Dr Lisa Pont is a registered pharmacist and Associate Professor in the Discipline of Pharmacy, Graduate School of Health at the University of Technology Sydney. She has a PhD in Clinical Pharmacology on Quality Use of Medicines from the University of Groningen in The Netherlands where she explored the development and validation of prescribing indicators for measuring quality of prescribing in general practice.
Lisa is a Fellow of the International Society for Pharmacoepidemiology (ISPE) and was elected to the ISPE Board of directors in 2016. She was the first Australian to lead an ISPE Special Interest Group, leading the Drug Utilisation and Health Services research Group from 2012-2015. She has worked with the World Health Organisation, in 2002 and in 2016 as an invited member of the Global Medication Safety Initiative team.
She has received a number of awards including a national NPS Medicinewise award in 2014 for her work leading the development of resource to support health professionals managing heart failure in Aboriginal and Torres Strait patients and a second in 2016 for her research into data driven solutions to improve the use of antipsychotics in residential age care.
Nationally Dr Pont is regarded for her research and service to the Pharmacy profession. She is a fellow and board member of the Society of Hospital Pharmacists of Australia and was elected to lead formation of the National Translational Research Collaborative for the Society. In 2018 she was awarded the Society of Hospital Pharmacists Medal of Merit.
Can supervise: YES
Lisa’s main research area is drug utilization research to understand and improve the quality and safety of medicines in older populations. Lisa leads the Medicines Use Research in Aged Care (MURAC) Research team where the research focus is on understanding and improving the quality and safety of medicines for older Australians.
Current MURAC research interests include:
· Predicting medication related hospital admissions among aged care residents.
· Medication safety culture in residential aged care.
· Quality and safety of respiratory medicines used in residential aged care.
· Opioid use in Australian hospitals and aged care facilities.
· Impact of medication discrepancies in aged care.
· Phamacoepidemiology among older populations.
· Electronic medication management in aged care.
· Social media and e-health literacy.
Lisa is the coordinator of the elective Advanced Clinical Pharmacy subjects, where students use their clinical knowledge and skills in the real world. This subject is hosted by Westmead Hospital.
Aldryhim, AY, Alomair, A, Alqhtani, M, Mahmoud, MA, Alshammari, TM, Pont, LG, Kamal, KM, Aljadhey, H, Mekonnen, AB, Alwhaibi, M, Balkhi, B & Alhawassi, TM 2019, 'Factors that facilitate reporting of adverse drug reactions by pharmacists in Saudi Arabia.', Expert opinion on drug safety, vol. 18, no. 8, pp. 745-752.View/Download from: UTS OPUS or Publisher's site
Objectives: Adverse drug reactions (ADRs) are a pervasive global problem, and its management is integral to patient safety and healthcare quality. Pharmacists play a pivotal role in monitoring and reporting ADRs, which has a direct impact on patient care. The aim of this study was to identify potential factors that facilitate pharmacists in community and hospital settings to report ADRs. Methods: A cross-sectional, online survey using a validated questionnaire was administered to pharmacists working in community and hospital pharmacies in Saudi Arabia. Results: 1,717 community and 153 hospital pharmacists participated in this study. Only 10.2% and 26.8% of community and hospital pharmacists, respectively, admitted ever reporting an ADR. The most reported factors that may facilitate ADRs reporting have included ongoing improvements in therapeutic knowledge about ADRs, attending educational programs with continuous medical education credits, the seriousness of the experienced ADRs and accessibility to patients' medical profile. The impact of peers by seeing colleagues reporting ADRs and ADRs due to herbal or traditional medicine were the least important factors reported by pharmacists. Conclusion: The study identified factors that can effectively address the under-reporting of ADRs by pharmacists. A multi-stakeholder, multi-pronged approach of ADR reporting is needed to develop greater awareness of this issue among pharmacists.
Raban, MZ, Walter, SR, Pont, LG, Cheung, L, Strumpman, D & Westbrook, JI 2019, 'The potential impact of an electronic medication management system on safety-critical prescribing errors in an emergency department', Journal of Pharmacy Practice and Research, vol. 49, no. 2, pp. 108-115.View/Download from: UTS OPUS or Publisher's site
© 2019 The Society of Hospital Pharmacists of Australia Background: Medication errors in hospitals are common. Although electronic medication management systems (eMMS) have the potential to reduce errors during inpatient care, little is known about their effect in emergency departments (ED). Aim: The aims of this study were to report on the types of prescribing errors in an ED prior to implementation of an eMMS, to assess the risk the errors pose to patient safety and to evaluate whether safety-critical errors were potentially preventable with a newly implemented eMMS. Methods: Medication orders on paper charts were assessed for prescribing errors by a clinical hospital pharmacist. Error severity was rated using a five-point scale. Errors of moderate or higher severity, and all errors involving defined high-risk medicines were considered safety-critical errors. The potential for safety-critical errors to be prevented by the eMMS was rated (likely, possibly or unlikely). Results: Across 239 medication orders, 208 errors (27 clinical, 181 legal or procedural) were identified. The overall prescribing error rate was 0.87 errors/order. There were 67 safety-critical errors (53 legal or procedural, 14 clinical). Overall, 82.1% of errors were likely preventable by eMMS. However, of the clinical safety-critical errors, only 2 (14.3%) were considered likely preventable. Conclusion: Although eMMS has the capacity to prevent a high proportion of safety-critical legal or procedural errors in the ED, clinical prescribing errors in this category were unlikely to be prevented by using eMMS. Further investigation of these more severe error types could guide the design of eMMS decision support to improve system effectiveness.
van der Meer, HG, Taxis, K, Teichert, M, Griens, F, Pont, LG & Wouters, H 2019, 'Anticholinergic and sedative medication use in older community-dwelling people: A national population study in the Netherlands', Pharmacoepidemiology and Drug Safety, vol. 28, no. 3, pp. 315-321.View/Download from: UTS OPUS or Publisher's site
© 2019 The Authors Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd Purpose: To identify the proportion of older adults with a high anticholinergic/sedative load and to identify patient subgroups based on type of central nervous system (CNS)-active medication used. Methods: A cross-sectional study of a nationwide sample of patients with anticholinergic/sedative medications dispensed by 1779 community pharmacies in the Netherlands (90% of all community pharmacies) in November 2016 was conducted. Patients aged older than 65 years with a high anticholinergic/sedative load defined as having a drug burden index (DBI) greater than 1 were included. Proportion of patients with a high anticholinergic/sedative load was calculated by dividing the number of individuals in our study population by the 2.4 million older patients using medications dispensed from study pharmacies. Patient subgroups based on type of CNS-active medications used were identified with latent class analysis. Results: Overall, 8.7% (209 472 individuals) of older adults using medications had a DBI greater than 1. Latent class analysis identified four patient subgroups (classes) based on the following types of CNS-active medications used: “combined psycholeptic/psychoanaleptic medication” (class 1, 57.9%), “analgesics” (class 2, 17.9%), “antiepileptic medication” (class 3, 17.8%), and “anti-Parkinson medication” (class 4, 6.3%). Conclusions: A large proportion of older adults in the Netherlands had a high anticholinergic/sedative load. Four distinct subgroups using specific CNS-active medication were identified. Interventions aiming at reducing the overall anticholinergic/sedative load should be tailored to these subgroups.
van der Meer, HG, Wouters, H, Teichert, M, Griens, F, Pavlovic, J, Pont, LG & Taxis, K 2019, 'Feasibility, acceptability and potential effectiveness of an information technology-based, pharmacist-led intervention to prevent an increase in anticholinergic and sedative load among older community-dwelling individuals', Therapeutic Advances in Drug Safety, vol. 10, pp. 1-13.View/Download from: UTS OPUS or Publisher's site
© The Author(s), 2018. Background: Anticholinergic/sedative medications are frequently used by older people, despite their negative impacts on cognitive and physical function. We explore the feasibility, acceptability and potential effectiveness of an innovative information technology (IT)-based intervention to prevent an increase in anticholinergic/sedative load in older people. Methods: This was a prospective study in 51 Dutch community pharmacies. Pharmacists used an IT-based tool to identify patients aged ⩾65 years, with existing high anticholinergic/sedative loads (drug burden index ⩾2) and a newly initiated anticholinergic/sedative medication. We determined the following. Feasibility: number of eligible patients identified. Acceptability: pharmacists’ satisfaction with the intervention, pharmacists’ time investment and patients’ willingness to reduce medication use. Potential effectiveness: number of recommendations, rate of agreement of general practitioners (GPs) with proposed recommendations and factors associated with agreement. To evaluate the latter, pharmacists conducted medication reviews and proposed recommendations to GPs for 5–10 patients selected by the IT-based tool. Results: We included 305 patients from 47 pharmacies. Feasibility: a mean of 17.0 (standard deviation, 8.8) patients were identified per pharmacy. Acceptability: 43 pharmacists (91.5%) were satisfied with the intervention. The median time investment per patient was 33 min (range 6.5–210). Of 35 patients, 30 (85.7%) were willing to reduce medication use. Potential effectiveness: pharmacists proposed 351 recommendations for 212 patients (69.5%). GPs agreed with recommendations for 108 patients (35.4%). Agreement to stop a medication was reached in 19.8% of recommendations for newly initiated medications (37 of 187) and for 15.2% of recommendations for existing medications (25 of 164). Agreement was more likely for recommendations on codeine [odds ratio (OR) 3.30; 95% confidence inter...
Werth, BL, Williams, KA, Fisher, MJ & Pont, LG 2019, 'Defining constipation to estimate its prevalence in the community: results from a national survey.', BMC gastroenterology, vol. 19, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Different definitions of constipation have been used to estimate its prevalence in the community but this creates difficulties when comparing results from various studies. This study explores the impact of different definitions on prevalence estimates in the same population and compares the performance of simple definitions with the Rome III criteria. METHODS:The prevalence of constipation in a large nationally representative sample of community-dwelling adults was estimated using five simple definitions of constipation and compared with definitions based on the Rome III criteria. The sensitivity, specificity, and positive and negative predictive values, were calculated for each definition using the Rome III criteria as the gold standards for chronic and sub-chronic constipation. RESULTS:Prevalence estimates for the five simple definitions ranged from 9.4 to 58.9%, while the prevalence estimates using the Rome III criteria were 24.0% (95%CI: 22.1, 25.9) for chronic constipation and 39.6% (95%CI: 37.5, 41.7) for sub-chronic constipation. None of the simple definitions were adequate compared to the Rome III criteria. Self-reported constipation over the past 12 months had the highest sensitivity (91.1%, 95%CI: 88.8, 93.4) and negative predictive value (94.5%, 95%CI: 93.1, 96.1) compared to the Rome III criteria for chronic constipation but an unacceptably low specificity (51.3%, 95%CI: 48.8, 53.8) and positive predictive value (37.1%, 95%CI: 34.4, 39.9). CONCLUSIONS:The definition used to identify constipation within a population has a considerable impact on the prevalence estimate obtained. Simple definitions, commonly used in research, performed poorly compared with the Rome III criteria. Studies estimating population prevalence of constipation should use definitions based on the Rome criteria where possible.
