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Baars EW, Kienle GS, Heusser P, Pedersen PA, van Wietmarschen HA, Kiene H, von Schoen-Angerer T, Hamre HJ. Anthroposophic Medicinal Products: A Literature Review of Features, Similarities and Differences to Conventional Medicinal Products, Scientific and Regulatory Assessment. Glob Adv Health Med 2022; 11:21649561211073079. [PMID: 35281956 PMCID: PMC8915225 DOI: 10.1177/21649561211073079] [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] [Received: 05/03/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Regulatory assessment of anthroposophic medicinal products (AMPs) can be challenging due to their specific features. Objective The aim of this paper is therefore to provide adequate scientific information on AMPs for regulatory purposes. Methods A literature review was executed with database searches in PubMed, Cinahl, Merkurstab, Anthromedics, and https://iaap-pharma.org/. Search terms were: anthroposophic medicinal products, anthroposophic medicines, anthroposophic pharmacy. There was no language restriction; searches were executed from onset until June 11, 2020. In addition, experts were invited to suggest relevant literature. Results Eighty-seven of 660 identified publications were included. The system of anthroposophic medicine (AM) with its conceptual background and various aspects of AMPs was described: definition, pharmaceutical properties, an example of AMP development, use in clinical practice, similarities with and differences to conventional medicinal products, societal aspects, scientific and regulatory assessment. Conclusion AMPs are part of the integrative whole medical system of AM. AMPs are manufactured according to Good Manufacturing Practice and national drug regulations and have an excellent safety status; the limited available evidence suggests clinical benefits. Current drug regulation of AMPs in the EU and most European countries does not take the special properties of AMPs into account. Future research should focus on appropriate methodologies for the evaluation of effects of AMPs as part of the AM whole medical system, the scientific quality of its non-atomistic holistic ontological position, and the integration of AM and conventional medicine in clinical practice. Future policies should focus on appropriate ways of addressing regulatory challenges to AMPs.
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Affiliation(s)
- Erik W Baars
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands.,Faculty of Healthcare, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Gunver S Kienle
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.,Faculty of Medicine, Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Heusser
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Peter A Pedersen
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Independent Pharmaceutical Consultant, Søborg, Denmark
| | - Herman A van Wietmarschen
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | | | - Harald J Hamre
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
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Magvanjav O, Cooper-Dehoff RM, McDonough CW, Gong Y, Hogan WR, Johnson JA. Combination Antihypertensive Therapy Prescribing and Blood Pressure Control in a Real-World Setting. Am J Hypertens 2020; 33:316-324. [PMID: 31853537 DOI: 10.1093/ajh/hpz196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/14/2019] [Accepted: 12/17/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Specific combinations of two drug classes are recommended in a variety of clinical situations in the management of hypertension. These preferred combinations are based on complimentary blood pressure (BP) lowering mechanisms or benefit for a concomitant disease. METHODS Using electronic health records (EHRs) data from 27,579 ambulatory hypertensive patients, we investigated antihypertensive therapy prescribing patterns and associations of preferred two drug classes with BP control. RESULTS Overall, BP control, defined as BP <140/90 mm Hg, was 65% among treated patients. Preferred dual antihypertensive therapy was prescribed in 55% of patients with uncomplicated hypertension, 49% of patients with diabetes, and 47% of patients with a history of myocardial infarction (MI); these prescribing frequencies of preferred combinations were not explained by worse BP control on those combinations. In fact, we found suggestive evidence of association between prescribing of preferred two drug classes and improved BP control among post-MI (OR: 1.21, 95% CI: 0.99-1.48, P = 0.061) and uncomplicated hypertensive (OR: 1.11, 95% CI: 0.98-1.26, P = 0.089) patients. CONCLUSIONS Prescribing of guideline-recommended antihypertensive drug classes for concomitant diseases is suboptimal and prescribing of preferred/optimized drug class combinations was moderate. We did not find a clear association between the use of optimized drug class combinations and greater BP control. Overall, using EHR data, we identified potential opportunities for re-examining prescribing practices with implications for clinical decision support and healthcare improvement at the community and health system-wide levels.
