By Q. Potros. University of Tennessee, Chattanooga.

Standard methods are available that measure the usability of a system and provide strategies to improve its usability aspects order zyprexa 7.5mg with amex medications you cant take while breastfeeding. Usefulness is a soft measure of whether the system or application meets its stated goals effective zyprexa 10 mg medicine joint pain. Broadly speaking, ‘value proposition’ refers to the benefits one receives by adopting a particular product, approach, or technology, as compared to what you currently have, or what some other competitive offering would provide. In monetary terms, the value proposition is what the customer gets for his/her money/time. It can also be regarded as differences in performance and/or cost between two different alternatives, such as response speed, product or service quality, and the relative performance in terms of satisfaction or preference. Search terms: ‘return on investment,’ ‘cost benefit,’ ‘relative value,’ ‘relative performance,’ etc. Nonetheless, non-adherence to antipsychotic medication regimens is common amongst consumers. Whilst ample research has attempted to quantify rates of adherence and identify influences on adherence and non-adherence, few qualitative studies have been undertaken in the area and the consumers’ voices have thereby been limited. The research presented in this thesis aimed to enhance understanding of medication adherence from the consumer perspective. Qualitative, semi- structured, one-to-one interviews were conducted with 25 outpatients with schizophrenia from metropolitan Adelaide. Interviews were audio-recorded, transcribed and analysed, guided by a grounded theory approach. Codes identified in open coding were grouped into categories, reflective of the different aspects of consumers’ medication taking experiences. It is argued that consumer-related factors, medication-related factors and service-related factors influence adherence behaviour. Whilst some of the codes that were identified as influences on adherence were consistent with previous research findings, such as insight, side effects, efficacy and therapeutic alliance, analysis elaborated different aspects of these factors and shed some light on how they influence adherence. The most commonly raised, novel codes that emerged from interview data related to reflection on experiences and peer worker intervention. Specifically, interviewees commonly reported that they learned from previous illness and medication-related experiences, including iv the experience of non-adherence, which was frequently constructed as a motivator for future adherence. Furthermore, when enquired about interventions, many interviewees suggested that peer workers may work more effectively with consumers to encourage adherence. In particular, peer workers were were positioned as having more credibility than other service providers due to their shared experiences with consumers. Research findings support greater involvement of consumers in research due to their valuable contributions. Furthermore, regarding the clinical implications, findings support tailored, individualised interventions, enhanced peer worker involvement and challenge service providers’ poor tolerance of non- adherence on the grounds that adherence may represent a learning process. In addition, I certify that no part of this work will, in the future, be used in a submission for any other degree or diploma in any university or other tertiary institution without the prior approval of the University of Adelaide. I give my consent to this copy of my thesis, when deposited in the University Library, being made available for loan and photocopying, subject to the provisions of the Copyright Act 1968. I also give permission for the digital version of my thesis to be made available on the web, via the University’s digital research repository, the Library catalogue, and also through web search engines, unless permission has been granted by the University to restrict access for a period of time. Firstly, to my supervisory panel, Professor Deborah Turnbull, Dr Shona Crabb and Professor Cherrie Galletly – thank you all for your perseverance, guidance and support. Deb, you have consistently provided me with constructive feedback, motivation and gave me a push when I needed it! Shona, your encouragement and positive regard have been much appreciated and your analytical knowledge has been invaluable. Cherrie, your extensive clinical experience combined with your enthusiasm for the subject matter was a true inspiration. I’d also like to mention Bev Hisee, Research Nurse, who assisted me greatly in my interactions with consumers and whose knowledge and genuineness impressed. To the incredible group of interviewees involved in this research and to those consumers who I met along the way – this thesis would not have been possible without your insightful contributions.