Alhawassi, TM, Krass, I & Pont, LG 2018, 'Antihypertensive-related adverse drug reactions among older hospitalized adults', International Journal of Clinical Pharmacy, vol. 40, no. 2, pp. 428-435.View/Download from: UTS OPUS or Publisher's site
© 2018, Springer International Publishing AG, part of Springer Nature. Background Antihypertensive medications are commonly used for a wide range of indications, yet it is unknown to what extent older adults are at risk of adverse drug reactions (ADRs) associated with their antihypertensive medication use. Objective The aim of this study was to determine the prevalence and characteristics of antihypertensive-related ADRs on hospital admission. Setting Metropolitan teaching hospital in Sydney, Australia. Method A retrospective cross-sectional audit of 503 older patients (≥ 65 years) admitted to hospital was conducted. Potential ADRS were identified from the medical record. Two independent clinical pharmacists reviewed each potential ADR using validated tools for causality, severity, preventability and contribution to hospitalization. Characteristics associated with an increased ADR risk among antihypertensive users were identified via logistic regression. Main outcome measure Antihypertensive related ADRs. Results Antihypertensives were used on admission by 68% of the cohort and the prevalence of ‘definite/probable’ antihypertensive-related ADRs among antihypertensive users was 16.4%. Antihypertensive medications were associated with a threefold ADR risk (OR = 3.09, 95% CI 1.85–5.16). Angiotensin II Receptor Blockers (ARB), impaired renal function, recent medication changes and previous history of allergy or ADR were all associated with an increased risk of experiencing an ADR. Conclusions ADRS associated with antihypertensive medicines were relatively common among older adults admitted to hospital. Increased awareness of those older persons who are most at risk of experiencing an antihypertensive-related ADR in the clinical setting may lead to early detection and minimization of ADR associated harms.
Gadzhanova, S, Roughead, EE & Pont, LG 2018, 'Antidepressant switching patterns in the elderly.', International psychogeriatrics, vol. 30, no. 9, pp. 1365-1374.View/Download from: UTS OPUS or Publisher's site
ABSTRACTBackground:Switching between antidepressants is complex due to potential adverse outcomes such as serotonin syndrome and antidepressant discontinuation syndrome, yet switching is often required due to non-response to initial treatment. This study aimed to examine the patterns and extent of antidepressant switching in a cohort of older adults in long-term residential care. METHODS:A cohort study of medication supply data from 6011 aged care residents in 60 long-term care facilities was conducted. Incident antidepressant users were followed for 12 months and their patterns of antidepressant use determined. The type of switching from and to different antidepressant classes was determined according to National and International recommendations for antidepressant switching. RESULTS:In total, 11% (n = 44) of the residents were initiated on an antidepressant medication (n = 402) switched to a different antidepressant agent within 12 months. Residents commenced on a SNRI or TCA were most likely to switch antidepressants (17% in each group). Almost half of the switches (n = 21, 48% of all switches) were not implemented according to guideline recommendations. Direct switch and taper followed by wash out and switch, accounted for all of the inappropriate switching (29% and 71%, respectfully), with half occurring to mirtazapine (N = 7) or from mirtazapine (N = 3). CONCLUSIONS:Over one in 10 long-term aged care residents who commence an antidepressant will switch to a different antidepressant within 12 months. Current antidepressant switching practices in long-term residential aged care may be increasing the risk of harm associated with antidepressant switching, with around half of all switches not following current guideline recommendations.
Jansen, K, Haugen, DF, Pont, L & Ruths, S 2018, 'Safety and Effectiveness of Palliative Drug Treatment in the Last Days of Life-A Systematic Literature Review', Journal of Pain and Symptom Management, vol. 55, no. 2, pp. 508-521.View/Download from: UTS OPUS or Publisher's site
© 2017 The Authors. Context: Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics, and benzodiazepines for symptom relief. Objectives: The objective of this study was to systematically review the effectiveness and safety of palliative drug treatment in the last days of life of adult patients, focusing on the management of pain, dyspnea, anxiety, restlessness, and death rattle. Methods: A systematic search of the literature was published before December 2016 in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Cochrane, ClinicalTrials.gov, and SveMed+. Studies on safety or effectiveness of drug therapy in dying adults with at least one outcome on symptom control, adverse effects, or survival were included. Data for included studies were extracted. Study quality was assessed using the Effective Public Health Practice Quality assessment tool for quantitative studies. Results: Of the 5940 unique titles identified, 12 studies met the inclusion criteria. Five studies assessed anticholinergics for death rattle, providing no evidence that scopolamine hydrobromide and atropine were superior to placebo. Five studies examined drugs for dyspnea, anxiety, or terminal restlessness, providing some evidence supporting the use of morphine and midazolam. Two studies examined opioids for pain, providing some support for morphine, diamorphine, and fentanyl. Eight studies included safety outcomes, revealing no important differences in adverse effects between the interventions and no evidence for midazolam shortening survival. Conclusion: There is a lack of evidence concerning the effectiveness and safety of palliative drug treatment in dying patients, and the reviewed evidence provides limited guidance for clinicians to assist in a distinct and significant phase of life.
Pont, LG, Raban, MZ, Jorgensen, ML, Georgiou, A & Westbrook, JI 2018, 'Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use', INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, vol. 30, no. 10, pp. 810-816.View/Download from: UTS OPUS or Publisher's site
Sezgin, G, Georgiou, A, Hardie, R-A, Li, L, Pont, LG, Badrick, T, Franco, GS, Westbrook, JI, Rinehart, N, McLeod, A, Pearce, C, Shearer, M, Whyte, R & Deveny, E 2018, 'Compliance with pathology testing guidelines in Australian general practice: protocol for a secondary analysis of electronic health record data', BMJ OPEN, vol. 8, no. 11.View/Download from: UTS OPUS or Publisher's site
van der Meer, HG, Taxis, K & Pont, LG 2018, 'Changes in prescribing symptomatic and preventive medications in the last year of life in older nursing home residents', Frontiers in Pharmacology, vol. 8, no. JAN.View/Download from: UTS OPUS or Publisher's site
© 2018 van der Meer, Taxis and Pont. Background: At the end of life goals of care change from disease prevention to symptomatic control, however, little is known about the patterns of medication prescribing at this stage. Objectives: To explore changes in prescribing of symptomatic and preventive medication in the last year of life in older nursing home residents. Methods: A retrospective cohort study was conducted using pharmacy medication supply data of 553 residents from 16 nursing home facilities around Sydney, Australia. Residents received 24-h nursing care, were aged = 65 years, died between June 2008 and June 2010 and were using at least one medication 1 year before death. Medications were classified as symptomatic, preventive, or other. A linear mixed model was used to compare changes in prescribing in the last year of life. Results: 68.1% of residents were female, mean age was 88.0 (SD: 7.5) years and residents used a mean of 9.1 (SD: 4.1) medications 1 year before death. The mean number of symptomatic medications per resident increased from 4.6 medications 1 year before death to 5.1 medications at death [95% CI 4.4-4.7 to 5.9-5.2, P = 0.000], while preventive medication decreased from 2.0 to 1.4 medications [95% CI 1.9-2.1 to 1.3-1.5, P = 0.000] . Symptomatic medications were used longer in the last year of life, compared to preventive medications (336.3 days [95% CI 331.8-340.8] versus 310.9 days [95% CI 305.2-316.7] , P = 0.000). Conclusion: Use of medications for symptom relief increased throughout the last year of life, while medications for prevention of long-term complications decreased. But changes were slight and clinical relevance can be questioned.
Van Der Meer, HG, Wouters, H, Pont, LG & Taxis, K 2018, 'Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review: A randomised controlled trial', BMJ Open, vol. 8, no. 7.View/Download from: UTS OPUS or Publisher's site
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Objective To evaluate if a pharmacist-led medication review is effective at reducing the anticholinergic/sedative load, as measured by the Drug Burden Index (DBI). Design Randomised controlled single blind trial. Setting 15 community pharmacies in the Northern Netherlands. Participants 157 community-dwelling patients aged ≥65 years who used ≥5 medicines for ≥3 months, including at least one psycholeptic/psychoanaleptic medication and who had a DBI≥1. Intervention A medication review by the community pharmacist in collaboration with the patient's general practitioner and patient. Primary and secondary outcomes measures The primary outcome was the proportion of patients whose DBI decreased by at least 0.5. Secondary outcomes were the presence of anticholinergic/sedative side effects, falls, cognitive function, activities of daily living, quality of life, hospital admission and mortality. Data were collected at baseline and 3 months follow-up. Results Mean participant age was 75.7 (SD, 6.9) years in the intervention arm and 76.6 (SD, 6.7) years in the control arm, the majority were female (respectively 69.3% and 72.0%). Logistic regression analysis showed no difference in the proportion of patients with a≥0.5 decrease in DBI between intervention arm (17.3%) and control arm (15.9%), (OR 1.04, CI 0.47 to 2.64, p=0.927). Intervention patients scored higher on the Digit Symbol Substitution Test, measure of cognitive function (OR 2.02, CI 1.11 to 3.67, p=0.021) and reported fewer sedative side effects (OR 0.61, CI 0.40 to 0.94, p=0.024) at follow-up. No significant difference was found for other secondary outcomes. Conclusions Pharmacist-led medication review as currently performed in the Netherlands was not effective in reducing the anticholinergic/sedative load, measured with the DBI,...
