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Visser CD, Faay MRA, Özdemir A, Guchelaar HJ, Teichert M. Short-acting β 2-agonists (SABA) overuse in asthma and patients' perceptions for this behavior. Respir Med 2024; 231:107723. [PMID: 38936636 DOI: 10.1016/j.rmed.2024.107723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/04/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Short-acting β2-agonists (SABA) overuse is associated with poor asthma control. The Global Initiative for Asthma (GINA) 2019-updated strategy report has therefore taken a paradigm shift in reliever therapy recommendations. OBJECTIVES (I) To investigate the status of SABA overuse and medication dispensing patters in asthma in the Netherlands (II) validate dispensing data for SABA overuse identification and (III) understand patients' perspectives towards this SABA-taking behavior to inform future improvement strategies. METHODS An annually repeated cross-sectional study was conducted from 2017 to 2021 using pharmacy dispensing data in a real-world setting, including asthma patients aged 18-45 with ≥1 inhaler. A following qualitative study was performed in identified SABA overusing patients with a questionnaire and semi-structured interviews, supported by theoretical frameworks. RESULTS Dispensing data was available from 87 % of all community pharmacies (n = 1994) in 2017 and 95 % (n = 2005) in 2021. SABA overuse prevalence was constant for the five study-years with 20.6 % (±0.5 %). Increased ICS-formoterol and decreased SABA dispenses were observed in starters of inhalation therapy in 2021. 53 asthma patients completed the questionnaire of whom 43 patients confirmed SABA overuse, generating a positive predictive value of 81 %. Key behavioral drivers covered 7 themes regarding capability (knowledge; skills; memory, attention and decision process) motivation (emotion; beliefs about-capabilities; consequences) and opportunity (environmental context). CONCLUSION SABA overuse remains in one-fifth of asthma patients across the Netherlands, requiring careful attention from healthcare professionals. Dispensing data is a valid measure for SABA overuse in a clinical setting, facilitating patient selection. To meet patients' varied supporting needs, integration of tailored behavioral interventions is essential.
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Affiliation(s)
- Claire D Visser
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike R A Faay
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ayşe Özdemir
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Martina Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands; Royal Dutch Pharmacists Association (KNMP), The Hague, the Netherlands
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2
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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3
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Turcotte C, Fénélon-Dimanche R, Lemière C, Beauchesne MF, Abou-Atmé B, Chabot I, Blais L. Development of a community pharmacy-based intervention for patients with uncontrolled asthma. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 7:100167. [PMID: 36051610 PMCID: PMC9424560 DOI: 10.1016/j.rcsop.2022.100167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 07/09/2022] [Accepted: 08/05/2022] [Indexed: 11/02/2022] Open
Abstract
Background Objective Methods Results Conclusions
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4
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Sorribas Morlán M, Galmés Garau MÁ, Esteva Cantó M, Leiva Rus A, Román-Rodríguez M. [Association between the use of short-acting bronchodilators and the risk of hospitalization for asthma in a real-life clinical practice population cohort]. Aten Primaria 2020; 52:600-607. [PMID: 32571597 PMCID: PMC7713391 DOI: 10.1016/j.aprim.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/06/2020] [Accepted: 03/05/2020] [Indexed: 11/06/2022] Open
Abstract
Objetivo Determinar la cantidad de envases de broncodilatadores de corta duración (SABA) dispensados en farmacia en un año que se asocia con mayor riesgo de hospitalización por asma en el mismo periodo en pacientes con asma activa. Diseño descriptivo transversal multicéntrico. Emplazamiento Atención primaria, cohorte MAJORICA. Incluye datos codificados durante la práctica asistencial, sociodemográficos, clínicos y del sistema de prescripción electrónica de 68.578 pacientes con EPOC y asma de Baleares. Participantes Se incluyeron 7.648 pacientes mayores de 18 años con asma activa, que retiraron envases de SABA durante el periodo 2014-2015. Se excluyeron pacientes con EPOC. Mediciones principales Hospitalización por asma, utilización de fármacos respiratorios, tabaquismo, comorbilidades, edad y sexo. Resultados Edad promedio 47 años, 38% mujeres, 23,2% fumadores activos. Setenta y siete pacientes (1%) ingresaron por exacerbación de asma en el periodo de estudio. Los pacientes que recibieron más de 8 envases de SABA por año aumentaron el riesgo de hospitalización (OR 2,81; IC95% 1,27-6,24). El escalón terapéutico de gravedad, la cantidad de corticoides inhalados, así como la insuficiencia cardíaca y la apnea del sueño se asociaron también significativamente con la hospitalización. Conclusiones Un mayor escalón terapéutico de gravedad, la presencia de algunas comorbilidades, el consumo de mayor cantidad de corticoides inhalados y de un mayor número de envases de SABA identifica a asmáticos con mayor riesgo de hospitalización. Existe una asociación significativa entre el riesgo de hospitalización y la retirada de un mayor número de envases de SABA de la farmacia. El número de envases/año que mejor define un mayor riesgo de hospitalización es ≥ 8 y se podría utilizar para identificar asmáticos de riesgo.
