individuals aged 65 years or older (and/or their carers) who were using long-term (6 months) warfarin therapy were recruited by voluntary response to study flyers.
Bajorek, B, Yau, L, Lee, K & Zulueta, W 2009, 'Management of over-anticoagulation in warfarinised hospital patients', Journal of Pharmacy Practice and Research, vol. 39, no. 1, pp. 13-18.
Aim: To determine the number of warfarinised hospital patients experiencing over-anticoagulation; to identify how overanticoagulation is managed and whether local guidelines are adhered to. Method: 2 prospective one-week clinical audits were conducted in 2005 (Audit 1) and 2008 (Audit 2). The medical notes, drug charts and anticoagulation charts of warfarinised patients admitted to hospital were reviewed. The following data were collected: medical histories, warfarin regimen, international normalised ratio results, clinical events and over-anticoagulation clinical management and treatment options.
Castelino, RL, Bajorek, BV & Chen, TF 2009, 'Targeting Suboptimal Prescribing in the Elderly: A Review of the Impact of Pharmacy Services', ANNALS OF PHARMACOTHERAPY, vol. 43, no. 6, pp. 1096-1106.View/Download from: Publisher's site
Hilmer, SN, Perera, V, Mitchell, S, Murnion, B, Dent, J, Bajorek, B, Matthews, S & Rolfson, D 2009, 'The assessment of frailty in older people in acute care', Australian Journal of Ageing, vol. 28, no. 4, pp. 182-188.View/Download from: Publisher's site
Aim: Develop A Measure Of Frailty For Older Acute Inpatients To Be Performed By Non-Geriatricians. Method: The Reported Edmonton Frail Scale (Refs) Was Adapted From The Edmonton Frail Scale For Use With Australian Acute Inpatients. With Acute Patients Ag
Perera, V, Bajorek, B, Matthews, S & Hilmer, SN 2009, 'The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation', Age And Ageing, vol. 38, no. 2, pp. 156-162.View/Download from: Publisher's site
Objective: To Investigate The Impact Of Frailty On The Utilisation Of Antithrombotics And On Clinical Outcomes In Older People With Atrial Fibrillation (Af). Design: Prospective Study Of A Cohort Of 220 Acute Inpatients Aged >= 70 Years With Af, Admitted
Shaw, E, Tofler, G, Buckley, TA, Bajorek, B & Ward, M 2009, 'Therapy for Triggered Acute Risk Prevention: A Study of Feasibility', Heart, Lung and Circulation, vol. 18, no. 5, pp. 347-352.View/Download from: Publisher's site
Background: Heavy physical exertion, emotional stress, heavy meals and respiratory infection transiently increase the risk of myocardial infarction, sudden death and stroke, however it remains uncertain how to use this information for disease prevention.
Buchan, D & Bajorek, B 2008, 'Incidence of venous thromboembolism and thromboprophylaxis after total hip or knee arthroplasty', Journal of Pharmacy Practice and Research, vol. 38, no. 3, pp. 200-204.View/Download from: Publisher's site
Background: Despite numerous guidelines and consensus statements on venous thromboembolism (VTE) prophylaxis, there appears to be a large gap between evidence and practice. Aim: To identify the incidence of VTE, thromboprophylaxis practice, VTE risk factors, and bleeding complications in patients undergoing elective total hip or knee arthroplasty. Method: Patients who underwent elective total hip or knee arthroplasty from 1 January 2004 to 31 December 2005 were identified retrospectively from medical records at two hospitals. A clinical case audit was performed and data collected on the 3- month incidence of VTE, thromboprophylaxis practice, VTE risk factors and bleeding episodes.
Glover, S & Bajorek, B 2008, 'Exploring point-of-care testing of capillary blood in warfarin management', Journal of Pharmacy Practice and Research, vol. 38, no. 4, pp. 300-304.
