Publications by authors named "Andrew R Kellie"

2 Publications

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Referrals to a tertiary hospital: A window into clinical management issues in functional gastrointestinal disorders.

JGH Open 2017 Nov 31;1(3):84-91. Epub 2017 Oct 31.

Department of Medicine, The University of Adelaide Adelaide South Australia Australia.

Background And Aim: To investigate the quality of and reasons for referrals of patients with likely functional gastrointestinal disorders (FGID) and explore patients' experience of clinical management.

Methods: A cross sectional, mixed-methods study was undertaken. Referrals (July 2013-2015) to one gastroenterology outpatient department triaged as "likely FGID", the referred patients and their referring primary healthcare providers were examined.

Results: A total of 69% of patients reported not yet receiving an initial diagnosis, 52% reported persistent/distressing symptoms or reduced quality of life, 24% feared missed or worsening pathology, and 35% were seeking repeat specialist consultation. Most patients were dissatisfied (40%) or only partially satisfied (36%) with current management. Dissatisfaction was significantly related to the lack of provision of a diagnosis and effective treatment options ( < 0.001). Referral quality was poor and with the reason for referral clearly communicated in only 25%. Common referral reasons included repeat presentations ( = 32), diagnostic uncertainty ( = 19), to ensure nothing is missed ( = 19), patient request ( = 17), no response to treatment ( = 16), and to allay patient fears ( = 14). A total of 28/60 primary healthcare providers were confident that their patient had a FGID, yet sought confirmation ( = 16), second opinion ( = 8), or advice ( = 4).

Conclusion: Current management of FGID in usual care is suboptimal, as evidenced by the tertiary referral load, patient dissatisfaction, and the lack of provision of diagnoses and effective treatment options. Some clinicians lack confidence in effectively identifying and managing these conditions. Resources and supports to equip and assist clinicians to identify and manage FGID successfully may enhance patient care.
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http://dx.doi.org/10.1002/jgh3.12015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207011PMC
November 2017

Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE).

Clin Interv Aging 2018 18;13:975-986. Epub 2018 May 18.

Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.

Background: Residents of aged care facilities use increasingly complex medication regimens. Reducing unnecessary medication regimen complexity (eg, by consolidating the number of administration times or using alternative formulations) may benefit residents and staff.

Objective: To develop and validate an implicit tool to facilitate medication regimen simplification in aged care facilities.

Method: A purposively selected multidisciplinary expert panel used modified nominal group technique to identify and prioritize factors important in determining whether a medication regimen can be simplified. The five prioritized factors were formulated as questions, pilot-tested using non-identifiable medication charts and refined by panel members. The final tool was validated by two clinical pharmacists who independently applied the tool to a random sample of 50 residents of aged care facilities to identify opportunities for medication regimen simplification. Inter-rater agreement was calculated using Cohen's kappa.

Results: The Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) was developed as an implicit tool comprising of five questions about 1) the resident; 2) regulatory and safety requirements; 3) drug interactions; 4) formulation; and 5) facility and follow-up considerations. Using MRS GRACE, two pharmacists independently simplified medication regimens for 29/50 and 30/50 residents (Cohen's kappa=0.38, 95% CI 0.12-0.64), respectively. Simplification was possible for all residents with five or more administration times. Changing an administration time comprised 75% of the two pharmacists' recommendations.

Conclusions: Using MRS GRACE, two clinical pharmacists independently simplified over half of residents' medication regimens with fair agreement. MRS GRACE is a promising new tool to guide medication regimen simplification in aged care.
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http://dx.doi.org/10.2147/CIA.S158417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963487PMC
October 2018