Alhawassi, TM, Krass, I & Pont, LG 2017, 'Prevalence, management and control of hypertension in older adults on admission to hospital', Saudi Pharmaceutical Journal, vol. 25, no. 8, pp. 1201-1207.View/Download from: UTS OPUS or Publisher's site
© 2017 The Authors Introduction The aim of this study was to explore the prevalence and management of hypertension among older adults on admission to hospital and to assess the choice of antihypertensive pharmacotherapy in light of relevant comorbid conditions using the national treatment guideline. Materials and methods A retrospective cross sectional study of 503 patients aged 65 years or older admitted to a large metropolitan teaching hospital in Sydney Australia was conducted. The main outcome measures were prevalence of hypertension, blood pressure (BP) control, antihypertensive medication use and the appropriateness of antihypertensive medications. Results Sixty-nine percent (n = 347) of the study population had a documented diagnosis of hypertension and of these, approximately one third were at target BP levels on admission to hospital. Some concerns regarding choice of antihypertensive noted with 51% of those with comorbid diabetes and 30% of those with comorbid heart failure receiving a potentially inappropriate antihypertensive agent. Conclusions Despite the use of antihypertensive pharmacotherapy, many older adults do not have optimal BP control and are not reaching target BP levels. New strategies to improve blood pressure control in older populations especially targeting women, those with a past history of myocardial infarction and those on multiple antihypertensive medications are needed.
Beuscart, J-B, Pont, LG, Thevelin, S, Boland, B, Dalleur, O, Rutjes, AWS, Westbrook, JI & Spinewine, A 2017, 'A systematic review of the outcomes reported in trials of medication review in older patients: the need for a core outcome set.', British journal of clinical pharmacology, vol. 83, no. 5, pp. 942-952.View/Download from: UTS OPUS or Publisher's site
Medication review has been advocated as one of the measures to tackle the challenge of polypharmacy in older patients, yet there is no consensus on how best to evaluate its efficacy. This study aimed to assess outcome reporting in trials of medication review in older patients.Randomized controlled trials (RCTs), prospective studies and RCT protocols involving medication review performed in patients aged 65 years or older in any setting of care were identified from: (1) a recent systematic review; (2) RCT registries of ongoing studies; (3) the Cochrane library. The type, definition, and frequency of all outcomes reported were extracted independently by two researchers.Forty-seven RCTs or prospective published studies and 32 RCT protocols were identified. A total of 327 distinct outcomes were identified in the 47 published studies. Only one fifth (21%) of the studies evaluated the impact of medication reviews on adverse events such as drug reactions or drug-related hospital admissions. Most of the outcomes were related to medication use (n = 114, 35%) and healthcare use (n = 74, 23%). Very few outcomes were patient-related (n = 24, 7%). A total of 248 distinct outcomes were identified in the 32 RCT protocols. Overall, the number of outcomes and the number and type of health domains covered by the outcomes varied largely.Outcome reporting from RCTs concerning medication review in older patients is heterogeneous. This review highlights the need for a standardized core outcome set for medication review in older patients, to improve outcome reporting and evidence synthesis.
Fong, J, Buckley, T, Cashin, A & Pont, L 2017, 'Nurse practitioner prescribing in Australia: A comprehensive literature review.', Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, vol. 30, no. 5, pp. 252-259.View/Download from: Publisher's site
In Australia, the nurse practitioner (NP) obtained prescriptive authority in some jurisdictions in 2001. One of the key aspects in which the scope of NPs differs from Registered Nurses (RNs) relates to the legal privilege to prescribe medications. Although NPs have had prescriptive authority in Australia since 2001, with access to the Commonwealth subsidy scheme (PBS) since 2010, little is known about NPs prescriptive patterns or outcomes of prescriptive practice.The aim of this scoping review was to examine the extent, range and nature of research conducted in relation to NP prescribing in the Australian health context as well as identify gaps in the existing literature. Whilst considerable research has been undertaken on medical prescribing, to date there is no published review of studies regarding NP prescribing in the Australian context.A structured search of the literature was undertaken using permutations of the following key words ’nurse practitioner prescribing Australia’, ’nurse practitioner and prescribing’, ’advanced practice nurse and prescribing’, ’nurse practitioner and Australia’. Databases where searched from January 2000 to January 2016. Databases searched include PsycInfo, Pubmed, CINAHL and Medline.There are a number of distinguishing features of NP prescribing practices in the Australian context. Little is known about the prescribing behaviours of critical care NPs in both the international and Australian context. Key themes identified were: barriers to prescribing, attitudes to NP prescribing, frequency of prescribing, types of medications prescribed, prescribing practice behaviours and confidence in prescribing.The impact of legislative changes on Australian NPs clinical practice and service delivery is still evolving. This review should create impetus for further research to determine the outcomes of NP prescribing on both patient and health service outcomes in the Australian healthcare context including critical care settings.
Lyell, D, Magrabi, F, Raban, MZ, Pont, LG, Baysari, MT, Day, RO & Coiera, E 2017, 'Automation bias in electronic prescribing.', BMC Medical Informatics and Decision Making, vol. 17, no. 1, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity and interruptions on AB.One hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system. Quality of CDS (correct, incorrect and no CDS) and task complexity (low, low + interruption and high) were varied between conditions. Omission errors (failure to detect prescribing errors) and commission errors (acceptance of false positive alerts) were measured.Compared to scenarios with no CDS, correct CDS reduced omission errors by 38.3% (p < .0001, n = 120), 46.6% (p < .0001, n = 70), and 39.2% (p < .0001, n = 120) for low, low + interrupt and high complexity scenarios respectively. Incorrect CDS increased omission errors by 33.3% (p < .0001, n = 120), 24.5% (p < .009, n = 82), and 26.7% (p < .0001, n = 120). Participants made commission errors, 65.8% (p < .0001, n = 120), 53.5% (p < .0001, n = 82), and 51.7% (p < .0001, n = 120). Task complexity and interruptions had no impact on AB.This study found evidence of AB omission and commission errors in e-prescribing. Verification of CDS alerts is key to avoiding AB errors. However, interventions focused on this have had limited success to date. Clinicians should remain vigilant to the risks of CDS failures and verify CDS.
Pont, LG 2017, 'Playing ball with the red sox: The 31st international conference on phamacoepidemiology and therapeutic risk management, boston, USA', Journal of Pharmacy Practice and Research, vol. 47, no. 5, pp. 402-402.View/Download from: Publisher's site
As a 2015 recipient of the Pfizer Pharmacy Grant, I attended the 31st International Conference on Phamacoepidemiology and Therapeutic Risk Management in Boston from August 21–26, 2015.
The International Conference on Pharmacoepidemiology (ICPE) is the annual meeting of the International Society of Pharmacoepidemiology (ISPE) and alternates annually between North America and Europe. Approximately 1500 researchers, clinicians, regulators, policy makers and academics from around the world attended the conference.
Prior to the main meeting, ISPE runs 2 days of pre‐conference educational courses in a number of specialty areas. I was involved in the Introduction to Drug Utilisation Research session, which introduced participants to the basic principles, methodologies, resources and use of drug utilisation research, including a session presented by the World Health Organization on their ATC/DDD (Anatomic Therapeutic Classification/Defined Daily Dose) methodology.1 I was also involved with colleagues from France and USA in a workshop on designing and conducting non‐database research where participants worked through a series of case studies to better understand the challenges of doing epidemiological research without large databases.
Each day the conference ran multiple concurrent sessions, each with a different therapeutic or methodological focus. With my research interest, drug utilisation research among older persons, I was able to attend relevant and interesting sessions each day in the drug utilisation stream, which showcased international research. It was interesting to see that many of the issues we are struggling with around medication use among older persons are international challenges.
One of the highlights of the meeting was the plenary session on ‘The eye of the beholder’, where adverse drug reactions were discussed from different perspectives, including those of a physician, the pharmaceutical industry, a lawyer, regulators and a patient. The patient ha...
Pont, LG, Morgan, TK, Williamson, M, Haaijer, FM & van Driel, ML 2017, 'Validity of prescribing indicators for assessing quality of antibiotic use in Australian general practice.', The International journal of pharmacy practice, vol. 25, no. 1, pp. 66-74.View/Download from: UTS OPUS or Publisher's site
The aim of this study was to assess the validity of a set of European quality indicators for assessing antimicrobial prescribing in Australian General Practice.A modified UCLA/RAND appropriateness method was used to assess the validity of 30 antimicrobial prescribing indicators. An expert panel of 12 general practitioners scored the validity of each indicator for measuring quality in Australian general practice. Four quality domains were considered: monitoring antibiotic resistance, benefit to individual patients, value for money and value to policymakers. Panel members were also asked to comment on the relevance to the Australian context and proposed benchmarks for each indicator.All panel members were in agreement regarding the validity of each indicator in each of the specified domains with exception of the indicator assessing the use of systemic antibiotics for pneumonia. The majority of the indicators and their associated benchmarks were considered valid for assessing quality in Australian General Practice, however, there were differences regarding the quality domain that each indicator was considered valid for. Monitoring quality considering individual patient benefit was the most problematic domain with respect to validity.This study demonstrates the validity of 30 European indicators for assessing quality of antimicrobial prescribing in general practice in a non-European setting and provides guidance regarding acceptable benchmarks for the indicators. With international concerns regarding misuse of antibiotics and global interest in prescribing quality, valid evidence-based antimicrobial prescribing indicators and associated benchmarks are an essential tool for assessing prescribing quality.
Taxis, K, Kochen, S, Wouters, H, Boersma, F, Jan Gerard, M, Mulder, H, Pavlovic, J, Stevens, G, Andrew, M & Pont, LG 2017, 'Cross-national comparison of medication use in Australian and Dutch nursing homes.', Age and ageing.View/Download from: Publisher's site
Taxis, K, Kochen, S, Wouters, H, Boersma, F, Jan Gerard, M, Mulder, H, Pavlovic, J, Stevens, G, McLachlan, A & Pont, LG 2017, 'Cross-national comparison of medication use in Australian and Dutch nursing homes.', Age and ageing, vol. 46, no. 2, pp. 320-323.View/Download from: UTS OPUS or Publisher's site
cross-national comparisons can be used to explore therapeutic areas and identify potential medication issues.we used cross-sectional pharmacy supply data to explore medication use for nursing home residents in Australia (AU n = 26 homes, 1,560 residents) and the Netherlands (NL n = 6 homes, 2,037 residents). Binary logistic regression analysis was used to calculate the sex and aged adjusted odds ratios (OR) and associated 95% confidence intervals with a flexible Bonferroni-Holm procedure used to adjust for multiple hypothesis testing.total use of antipsychotics (AU: 37.7%, NL: 40.3%; OR 0.91 (0.79-1.04, P = 0.16) and antibacterials (66.8% AU, 62.4% NL, OR 1.08 (0.93-1.24, P = 0.31) was similar, but choice of individual agents differed between the two countries. Differences were observed in the use of antithrombotics (46.7% AU, 64.7% NL, OR 0.48 (0.42-0.56, P > 0.01), ophthalmologicals (44.3% AU, 22.1% NL, OR 2.80 (2.42-3.24, P < 0.001), laxatives (77.1% AU, 65.8% NL, OR 1.65 (1.41-1.92, P < 0.001).while the general prevalence of medication use in nursing home residents was similar across the two countries, distinct differences existed in the choice of agent among therapeutic groups. Comparing use between countries identified a number of potential medication related problem areas that need further exploration.