Background: Long-term warfarin therapy requires intensive laboratory monitoring of venous blood. Reliable and efficient pointofcare testing (POCT) of capillary blood offers an alternative to laboratory monitoring. Aim: To explore the perceptions of health professionals to POCT in warfarin management and to identify the models of monitoring warfarinised patients preferred by health professionals. Method: An exploratory descriptive study that purposively sampled health professionals (hospital pharmacists, specialists, nurses, general practitioners) involved in the management of anticoagulated patients and practising within an area health service. Health professionals were invited to participate in a group discussion on POCT and to then complete a brief survey ranking proposed monitoring models incorporating POCT.
Kung, M & Bajorek, B 2008, 'Medications in pregnancy: Impact on time to lactogenesis after parturition', Journal of Pharmacy Practice and Research, vol. 38, no. 3, pp. 205-208.
Background: Although the many factors that affect the initiation of lactation have been identified, the impact of medications on lactogenesis remains largely unknown. Aim: To explore the impact of medications used during pregnancy on time to lactogenesis after parturition. Method: Data were collected prospectively from women admitted to a metropolitan Sydney hospital for parturition. Information was obtained via a short interview with each patient, as well as from medical notes, drug charts and infant feeding charts.
Nguyen, N & Bajorek, B 2008, 'Pharmacist prescribing in warfarin therapy: Exploring clinical utility in the hospital setting', Journal of Pharmacy Practice and Research, vol. 38, no. 1, pp. 35-39.
Background: Managing warfarin therapy can be challenging and a multidisciplinary approach to achieve optimal outcomes can be beneficial. Internationally, extended roles for pharmacists have involved collaborative prescribing privileges. Aim: To explore the clinical utility and capacity of pharmacists to undertake prescribing functions in anticoagulation management in the hospital setting. Methods: Pharmacists were recruited from a large Sydney teaching hospital. A questionnaire was used to simulate a pharmacist prescribing function and to explore their opinion of the usefulness of prescribing and their confidence to undertake such roles. The appropriateness of pharmacists prescribing decisions was evaluated.
Page, M, Bajorek, B & Brien, JE 2008, 'Prescribing in teaching hospitals: A qualitative study of social and cultural dynamics', Journal of Pharmacy Practice and Research, vol. 38, no. 4, pp. 286-291.
Background: General practitioners integrate an array of social and environmental factors into their prescribing decisions. In teaching hospitals, despite the involvement of multiple practitioners in making and acting on prescribing decisions, little is known about the influence of roles, relationships, professional subcultures and underlying beliefs, on prescribing practices. Aim: To explore the social and cultural dynamics of prescribing in teaching hospitals.
Su, E, Naganathan, V, Fallah, H, Bajorek, B & McLachlan, A 2008, 'Anticoagulation control in hospitalised patients on warfarin', Journal of Pharmacy Practice and Research, vol. 38, no. 4, pp. 292-295.View/Download from: Publisher's site
Background: Anticoagulation control is a strong predictor of clinical outcomes for patients on warfarin. Aim: To identify instances of excessive anticoagulation in hospitalised patients on warfarin and to determine the causes of international normalised ratios (INRs) of 5 and above and the management strategies used to correct it. Method: An observational descriptive study undertaken at a teaching hospital over a 3-month period. Data were reviewed prospectively and retrospectively to measure the percentage of time patients were maintained within their target INR range while in hospital and to identify cases of excessive anticoagulation. Patients were divided into a control group (INR < 5) and a high INR group (INR . 5). Possible causes of INRs of 5 and above and its management strategies were recorded.