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Affiliation(s)
- Oyunbileg Magvanjav
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rhonda M Cooper-Dehoff
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Caitrin W McDonough
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Basopo V, Mujasi PN. To what extent do prescribing practices for hypertension in the private sector in Zimbabwe follow the national treatment guidelines? An analysis of insurance medical claims. J Pharm Policy Pract 2017; 10:37. [PMID: 29214027 PMCID: PMC5713660 DOI: 10.1186/s40545-017-0125-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/27/2017] [Indexed: 02/01/2023] Open
Abstract
Background Hypertension is the most prevalent cardiovascular disease in Zimbabwe. The prevalence of Hypertension in the country is above 30% regardless of the cut off used. Currently, majority of patients in Zimbabwe seek health care from the private sector due to limited government funding for the public health sector. However, Standard treatment guidelines for hypertension are only available in the public sector and are optional in the private sector. This study assesses compliance of private sector prescribing to Standard Treatment guidelines for hypertension. Methods We reviewed hypertension prescription claims to a private health insurance company in Zimbabwe for the period Jan 1-Dec 31 2015. We used the last prescription claimed in the year on the assumption that it represented the patient’s current treatment. Prescription data was analyzed by comparing medicines prescribed to those recommended in the Zimbabwe 7th Essential Medicines List and Standard Treatment Guidelines 2015. We used Microsoft Excel© 2010 to conduct the analysis. Results A total of 1019 prescriptions were reviewed. Most patients were either on mono or dual therapy (76%). The mostly prescribed class of antihypertensive as first line were Angiotensin Converting Enzyme Inhibitors /Angiotensin Receptor Blockers. Regardless of whether they were being used as first, second or third line this class of antihypertensives emerged as the most prescribed (639 times). Only 358 (35%) prescriptions were compliant with standard treatment guidelines; the rest (661) did not meet several criteria. Areas of non-compliance included use of second line medicines as first line, failure to consider patient characteristics when prescribing, use of contraindicated medicines for certain patients, clinically significant interactions among prescribed medicines and illogical combinations that predispose patients to toxicity. Conclusion The poor compliance to standard treatment guidelines observed in our study indicates need to improve prescription practices for Hypertension in the private sector in Zimbabwe for its cost-effective management among the covered patients. However, further investigation is needed to understand the drivers of the prescribing habits and the non-compliance to the Essential Medicines List and Standard Treatment guidelines observed. This will enable design of appropriate educational, managerial and economic interventions to improve compliance.
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Affiliation(s)
- Victor Basopo
- International Master in Health Economics & Pharmacoeconomics, Barcelona School of Management, Universitat Pompeu Fabra, Balmes 132, 08001 Barcelona, Spain
| | - Paschal N Mujasi
- International Master in Health Economics & Pharmacoeconomics, Barcelona School of Management, Universitat Pompeu Fabra, Balmes 132, 08001 Barcelona, Spain
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Jarari N, Rao N, Peela JR, Ellafi KA, Shakila S, Said AR, Nelapalli NK, Min Y, Tun KD, Jamallulail SI, Rawal AK, Ramanujam R, Yedla RN, Kandregula DK, Argi A, Peela LT. A review on prescribing patterns of antihypertensive drugs. Clin Hypertens 2016; 22:7. [PMID: 27019747 PMCID: PMC4808570 DOI: 10.1186/s40885-016-0042-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/08/2016] [Indexed: 02/08/2023] Open
Abstract
Hypertension continues to be an important public health concern because of its associated morbidity, mortality and economic impact on the society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. It has been estimated that by 2025, 1.56 billion individuals will have hypertension. The increasing prevalence of hypertension and the continually increasing expense of its treatment influence the prescribing patterns among physicians and compliance to the treatment by the patients. A number of national and international guidelines for the management of hypertension have been published. Since many years ago, diuretics were considered as the first-line drugs for treatment of hypertension therapy; however, the recent guidelines by the Joint National Commission (JNC8 guidelines) recommend both calcium channel blockers as well as angiotensin-converting enzyme inhibitors as first-line drugs, in addition to diuretics. Antihypertensive drug combinations are generally used for effective long-term management and to treat comorbid conditions. This review focuses on the antihypertensive medication utilization, their cost factors, adherence to treatment by patients, and physicians’ adherence to guidelines in prescribing medications in different settings including Indian scenario. The antihypertensive medication prescribing pattern studies help in monitoring, evaluation and necessary modifications to the prescribing habits to achieve rational and cost-effective treatment. Additionally, periodic updating of recommended guidelines and innovative drug formulations, and prescription monitoring studies help in rational use of antihypertensive drugs, which can be tailored to suit the patients' requirements, including those in the developing countries.