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Affiliation(s)
| | | | - Magdalena Esteva Cantó
- Atención Primaria de Mallorca, IBSalut, Palma, Baleares, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Hospital Son Espases, Palma, Baleares, España
| | - Alfonso Leiva Rus
- Atención Primaria de Mallorca, IBSalut, Palma, Baleares, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Hospital Son Espases, Palma, Baleares, España
| | - Miguel Román-Rodríguez
- Atención Primaria de Mallorca, IBSalut, Palma, Baleares, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Hospital Son Espases, Palma, Baleares, España.
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5
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Bleecker ER, Menzies-Gow AN, Price DB, Bourdin A, Sweet S, Martin AL, Alacqua M, Tran TN. Systematic Literature Review of Systemic Corticosteroid Use for Asthma Management. Am J Respir Crit Care Med 2020; 201:276-293. [PMID: 31525297 PMCID: PMC6999108 DOI: 10.1164/rccm.201904-0903so] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Systemic corticosteroid use to manage uncontrolled asthma and its associated healthcare burden may account for important health-related adverse effects. We conducted a systematic literature review to investigate the real-world extent and burden of systemic corticosteroid use in asthma. We searched MEDLINE and Embase databases to identify English-language articles published in 2010–2017, using search terms for asthma with keywords for oral corticosteroids and systemic corticosteroids. Observational studies, prescription database analyses, economic analyses, and surveys on oral/systemic corticosteroid use in children (>5 yr old), adolescents (12–17 yr old), and adults with asthma were included. We identified and reviewed 387 full-text articles, and our review included data from 139 studies. The included studies were conducted in Europe, North America, and Asia. Overall, oral/systemic corticosteroids were commonly used for asthma management and were more frequently used in patients with severe asthma than in those with milder disease. Long-term oral/systemic corticosteroid use was, in general, less frequent than short-term use. Compared with no use, long-term and repeated short-term oral/systemic corticosteroid use were associated with an increased risk of acute and chronic adverse events, even when doses were comparatively low. Greater oral/systemic corticosteroid exposure was also associated with increased costs and healthcare resource use. This review provides a comprehensive overview of oral/systemic corticosteroid use and associated adverse events for patients with all degrees of asthma severity and exposure duration. We report that oral/systemic corticosteroid use is prevalent in asthma management, and the risks of acute and chronic complications increase with the cumulative oral corticosteroid dosage.
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Affiliation(s)
- Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, Arizona
| | | | - David B Price
- Department of Primary Care Respiratory Medicine, University of Aberdeen, Aberdeen, United Kingdom.,Observational and Pragmatic Research Institute, Singapore
| | - Arnaud Bourdin
- Department of Respiratory Diseases, University of Montpellier, Montpellier, France
| | - Stephen Sweet
- Research Evaluation Unit, Oxford PharmaGenesis Ltd., Oxford, United Kingdom
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6
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Theoretical study of metal ion impact on geometric and electronic properties of terbutaline compounds. MONATSHEFTE FUR CHEMIE 2019. [DOI: 10.1007/s00706-019-02419-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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Kuipers E, Wensing M, De Smet PA, Teichert M. Considerations of prescribers and pharmacists for the use of non-selective β-blockers in asthma and COPD patients: An explorative study. J Eval Clin Pract 2018; 24:396-402. [PMID: 29319215 PMCID: PMC5901013 DOI: 10.1111/jep.12869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Despite recommendations in prevailing guidelines to avoid the use of non-selective (NS) β-blockers in patients with asthma or COPD, on average, 10 patients per community pharmacy receive NS β-blockers monthly. The aim of our study was to identify the reasons of prescribers and pharmacists to treat asthma and COPD patients with NS β-blockers. METHODS Fifty-three community pharmacists in the Netherlands selected patients with actual concurrent use of inhalation medication and NS β-blockers. For at least 5 patients, each pharmacist screened all medication surveillance signals and actions taken at first dispensing. Each pharmacist selected 3 different initial prescribers for a short interview to explore their awareness of the co-morbidity and reasons to apply NS β-blockers. RESULTS Pharmacists identified 827 asthma/COPD patients with actual use of NS β-blockers. From these, 153 NS β-blocker prescribers were selected and interviewed (64 general practitioners, 45 ophthalmologists, 24 cardiologists, and 20 other prescribers). One hundred seven prescribers were aware of the drug-disease interaction of the asthma or COPD co-morbidity when initiating the NS β-blocker, and 46 were not. From these, 40 prescribers did not consider the contraindication to be relevant. For 299 patients, medication surveillance signals and actions at first dispensing were retrieved. Patients used predominantly ocular timolol (39.8%), and the oral preparations propranolol (30.8%) and carvedilol (15.1%). In 154 cases, the pharmacy system generated a warning alert. CONCLUSIONS A substantial number of prescribers was unaware of the co-morbidity or did not regard NS β-blockers contraindicated, despite prevailing clinical guidelines. Improvement programs should target prescribers' awareness and knowledge of NS β-blockers in patients with asthma or COPD.
