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Huang WJ, Zhang MW, Li BY, Wang XH, Zhang CH, Yu JG. 5S management improves the service quality in the outpatient-emergency pharmacy: from management process optimisation to staff capacity enhancement. Eur J Hosp Pharm 2024; 31:259-266. [PMID: 36424124 DOI: 10.1136/ejhpharm-2022-003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE As a high-efficiency demanding department in a hospital, the outpatient pharmacy has a great need for quality improvement to provide superior medical service for patients. Little is known about the application of 5S management in a hospital pharmacy department. The aim of this study was to evaluate the impacts of 5S management on pharmaceutical service quality and staff capacity in the outpatient-emergency pharmacy. METHODS We carried out a 5S project in the outpatient-emergency pharmacy at a local hospital that involved processes including waste elimination, workplace standardisation, and optimisation of workflow and staff quality, and then evaluated the effects of the project. RESULTS The equipment and items in the outpatient-emergency pharmacy were sorted. All the drugs were categorised and put in order. The redesigned workspace and standardised workflow during the project improved the accuracy and efficiency of drug dispensing. The satisfaction rate of patients regarding the pharmaceutical service quality in the outpatient-emergency pharmacy was elevated, as well as the satisfaction rate of pharmacists about their work experiences. The optimisation of objective conditions also stimulated a positive working attitude and professional ability promotion of pharmacists in the outpatient-emergency pharmacy. CONCLUSIONS In this study, the 5S management method has proven useful for quality and efficiency improvement in the outpatient-emergency pharmacy, and could be generalised to other departments in a hospital, which provides further evidence of the advantages of the Lean tool in healthcare system management.
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Affiliation(s)
- Wen-Jing Huang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Meng-Wan Zhang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Bei-Yi Li
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Xiao-Hui Wang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Chu-Han Zhang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Jian-Guang Yu
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
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Vanderbleek JJ, Owensby JK, McAnnally A, England BR, Chen L, Curtis JR, Yun H. Classifying Multimorbidity Using Drug Concepts via the Rx-Risk Comorbidity Index: Methods and Comparative Cross-Sectional Study. Arthritis Care Res (Hoboken) 2024; 76:559-569. [PMID: 37986017 DOI: 10.1002/acr.25273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/26/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE The study objective was to update a method to identify comorbid conditions using only medication information in circumstances in which diagnosis codes may be undercaptured, such as in single-specialty electronic health records (EHRs), and to compare the distribution of comorbidities across Rx-Risk versus other traditional comorbidity indices. METHODS Using First Databank, RxNorm, and its web-based clients, RxNav and RxClass, we mapped Drug Concept Unique Identifiers (RxCUIs), National Drug Codes (NDCs), and Anatomical Therapeutic Chemical (ATC) codes to Rx-Risk, a medication-focused comorbidity index. In established rheumatoid arthritis (RA) and osteoarthritis (OA) cohorts within the Rheumatology Informatics System for Effectiveness registry, we then compared Rx-Risk with other comorbidity indices, including the Charlson Comorbidity Index, Rheumatic Disease Comorbidity Index (RDCI), and Elixhauser. RESULTS We identified 965 unique ingredient RxCUIs representing the 46 Rx-Risk comorbidity categories. After excluding dosage form and ingredient related RxCUIs, 80,911 unique associated RxCUIs were mapped to the index. Additionally, 187,024 unique NDCs and 354 ATC codes were obtained and mapped to the index categories. When compared to traditional comorbidity indices in the RA cohort, the median score for Rx-Risk (median 6.00 [25th percentile 2, 75th percentile 9]) was much greater than for Charlson (median 0 [25th percentile 0, 75th percentile 0]), RDCI (median 0 [25th percentile 0, 75th percentile 0]), and Elixhauser (median 1 [25th percentile 1, 75th percentile 1]). Analyses of the OA cohort yielded similar results. For patients with a Charlson score of 0 (85% of total), both the RDCI and Elixhauser were close to 1, but the Rx-Risk score ranged from 0 to 16 or more. CONCLUSION The misclassification and under-ascertainment of comorbidities in single-specialty EHRs can largely be overcome by using a medication-focused comorbidity index.