Werth, BL, Williams, KA & Pont, LG 2017, 'Laxative Use and Self-Reported Constipation in a Community-Dwelling Elderly Population: A Community-Based Survey From Australia', Gastroenterology Nursing, vol. 40, no. 2, pp. 134-141.View/Download from: UTS OPUS or Publisher's site
© 2016 by the Society of Gastroenterology Nurses and Associates, Inc.The objectives of this study were to 1) determine the prevalence of laxative use and self-reported constipation and 2) identify risk factors associated with constipation in a community-dwelling elderly population. A retrospective cross-sectional survey using data from the Australian Longitudinal Study of Ageing was used to explore laxative use and constipation in a cohort of community-dwelling older persons. The prevalence of laxative use was 15% and the prevalence of self-reported constipation was 21%. Females were more likely to report constipation and use laxatives. Of those using laxatives, men were more likely to have their laxatives prescribed by a doctor whereas women were more likely to self-medicate. Poor self-rated health and a higher need for assistance with activities of daily living were identified as risk factors for constipation. Constipation is a common condition affecting the community-dwelling elderly. There is a need to optimize the management of constipation and use of laxatives in such populations.
BinDhim, NF, Alanazi, EM, Aljadhey, H, Basyouni, MH, Kowalski, SR, Pont, LG, Shaman, AM, Trevena, L & Alhawassi, TM 2016, 'Does a Mobile Phone Depression-Screening App Motivate Mobile Phone Users With High Depressive Symptoms to Seek a Health Care Professional’s Help?', Journal of medical Internet research, vol. 18, no. 6, pp. e156-e156.View/Download from: Publisher's site
The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question.This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple’s App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app’s download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month.A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74% of those completed the follow-up; approximately 38% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29).A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use ...
Leow, JB, Pont, L & Low, L-F 2016, 'Effect of humour therapy on psychotropic medication use in nursing homes.', Australasian journal on ageing, vol. 35, no. 4, pp. E7-E12.View/Download from: Publisher's site
The aim of this study was to assess the effect of Play Up humour therapy on antipsychotic, benzodiazepine and antidepressant use in Australian nursing homes.Play Up is a humour therapy program that has been implemented in Australian nursing homes. This study was an uncontrolled retrospective review of psychotropic medication charts of 406 residents in thirty-three nursing homes before and after 12 weeks of participation in Play Up. Prevalence and mean daily equivalent doses of psychotropic medication use were analysed.There were significant reductions from before to after the Play Up program in the prevalence of any psychotropic medication use, antipsychotic use and benzodiazepine use (P = 0.001, 0.02, 0.007, respectively). Mean daily dose equivalents of pro re nata (PRN) antipsychotics and PRN benzodiazepines significantly reduced over time (P = 0.007; P = 0.001).Play Up was associated with an overall decline in the use of psychotropic medications. Further trials are required to confirm and better define this association.
Pont, L, Jansen, K, Schaufel, MA, Haugen, DF & Ruths, S 2016, 'Drug utilization and medication costs at the end of life.', Expert review of pharmacoeconomics & outcomes research, vol. 16, no. 2, pp. 237-243.View/Download from: Publisher's site
In the end stages of life, drug treatment goals shift to symptom control and quality of life and as such changes in drug utilization are expected. The aim of this paper is to review the extent to which costs are considered in drug utilization research at the end of life, with a particular focus on the outcome measures being used. This systematic review identified seven studies across varied settings studies reporting both drug utilization and medication cost outcome measures. The main factors identified that impacted medication use and cost were the time period considered and the provision of specialist palliative care services. Combining drug utilization and medication cost outcomes is critical for the allocation of healthcare resources and the development of a sound health policy.
Shin, H-Y, Gadzhanova, S, Roughead, EE, Ward, MB & Pont, LG 2016, 'The use of antipsychotics among people treated with medications for dementia in residential aged care facilities.', International psychogeriatrics, vol. 28, no. 6, pp. 977-982.View/Download from: Publisher's site
Antipsychotic agents have limited efficacy for Behavioral and Psychological Symptoms of Dementia (BPSD) and there are concerns about their safety. Despite this, they are frequently used for the management of BPSD. This study aimed to assess the use of antipsychotics among people on anti-dementia medicines in Australian residential aged care facilities.Data were obtained from an individual patient unit dose packaging database covering 40 residential aged care facilities in New South Wales, Australia. Residents supplied an anti-dementia medicine between July 2008 and June 2013 were included. Prevalence of concurrent antipsychotic use was established. Incident antipsychotic users between January 2009 and December 2011 were identified. We examined initial antipsychotic dose, maximum titrated doses, type and duration of antipsychotic use, and compared use with Australian guidelines.There were 291 residents treated with anti-dementia medicines, 129 (44%) of whom received antipsychotics concomitantly with an anti-dementia medicine. Among the 59 incident antipsychotic users, risperidone (73%) was the most commonly used antipsychotic agent. Amongst the risperidone initiators, 43% of patients had initial doses greater than 0.5 mg/day and 6% of patients exceeded 2.0 mg/day for their maximum dose. 53% of concomitant users received daily treatment for greater than six months.Our study using records of individual patient unit dose supply, which represents the intended medication consumption schedule, shows high rates of concurrent use of antipsychotics and anti-dementia medicines and long durations of use. The use of antipsychotics in patients with dementia needs to be carefully monitored to improve patient outcomes.
Alhawassi, TM, Krass, I & Pont, LG 2015, 'Hypertension in Older Persons: A Systematic Review of National and International Treatment Guidelines', JOURNAL OF CLINICAL HYPERTENSION, vol. 17, no. 6, pp. 486-492.View/Download from: Publisher's site
Alhawassi, TM, Krass, I & Pont, LG 2015, 'Impact of Hospitalization on Antihypertensive Pharmacotherapy among Older Persons', Drugs - Real World Outcomes, vol. 2, no. 3, pp. 239-247.View/Download from: Publisher's site
© 2015, The Author(s). Background: Little is known about the impact of hospitalization on antihypertensive pharmacotherapy and blood pressure control in older persons. Objectives: The aim of this study was to explore the impact of hospitalization on the management of hypertension and antihypertensive pharmacotherapy in a cohort of older patients with a documented diagnosis of hypertension. Methods: A retrospective, cross-sectional medical record audit was conducted in a large Australian metropolitan teaching hospital. Patients aged 65 years or older, admitted between January 1st 2010 and December 31st 2010, and with a documented diagnosis of hypertension in their medical record were included in the study. Antihypertensive pharmacotherapy and blood pressure control was compared between admission and discharge. Factors associated with changes to antihypertensive pharmacotherapy were identified. Results: Changes to antihypertensive pharmacotherapy occurred in 39.5 % (n = 135) of patients (n = 342). On discharge, the proportion of patients receiving antihypertensive pharmacotherapy (89.0 vs 85.3 %, p < 0.0001) and the mean number of antihypertensive agents per patient (1.7 ± 1.1 vs 1.5 ± 1.1, p < 0.0001) declined compared with admission. Adverse drug reactions [odds ratio (OR) = 5, 95 % confidence interval (CI): 2.80–9.34] were the main reason documented for antihypertensive pharmacotherapy changes. Patients admitted under the care of medical (OR = 0.3, 95 % CI: 0.17–0.70) or surgical (OR = 0.3, 95 % CI: 0.12–0.53) specialties were less likely to experience changes to their antihypertensive pharmacotherapy than those treated by gerontology or cardiology teams. Conclusions: Hospitalization has a significant impact on antihypertensive pharmacotherapy. Two out of every five older persons on antihypertensive medications will experience changes to their regimens during admission to hospital with most changes in antihypertensive pharmacotherapy due to adverse drug reaction...
Alhawassi, TM, Krass, I & Pont, LG 2015, 'Impact of Hospitalization on Antihypertensive Pharmacotherapy among Older Persons.', Drugs - real world outcomes, vol. 2, no. 3, pp. 239-247.View/Download from: Publisher's site
Little is known about the impact of hospitalization on antihypertensive pharmacotherapy and blood pressure control in older persons.The aim of this study was to explore the impact of hospitalization on the management of hypertension and antihypertensive pharmacotherapy in a cohort of older patients with a documented diagnosis of hypertension.A retrospective, cross-sectional medical record audit was conducted in a large Australian metropolitan teaching hospital. Patients aged 65 years or older, admitted between January 1st 2010 and December 31st 2010, and with a documented diagnosis of hypertension in their medical record were included in the study. Antihypertensive pharmacotherapy and blood pressure control was compared between admission and discharge. Factors associated with changes to antihypertensive pharmacotherapy were identified.Changes to antihypertensive pharmacotherapy occurred in 39.5 % (n = 135) of patients (n = 342). On discharge, the proportion of patients receiving antihypertensive pharmacotherapy (89.0 vs 85.3 %, p < 0.0001) and the mean number of antihypertensive agents per patient (1.7 ± 1.1 vs 1.5 ± 1.1, p < 0.0001) declined compared with admission. Adverse drug reactions [odds ratio (OR) = 5, 95 % confidence interval (CI): 2.80-9.34] were the main reason documented for antihypertensive pharmacotherapy changes. Patients admitted under the care of medical (OR = 0.3, 95 % CI: 0.17-0.70) or surgical (OR = 0.3, 95 % CI: 0.12-0.53) specialties were less likely to experience changes to their antihypertensive pharmacotherapy than those treated by gerontology or cardiology teams.Hospitalization has a significant impact on antihypertensive pharmacotherapy. Two out of every five older persons on antihypertensive medications will experience changes to their regimens during admission to hospital with most changes in antihypertensive pharmacotherapy due to adverse drug reactions.