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Affiliation(s)
- Esther Kuipers
- Department of IQ Healthcare, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- BENU Apotheek Zeist WestZeistThe Netherlands
| | - Michel Wensing
- Department of IQ Healthcare, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of General Practice and Health Services ResearchUniversity Hospital HeidelbergHeidelbergGermany
| | - Peter A.G.M. De Smet
- Department of IQ Healthcare, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of Clinical Pharmacy, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
| | - Martina Teichert
- Department of IQ Healthcare, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of Clinical Pharmacy & ToxicologyLeiden University Medical CentreLeidenThe Netherlands
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8
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van Boven JFM, Ryan D, Eakin MN, Canonica GW, Barot A, Foster JM. Enhancing Respiratory Medication Adherence: The Role of Health Care Professionals and Cost-Effectiveness Considerations. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 4:835-46. [PMID: 27587317 DOI: 10.1016/j.jaip.2016.03.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 12/13/2022]
Abstract
Adherence to medication comprises a multiphased temporal process involving (1) initiation of prescribed therapy, (2) implementation as prescribed, and (3) subsequent persistence. Medication adherence remains suboptimal in most patients with long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Interventions have been shown to effectively improve treatment initiation, implementation, and persistence when delivered at the health care professional level or the system level, but demonstration of the cost-effectiveness of these interventions is necessary to ensure their widespread use. This review summarizes how health care professionals can intervene to improve medication adherence in patients with asthma and COPD, provides some examples of effective primary care interventions, and illustrates some of the challenges to optimal implementation arising from cost-effectiveness modeling. Improving adherence is shown to be an economically viable treatment option for patients with asthma and COPD, but there are differences in the health economics pertaining to each condition and setting that can affect whether an intervention is considered cost-effective. Targeting adherence interventions at patients with the greatest to gain, and tailoring them to individual patient needs, may help to optimize cost-effectiveness ratios and improve the probability of positive reimbursement decisions, systemwide implementation, and resultant health benefits.
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Affiliation(s)
- Job F M van Boven
- Department of Primary Care, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Dermot Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Giorgio W Canonica
- Allergy and Respiratory Diseases Clinica, DIMI Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Aji Barot
- Patient Connect Service, Surrey, United Kingdom
| | - Juliet M Foster
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
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9
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Arabkhazaeli A, Vijverberg SJH, van der Ent CK, Raaijmakers JAM, Maitland-van der Zee AH. Asthma treatment patterns in Dutch children using medication dispensing data. Pediatr Allergy Immunol 2017; 28:606-608. [PMID: 28661552 DOI: 10.1111/pai.12751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ali Arabkhazaeli
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Susanne J H Vijverberg
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.,Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - C Kors van der Ent
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jan A M Raaijmakers
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.,Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
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10
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van der Lee M, Arabkhazaeli A, van Erp FC, Raaijmakers JA, van der Ent CK, Bruijnzeel-Koomen CAFM, de Bruin-Weller MS, Vijverberg SJH, Maitland-van der Zee AH. Atopic dermatitis characteristics and medication-use patterns in school-age children with AD and asthma symptoms. Clin Exp Dermatol 2017; 42:503-508. [PMID: 28585727 DOI: 10.1111/ced.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) and asthma often coexist. Both diseases can have a major impact on the lives of children with AD and their caregivers. AIM To investigate the association of patient characteristics, comorbidities and impact of AD on children who have both asthma and AD. METHODS Children with AD (n = 140) were selected from a larger cohort of children with a reported use of asthma medication. The Children's Dermatology Life Quality Index (CDLQI) was used to assess Quality of Life (QoL), and the Self-Assessed Eczema Area and Severity Index (SA-EASI) was used to measure AD severity. Characteristics assessed included: age, sex, and the number and type of atopic comorbidities. Medication use for AD was defined using the total number of AD prescriptions, the number of different topical AD prescriptions and the highest potency topical corticosteroid (TCS) used. Determinants of AD severity and QoL were evaluated using Spearman rank tests. RESULTS The following factors were most strongly associated with a lower QoL: characteristics of AD lesions (Spearman Rs = 0.61-0.69, P < 0.01), a higher SA-EASI score (Rs = 0.54, P < 0.01) and a larger number of different topical AD prescriptions (Rs = 0.38, P < 0.01). The following factors were correlated with more severe AD: age (Rs = -0.36, P < 0.01), larger number of different TCS preparations used (Rs = 0.27, P < 0.05) and larger number of TCS prescriptions (Rs = 0.25, P < 0.05). CONCLUSION In children with asthma and AD, the number of TCS preparations used is associated with lower QoL and increased AD severity.