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Affiliation(s)
- Jared J Vanderbleek
- University of Alabama at Birmingham and University of Alabama at Birmingham Hospital
| | | | | | - Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
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Alanazi MF, Shahein MI, Alsharif HM, Alotaibi SM, Alanazi AO, Alanazi AO, Alharbe UA, Almfalh HSS, Amirthalingam P, Hamdan AM, Veeramani VP, Mohamed SHP, Ali MAS. Impact of automated drug dispensing system on patient safety. Pharm Pract (Granada) 2022; 20:2744. [PMID: 36793902 PMCID: PMC9891784 DOI: 10.18549/pharmpract.2022.4.2744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives Automated drug dispensing system (ADDs) is an emerging technology positively impacts drug dispensing efficiency by minimizing medication errors. However, the pharmacist perception of the impact of ADDs on patient safety is not well-established. This cross-sectional observational study aimed to evaluate the dispensing practice and pharmacist perception of ADDs towards patient safety through a validated questionnaire. Methods A self-designed questionnaire was validated and the pharmacist perception of dispensing practice was compared between two hospitals adopting ADDs and traditional drug dispensing system (TDDs). Results The developed questionnaire had an excellent internal consistency (both Cronbach's α and McDonald's ω coefficients were >0.9). Factor analysis retained three significant factors (subscales) that explained pharmacist perception of dispensing system, dispensing practice, and patient counseling (p<0.001 for each factor). The average number of prescriptions dispensed per day, drugs contained in each prescription, average time for labeling each prescription and inventory management were significantly varied between ADDs and TDDs (p=0.027, 0.013 0.044 and 0.004, respectively). The perception of pharmacists using ADDs on three domains were higher than the TDDs. The pharmacists in ADDs agreed that they had enough time to review the medications before dispensing than TDDs and this difference was found to be statistically significant (p=0.028). Conclusions ADDs was highly effective in improving dispensing practice and medication review; however, the pharmacists need to emphasize the importance of ADDs to translate the pharmacists' freed-time towards patient care.
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Affiliation(s)
- Majed Falah Alanazi
- Pharm.D student, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
| | | | | | | | | | | | - Umar Abdolah Alharbe
- Director of Pharmaceutical Care Department, King Fahd Multispecialty Hospital, Tabuk, Saudi Arabia.
| | - Hanad S S Almfalh
- Clinical Pharmacist, King Khalid Civil Hospital, Tabuk, Saudi Arabia.
| | | | - Ahmed Mohsen Hamdan
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
| | - Vinoth Prabhu Veeramani
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
| | | | - Mostafa A Sayed Ali
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia and Department of Clinical Pharmacy, Faculty of Pharmacy, Assuit University, Egypt.
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Zeng E, He W, Smedby KE, Czene K. Adjuvant Hormone Therapy-Related Hot Flashes Predict Treatment Discontinuation and Worse Breast Cancer Prognosis. J Natl Compr Canc Netw 2022; 20:683-689.e2. [PMID: 35385829 DOI: 10.6004/jnccn.2021.7116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/29/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Clinical trials have shown that adjuvant hormone therapy (AHT)-related hot flashes can predict better breast cancer outcomes. This population-based cohort study investigated whether this result can be generalized to a real-world setting. PATIENTS AND METHODS By linking the National Quality Registry for Breast Cancer, Prescribed Drug Register, and Cause-of-Death Register, we identified 7,152 chemotherapy-free patients with breast cancer who initiated AHT in Stockholm from 2006 through 2019, and followed them until 2020. Hot flashes were defined as new use of drugs for hot flashes within 6 months after initiating AHT. We used Cox models to compare disease-free survival and treatment discontinuation among patients with and without hot flashes. RESULTS Patients who newly used drugs for hot flashes shortly after AHT initiation had worse disease-free survival (adjusted hazard ratio [HR], 1.67; 95% CI, 1.11-2.52) and a higher treatment discontinuation rate (adjusted HR, 1.47; 95% CI, 1.21-1.78). The association between drugs for hot flashes and discontinuation of AHT differed by patient characteristics, with stronger associations among low-income patients (HR, 1.91; 95% CI, 1.41-2.59) and those without first-degree relatives who had cancer (HR, 1.81; 95% CI, 1.39-2.35) or died from cancer (HR, 1.71; 95% CI, 1.37-2.12). CONCLUSIONS AHT-related hot flashes predict worse, rather than better, breast cancer outcomes among patients in clinical routine practice. The identification of adverse effects by the initiation of hot flash medications may identify a subset of patients with more severe hot flashes who are more likely to discontinue AHT and need more support for treatment adherence.