Alhawassi, TM, Krass, I & Pont, LG 2015, 'Prevalence, prescribing and barriers to effective management of hypertension in older populations: A narrative review', Journal of Pharmaceutical Policy and Practice, vol. 8, no. 1, pp. 1-6.View/Download from: Publisher's site
© 2015 Alhawassi et al. Objectives: Hypertension is the leading modifiable cause of mortality worldwide. Unlike many conditions where limited evidence exists for management of older individuals, multiple large, robust trials have provided a solid evidence-base regarding the management of hypertension in older adults. Understanding the impact of age on how the prevalence of hypertension and the role of pharmacotherapy in managing hypertension among older persons is a critical element is the provision of optimal health care for older populations. The aim of this study was to explore how the prevalence of hypertension changes with age, the evidence regarding pharmacological management in older adults and to identify known barriers to the optimal management of hypertension in older patients. Methods: A review of English language studies published prior to 2013 in Medline, Embase and Google scholar was conducted. Key search terms included hypertension, pharmacotherapy, and aged. Results: The prevalence of hypertension was shown to increase with age, however there is good evidence for the use of a number of pharmacological agents to control blood pressure in older populations. System, physician and patient related barriers to optimal blood pressure control were identified. Conclusions: Despite good evidence for pharmacological management of hypertension among olderpopulations, under treatment of hypertension is an issue. Concerns regarding adverse effects appearcentral to under treatment of hypertension among older populations.
BinDhim, NF, Shaman, AM, Trevena, L, Basyouni, MH, Pont, LG & Alhawassi, TM 2015, 'Depression screening via a smartphone app: cross-country user characteristics and feasibility', JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, vol. 22, no. 1, pp. 29-34.View/Download from: Publisher's site
Carvajal, A, Sáinz, M, Velasco, V, García Ortega, P, Treceño, C, Martín Arias, LH, Pellón, M & García Sevillano, L 2015, 'Emergency contraceptive pill safety profile. Comparison of the results of a follow-up study to those coming from spontaneous reporting', Pharmacoepidemiology and Drug Safety, vol. 24, no. 1, pp. 93-97.View/Download from: Publisher's site
© 2014 John Wiley & Sons, Ltd. The emergency contraceptive pill (ECP) containing levonorgestrel is dispensed without a prescription in Spain since 2009. An easy access could diminish unwanted pregnancies; however, there is a risk of misuse and, in any case, of developing some adverse events. The aim of the present study is to further learn the adverse effects of this ECP. Methods: An ad hoc follow-up study was carried out in three community pharmacies in a city of Central Spain; the sample was composed of those women asking for the ECP; they were interviewed by telephone after at least a month since the last menses. We completed the safety profile obtained with that coming from spontaneous reporting in Spain. Results: Out of 139 women surveyed, 113 developed any adverse event-two considered as severe; the most frequently reported events were menstrual disturbances, which accounted for 21% of all events. Through spontaneous reporting, 36 cases of whatever adverse events related to levonorgestrel as ECP were identified. Twenty-five cases were considered as severe. Both types of reaction and severity were significantly different in the follow-up study and in the spontaneous reporting. Some of the reactions identified, such as miscarriage, febrile neutropenia, and porphyria, are not included in the Summary of Product Characteristics. Conclusions: Levonorgestrel as an ECP is mostly safe. Attention should be paid to some severe events and particularly to those risk factors for them to appear. Combining spontaneous reporting with an ad hoc follow-up study, the whole safety profile of a given medication can be obtained.
Gadzhanova, S, Roughead, EE & Pont, LG 2015, 'Safety of opioid patch initiation in Australian residential aged care', The Medical journal of Australia, vol. 203, no. 7, pp. 298-298.
OBJECTIVE: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. DESIGN: A cross-sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. SETTING: Sixty residential aged care facilities in New South Wales. PARTICIPANTS: Residents receiving an initial opioid patch during the study period. MAIN OUTCOME MEASURE: The proportion of residents who were opioid-naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. RESULTS: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid-naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up-titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. CONCLUSIONS: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid-naive in the 4 weeks before initiation.
Gadzhanova, S, Roughead, EE & Pont, LG 2015, 'Safety of opioid patch initiation in Australian residential aged care.', The Medical journal of Australia, vol. 203, no. 7, pp. 298-298.View/Download from: Publisher's site
To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches.A cross-sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013.Sixty residential aged care facilities in New South Wales.Residents receiving an initial opioid patch during the study period.The proportion of residents who were opioid-naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined.An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid-naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up-titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation.The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid-naive in the 4 weeks before initiation.
Pont, LG 2015, 'Barriers and facilitators to the provision of clinical pharmacy services in aboriginal communities', Journal of Pharmacy Practice and Research, vol. 45, no. 2, p. 248.View/Download from: Publisher's site
Pont, LG, Nielen, JTH, McLachlan, AJ, Gnjidic, D, Chan, L, Cumming, RG & Taxis, K 2015, 'Measuring anticholinergic drug exposure in older community-dwelling Australian men: a comparison of four different measures.', British journal of clinical pharmacology, vol. 80, no. 5, pp. 1169-1175.View/Download from: Publisher's site
Anticholinergic drug exposure is associated with adverse outcomes in older people. While a number of tools have been developed to measure anticholinergic drug exposure, there is limited information about the agreement and overlap between the various scales. The aim of this study was to investigate the agreement and overlap between different measures of anticholinergic drug exposure in a cohort of community-dwelling older men.A cross-sectional study was used to compare anticholinergic drug exposure calculated using the Anticholinergic Risk Scale (ARS), the Anticholinergic Drug Scale (ADS), the Anticholinergic Cognitive Burden (ACB) and the Drug Burden Index anticholinergic subscale (DBI-ACH) in a cohort of community-dwelling men aged 70 years and older (n = 1696). Statistical agreement, expressed as Cohen’s kappa (κ), between these measurements was calculated.Differences were found between the tools regarding the classification of anticholinergic drug exposure for individual participants. Thirteen percent of the population used a drug listed as anticholinergic on the ARS, 39% used a drug listed on the ADS and the ACB, and 18% of the population used one or more anticholinergic drugs listed on the DBI-ACH. While agreement was good between the ACB and ADS (κ = 0.628, 95% CI 0.593, 0.664), little agreement was found between remaining tools (κ = 0.091-0.264).With the exception of the ACB and ADS, there was poor agreement regarding anticholinergic drug exposure among the four tools compared in this study. Great care should be taken when interpreting anticholinergic drug exposure using existing scales due to the wide variability between the different scales.
Werth, BL, Williams, KA & Pont, LG 2015, 'A longitudinal study of constipation and laxative use in a community-dwelling elderly population', Archives of Gerontology and Geriatrics, vol. 60, no. 3, pp. 418-424.View/Download from: Publisher's site
Background: Little is known about laxative use, the association of constipation with laxative use, risk factors for constipation and how each of these changes over time in the community-dwelling elderly. Objective: The aim was to explore the prevalence of laxative use and of self-reported constipation, and identify risk factors (including age) associated with constipation, in a cohort of community-dwelling elderly residents. Methods: Data from the Australian Longitudinal Study of Ageing (ALSA) was used to compare differences in constipation and laxative use in the community-dwelling elderly between 1992-1993 and 2003-2004. Results: Relevant data was available for 239 ALSA participants. The prevalence of self-reported constipation increased from 14% in 1992-1993 to 21% in 2003-2004. There was a corresponding increase in the prevalence of laxative use from 6% to 15% over the same period. At both time points, females reported a higher prevalence of both constipation and laxative use however the female:male prevalence ratios decreased over time indicating higher increases in the prevalence of each among males. Persistent chronic constipation occurred in 9% of the cohort. The association between laxative use and self-reported constipation was poor and laxative use was associated with self-reported constipation in less than a third of cases. Conclusion: The prevalence of both constipation and laxative use increases with age in the elderly, and these increases are greater for males than for females. Discrepancies between self-reported constipation and laxative use may suggest sub-optimal management of constipation in the community-dwelling elderly and further work is needed to fully understand this.
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: UTS OPUS or Publisher's site
Azzi, M, Constantino, M, Pont, L, McGill, M, Twigg, S & Krass, I 2014, 'Medication Safety: an audit of medication discrepancies in transferring type 2 diabetes mellitus (T2DM) patients from Australian primary care to tertiary ambulatory care', INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, vol. 26, no. 4, pp. 397-403.View/Download from: Publisher's site
Cashin, A, Stasa, H, Dunn, SV, Pont, L & Buckley, T 2014, 'Nurse practitioner prescribing practice in Australia: Confidence in aspects of medication management', INTERNATIONAL JOURNAL OF NURSING PRACTICE, vol. 20, no. 1, pp. 1-7.View/Download from: Publisher's site
Dolton, MJ, Perera, V, Pont, LG & McLachlan, AJ 2014, 'Terbinafine in Combination with Other Antifungal Agents for Treatment of Resistant or Refractory Mycoses: Investigating Optimal Dosing Regimens Using a Physiologically Based Pharmacokinetic Model', ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, vol. 58, no. 1, pp. 48-54.View/Download from: Publisher's site
Dolton, MJ, Perera, V, Pont, LG & McLachlan, AJ 2014, 'Terbinafine in Combination with Other Antifungal Agents for Treatment of Resistant or Refractory Mycoses: Investigating Optimal Dosing Regimens Using a Physiologically Based Pharmacokinetic Model', Antimicrobial Agents and Chemotherapy, vol. 58, no. 1, pp. 48-54.View/Download from: Publisher's site
Terbinafine is increasingly used in combination with other antifungal agents to treat resistant or refractory mycoses due to synergistic in vitro antifungal activity; high doses are commonly used, but limited data are available on systemic exposure, and no assessment of pharmacodynamic target attainment has been made. Using a physiologically based pharmacokinetic (PBPK) model for terbinafine, this study aimed to predict total and unbound terbinafine concentrations in plasma with a range of highdose regimens and also calculate predicted pharmacodynamic parameters for terbinafine. Predicted terbinafine concentrations accumulated significantly during the first 28 days of treatment; the area under the concentration-time curve (AUC)/MIC ratios and AUC for the free, unbound fraction (fAUC)/MIC ratios increased by 54 to 62% on day 7 of treatment and by 80 to 92% on day 28 compared to day 1, depending on the dose regimen. Of the high-dose regimens investigated, 500 mg of terbinafine taken every 12 h provided the highest systemic exposure; on day 7 of treatment, the predicted AUC, maximum concentration (Cmax), and minimum concentration (C min) were approximately 4-fold, 1.9-fold, and 4.4-fold higher than with a standard-dose regimen of 250 mg once daily. Close agreement was seen between the concentrations predicted by the PBPK model and the observed concentrations, indicating good predictive performance. This study provides the first report of predicted terbinafine exposure in plasma with a range of high-dose regimens. © 2014, American Society for Microbiology. All Rights Reserved.