Vermeer, N & Bajorek, B 2008, 'Utilization of evidence-based therapy for the secondary prevention of acute coronary syndromes in Australian practice', Journal Of Clinical Pharmacy And Therapeutics, vol. 33, no. 6, pp. 591-601.View/Download from: Publisher's site
Aim: To review and document the current utilization of pharmacotherapy for the secondary prevention of acute coronary syndromes (ACS) in patients discharged from an Australian hospital. Methods: A retrospective cross-sectional study was conducted at a major Sydney teaching hospital. Patients with either a primary or secondary diagnosis of acute coronary syndrome were identified from medical records over a 4-month period (JanuaryApril 2007). A range of clinical data was extracted from medical records, including medical history, clinical presentation and pharmacotherapy both on admission and at discharge. This audit focussed on the use of four guideline-recommended therapies: aspirin ± clopidogrel, beta blockers, statins and ACEinhibitors (ACE-I), as well as the utilization of multiple antithrombotics.
Vracar, D & Bajorek, B 2008, 'Australian general practitioners' views on pharmacist prescribing', Journal of Pharmacy Practice and Research, vol. 38, no. 2, pp. 96-102.
Aim: To explore Australian general practitioners views on extending prescribing rights to pharmacists, the appropriateness of pharmacist prescribing models, and the influence of general practitioners characteristics on their preference for a particular pharmacist prescribing model. Method: The study consisted of two parts. Part A was a scenario-based questionnaire using Likert-scale responses and Part B was a semi-structured interview. General practitioners were randomly recruited from two Sydney divisions of general practice. Data were analysed using descriptive statistics and qualitative responses were thematically analysed.
Bajorek, B, Ogle, S, Duguid, M, Shenfield, G & Krass, I 2007, 'Management of warfarin in atrial fibrillation: Views of health professionals, older patients and their carers', Medical Journal of Australia, vol. 186, no. 4, pp. 175-180.
Objective: To identify the views of health professionals, patients and their carers on strategies to improve the use and management of warfarin in older patients with atrial fibrillation. Design: Qualitative study based on analysis of group interviews. S
Hilmer, SN, Rangiah, C, Bajorek, B & Shenfield, G 2007, 'Failure to weigh patients in hospital: a medication safety risk', Internal Medicine Journal, vol. 37, no. 9, pp. 647-650.View/Download from: Publisher's site
Often Patients Are Not Weighed In Hospital. Failure To Weigh Patients Prescribed Renally Excreted Drugs May Correlate To Adverse Drug Events. We Carried Out A Cross-Sectional Study Of Patients Prescribed Common Renally Excreted Drugs (Heparin, Enoxaparin
Bajorek, B, Krass, I, Ogle, S, Duguid, M & Shenfield, G 2006, 'Warfarin use in the elderly: The nurses' perspective', Australian Journal of Advanced Nursing, vol. 23, no. 3, pp. 19-25.
Objective: To Explore The Barriers To Warfarin Use From The Perspective Of Nurses Working In Aged Care. Design: A Qualitative Study, Involving A Semi-Structured Group Interview, During March-April 2001. Setting And Subjects: Eleven Nurses, Employed Withi
Bajorek, BV, Krass, I, Ogle, SJ, Duguid, MJ & Shenfield, GM 2006, 'Warfarin use in the elderly: the nurses' perspective.', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation., vol. 23, no. 3, pp. 19-25.
OBJECTIVE: To explore the barriers to warfarin use from the perspective of nurses working in aged care. DESIGN: A qualitative study, involving a semi-structured group interview, during March-April 2001. SETTING AND SUBJECTS: Eleven nurses, employed within the catchment of the Northern Sydney Area Health Service, who were involved in the care of elderly warfarinised patients. MAIN OUTCOME MEASURE: Identification, via thematic analysis, of the main themes underpinning the nursing perspective on warfarin use in this setting, with regard to their perceived role/s, experiences with patients, and potential strategies for managing the therapy. RESULTS: Five main themes were identified: perceived patient attitude toward warfarin; barriers to the use of warfarin; expressed lack of confidence in the processes involved; nurses' role in warfarin use; and strategies to improve warfarin use. Nurses were concerned about warfarin use in the elderly, but felt they had a limited capacity to intervene. CONCLUSION: Nurses are potentially underutilised as a resource and support for both patients and prescribers, in the management of warfarin therapy.