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Affiliation(s)
- Erwei Zeng
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Wei He
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,2Chronic Disease Research Institute, the Children's Hospital, and.,3Department of Nutrition and Food Hygiene, and National Clinical Research Center for Child Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; and
| | - Karin E Smedby
- 4Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Vouri SM, Morris EJ, Usmani SA, Reise R, Jiang X, Pepine CJ, Manini TM, Malone DC, Winterstein AG. Evaluation of the key prescription sequence symmetry analysis assumption using the calcium channel blocker: Loop diuretic prescribing cascade. Pharmacoepidemiol Drug Saf 2022; 31:72-81. [PMID: 34553438 PMCID: PMC8688319 DOI: 10.1002/pds.5362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the prescription sequence symmetry analysis assumption regarding balance between marker drug (i.e., medication used to treat a drug-induced adverse event) initiation rates before and after initiation of an index drug (i.e., medication that is potentially associated with the drug-induced adverse event) in the absence of prescribing cascades, we used a well-described example of loop diuretic initiation to treat dihydropyridine calcium channel blockers (DH CCB)-induced edema. STUDY DESIGN AND SETTING The University of Florida Health Integrated Data Repository from June 2011 and July 2018 was used to assess temporal prescribing of DH CCB and loop diuretics within the prescription sequence symmetry analysis framework. Validation of the prescribing cascade was performed via clinical expert chart review. RESULTS Among patients without heart failure who were initiated on DH CCB, 26 and 64 loop diuretics initiators started within 360 days before versus after DH CCB initiation, respectively, resulting in an adjusted sequence ratio (aSR) of 2.27 (95% CI, 1.44-3.58). Overall, 35 (54.7%) patients were determined to have a prescribing cascade. Removing patients who experienced a prescribing cascade resulted in an aSR of 1.05, 95% CI 0.62-1.78). CONCLUSION Loop diuretic initiation rates before and after DH CCB initiation for reasons other a prescribing cascade were similar, thus confirming the prescription sequence symmetry analysis assumption.
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Affiliation(s)
- Scott M. Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL,University of Florida Health Physicians, Gainesville, FL,Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL
| | - Earl J. Morris
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Silken A. Usmani
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,University of Florida Health Physicians, Gainesville, FL
| | - Rachel Reise
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,University of Florida Health Physicians, Gainesville, FL
| | - Xinyi Jiang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Todd M. Manini
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL
| | - Daniel C. Malone
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL,Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL
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Morris EJ, Hollmann J, Hofer AK, Bhagwandass H, Oueini R, Adkins LE, Hallas J, Vouri SM. Evaluating the use of prescription sequence symmetry analysis as a pharmacovigilance tool: A scoping review. Res Social Adm Pharm 2021; 18:3079-3093. [PMID: 34376366 DOI: 10.1016/j.sapharm.2021.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The (prescription) sequence symmetry analysis (PSSA) design has been used to identify potential prescribing cascade signals by assessing the prescribing sequence of an index drug relative to a marker drug presumed to treat an adverse drug event provoked by the index drug. OBJECTIVES This review aimed to explore the use of the PSSA design as a pharmacovigilance tool with a particular focus on the breadth of identified signals and advances in PSSA methodology. METHODS We searched Embase, PubMed/Medline, Google Scholar, Web of Science and grey literature to identify studies that used the PSSA methodology. Two reviewers independently extracted relevant data for each included