Swain, L, Griffits, C, Pont, L & Barclay, L 2014, 'Attitudes of pharmacists to provision of Home Medicines Review for Indigenous Australians', INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, vol. 36, no. 6, pp. 1260-1267.View/Download from: Publisher's site
Ball, P & Pont, L 2013, 'Keep taking the tablets', Australian Journal of Pharmacy, vol. 94, no. 1113, p. 26.
Margulis, AV, Setoguchi, S, Mittleman, MA, Glynn, RJ, Dormuth, CR & Hernández-Díaz, S 2013, 'Algorithms to estimate the beginning of pregnancy in administrative databases', Pharmacoepidemiology and Drug Safety, vol. 22, no. 1, pp. 16-24.View/Download from: Publisher's site
Purpose: The role of administrative databases for research on drug safety during pregnancy can be limited by their inaccurate assessment of the timing of exposure, as the gestational age at birth is typically unavailable. Therefore, we sought to develop and validate algorithms to estimate the gestational age at birth using information available in these databases. Methods: Using a population-based cohort of 286,432 mother-child pairs in British Columbia (1998-2007), we validated an ICD-9/10-based preterm-status indicator and developed algorithms to estimate the gestational age at birth on the basis of this indicator, maternal age, singleton/multiple status, and claims for routine prenatal care tests. We assessed the accuracy of the algorithm-based estimates relative to the gold standard of the clinical gestational age at birth recorded in the delivery discharge record. Results: The preterm-status indicator had specificity and sensitivity of 98% and 91%, respectively. Estimates from an algorithm that assigned 35weeks of gestational age at birth to deliveries with the preterm-status indicator and 39weeks to those without them were within 2weeks of the clinical gestational age at birth in 75% of preterm and 99% of term deliveries. Conclusions: Subtracting 35weeks (245days) from the date of birth in deliveries with codes for preterm birth and 39weeks (273days) in those without them provided the optimal estimate of the beginning of pregnancy among the algorithms studied. © 2012 John Wiley & Sons, Ltd.
Okuyan, B, Sancar, M & Izzettin, FV 2013, 'Assessment of medication knowledge and adherence among patients under oral chronic medication treatment in community pharmacy settings', Pharmacoepidemiology and Drug Safety, vol. 22, no. 2, pp. 209-214.View/Download from: Publisher's site
Purpose: This study aimed to determine whether there is a relationship between the lack of medication knowledge and the self-reported rates of patient medication adherence. Methods: Patients eligible to participate in the study had been taking oral medication at least once daily over the course of a minimum of three consecutive months before recruitment to the study. All participants were older than 18 years. The level of each patient's knowledge of his or her medication was randomly assessed by a trained fifth-year pharmacy student through an adapted questionnaire. In addition, patient adherence was evaluated via utilization of the Morisky Medication Adherence Scale. Results: Of the 765 study participants (mean±SD age = 55.45±15.05 years, range = 20-91 years, 56.2% women), 58.0% reported adherence to their medication regimen and 64.5% professed optimal knowledge of their medication. The mean duration of medication utilization was 26.77±40.62 months (range = 3-504 years). A statistically significant correlation exists between the total medication knowledge score on the questionnaire and the level of medication adherence (r=-0.964, p<0.001). Conclusion: Improvement in the patient's knowledge of medications taken would bear a positive effect on medication adherence. © 2012 John Wiley & Sons, Ltd..
Smith, JD, White, C, Roufeil, L, Veitch, C, Pont, L, Patel, B, Battye, K, Luetsch, K & Mitchell, C 2013, 'A national study into the rural and remote pharmacist workforce', Rural and Remote Health, vol. 13, no. 2, pp. 1-11.
© JD Smith, C White, L Roufeil, C Veitch, L Pont, B Patel, K Battye, K Luetsch, C Mitchell, 2013. Introduction: As for many health professionals, distance presents an enormous challenge to pharmacists working in rural and remote Australia. Previous studies have identified issues relating to the size of the rural and remote pharmacist workforce, and a number of national initiatives have been implemented to promote the recruitment and retention of pharmacists in rural and remote locations. The aim of this study was to explore and describe the current rural and remote pharmacy workforce, and to identify barriers and drivers influencing rural and remote pharmacy practice. Methods: A mixed-methods approach was used, which comprised a qualitative national consultation and a quantitative rural and remote pharmacist workforce survey. Semi-structured interviews (n=83) and focus groups (n=15, 143 participants) were conducted throughout Australia in 2009 with stakeholders with an interest in rural and remote pharmacy, practising rural/remote pharmacists and pharmacy educators, and as well as with peak pharmacy organizations, to explore the issues associated with rural/remote practice. Based on the findings of the qualitative work a 45-item survey was developed to further explore the relevance of the issues identified in the qualitative consultation. All registered Australian pharmacists practising in non-urban locations (RRMA 3-7, n=3,300) were identified and invited to participate in the study, with a response rate of 23.4%. Results: The main themes identified from the qualitative consultation were the impact of national increases in the pharmacist workforce on rural/remote practice; the role of the regional pharmacy schools in contributing to the rural/remote workforce; and the perceptions of differences in pharmacist roles in rural/remote practice. The survey indicated that pharmacists practising in rural and remote locations were older than the national average (55.8 ye...
Aplenc, R, Fisher, BT, Huang, YS, Li, Y, Alonzo, TA, Gerbing, RB, Hall, M, Bertoch, D, Keren, R, Seif, AE, Sung, L, Adamson, PC & Gamis, A 2012, 'Merging of the National Cancer Institute-funded cooperative oncology group data with an administrative data source to develop a more effective platform for clinical trial analysis and comparative effectiveness research: A report from the Children's Oncology Group', Pharmacoepidemiology and Drug Safety, vol. 21, no. SUPPL.2, pp. 37-43.View/Download from: Publisher's site
Purpose: The National Cancer Institute-funded cooperative oncology group trials have improved overall survival for children with cancer from 10% to 85% and have set standards of care for adults with malignancies. Despite these successes, cooperative oncology groups currently face substantial challenges. We are working to develop methods to improve the efficiency and effectiveness of these trials. Specifically, we merged data from the Children's Oncology Group (COG) and the Pediatric Health Information Systems (PHIS) to improve toxicity monitoring, to estimate treatment-associated resource utilization and costs, and to address important clinical epidemiology questions. Methods: COG and PHIS data on patients enrolled on a phase III COG trial for de novo acute myeloid leukemia at 43 PHIS hospitals were merged using a probabilistic algorithm. Resource utilization summary statistics were then tabulated for the first chemotherapy course based on PHIS data. Results: Of 416 patients enrolled on the phase III COG trial at PHIS centers, 392 (94%) were successfully matched. Of these, 378 (96%) had inpatient PHIS data available beginning at the date of study enrollment. For these, daily blood product usage and anti-infective exposures were tabulated and standardized costs were described. Conclusions: These data demonstrate that patients enrolled in a cooperative group oncology trial can be successfully identified in an administrative data set and that supportive care resource utilization can be described. Further work is required to optimize the merging algorithm, map resource utilization metrics to the National Cancer Institute Common Toxicity Criteria for monitoring toxicity, to perform comparative effectiveness studies, and to estimate the costs associated with protocol therapy. © 2012 John Wiley & Sons, Ltd.
Ball, P & Pont, L 2012, 'Home grown or imported?', Australian Journal of Pharmacy, vol. 93, no. 1110, p. 34.
Ball, P & Pont, L 2012, 'Let he who is without sin...', Australian Journal of Pharmacy, vol. 93, no. 1106, p. 33.
Ball, P & Pont, L 2012, 'Moving on from the Olympics', Australian Journal of Pharmacy, vol. 93, no. 1108, p. 39.
Ball, P & Pont, L 2012, 'Mushrooming practice', Australian Journal of Pharmacy, vol. 93, no. 1102, p. 32.
Ball, P & Pont, L 2012, 'Student placement support', Australian Journal of Pharmacy, vol. 93, no. 1100, p. 23.
Ball, P & Pont, L 2012, 'Will the circle be unbroken?', Australian Journal of Pharmacy, vol. 93, no. 1104, p. 38.
Dolton, MJ, Pont, L, Stevens, G & McLachlan, AJ 2012, 'Prevalence of potentially harmful drug interactions in older people in Australian aged-care facilities', Journal of Pharmacy Practice and Research, vol. 42, no. 1, pp. 33-36.View/Download from: Publisher's site
Background: Older people living in aged-care facilities are prescribed more medications than those living in their own homes. Thus, increasing their risk of potentially harmful drug interactions. Few studies have investigated potential drug interactions in residents of aged-care facilities. Aim: To determine the prevalence of potentially harmful drug interactions in long-term residents of aged-care facilities. Method: Potentially harmful drug interactions were investigated using dispensing data from residents of 26 aged-care facilities who received one or more medications from July 2008 to June 2010. Drug interactions analysed were chosen based on their inclusion at the highest severity rating in at least 3 of 4 international drug information resources. Data were compared to findings from a cohort of Australian veterans. Results: Potentially harmful drug interactions were identified for 6.1% of the 3876 residents included in the study. A substantially higher incidence than previously reported in Australian veterans (1.5%) and certain overseas populations. Interactions involving warfarin, amiodarone, verapamil, lithium and methotrexate had the highest prevalence in aged-care residents, and generally a higher prevalence than in the Australian veteran population. Conclusion: Potentially harmful drug interactions were more prevalent in aged-care residents than in an Australian veteran population.