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Affiliation(s)
- Noah Jarari
- Department of Pharmacology, University of Benghazi, Benghazi, Libya
| | - Narasinga Rao
- Department of Medicine, Andhra Medical College, Visakhapatnam, India
| | - Jagannadha Rao Peela
- Department of Biochemistry, Quest International University Perak, 227 The Teng Seng Plaza, Level 2, Jalan Raja Permaisuri Bainun, Ipoh, Perak Malaysia
| | - Khaled A Ellafi
- Libyan Cardiac Society, Department of Cardiology, Benghazi Medical Center, Benghazi University, Benghazi, Libya
| | - Srikumar Shakila
- Department of Biochemistry, Quest International University Perak, 227 The Teng Seng Plaza, Level 2, Jalan Raja Permaisuri Bainun, Ipoh, Perak Malaysia
| | - Abdul R Said
- Department of Biochemistry, Quest International University Perak, 227 The Teng Seng Plaza, Level 2, Jalan Raja Permaisuri Bainun, Ipoh, Perak Malaysia
| | | | - Yupa Min
- Department of Pathology, Quest International University Perak, Ipoh, Malaysia
| | - Kin Darli Tun
- Department of Pathology, Management and Science University, Selangor, Malaysia
| | | | - Avinash Kousik Rawal
- Department of Biochemistry, St. Mathews Medical University, Grand Cayman, Cayman Islands
| | - Ranjani Ramanujam
- Department of Pharmacology, Dr Ambethkar Medical College, Bengaluru, India
| | | | | | - Anuradha Argi
- Department of Human Genetics, Andhra University, Visakhapatnam, India
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Tandon VR, Sharma S, Mahajan S, Mahajan A, Khajuria V, Mahajan V, Prakash C. Antihypertensive drug prescription patterns, rationality, and adherence to Joint National Committee-7 hypertension treatment guidelines among Indian postmenopausal women. J Midlife Health 2014; 5:78-83. [PMID: 24970986 PMCID: PMC4071649 DOI: 10.4103/0976-7800.133994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim of Study: The aim of this study is to evaluate antihypertensive drug prescription patterns, rationality and adherence to Joint National Committee (JNC-7) hypertension (HT) treatment recommendations among Indian postmenopausal women (PMW). Materials and Methods: An observational and cross-sectional prospective prescription audit study was carried over a period of 1 year. A total of 500 prescriptions prescribed to PMW for diagnosed HT, were identified for one point analysis. Drug prescription patterns/trends, and their adherence to JNC-7 report as well as rationality using WHO guide to good prescribing was assessed. Results: In the monotherapy, category angiotensin receptor blockers (ARBs) accounted (24.8%), calcium channel blockers (CCBs) (19.4%), angiotensin converting enzyme inhibitors (ACEIs) (11%), beta blockers (BBs) (2.8%), and diuretics (2%) of the total prescription. Individually, amlodipine was maximally prescribed in 16.4%. 31.6% had double combination, whereas 2.2% and 1% had triple and four drug combinations, respectively. About 3.6% of the prescription contained antihypertensive combination along with other class of drug. ARBs + diuretic were observed in 11%, CCBs + BB 10% and ACEI + diuretic in 2.6% of the total prescriptions. Among the combination therapy amlodipine + atenolol (8.4%), telmisartan + hydrochlorothiazide (6%) and losartan + hydrochlorothiazide (4.4%) were maximally prescribed. 84.21% (P < 0.001) of the prescription showed nonadherence as per recommendations for pre-HT. 100% and 43.25% adherence rates were noticed for Stage 1 HT (P < 0.001) and Stage 2 HT (P > 0.05) patients. Conclusion: Antihypertensive prescription trends largely adhere to existing guidelines and are rational except polypharmacy, generic and fixed dose combinations prescribing, were some of the common pharmacologically considered irrationality noticed.