article. Study characteristics including signals identified, exposure time window, stratified analyses, and use of controls were extracted. RESULTS We identified 53 studies which reported original results obtained using PSSA methodology or quantified the validity of components of the PSSA design. Of those, nine studies provided validation metrics showing reasonable sensitivity and high specificity of PSSA to identify prescribing cascade signals. We identified 340 unique index drug - marker drug signals published in the PSSA literature, representing 281 unique index - marker pharmacological class dyads (i.e., unique fourth-level Anatomical Therapeutic Chemical [ATC] classification dyads). Commonly observed signals were identified for index drugs acting upon the nervous system (34%), cardiovascular system (21%), and blood and blood-forming organs (15%), and many marker drugs were related to the nervous system (25%), alimentary tract and metabolism (23%), cardiovascular system (17%), and genitourinary system and sex hormones (14%). Negative controls and positive controls were utilized in 21% and 13% of studies, respectively. CONCLUSIONS The PSSA methodology has been used in 53 studies worldwide to detect and evaluate over 300 unique prescribing cascades signals. Researchers should consider sensitivity analyses incorporating negative and/or positive controls and additional time windows to evaluate time-varying biases when designing PSSA studies.
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Affiliation(s)
- Earl J Morris
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Josef Hollmann
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Ann-Kathrin Hofer
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Hemita Bhagwandass
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Razanne Oueini
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Lauren E Adkins
- Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, IST, University of Southern Denmark, Odense, Denmark; Department of Clinical Pharmacology and Biochemistry, Odense University Hospital, Odense, Denmark
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
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7
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Vouri SM, Jiang X, Morris EJ, Brumback BA, Winterstein AG. Use of negative controls in a prescription sequence symmetry analysis to reduce time-varying bias. Pharmacoepidemiol Drug Saf 2021; 30:1192-1199. [PMID: 33993606 DOI: 10.1002/pds.5293] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 04/02/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE There is an increased use in the (prescription) sequence symmetry analysis (PSSA); however, limited studies have incorporated a negative control, and no study has formally quantified and controlled for within-patient time-varying bias using a negative control. Our aim was to develop a process to incorporate the effect of negative controls into the main analysis of a PSSA. METHODS Using a previously assessed dihydropyridine calcium channel blocker (DH-CCB) and loop diuretic PSSA, we directly compared the adjusted sequence ratios (aSRs) of DH-CCBs to each of the two negative control index drugs (levothyroxine and angiotensin converting enzyme [ACE] inhibitor/angiotensin-2 receptor blocker [ARB]) using the ratio of the aSRs to estimate a relative aSR with a Z test. Further, we utilized the relative aSR in stratum-specific analyses and varying exposure windows. RESULTS The relative aSR of DH-CCBs decreased from 1.87 to 1.72 (95% CI 1.66-1.78) using levothyroxine as a negative control index drug. ACE inhibitor/ARB negative control index drug resulted in an aSR of 1.27 thus reducing the relative aSR for DH-CBB from 1.84 to 1.45 (95% CI 1.41-1.49). When restricting the exposure window to 180 and 90 days, the relative aSR of DH-CCBs increased to 1.68 (95% CI 1.62-1.74) and 1.86 (95% CI 1.78-1.94), respectively, relative to the ACE inhibitor/ARB negative control index drug. CONCLUSION We illustrated how to incorporate negative control index drugs into a PSSA and generate relative aSRs. Stratum-specific assessments and varying the exposure windows while using negative control index drugs can yield more informative results.