Dolton, MJ, Ray, JE, Chen, SC-A, Ng, K, Pont, L & McLachlan, AJ 2012, 'Multicenter Study of Posaconazole Therapeutic Drug Monitoring: Exposure-Response Relationship and Factors Affecting Concentration', ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, vol. 56, no. 11, pp. 5503-5510.View/Download from: Publisher's site
Dolton, MJ, Ray, JE, Chen, SC-A, Ng, K, Pont, LG & McLachlan, AJ 2012, 'Multicenter Study of Voriconazole Pharmacokinetics and Therapeutic Drug Monitoring', ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, vol. 56, no. 9, pp. 4793-4799.View/Download from: Publisher's site
Hammill, BG, Curtis, LH & Setoguchi, S 2012, 'Performance of propensity score methods when comparison groups originate from different data sources', Pharmacoepidemiology and Drug Safety, vol. 21, no. SUPPL.2, pp. 81-89.View/Download from: Publisher's site
Purpose: To examine the performance of propensity score-based methods for estimating relative risks when exposed and comparison subjects are selected from different data sources. Methods: We conducted Monte Carlo simulations to assess the performance of propensity score methods under various scenarios in which exposed and comparison subjects were selected from different data sources for a comparative effectiveness study of a medical device. Results: The use of propensity score methods in our simulated data scenarios often yielded estimates of relative risk that were close to the true effect, unless the comparison group differed from the exposed group systematically on a factor associated with the outcome. This situation caused severe bias regardless of which method was used but could be overcome if the exposed group could be restricted similarly to the comparison group. Mean square error of relative risk estimates was lowest for similarly restricted study groups and when the comparison group could be considered a random sample of the source population that generated the exposed group. Conclusions: When exposed and comparison groups originated from different data sources, all propensity score methods yielded relatively unbiased and consistent estimates of relative risk in most situations reflected in our simulation study. © 2012 John Wiley & Sons, Ltd.
McLachlan, AJ & Pont, LG 2012, 'Drug Metabolism in Older People-A Key Consideration in Achieving Optimal Outcomes With Medicines', JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, vol. 67, no. 2, pp. 175-180.View/Download from: Publisher's site
Stupans, I, Owen, S, McKauge, L, Pont, L, Ryan, G & Woulfe, J 2012, 'Development and trialling of a graduated descriptors tool for Australian pharmacy students', Assessment and Evaluation in Higher Education, vol. 37, no. 7, pp. 829-845.View/Download from: UTS OPUS or Publisher's site
Profession-derived competency standards are key determinants for curriculum and assessment in many professional university programmes. An Australian Learning and Teaching Council funded project used a participatory action research approach to enable the collaborative development of a graduated (or incremental) descriptors tool related to competencies, applicable to Australian pharmacy students at various stages within their university programmes. Consultations with pharmacy professional/ registration organisations, students, preceptors and academics throughout Australia were undertaken. Recording of key themes of discussions and progressive development of the tool occurred. Initial trialling of the tool in pharmacy programmes at two different Australian universities has indicated that students were ambivalent regarding the tool and, for example, its usefulness for self-assessment against competencies and its role in supporting learning. Preceptors, supporting students on placements, were however very positive about the tool, its usefulness in supporting learning and in supporting discussions between preceptors and students.
Ball, P & Pont, L 2011, 'Addressing the gap', Australian Journal of Pharmacy, vol. 92, no. 1096, p. 42.
Ball, P & Pont, L 2011, 'Divided we fail', Australian Journal of Pharmacy, vol. 92, no. 1088, p. 23.
Ball, P & Pont, L 2011, 'Rural solution can lead change', Australian Journal of Pharmacy, vol. 92, no. 1094, p. 43.
Ball, P & Pont, L 2011, 'Time to move on eHealth', Australian Journal of Pharmacy, vol. 92, no. 1098, p. 36.
Chaar, BB, Brien, JA, Hanrahan, J, McLachlan, A, Penm, J & Pont, L 2011, 'Experimental education in Australian pharmacy: Preceptors' perspectives', Pharmacy Education, vol. 11, no. 1, pp. 166-171.
Background: Experiential education is key to students understanding their future practice settings. The quality and success of experiential education rest largely on volunteer preceptors, who are an essential asset to the education of pharmacy students in Australia. This asset needs constant support and nurturing. Aims: This study aims to explore the perceptions of Australian preceptors" and their needs regarding their role in training future generations of pharmacists. Method: Five focus groups of pharmacist preceptors were conducted, audio-taped and transcribed verbatim. Transcripts were thematically analysed to identify major themes related to pharmacy experiential education. Results: Thirty seven pharmacists participated in the focus group interviews, representing diverse demographics and workplace settings. Pharmacists reported enjoying the role of preceptor however, lack of insight into education techniques, increased workload, lack of time and space, and increased stress levels were identified by participants as obstacles to achieving good educational outcomes. Conclusion: Preceptors are role models for novice practitioners, and the relationships between universities and preceptors need to be robust, supportive and relevant to changing professional and health sector environments. © 2011 FIP.
Pont, L & Ball, P 2011, 'In the face of adversity', Australian Journal of Pharmacy, vol. 92, no. 1090, p. 36.
Ball, P & Pont, L 2010, 'Good health not only from GPs', Australian Journal of Pharmacy, vol. 91, no. 1084, p. 38.
Ball, P & Pont, L 2010, 'Rural funding drops academics', Australian Journal of Pharmacy, vol. 91, no. 1082, p. 29.
Ball, P & Pont, L 2010, 'Teamwork in practice', Australian Journal of Pharmacy, vol. 91, no. 1078, p. 28.
Pont, LG, Denig, P, van der Molen, T, van der Veen, WJ & Haaijer-Ruskamp, FM 2004, 'Validity of performance indicators for assessing prescribing quality: the case of asthma', EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, vol. 59, no. 11, pp. 833-840.View/Download from: Publisher's site
Pont, LG, van der Molen, T, Denig, P, van der Werf, GT & Haaijer-Ruskamp, FM 2004, 'Relationship between guideline treatment and health-related quality of life in asthma', EUROPEAN RESPIRATORY JOURNAL, vol. 23, no. 5, pp. 718-722.View/Download from: Publisher's site
Pont, LG, Sturkenboom, MCJM, van Gilst, WH, Denig, P & Haaijer-Ruskamp, FM 2003, 'Trends in prescribing for heart failure in Dutch primary care from 1996 to 2000', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, vol. 12, no. 4, pp. 327-334.View/Download from: Publisher's site
Pont, LG, van Gilst, WH, Lok, DJA, Kragten, HJA & Haaijer-Ruskamp, FM 2003, 'The relevance of heart failure severity for treatment with evidence-based pharmacotherapy in general practice', EUROPEAN JOURNAL OF HEART FAILURE, vol. 5, no. 2, pp. 187-193.View/Download from: Publisher's site
van Dijk, KN, Pont, LG, de Vries, CS, Franken, M, Brouwers, JRBJ & de Jong-van den erg, LTW 2003, 'Prescribing indicators for evaluating drug use in nursing homes', ANNALS OF PHARMACOTHERAPY, vol. 37, no. 7-8, pp. 1136-1141.View/Download from: Publisher's site
Pont, LG, van der Werf, GT, Denig, P & Haaijer-Ruskamp, FM 2002, 'Identifying general practice patients diagnosed with asthma and their exacerbation episodes from prescribing data', EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, vol. 57, no. 11, pp. 819-825.View/Download from: Publisher's site
Veninga, CC, Denig, P, Pont, LG & Haaijer-Ruskamp, FM 2001, 'Comparison of indicators assessing the quality of drug prescribing for asthma.', Health services research, vol. 36, no. 1 Pt 1, pp. 143-161.
OBJECTIVE: To compare different indicators for assessing the quality of drug prescribing and establish their agreement in identifying doctors who may not adhere to treatment guidelines. DATA SOURCES/STUDY SETTING: Data from 181 general practitioners (GPs) from The Netherlands. The case of asthma is used as an example because, in this area, different quality indicators exist whose validity is questioned. The study is part of the European Drug Education Project. STUDY DESIGN: Spearman rank correlations were assessed among the GPs' scores on self-report instruments, aggregated prescribing indicators, and individualized prescribing indicators. Kappa values were calculated as agreement measures for identifying low adherence to the guidelines. DATA COLLECTION: Prescribing data from GPs were collected through pharmacies, public health insurance companies, or computerized GP databases. Two self-report instruments were mailed to the GPs. The GPs first received a questionnaire assessing their competence regarding the treatment of asthma patients. Three months later they received a series of 16 written asthma cases asking for their intended treatment for each case. PRINCIPAL FINDINGS: Correlations between scores based on self-report instruments and indicators based on actual prescribing data were mostly nonsignificant and varied between 0 and 0.21. GPs identified as not adhering to the guidelines by the prescribing indicators often had high scores on the self-report instruments. Correlations between 0.20 and 0.55 were observed among indicators based on aggregated prescribing data and those based on individualized data. The agreement for identifying low adherence was small, with kappa values ranging from 0.19 to 0.30. CONCLUSIONS: Indicators based on self-report instruments seem to overestimate guideline adherence. Indicators assessing prescribing quality at an aggregated level give clearly different results, as compared to indicators evaluating prescribing data on an indivi...
Veninga, CCM, Denig, P, Pont, LG & Haaijer-Ruskamp, FM 2001, 'Comparison of indicators assessing the quality of drug prescribing for asthma', Health Services Research, vol. 36, no. 1 I, pp. 143-161.
Objective. To compare different indicators for assessing the quality of drug prescribing and establish their agreement in identifying doctors who may not adhere to treatment guidelines. Data Sources/Study Setting. Data from 181 general practitioners (GPs) from The Netherlands. The case of asthma is used as an example because, in this area, different quality indicators exist whose validity is questioned. The study is part of the European Drug Education Project. Study Design. Spearman rank correlations were assessed among the GPs' scores on self-report instruments, aggregated prescribing indicators, and individualized prescribing indicators. Kappa values were calculated as agreement measures for identifying low adherence to the guidelines. Data Collection. Prescribing data from GPs were collected through pharmacies, public health insurance companies, or computerized GP databases. Two self-report instruments were mailed to the GPs. The GPs first received a questionnaire assessing their competence regarding the treatment of asthma patients. Three months later they received a series of 16 written asthma cases asking for their intended treatment for each case. Principal Findings. Correlations between scores based on self-report instruments and indicators based on actual prescribing data were mostly nonsignificant and varied between 0 and 0.21. GPs identified as not adhering to the guidelines by the prescribing indicators often had high scores on the self-report instruments. Correlations between 0.20 and 0.55 were observed among indicators based on aggregated prescribing data and those based on individualized data. The agreement for identifying low adherence was small, with kappa values ranging from 0.19 to 0.30. Conclusions. Indicators based on self-report instruments seem to overestimate guideline adherence. Indicators assessing prescribing quality at an aggregated level give clearly different results, as compared to indicators evaluating prescribing data on an indivi...