Kay, OC, Bajorek, BV & Brien, JAE 2006, 'Pharmacist prescribing activities - An electronic survey on the opinions of Australian Pharmacists', Journal of Pharmacy Practice and Research, vol. 36, no. 3, pp. 199-203.View/Download from: Publisher's site
Aim: To identify Australian pharmacists' awareness of their international colleagues' prescribing practices and explore their views about the feasibility and utility of pharmacist prescribing privileges within the scope of their current practice. Method: Members of the AusPharmList, Australian Association of Consultant Pharmacy and The Society of Hospital Pharmacists of Australia were invited by e-mail to participate in a community pharmacist, consultant pharmacist or hospital pharmacist electronic survey. These surveys were designed to elicit views concerning: dependent and independent prescribing; resource availability to support pharmacist prescribing; ability to justify prescribing decisions; and limitations of pharmacist prescribing. Results: Of the 268 surveys completed (response rate 6.4%), 45% of respondents were aware of their international colleagues' prescribing activities. 74% agreed that pharmacists should be granted dependent prescribing authority, while 52% agreed that pharmacists should be granted independent prescribing authority. The majority (88%) indicated they could identify their own limitations and 86% believed they could justify their prescribing decisions as dependent prescribers. 73% believed they would benefit from prescribing authority in their daily scope of practice. Conclusion: In 2004, awareness of international developments in pharmacist prescribing was not extensive among the respondents. However, many identified areas where they would benefit from dependent prescribing activities in their daily scope of practice.
Khoo, A & Bajorek, B 2006, 'Extended roles for pharmacists in warfarin therapy: Identifying opportunities for pharmacist prescribing', Journal of Pharmacy Practice and Research, vol. 36, no. 3, pp. 190-193.
Background: Warfarin has traditionally posed a challenge to clinicians because ofits nan'ow therapeutic index. Extended roles for pharmacists may address some ofthe problems in warfarin management. International experience has involved anticoagulation clinics in which pharmacists have authority to engage in collaborative prescribing activities with physicians. Aim: To identify opportunities for pham1acist prescribing activities in warfarin management within the hospital setting. Method: Pham1acists from a Sydney teaching hospital were recruited. The first stage involved an audit of pharmacists' interventions in patients receiving warfarin. Stage two involved a focus group discussion to further explore these issues.
Bajorek, B, Krass, I, Ogle, S, Duguid, M & Shenfield, G 2005, 'Optimizing the use of antithrombotic therapy for atrial fibrillation in older people: A pharmacist-led multidisciplinary intervention', Journal of the American Geriatrics Society, vol. 53, no. 11, pp. 1912-1920.View/Download from: Publisher's site
OBJECTIVES: To develop, implement, and evaluate a pharmacist-led multidisciplinary intervention in a hospital setting that would optimize antithrombotic use in elderly atrial fibrillation patients. The hypothesis that there would be an increase in the proportion of patients receiving antithrombotic therapy at discharge was tested. DESIGN: Evidence-based algorithms were developed to define the criteria (stroke risk vs contraindications) by which an elderly patients requirement for antithrombotic therapy was assessed. SETTING: A major Sydney teaching hospital. PARTICIPANTS: Two hundred eighteen consecutively admitted elderly patients (mean age 85.2) were recruited over a 6-month period.
Hanes, C & Bajorek, B 2005, 'Pharmacist prescribing: Views of Australian hospital pharmacists', Journal of Pharmacy Practice and Research, vol. 35, no. 3, pp. 178-180.