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Affiliation(s)
- Scott Martin Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida-College of Pharmacy, Gainesville, Florida, USA.,University of Florida-Center for Drug Evaluation and Safety (CoDES), Gainesville, Florida, USA
| | - Xinyi Jiang
- Department of Pharmaceutical Outcomes & Policy, University of Florida-College of Pharmacy, Gainesville, Florida, USA
| | - Earl J Morris
- Department of Pharmaceutical Outcomes & Policy, University of Florida-College of Pharmacy, Gainesville, Florida, USA
| | - Babette A Brumback
- University of Florida-Center for Drug Evaluation and Safety (CoDES), Gainesville, Florida, USA.,Department of Biostatistics, University of Florida-College of Public Health & Health Professions College of Medicine, Gainesville, Florida, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes & Policy, University of Florida-College of Pharmacy, Gainesville, Florida, USA.,University of Florida-Center for Drug Evaluation and Safety (CoDES), Gainesville, Florida, USA
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King CE, Pratt NL, Craig N, Thai L, Wilson M, Nandapalan N, Kalisch Ellet L, Behm EC. Detecting Medicine Safety Signals Using Prescription Sequence Symmetry Analysis of a National Prescribing Data Set. Drug Saf 2020; 43:787-795. [DOI: 10.1007/s40264-020-00940-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Salas M, Lopes LC, Godman B, Truter I, Hartzema AG, Wettermark B, Fadare J, Burger JR, Appenteng K, Donneyong M, Arias A, Ankrah D, Ogunleye OO, Lubbe M, Horne L, Bernet J, Gómez-Galicia DL, Del Carmen Garcia Estrada M, Oluka MN, Massele A, Alesso L, Herrera Comoglio R, da Costa Lima E, Vilaseca C, Bergman U. Challenges facing drug utilization research in the Latin American region. Pharmacoepidemiol Drug Saf 2020; 29:1353-1363. [PMID: 32419226 DOI: 10.1002/pds.4989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/20/2019] [Accepted: 02/03/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The International Society of Pharmacoepidemiology (ISPE) in collaboration with the Latin America Drug Utilization Research Group (LatAm DURG), the Medicines Utilization Research in Africa (MURIA) group, and the Uppsala Monitoring Center, is leading an initiative to understand challenges to drug utilization research (DUR) in the Latin American (LatAm) and African regions with the goal of communicating results and proposing solutions to these challenges in four scientific publications. The purpose of this first manuscript is to identify the main challenges associated with DUR in the LatAm region. METHODS Drug utilization (DU) researchers in the LatAm region voluntarily participated in multiple discussions, contributed with local data and reviewed successive drafts and the final manuscript. Additionally, we carried out a literature review to identify the most relevant publications related to DU studies from the LatAm region. RESULTS Multiple challenges were identified in the LatAm region for DUR including socioeconomic inequality, access to medical care, complexity of the healthcare system, limited investment in research and development, limited institutional and organization resources, language barriers, limited health education and literacy. Further, there is limited use of local DUR data by decision makers particularly in the identification of emerging health needs coming from social and demographic transitions. CONCLUSIONS The LatAm region faces challenges to DUR which are inherent in the healthcare and political systems, and potential solutions should target changes to the system.
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Affiliation(s)
- Maribel Salas
- Daiichi Sankyo, Inc, Basking Ridge, USA.,CCEB/CPeRT, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Luciane C Lopes
- Pharmaceutical Science graduate Course, Universidade de Sorocaba UNISO, Sao Paulo, Brazil
| | - Brian Godman
- Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Gainesville, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, South Africa
| | | | - Bjorn Wettermark
- Clinical epidemiology & Clinical pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa
| | - Kwame Appenteng
- Department of Epidemiology, Astellas Pharma US, Northbrook, IL
| | - Macarius Donneyong
- Pharmacy Practice and Science, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Ariel Arias
- Centre for Biologics Evaluation, Health Canada, Ottawa, ON and Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | | | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Martha Lubbe
- Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa
| | - Laura Horne
- Department of Epidemiology, Daiichi Sankyo, Inc, Basking Ridge, NJ
| | - Jorgelina Bernet
- School of Medicine, Cordoba National University, Cordoba, Argentina
| | - Diana L Gómez-Galicia
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
| | | | | | - Amos Massele
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Luis Alesso
- School of Medicine, Cordoba National University, Cordoba, Argentina
