Facteurs à prendre en considération pour la gestion des interactions médicamenteuses en pratique clinique

[Contribution of the pharmaceutical record in the analysis of drug interactions during retrocession in a centre for cancer research]

OBJECTIVES

To implement the pharmaceutical record in retrocession, to evaluate its contribution to the analysis of drug interactions and to estimate the sustainability of this approach.

METHODS

This prospective, descriptive, monocentric study was conducted over five months. All patients presenting at the retrocession were eligible. After having offered them the pharmaceutical record and having completed it, drug interactions were sought. If the impact was considered significant, a pharmaceutical intervention was transmitted to the referring physician of the institution and recorded in the computerized patient record.

RESULTS

The pharmaceutical record was offered to 497 patients, i.e., 87 % of eligible patients. At the first meeting, 7 % of patients (n=34) were aware of it and 72 % had one open. In total, 395 pharmaceutical records were filled in at least once, 41 of which we created. Only 25 patients (5 %) refused the process and 90 % of the existing records were filled by the pharmacy. In total, 419 prescriptions were analysed for 330 patients: the pharmaceutical record was therefore a useful tool for 66 % of patients. For 17 % (n=57) of them, or 11 % of included patients, 99 drug interactions with a high risk of clinical impact were detected with the retroceded drug. On average, the presentation, creation and feeding of the drug record took one minute each and the analysis of interactions 14minutes.

CONCLUSIONS

Easy to implement, the pharmaceutical record is a useful tool to search for drug interactions with retroceded drugs. It helps to optimize patient follow-up, despite the limited information available.

[Analysis of the question-answer activity of a hospital pharmacy. Example of the handling of drug interactions]

INTRODUCTION

The medical care of patients generates questions among healthcare professionals. Some will necessitate an advanced research. The hospital pharmacist is at the interface between prescribers, caregivers and the medicines and is requested to answer these requests. Studies conducted in other countries showed that this question-answer activity represents a significant amount of time in daily work. In France, this topic was poorly explored. The objective of our work was to study the volume and the type of questions, the clinical situations, the time required, the medicines implicated and the sources of information used.

MATERIALS AND METHODS

A prospective study was conducted in the pharmacy of a university hospital. All the requests answered by the pharmaceutical team, which needed a specific research, analysis and writing of an answer were collected.

RESULTS

A hundred and one questions were analyzed, originating from doctors or medicals interns. Almost half concerned drug interactions, and among them, almost a fourth were not mentioned in the Summary of Product Characteristics of the medicines involved. A pharmaceutical advice was provided in 91.5% of the cases. Time dedicated to the research varied between less than 30 minutes and more than 8 hours.

DISCUSSION AND CONCLUSION

This study illustrates the question-answer activity of a hospital pharmacy, which is currently not taken into account as an indicator of pharmaceutical activity. A large part concerns analysis and management of drug interactions and requires a significant amount of pharmaceutical time.

[Assessment of pharmaceutical databases available in France]

OBJECTIVE

To assess the relevance of several pharmaceutical databases (PDBs) to be integrated in a computerized prescription system for hospitals.

MATERIALS AND METHODS

Fifty medical prescriptions were designed as tests. They were supposed to answer to a security or a relevance assessment item. They were analyzed using four French PDBs (Claude-Bernard, Thériaque, Thésorimed, Vidal), available online. The outcome was the rate of conformity with the expected answers.

RESULTS

The rate of conformity was: 31% for Claude-Bernard, 30% for Thériaque, 26% for Vidal, and 20% for Thésorimed (no statistical significance).

DISCUSSION

The PDBs easily detect interactions between different pharmacological class drugs but redundancies and illogical situations are poorly intercepted. They seem to manage medicines only by the active ingredient, irrespective of the dose or the indication. The knowledge of the patient profile and the context are not really enriched by the content of the prescription.

CONCLUSION

The efficacy of these PDB has to be improved.

[Designing a tool to describe drug interactions and adverse events for learning and clinical routine]

Pharmacists play an important role in prescription analysis. They are involved in therapeutic drug monitoring, particularly for drugs with a narrow therapeutic index, prevention and management of drug interactions, and may be called in to identify side effects and adverse events related to drug therapy. For the polymedicated patient, the medical file, the list of prescribed drugs and the history of their administration may be insufficient to adequately assign the responsibility of a given adverse effect to one or more drugs. Graphical representations can sometimes be useful to describe and clarify a sequence of events. In addition, as part of their academic course, students have many occasions to hear about "side effects" and "drug interactions". However, in the academic setting, there are few opportunities to observe the evolution and the consequences of these events. In the course of their hospital training, these students are required to perform patient follow-up for pharmacotherapeutic or educational purposes and to comment case reports to physicians. The aim of this paper is to present a tool facilitating the graphic display of drug interaction consequences and side effects. This tool can be a useful aid for causality assessment. It structures the students' training course and helps them better understand the commentaries pharmacists provide for physicians. Further development of this tool should contribute to the prevention of adverse drug events.