Aim: To explore the views of a sample ofAustralian hospital pharmacists on prescribing privileges. Method: The study involved a questionnaire and a focus group discussion for hospital pharmacists and teacher practitioners. Participants could participate in either or both ofthese activities. Results: 15 pharmacists completed the questionnaire and 8 participated in the focus group discussion. Several models of pharmacist prescribing (discharge and specialist settings) were seen to be appropriate and useful to Australian practice. 93% ofpharmacists noted that prescribing privileges would enable them to provide more efficient/improved pharmaceutical care; 64% that prescribing would result in reduced healthcare costs; and all noted physician opposition as a barrier. Pharmacists indicated that they already prescribed on' an 'unofficial' basis. Training and accreditation beyond registration was deemed necessary by all pharmacists.
Valiya, S & Bajorek, B 2005, 'Ximelagatran cost effectiveness for stroke prevention in atrial fibrillation', Journal of Pharmacy Practice and Research, vol. 35, no. 4, pp. 279-283.
Background: The benefit of warfarin for stroke prevention in non-valvular atrial fibrillation has been demonstrated in various clinical trials. Warfarin has a nan'ow therapeutic window and carries a significant risk ofbleeding. Ximelagatran is a new oral antithrombotic with predictable plasma concentrations and excellent bioavailability. Aim: To compare the costs and benefits of ximelagatran to that of warfarin and aspirin. Method: In a preliminary cost-effectiveness analysis, the costs and clinical consequences ofwarf31in, aspirin and ximelagatran were compared. The principal outcome was measured in the fonn of an incremental cost-effectiveness ratio. A decision analysis model was constructed to map the expected outcomes of three treatment alternatives. Sensitivity analysis tested the robustness of the data.
Hanes, C & Bajorek, B 2004, 'Pharmacist prescribing: Is Australia behind the times?', Australian Journal of Pharmacy, vol. 85, no. 1014, pp. 680-681.
Gelgor, L, Bajorek, B & Chen, T 2003, 'Evaluating pain management in rural community pharmacy: The importance of HMR and regular pain assessment', Australian Journal of Pharmacy, vol. 84, no. 998, pp. 366-369.
It is estimated that the best practice management of pain in Australia could result in savings (on medications, drug-related hospital admissions, utilisation of ancillary health services, social benefits such as those to the workforce) of approximately $4.8bn per annum.1,5 Pharmacy-based interventions have demonstrated cost savings and increased quality use of medicines, as well as healthcare practitioner satisfaction, in other healthcare priority areas (for example, asthma and diabetes). However, in Australia so far, no pharmacy-based interventions have been evaluated for the management of chronic pain, despite the pharmacist's accessibility and ideal placement to play a significant role in its management.
Bajorek, B, Krass, I, Ogle, S, Duguid, M & Shenfield, G 2002, 'The impact of age on antithrombotic use in elderly patients with non-valvular atrial fibrillation', Australian Journal of Ageing, vol. 21, no. 1, pp. 36-41.View/Download from: Publisher's site
Aim of study: To investigate the use of antithrombotic therapy in elderly patients with atrial fibrillation (AF). Methods: Data were collected retrospectively from the medical records of 262 AF patients â¥65 years, who were admitted to a Sydney teaching
Krass, I, Ogle, SJ, Duguid, MJ, Shenfield, GM & Bajorek, B 2002, 'The impact of age on antithrombotic use in elderly patients with non-valvular atrial fibrillation', Australasian Journal on Ageing, vol. 21, no. 1, pp. 36-41.View/Download from: Publisher's site
Aim of study: To investigate the use of antithrombotic therapy in elderly patients with atrial fibrillation (AF). Methods: Data were collected retrospectively from the medical records of 262 AF patients ≥65 years, who were admitted to a Sydney teaching hospital over a 12-month period. Results: Overall, 202 (79%) patients were discharged on some antithrombotic therapy. Patients ≥80 years were as likely to receive antithrombotic therapy as those <80 years (75.8% versus 81.9%, P=0.23), but a significantly lower proportion received warfarin than did those <80 years (25.5% versus 61.5%, P<0.0001). Definite contraindications to anticoagulation were a significant influence on antithrombotic agent selection (P=0.04), but multivariate analysis indicated that 'old age' was the largest contributing factor: patients ≥80 years were 5.46 times more likely to receive aspirin in preference to warfarin than their younger counterparts (P<0.0001). Conclusion: Warfarin is being withheld in AF patients ≥80 years for reasons other than recognised contraindications and is, therefore, potentially underutilised in the target elderly population. Further studies are necessary to determine whether this is appropriate.