| | | | - Elisangela da Costa Lima
- Observatorio de Vigilancia e Uso de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Cidade Universitária, Rio de Janeiro, RJ
| | - Carmen Vilaseca
- Colegio de Bioquimica y Farmacia, La Paz, Bolivia, Plurinational State
| | - Ulf Bergman
- Departments of Clinical Pharmacology and Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Huddinge
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Hirschtritt ME, Palzes VA, Kline-Simon AH, Kroenke K, Campbell CI, Sterling SA. Benzodiazepine and unhealthy alcohol use among adult outpatients. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:e358-e365. [PMID: 31860229 PMCID: PMC7217068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Concomitant excessive alcohol consumption and benzodiazepine use is associated with adverse health outcomes. We examined associations of unhealthy alcohol use and other patient characteristics with benzodiazepine use. STUDY DESIGN A cross-sectional analysis of 2,089,525 Kaiser Permanente of Northern California outpatients screened for unhealthy alcohol use in primary care between November 1, 2014, and December 31, 2016. METHODS We fit multivariable generalized linear models to estimate the associations between unhealthy alcohol use and benzodiazepine dispensation and, among patients who were dispensed a benzodiazepine, mean doses (in mean lorazepam-equivalent daily doses [LEDDs]) and prescription durations. We controlled for patient sex, age, race/ethnicity, estimated household income, Charlson Comorbidity Index (CCI) score, anxiety disorder, alcohol use disorder, insomnia, musculoskeletal pain, and epilepsy. RESULTS In the 12 months centered around (6 months before and 6 months after) the first alcohol-screening visit, 7.5% of patients used benzodiazepines. The following characteristics were independently associated with higher rates of benzodiazepine use, higher LEDD, and longer prescription duration: older age, white race/ethnicity, lower estimated household income, higher CCI score, and the presence of an anxiety disorder, insomnia, musculoskeletal pain, or epilepsy. Women and patients with an alcohol use disorder or unhealthy alcohol use, compared with men and patients with low-risk drinking or abstinence, were more likely to use a benzodiazepine; however, their LEDDs were lower and their prescription durations were shorter. CONCLUSIONS Benzodiazepine use in primary care was associated with older age, female sex, white race/ethnicity, lower socioeconomic status, and unhealthy alcohol use. These findings may be applied to develop policies and interventions to promote judicious benzodiazepine use.
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Affiliation(s)
- Matthew E Hirschtritt
- Department of Psychiatry and the UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave, Box 0984, San Francisco, CA 94143.
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Mohiuddin AK. The New Era of Pharmacists in Ambulatory Patient Care. Innov Pharm 2019; 10:10.24926/iip.v10i1.1622. [PMID: 34007527 PMCID: PMC7643699 DOI: 10.24926/iip.v10i1.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pharmacy is evolving from a product-oriented to a patient-oriented profession. This role modification is extremely healthy for the patient, the pharmacist, and other members of the health-care team. However, the evolution will present pharmacists with a number of new challenges. Now, more than in the past, pharmacists must make the acquisition of contemporary practice knowledge and skills a high priority, to render the level of service embodied in the concept of pharmaceutical care. Pharmacy educators' organizations and regulatory bodies must all work together to support pharmacists as they assume expanded health-care roles. Pharmacy and the healthcare industry must work to ensure that the pharmacist is compensated justly for all services. But before this can happen it will be necessary for pharmacy to demonstrate value-added to the cost of the prescription. Marketing of the purpose of pharmacy in the health-care morass and of the services provided by the pharmacist is needed to generate an appropriate perceived value among purchasers and users of health-care services. Pharmacists should view themselves as dispensers of therapy and drug effect interpretations as well as of drugs themselves. Service components of pharmacy should be identified clearly to third party payers and be visible to consumers, so that they know what is available at what cost and how it may be accessed. In the future, pharmacy services must be evaluated on patient outcome (i.e., pharmaceutical care) rather than the number of prescriptions dispensed, and pharmacy must evolve toward interpretation and patient consultation, related to the use of medication technologies.
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Affiliation(s)
- AK Mohiuddin
- Department of Pharmacy, World University of Bangladesh
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