Journal of evaluation in clinical practice
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The aim of this study was to identify temporal readmission patterns according to baseline disease categories to provide opportunities for targeted interventions. ⋯ Reasons for readmission appear to be universal across different disease categories. Targeted educational and collaborative measures may help to mitigate the burden of hospital readmissions to index facilities.
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The collection, storage and exchange of medical information are becoming increasingly complex. More parties are involved in this process, and the data are expected to serve many different purposes beside patient care. This raises several ethical questions regarding privacy, data ownership, security and confidentiality. It is vital to consider patients' moral attitudes and preferences in this digital information exchange. The voice of vulnerable patients is rarely heard in research addressing these questions. This study aims to address this void. ⋯ Patient portal design should take into consideration the obstacles that discourage vulnerable patients' access and hamper meaningful use. There is a need for more transparency on secondary use of medical data by third parties. Patients should be better informed about the potential consequences of sharing data with them.
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Non-adherence is a major problem among patients with chronic diseases. Community pharmacists are ideally positioned to detect non-adherence and to provide patient-centred interventions. ⋯ Pharmacist-led intervention can improve LLM adherence, but its influence on clinical outcomes, including lipid level control, remains to be clarified.
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As the recent literature has growing concerns about research replicability and the misuse and misconception of P-values, the fragility index (FI) has been an attractive measure to assess the robustness (or fragility) of clinical study results with binary outcomes. It is defined as the minimum number of event status modifications that can alter a study result's statistical significance (or non-significance). Owing to its intuitive concept, the FI has been applied to assess the fragility of clinical studies of various specialties. However, the FI may be limited in certain settings. As a relatively new measure, more work is needed to examine its properties. ⋯ Our findings may help clinicians properly use the FI and appraise the reliability of a study's conclusion.
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Clinical inertia, defined as a delay in treatment intensification, is prevalent in people with diabetes. Treatment intensification rates are as low as 37.1% in people with haemoglobin A1c (HbA1c) values >7%. Intensification by addition of medication therapy may take 1.6 to more than 7 years. Clinical inertia increases the risk of cardiovascular events. The primary objective was to evaluate rates of clinical inertia in people whose diabetes is managed by both pharmacists and primary care providers (PCPs). Secondary objectives included characterizing types of treatment intensification, HbA1c reduction, and time between treatment intensifications. ⋯ Pharmacist involvement in diabetes management may reduce the clinical inertia patients may otherwise experience in the primary care setting.