Bajorek, B, Krass, I, Ogle, S, Duguid, M & Shenfield, G 2001, 'A survey of long-term antiarrhythmic therapy in elderly patients with atrial fibrillation', Australian Journal of Hospital Pharmacy, vol. 31, no. 2, pp. 93-97.
Aim: To investigate the use of long-term antiarrhythmic (rhythm-control [RHY] and rate-control [RAC]) therapy for the management of atrial fibrillation (AF) in elderly patients. Method: Data were collected retrospectively from the medical records of 255
Krass, I, Bajorek, B, Bagia, M, Fragoudakis, I, Ozgur, B & Chin, S 1997, 'An evaluation of three methods used in the prophylaxis of cyclophosphamide-induced haemorrhagic cystitis in bone marrow transplant patients', Journal of Oncology Pharmacy Practice, vol. 3, no. 4, pp. 193-199.
Background. Bone marrow transplant (BMT) recipi ents, who receive high-dose cyclophosphamide as part of conditioning therapy, are at considerable risk of developing haemorrhagic cystitis (HC). The role of prophylaxis of cyclophosphamide-induced HC is wel
Ferguson, C, Saliba, B & Bajorek, B 2017, 'Educational interventions to increase clinicians and patient knowledge of atrial fibrillation and anticoagulation: a systematic review', Australasian Cardiovascular Nursing College, Brisbane.
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice. Nurses are well-placed across a range of practice settings to provide both structured and informal education to clinicians, patients and caregivers on various aspects of AF management, particularly anticoagulant therapy.
Purpose: To summarise key educational interventions targeted at clinicians, patients and caregivers that have previously evidenced to increase knowledge of AF and/ or anticoagulation.
Methods: Researchers undertook a systematic search of electronic databases including Medline, Scopus, CINAHL and the Cochrane Library. Original studies that were published in the date range 2006-2016 were included if they described targeted educational interventions, and/or included decision support at both the levels of the patient and the clinicians. Additionally, manual reference list searching was also conducted.
Results: A total of 42 studies were reviewed. A number of core components, methods and approaches were identified within the interventions including: clinician decision support; patient decision aides; shared decision making tools; counselling and education; distance education; supply of written or textual information; multi-media resource; patient worksheet or checklist; self-monitoring; audit and feedback; academic detailing; contemporary models of AF care; individualised or group, targeted education sessions. All these demonstrated differing levels of impact on knowledge.
A diverse range of educational interventions were identified in this review, however the quality of evidence is limited by study designs. There is scope for robust clinical trials of complex educational interventions regarding AF management, focusing on interventions that are individualised to the needs of patients and their caregivers.
Ferguson, C, Hickman, L, Phillips, J, Newton, P, Inglis, S, Lam, L & Bajorek, B 2017, 'An mHealth intervention to improve nurses' atrial fibrillation and anticoagulation knowledge and practice: the EVICOAG study', International Journal of Stroke, Stroke Society of Australasia, SAGE Publications, Queenstown, New Zealand, pp. 9-9.
Ferguson, C, Hickman, L, Phillips, J, Newton, P, Inglis, S, Lam, L & Bajorek, B 2017, 'Exploring the acute care registered nurses' contribution in anticoagulation decision making for stroke prevention in atrial fibrillation', International Journal of Stroke, Stroke Society of Australasia, SAGE Publications, Queenstown, New Zealand, pp. 48-48.