Veninga, CCM, Denig, P, Pont, LG & Haaijer-Ruskamp, FM 2001, 'Comparison of indicators assessing the quality of drug prescribing for asthma', HEALTH SERVICES RESEARCH, vol. 36, no. 1, pp. 143-161.
Walton, LJ, Franklin, IJ, Bayston, T, Brown, LC, Greenhalgh, RM, Taylor, GW & Powell, JT 1999, 'Inhibition of prostaglandin E2 synthesis in abdominal aortic aneurysms: Implications for smooth muscle cell viability, inflammatory processes, and the expansion of abdominal aortic aneurysms', Circulation, vol. 100, no. 1, pp. 48-54.View/Download from: Publisher's site
Background - There is no treatment proven to limit the growth of abdominal aortic aneurysms, in which the histological hallmarks include inflammation and medial atrophy, with apoptosis of smooth muscle cells and destruction of elastin. Methods and Results - Aneurysm biopsies were used for explant cultures, the preparation of smooth muscle cell cultures, and isolation of macrophages. Tissue macrophages stained strongly for cyclooxygenase 2. Prostaglandin E2 (PGE2) concentrations in aneurysm tissue homogenates, conditioned medium from explants, and isolated macrophages were 49 ± 22 ng/g, 319 ± 38 ng/mL, and 22 ± 21 ng/mL, respectively. PGE2 inhibited DNA synthesis and proliferation in normal aortic smooth muscle cells (IC50, 23.2 ± 3.8 and 23.6 ± 4.5 ng/mL, respectively). In smooth muscle cells derived from aneurysmal aorta, PGE2 also caused cell death, with generation of oligonucleosomes. Conditioned medium from the mixed smooth muscle and monocyte cultures derived from explants also had potent growth- inhibitory effects, and fractionation of this medium showed that the growth- inhibitory molecule(s) coeluted with PGE2. In explants, indomethacin 10/μmol/L or mefenamic acid 10 μmol/L abolished PGE2 secretion and significantly reduced IL-1β and IL-6 secretion. In a separate case-control study, the expansion of abdominal aortic aneurysms was compared in 15 patients taking nonsteroidal anti-inflammatory drugs and 63 control subjects; median growth rates were 1.5 and 3.2 mm/y, respectively, P = 0.001. Conclusions - The adverse effects of PGE2 on aortic smooth muscle cell viability and cytokine secretion in vitro and the apparent effect of anti- inflammatory drugs to lower aneurysm growth rates suggest that selective inhibition of PGE2 synthesis could be an effective treatment to curtail aneurysm expansion.
The prevalence of hypertension increases with age making it a significant health concern for older persons. Aging involves a range of physiological changes such as increases in arterial stiffness, widening pulse pressure, changes in renin and aldosterone levels, decreases in renal salt excretion, declining in renal function, changes in the autonomic nervous system sensitivity and function and changes to endothelial function all of which may not only affect blood pressure but may also affect individual response to pharmacotherapy used to manage hypertension and prevent end organ damage and other complications associated with poor blood pressure control.Unlike many chronic conditions where there is limited evidence for management in older populations, there is good evidence regarding the management of hypertension in the elderly. The findings from multiple large, robust trials have provided a solid evidence-base regarding the management of hypertension in older adults, showing that reduction of blood pressure in older hypertensive populations is associated with reduced mortality and morbidity. Diuretics, agents action on the renin angiotensin system, beta blockers and calcium channel blockers have all been well studied in older populations both in view of the benefits associated with blood pressure lowering and the risks associated with associated adverse events. While all antihypertensive agents will lower blood pressure, when managing hypertension in older persons the choice of agent is dependent not only on the ability to lower blood pressure but also on the potential for harm with older persons. Understanding such potential harms in older populations is essential with older persons experiencing increased sensitivity to many of the adverse effects such as dizziness associated with the use of antihypertensive agents.Despite the wealth of evidence regarding the benefits of managing hypertension in the old and very old, a significant proportion of older individuals...
Ata, SI, Alhawassi, TM, Alshammary, TM, Bin Dhim, N, Pont, LG & Aljadhey, HS 2016, 'Assessing Studies of Patients Spontaneously Reported Adverse Drug Reactions (ADR's): A Review Study', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 410-411.
Pont, LG, Semerdijan, M, Burke, T, Mekhael, L, Vucic, S & Hughes, V 2016, 'Time-to-Treatment In The Management Of Relapsing/Remitting Multiple Sclerosis', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 207-208.
Pont, LG, Taxis, K, Wirtz, V, Gallagher, P, Byrne, S & Fourrier-Reglat, A 2016, 'Drug Utilisation In Older Populations: The Irish View On Knowing Right From Wrong', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 49-49.
Pradhan, E & Pont, LG 2016, 'Safety Of Non-Prescription NSAIDs', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 446-447.
Alhawassi, TM, Krass, I & Pont, LG 2015, 'Effect of Hospital Admission on Antihypertensive Medication Utilization Among Older Persons', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 80-81.
Alhawassi, TM, Krass, I & Pont, LG 2015, 'Hypertension management and control in older persons on admission to an acute care setting', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 93-94.
Alhawassi, TM, Krass, I & Pont, LG 2015, 'Prevalence and risk factors for adverse drug reactions in older adults in the acute care setting', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 91-91.
Bosnic-Anticevich, S, Lim, D, Steel, J, Kritikos, V, Nikolaou, V, Bjermer, L, Chrystyn, H, Lavorini, F, Dekhuijzen, R, Rand, C, Roche, N, Smith, L, Pont, L, Smita, S, Nicholas, Z & Price, D 2015, 'Investigating the maintenance of inhaler device mastery of healthcare professionals', ALLERGY, Congress of the European-Academy-of-Allergy-and-Clinical-Immunology, WILEY-BLACKWELL, Barcelona, SPAIN, pp. 645-645.
Caughey, G, Taxis, K, Wettermark, B, Sketris, I, Chen, L-C & Pont, L 2015, 'An International Working Collaborative to Examine Global Drug Utilisation: Opioid Use and Misuse', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 43-44.
Pont, LG, van der Meer, H, Stevens, G, McLachlan, A & Taxis, K 2015, 'Changes in Drug Utilization at the End of Life', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 35-36.
Pont, LG, Veal, C, Flemming, A, Low, L-F & Pinto, S 2015, 'Using Data to Change Drug Utilization in the Real World', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 35-35.
Pont, LG, Nielen, JTHY, McLachlan, A, Gnjidic, D, Chan, L, Cumming, R & Taxis, K 2014, 'Safety of Anticholinergic Medications in the Elderly: Anticholinergic Burden and Lower Urinary Tract Symptoms (LUTS)', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 191-191.
Roughead, L, Haaijer-Ruskamp, F, Wirtz, V, Gurumurthy, P & Pont, LG 2014, 'Using Pharmaceutical Data for Evaluating Medicines Policy and Informing Quality Use of Medicines', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 365-365.
Taxis, K, Kochen, S, Geerens, S, Wouters, H, Boersma, F, Maring, JG, Mulder, H, Pavlovic, J, Stevens, G, McLachlan, AJ & Pont, L 2014, 'Cross-National Comparison of Prescribing Patterns in Australian and Dutch Nursing Homes', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 173-173.
Gregoire, J-P, Gross, R, Lauzier, S, Choudry, N & Pont, L 2013, 'Looking for Efficient Solutions to Optimize Adherence to Drug Treatment: The Clinical, Health Services Research and Economics Perspectives', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 209-209.
Pont, LG, Cheng, A, Stevens, G & McLachlan, AJ 2013, 'Warfarin Safety in a Residential Aged Care Setting', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 16-16.
Pont, LG, Jomaa, H, Stevens, G & McLachlan, AJ 2013, 'Non-Prescription Medicines - The Missing Pieces of the Drug Utilization Puzzle', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY-BLACKWELL, pp. 487-487.
Denig, P, Andersen, M, Kildemoes, HW, Pont, L, Voorham, J & Gregoire, JP 2012, 'Advanced Methods and Measures for Studying Complex Drug Utilization Patterns with Patient-Level Databases', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY PERIODICALS, INC, pp. 37-37.
Pont, LG, Gilbert, AL, Truter, I, Wirtz, VJ, Yang, Y-HK, May, F & Anderson, M 2012, 'Globalisation of Utilisation Research: Current Challenges and Triumphs', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY PERIODICALS, INC, pp. 338-338.
Pont, LG, Postma, M, Stevens, G, Dolton, M & McLaclan, A 2012, 'Feasibility of a Novel Data Source for Drug Utilisation Research in Aged Care', PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, WILEY PERIODICALS, INC, pp. 81-81.
Pont, LG, van Gilst, WH, Lok, DJA, Kragten, JA & Haaijer-Ruskamp, FM 2002, 'Are heart failure patients in general practice receiving evidence-based pharmacotherapy?', EUROPEAN HEART JOURNAL, Congress of the European-Society-of-Cardiology, W B SAUNDERS CO LTD, BERLIN, GERMANY, pp. 402-402.
Pont, LG, van Gilst, WH, Lok, DJA, Kragten, JA & Haaijer-Ruskamp, FM 2002, 'Prescribing for heart failure in general practice: the relationship between physician knowledge and prescribing quality', EUROPEAN HEART JOURNAL, Congress of the European-Society-of-Cardiology, W B SAUNDERS CO LTD, BERLIN, GERMANY, pp. 596-596.
Monnink, SHJ, Tio, RA, van Boven, AJ, van Geel, PP, Veeger, NJGM, de Kam, PJ, Pont, L & van Gilst, WH 1999, 'Angiotensin II receptor polymorphism is associated with endothelial function on top of other cardiovascular risk factors: The intervention cardiology risk stratification (ICARIS) study', CIRCULATION, LIPPINCOTT WILLIAMS & WILKINS, pp. 48-48.