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Affiliation(s)
- M van der Lee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - A Arabkhazaeli
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - F C van Erp
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J A Raaijmakers
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - C K van der Ent
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C A F M Bruijnzeel-Koomen
- Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M S de Bruin-Weller
- Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S J H Vijverberg
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - A H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Respiratory Disease, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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11
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Sodihardjo-Yuen F, van Dijk L, Wensing M, De Smet PAGM, Teichert M. Use of pharmacy dispensing data to measure adherence and identify nonadherence with oral hypoglycemic agents. Eur J Clin Pharmacol 2016; 73:205-213. [PMID: 27796465 PMCID: PMC5226973 DOI: 10.1007/s00228-016-2149-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/13/2016] [Indexed: 11/27/2022]
Abstract
Purpose A framework for calculation of adherence for oral hypoglycemic agents (OHAs) based on data from health-insurance claims is available. Pharmacy dispensing data aid identification of nonadherent patients in pharmacy practices. However, use of these data for calculation of OHA adherence requires additional methodological categories. We examined the impact of different methodological choices on estimation of OHA adherence using pharmacy dispensing data. Methods Four methodological categories were added to the framework available to be used for adherence calculation with pharmacy dispensing data. Three adherence measures were defined to supply pharmacists with significant information on OHA use of their patients: (i) percentage of days covered by use periods of dispensed medication (PDC), (ii) mean rate of adherent patients with a PDC ≥80 % (MRAP80), and (iii) mean number of nonadherent patients (MNNP80) per pharmacy with a PDC <80 %. A basic scenario was developed from 16 methodological categories. Consequences of choices for different parameters within these categories on the scores of the three adherence measures were calculated from dispensing data between July 2013 and July 2014. Results Data were available for 604,500 OHA users in 1737 community pharmacies in the Netherlands. For the basic scenario, mean PDC for OHA was 88.3 %. MRAP80 was 80.3 %, which corresponded to an average of 69 nonadherent patients per pharmacy. Different choices for parameter values resulted in score variations for PDC of 85.0–91.8 %, for MRAP80 of 75.3–86.1 %, and between 49 and 92 MNNP80 per pharmacy. Conclusion Sixteen methodological categories specified calculation of OHA adherence based on pharmacy dispensing data. Adherence scores expressed as percentages were relatively robust to variation in parameter values, but differed substantially for the absolute numbers of nonadherent patients per pharmacy. Electronic supplementary material The online version of this article (doi:10.1007/s00228-016-2149-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Liset van Dijk
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Michel Wensing
- Radboud Institute for Health Sciences, Department of IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Peter A G M De Smet
- Royal Dutch Pharmacists Association, 2514 JL, The Hague, the Netherlands
- Radboud Institute for Health Sciences, Department of IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, Department of Clinical Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Martina Teichert
- Royal Dutch Pharmacists Association, 2514 JL, The Hague, the Netherlands
- Radboud Institute for Health Sciences, Department of IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, the Netherlands
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12
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Fraeyman J, Foulon V, Mehuys E, Boussery K, Saevels J, De Vriese C, Dalleur O, Housiaux M, Steurbaut S, Naegels M, De Meyer GR, De Loof H, Van Hal G, Van den Broucke S. Evaluating the implementation fidelity of New Medicines Service for asthma patients in community pharmacies in Belgium. Res Social Adm Pharm 2016; 13:98-108. [PMID: 26975932 DOI: 10.1016/j.sapharm.2016.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 11/13/2022]
Abstract
