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Fulltext Identifying Adverse Drug Events in Older Community-Dwelling Patients

Cahir C, Wallace E, Cummins A, Teljeur C, Byrne C, Bennett K, et al.

Ann Fam Med, 2019 Mar;17(2):133-140.
PMID: 30858256 DOI: 10.1370/afm.2359

PURPOSE: To evaluate a patient-report instrument for identifying adverse drug events (ADEs) in older populations with multimorbidity in the community setting.
METHODS: This was a retrospective cohort study of 859 community-dwelling patients aged ≥70 years treated at 15 primary care practices. Patients were asked if they had experienced any of a list of 74 symptoms classified by physiologic system in the previous 6 months and if (1) they believed the symptom to be related to their medication, (2) the symptom had bothered them, (3) they had discussed it with their family physician, and (4) they required hospital care due to the symptom. Self-reported symptoms were independently reviewed by 2 clinicians who determined the likelihood that the symptom was an ADE. Family physician medical records were also reviewed for any report of an ADE.
RESULTS: The ADE instrument had an accuracy of 75% (95% CI, 77%-79%), a sensitivity of 29% (95% CI, 27%-31%), and a specificity of 93% (95% CI, 92%-94%). Older people who reported a symptom had an increased likelihood of an ADE (positive likelihood ratio [LR+]: 4.22; 95% CI, 3.78-4.72). Antithrombotic agents were the drugs most commonly associated with ADEs. Patients were most bothered by muscle pain or weakness (75%), dizziness or lightheadedness (61%), cough (53%), and unsteadiness while standing (52%). On average, patients reported 39% of ADEs to their physician. Twenty-six (3%) patients attended a hospital outpatient clinic, and 32 (4%) attended an emergency department due to ADEs.
CONCLUSION: Older community-dwelling patients were often not correct in recognizing ADEs. The ADE instrument demonstrated good predictive value and could be used to differentiate between symptoms of ADEs and chronic disease in the community setting.
Fulltext Primary Care Physicians' Perspectives on Identifying Familial Hypercholesterolaemia in Primary Care: A Qualitative Study

Abdul-Hamid H, Kai J, Anis Safura R

Ann Fam Med, 2023 Jan 01.
PMID: 37037012 DOI: 10.1370/afm.21.s1.4220

Context Familial hypercholesterolaemia (FH) is a common autosomal dominant disorder, causing elevated cholesterol from birth, premature heart disease, and early death. Objective This study explored primary care physicians' experiences and perspectives on identifying FH in Malaysian primary care. Study Design and Analysis A qualitative study involving semi-structured interviews and focus group discussions with 22 primary care physicians (PCPs) in two primary care clinic settings. The interviews and focus group discussions were audio recorded, and the recordings were transcribed verbatim. The data in the transcripts were analysed using thematic approach. Setting Primary Care Clinics Population Studied Primary Care Physicians in two primary care clinics. Intervention A qualitative study involving semi-structured interviews and focus group discussions Outcome Measures Primary Care Physicians' perceptions and experiences of identifying individuals at high risk of FH in their clinical practice, and the acceptability and perceived challenges of trying to do this were explored during the interviews and focus group discussions. Findings PCPs felt there was potential for FH to be identified earlier in primary care. They had some existing knowledge and awareness of diagnostic criteria for FH but highlighted several challenges. In their practice, this included limited time in routine clinical care, availability of medication and clinical expertise; and critical lack of family history and physical examination findings in health records. The barriers on a systemic level were shortage of lipid specialist services and the absence of local care pathways for FH. The PCPs recommended a user-friendly case-finding tool for FH, and establishing FH registry and clinical practice guideline in Malaysia, alongside a national FH screening strategy and awareness campaigns for both clinicians and general public. Conclusions PCPs are positive about improving the identification of FH in primary care. However greater support in their practice and wider system developments and change are needed.
Fulltext Improving Erectile Dysfunction Management Among Asian Men With Diabetes Using the Knowledge Translation Intervention

Muin MRA, Ahmad S, Jasman MH, Aziz AFA, Ali MF, Zainuddin ZM

Ann Fam Med, 2023;21(6):502-507.
PMID: 38012042 DOI: 10.1370/afm.3030

PURPOSE: Erectile dysfunction (ED) is frequently undermanaged due to communication barriers, particularly among Asian men. We looked at how ED discussion and treatment were affected by the patient's prompt sheet and the Knowledge Translation Tools in the Management of Erectile Dysfunction (LASTED).
METHODS: We conducted a quasi-experimental study in a primary care clinic in Kedah, Malaysia involving 120 Asian men with diabetes. In the intervention group, patients were given a prompt sheet to indicate their intention to discuss or receive ED treatment, and physicians were provided with LASTED to assist with ED consultation. The control group patients received standard care from their physicians.
RESULTS: The intervention increased the initiation of ED discussion up to 66.7% compared with 8.3% in the control group. In the intervention group, 57.5% of patients were prescribed phosphodiesterase-5 inhibitors and men with ED of moderate severity were more likely to be prescribed oral ED medication. Use of the LASTED flipchart was associated with prescription of phosphodiesterase-5 inhibitors (P = .011) and patient satisfaction with ED consultation (P
Fulltext Feasibility and Acceptability of the "About Me" Care Card as a Tool for Engaging Older Adults in Conversations About Cognitive Impairment

Grande SW, Epperly M, Tan KY, Yagnik S, Ellenbogen M, Pederson J, et al.

Ann Fam Med, 2025 Mar 24;23(2):117-126.
PMID: 40127970 DOI: 10.1370/afm.240165

PURPOSE: We aimed to address fears and lived experiences of cognitive decline among adults via whole-person conversations that elicit problems and goals that matter most to patients. Currently, 6.7 million Americans have Alzheimer disease or related dementias, with an additional 28 million people reporting subjective cognitive decline-a possible indicator of Alzheimer disease and related dementias. A review of tools for older adults with cognitive impairment showed strong clinical specificity, with insufficient whole-person support for patients. We developed and tested the feasibility and acceptability of a tool to enhance conversations for adults with cognitive impairment at the point of care.
METHODS: We conducted a feasibility study to build a conversation tool, guided by principles of shared decision making, called the "About Me" Care Card. Informed by an environmental scan, we created and pilot-tested prototypes at implementation sites. All phases were overseen by a multidisciplinary steering committee.
RESULTS: Fourteen diverse clinicians consisting of 7 clinician types across 7 institutions piloted the card during in-person visits or by telephone. Observations showed that the card (1) allowed time to elicit what matters most to patients, (2) created space for personalized care conversations, (3) opened an examination of social care needs, and (4) moderated emotional relationships between families and individuals.
CONCLUSION: A community-based codesign process led to a feasible tool for primary care teams to facilitate whole-person conversations with aging adults. The About Me Care Card appeared to broaden conversations compared with routine care. More work is needed to determine scalability and effects on outcomes.