It wasn’t- cheap zyprexa 7.5 mg on line medicine nelly, I don’t think I was better at the time discount 5 mg zyprexa with amex medicine emblem, um (inaudible) probably too soon, but like I said, it’s not up to me, it’s up to the mental health, up to the psychiatrist to prescribe all that stuff. Brodie recalled previously requesting to have his dosage lowered as he “figured [he] could still be alright” which was then disproven by his experience (“but I guess not”). He could be seen to relate this experience to his present trust in his prescriber to manage his treatment. Whilst Brodie may appear to position himself as subservient to his prescriber, his decision to allow his prescriber to dictate his medication regiment could also be seen to reflect a sensible, rational choice and an attempt to ensure that his treatment decisions are not influenced by his mental instability. That is, in the context of mental instability, allowing the prescriber to have control over the treatment regimen may be more beneficial for consumers, thus, challenging whether true collaboration is a positive goal, when consumers’ symptoms are florid and their judgment is potentially impeded. This is contrasted with interviewees’ experiences of prescribers focusing solely on illness symptoms or prescription information, asking the same questions week after week and, generally, adopting a more impersonal approach to treatment. In line with research which indicates that longer duration of treatment with the same prescriber influences adherence (i. Below, interviewees highlight the types of questions they think prescribers should ask them and contrast this to a lack of interest in consumer experiences: Gary and Ruth, 31/07/2008 L: Cool, thanks. Ummm, so are there any other ways that you think um health workers could help people, could assist people in ta-, to take their medications? G: Well, umm, see I think that health workers don’t ask enough questions, you know what I mean? G: They just ask you how you, you know, they ask you how are your symptoms and you tell ‘em your symptoms and…you know like the psychiatrists I’ve had, they seem to be a bit ignorant, you know what I mean? L: Oh ok, so they’ll just ask about how your symptoms are and not so much about your experiences with, of taking the medication. G: Yeah, yeah, whereas Doctor T has been pretty thorough with that, you know and the health workers I’ve had recently, they’ve been pretty good but 225 like, years ago, when I went off my medication the psychiatrist, I don’t know, he just, just wasn’t a very good one, you know what I mean? Oliver, 21/08/2008 O: And the psychiatrist just says the same thing: How does your medications? O: Yeah, and they’re like, every time we see them they ask you what medications you’re on, it’s like, check the notes. L: So you were saying that you find like, they just ask you the same sort of things. L: What do you think would be useful for them to ask, or like, what sorts of things, how do you think it should be when you go and see your psychiatrist? O: Well they should ask you, have you got any problems, have you got any concerns, have you got any worried about anything, you know. O: Some of them, I don’t even feel like they care, they’re just like, “yeah yeah”. In the context of being asked about how health workers could assist consumers with adherence, Gary suggests that prescribers should ask consumers more questions, as they “don’t ask enough”, which is also illustrated through his elaboration that prescribers “just ask you how you, you know, they ask you how are your symptoms”. He indicates that prescribers’ questions focus on medication and dosage information and implies that prescribers fail to read notes prior to appointments. Gary could be seen to suggest that a past prescriber failed to assist him during a period of non-adherence by not asking enough questions and thereby assesses him negatively (“he wasn’t a very good one”). Oliver negatively appraises prescribers who fail to provide a personal (“they’re just like, yeah yeah”), considerate (“he didn’t care”) and thorough (“I was in there 10 minutes and she just sent me out”) service. Gary and Oliver provide examples of the types of questions that prescribers could ask consumers to assist with adherence and their general well-being, such directly asking about their adherence (“Are you still taking your medication? Oliver also 227 indicates that friendly rapport would be appreciated (“joke around, give a bit of advice”). It was surprising that some consumers indicated that their prescribers did not ask questions about adherence or potential stressors which could lead to relapse, given the established importance of relapse prevention amongst people with schizophrenia. This may reflect time constraints and a lack of resources in the mental health system, which prevents prescribers from being able to spend time gaining information about consumers they are treating. It could be argued that there may be a role for psychologists in providing a more personalized service for consumers, whereby they can discuss stressors and barriers to adherence for example.

Exclude - Not a Primary Study E-27 Standards on verbal orders rank high among common compliance problems 2.5 mg zyprexa treatment with cold medical term. Exclude - Not a Primary Study Study finds benefits in ‘paperless’ hospitals: ‘patients appear safer and hospital bottom lines may imrpove’ purchase zyprexa 10 mg with amex symptoms after flu shot. Exclude - Not a Primary Study Technological advances in adherence interventions are not expected panacea. Exclude - Not a Primary Study Technology, government incentives drive electronic prescribing. Exclude - Not a Primary Study E-28 Universal patient floor increases patient flow, decreases handoff, improves patient safety. Exclude - Not a Primary Study Consider human factors engineering when designing your patient safety projects. Exclude - Not a Primary Study Federal government’s paperless requirements come with many Practical benefits. Exclude - Not a Primary Study E-30 Follow-up calls help patients adhere to treatment plan, avoid readmissions. Exclude - Not a Primary Study Health system sets ‘zero errors’ as its goal for patient safety, quality. Exclude - Not a Primary Study State e-health activities in 2007: Findings from a state survey. Patient’s medication information and e-Health development in Finland: A case study of a Finnish primary care organization. Understanding implementation: The case of a computerized physician order entry system in a large Dutch university medical center. Same systems, different outcomes: Comparing the implementation of computerized physician order entry in two dutch hospitals. Evaluation of the performance of drug-drug interaction screening software in community and hospital pharmacies. Evaluation of a computer-assisted method for individualized anticoagulation: Retrospective and prospective studies with a pharmacodynamic model. Designing a patient care medication and recording system that uses bar code technology. Feasibility and acceptability to patients of a longitudinal system for evaluating cancer-related symptoms and quality of life: pilot study of an e/Tablet data-collection system in academic oncology. Safe medication practices compared at a teaching hospital and a community hospital. Using the electronic medical record to predict the pharmacological management of acute myocardial infarction The University of UtahEditor. Problems and some solutions in adapting clinical practice guidelines for asthma patient management into a computerised management system. Medical informatics in the intensive care unit: overview of technology assessment. Implementation of computerized chemotherapy provider order entry in veterans affairs medical center and its role in a three tier check system. Implementation of computerized chemotherapy provider order in veterans affairs medical center and its role in the three tier check system. Personal health information management and the design of consumer health information technology: Background report. A randomized comparison of a computer-based dosing program with a manual system to monitor oral anticoagulant therapy. A computer generated induction system for hospitalized patients starting on oral anticoagulant therapy. Cost effectiveness of telemedicine for the delivery of outpatient pulmonary care to a rural population. Experiences from the use of data-driven decision support in different environments. International Journal of Advanced Pervasive and Ubiquitous Computing 2009;1(3):42-60. Monatsschrift Kinderheilkunde 1993;Organ der Deutschen Gesellschaft fur Kinderheilkunde. Six generations of the insulin dosage computer: a new clinical device for diabetes self-management through specialized centres. The impact of initiatives in education, self- management training, and computer-assisted self-care on outcomes in diabetes disease management.

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