BACKGROUND In October 2013, a New Medicines Service (NMS) was introduced in community pharmacies in Belgium to support asthma patients who are novice users of inhaler devices with corticosteroids. The protocol-based intervention used the Asthma Control Test (ACT) and the Medication Adherence Report Scale (MARS) to assess asthma control and medication adherence. The NMS is the first initiative that puts advanced pharmaceutical care into practice in Belgium. The present study evaluated the degree to which the NMS program is delivered as intended, drawing on the concept of implementation fidelity (IF). METHODS The main dimensions of IF and potential moderating and facilitating factors for the implementation of NMS in community pharmacies were evaluated using telephone interviews with pharmacists (n = 497), semi-structured interviews with patients eligible for NMS (n = 30), focus groups among general practitioners (n = 72) and lung specialists (n = 5), and a work system analysis in community pharmacies (n = 19). RESULTS The uptake of NMS in Belgian community pharmacies remains low. In addition to practical barriers, pharmacists found it difficult to identify new asthmatic patients when they were not informed about the diagnosis. A lack of commitment from physicians, patients and pharmacists was noted in the early start-up phase of the program. Many pharmacists did not see how NMS differed from existing pharmaceutical care. Physicians considered this service as part of their own tasks and discouraged ACT for asthma follow-up in the community pharmacy. CONCLUSIONS The introduction of the NMS program was not sufficiently embedded in the Belgian health care organization, causing low uptake and resistance to its implementation by pharmacists, patients, and other health care professionals. To increase the uptake of this type of service and its possible extension to other patient groups, more collaboration among the different health care professionals during design and implementation is necessary, as well as systematic data collection to monitor the quality of the service, better training of pharmacists, and more information for patients and physicians.
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Affiliation(s)
- Jessica Fraeyman
- Research Group Medical Sociology and Health Policy, University of Antwerp, Belgium.
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Belgium
| | - Els Mehuys
- Pharmaceutical Care Unit, Ghent University, Belgium
| | | | - Jan Saevels
- Association of Pharmacists in Belgium (APB), Belgium
| | | | - Olivia Dalleur
- Clinical Pharmacy, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
| | - Marie Housiaux
- Psychological Sciences Research Institute (IPSY), Université catholique de Louvain, Belgium
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology & Clinical Pharmacy (KFAR), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium
| | - Marc Naegels
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Belgium
| | - Guido Ry De Meyer
- Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Department Farmaceutical Sciences, Pharmaceutical Care, University of Antwerp, Antwerp, Belgium
| | - Guido Van Hal
- Research Group Medical Sociology and Health Policy, University of Antwerp, Belgium
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Beck AF, Bradley CL, Huang B, Simmons JM, Heaton PC, Kahn RS. The pharmacy-level asthma medication ratio and population health. Pediatrics 2015; 135:1009-17. [PMID: 25941301 PMCID: PMC4444803 DOI: 10.1542/peds.2014-3796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Community pharmacies may be positioned for an increased role in population health. We sought to develop a population-level measure of asthma medication fills and assess its relationship to asthma-related utilization. METHODS We conducted a retrospective, ecological study (2010-2012). Medication data from a chain of pharmacies (n = 27) within 1 county were used to calculate a Pharmacy-level Asthma Medication Ratio (Ph-AMR), defined as controller fills divided by controller plus rescue fills. Higher values are superior because they indicate more controller compared with rescue fills. The outcome was the asthma-related utilization rate among children in the same census tract as the pharmacy, calculated by dividing all emergency visits and hospitalizations by the number of children in that tract. Covariates, including ecological measures of poverty and access to care, were used in multivariable linear regression. RESULTS Overall, 35 467 medications were filled. The median Ph-AMR was 0.53 (range 0.38-0.66). The median utilization rate across included census tracts was 22.4 visits per 1000 child-years (range 1.3-60.9). Tracts with Ph-AMR <0.5 had significantly higher utilization rates than those with Ph-AMR ≥0.5 (26.1 vs 9.9; P = .001). For every 0.1 increase in Ph-AMR, utilization rates decreased by 9.5 (P = .03), after adjustment for underlying poverty and access. Seasonal variation in fills was evident, but pharmacies in high-utilizing tracts filled more rescue than controller medications at nearly every point during the study period. CONCLUSIONS Ph-AMR was independently associated with ecological childhood asthma morbidity. Pharmacies may be a community-based leverage point for improving population-level asthma control through targeted interventions.
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Affiliation(s)
- Andrew F. Beck
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Courtney L. Bradley
- University of North Carolina School of Pharmacy, Chapel Hill, North Carolina;,Kroger Pharmacy, Cincinnati, Ohio; and,University of Cincinnati College of Pharmacy, Cincinnati, Ohio
| | - Bin Huang
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey M. Simmons
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Robert S. Kahn
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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