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Affiliation(s)
- Vishal R Tandon
- Department of Pharmacology and Therapeutics, Govt. Medical College, Jammu, Jammu and Kashmir, India
| | - Sudhaa Sharma
- Department of Obstetrics and Gyanecology, Govt. Medical College, Jammu, Jammu and Kashmir, India
| | - Shagun Mahajan
- Department of Nephrology-Superspecialty Hospital, Govt. Medical College, Jammu, Jammu and Kashmir, India
| | - Annil Mahajan
- Department of Internal Medicine, Govt. Medical College, Jammu, Jammu and Kashmir, India
| | - Vijay Khajuria
- Department of Pharmacology and Therapeutics, Govt. Medical College, Jammu, Jammu and Kashmir, India
| | - Vivek Mahajan
- Department of Pharmacology and Therapeutics, Govt. Medical College, Jammu, Jammu and Kashmir, India
| | - Chander Prakash
- Department of Pharmacology and Therapeutics, Govt. Medical College, Jammu, Jammu and Kashmir, India
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Simões-Wüst AP, Jeschke E, Mennet M, Schnelle M, Matthes H, von Mandach U. Prescribing Pattern of Bryophyllum Preparations among a Network of Anthroposophic Physicians. ACTA ACUST UNITED AC 2012; 19:293-301. [DOI: 10.1159/000345841] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jeschke E, Ostermann T, Tabali M, Vollmar HC, Kröz M, Bockelbrink A, Witt CM, Willich SN, Matthes H. Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study. BMC Geriatr 2010; 10:48. [PMID: 20663129 PMCID: PMC2916899 DOI: 10.1186/1471-2318-10-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 07/21/2010] [Indexed: 01/12/2023] Open
Abstract
Background Pharmacotherapy in the older adult is a complex field involving several different medical professionals. The evidence base for pharmacotherapy in elderly patients in primary care relies on only a few clinical trials, thus documentation must be improved, particularly in the field of complementary and alternative medicine (CAM) like phytotherapy, homoeopathy, and anthroposophic medicine. This study describes diagnoses and therapies observed in elderly patients treated with anthroposophic medicine in usual care. Methods Twenty-nine primary care physicians in Germany participated in this prospective, multicenter observational study on prescribing patterns. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients were at least 60 years of age. Multiple logistic regression analysis was used to determine factors associated with anthroposophic prescriptions. Results In 2005, a total of 12 314 prescriptions for 3076 patients (68.1% female) were included. The most frequent diagnoses were hypertension (11.1%), breast cancer (3.5%), and heart failure (3.0%). In total, 30.5% of the prescriptions were classified as CAM remedies alone, 54.4% as conventional pharmaceuticals alone, and 15.1% as a combination of both. CAM remedies accounted for 41.7% of all medications prescribed (35.5% anthroposophic). The adjusted odds ratio (AOR) for receiving an anthroposophic remedy was significantly higher for the first consultation (AOR = 1.65; CI: 1.52-1.79), treatment by an internist (AOR = 1.49; CI: 1.40-1.58), female patients (AOR = 1.35; CI: 1.27-1.43), cancer (AOR = 4.54; CI: 4.12-4.99), arthropathies (AOR = 1.36; CI: 1.19-1.55), or dorsopathies (AOR = 1.34; CI: 1.16-1.55) and it decreased with patient age (AOR = 0.97; CI: 0.97-0.98). The likelihood of being prescribed an anthroposophic remedy was especially low for patients with hypertensive diseases (AOR = 0.36; CI: 0.32-0.39), diabetes mellitus (AOR = 0.17; CI: 0.14-0.22), or metabolic disorders (AOR = 0.17; CI: 0.13-0.22). Conclusion The present study is the first to provide a systematic overview of everyday anthroposophic medical practice in primary care for elderly patients. Practitioners of anthroposophic medicine prescribe both conventional and complementary treatments. Our study may facilitate further CAM-research on indications of, for example, dementia or adverse drug reactions in the elderly.
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