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Makihara K, Yamamoto Y, Miyazaki M, Taguchi M, Sato J, Takase H, Uezono Y. A Multicenter Retrospective Observational Study Analyzing the Effect of Polypharmacy on Oxycodone Tolerability. J Pain Palliat Care Pharmacother 2024; 38:3-12. [PMID: 38227839 DOI: 10.1080/15360288.2023.2301341] [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: 07/14/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Abstract
Polypharmacy is becoming increasingly troublesome in the treatment of cancer. The aim of this study was to explore the effects of concomitant polypharmacy comprising drugs that inhibit CYP3A4 and/or CYP2D6 on the oxycodone tolerability in patients with cancer. We conducted a multicenter retrospective study encompassing 20 hospitals. The data used for the study were obtained during the first 2 wk of oxycodone administration. The incidence of oxycodone discontinuation or dose reductions due to side effects and oxycodone-induced nausea and vomiting (OINV) were compared between patients not treated with either inhibitor and those treated with concomitant CYP3A4 or CYP2D6 inhibitors. The incidence of oxycodone discontinuation or dose reductions in patients treated with ≥3 concomitant CYP2D6 inhibitors (18.2%) tended to be higher than that in patients without this treatment (8.2%; p = 0.09). Moreover, the incidence of OINV in patients treated with 2 concomitant CYP3A4 inhibitors (29.8%) was significantly higher than that in patients without this treatment (15.5%; p = 0.049). Multivariate analysis showed that more than two concomitant CYP3A4 inhibitors and no concomitant use of naldemedine were independent risk factors for OINV. Concomitant polypharmacy involving CYP3A4 inhibitors increases the risk of OINV. Therefore, medications concomitantly used with oxycodone should be optimized.
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Affiliation(s)
- Katsuya Makihara
- Department of Pharmacy, Yodogawa Christian Hospital, Osaka, Japan
| | - Yoshihiro Yamamoto
- Departments of Pharmacy, Komaki City Hospital, Komaki City, Aichi, Japan
| | - Masayuki Miyazaki
- Department of Pharmacy, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Maho Taguchi
- Laboratory of Regulatory Sciences, Yokohama University of Pharmacy, Yokohama, Kanagawa, Japan
| | - Junya Sato
- Department of Pharmacy, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, Japan
| | - Hisamitsu Takase
- Nippon Medical School Tama-Nagayama Hospital, Tama, Tokyo, Japan
| | - Yasuhito Uezono
- Department of Pain Control Research, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Supportive and Palliative Care Research Support Office, National Center Hospital East, Kashiwa-City, Chiba, Japan
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Kawashiri T, Sugawara H, Makihara K, Ohno R, Miyamoto Y, Hidaka N, Uchida M, Takase H. Medical Economic Effect of Pharmaceutical Interventions by Board-Certified Pharmacists in Palliative Pharmacy for Patients with Cancer Using Medical Narcotics in Japan: A Multicenter, Retrospective Study. J NIPPON MED SCH 2024; 91:59-65. [PMID: 38462441 DOI: 10.1272/jnms.jnms.2024_91-105] [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] [Indexed: 03/12/2024]
Abstract
BACKGROUND The Japanese Society for Pharmaceutical Palliative Care and Sciences specializes in pharmacology in the field of palliative medicine. More than 700 board-certified pharmacists in palliative pharmacy (BCPPP) are actively involved in palliative pharmacotherapy at various hospitals and pharmacies. The purpose of this study was to determine the economic effect of pharmaceutical interventions by BCPPPs. METHODS This multicenter retrospective study included 27 medical centers and analyzed the medical economic effect of interventions by BCPPPs (17 pharmacists) and non-BCPPPs (24 pharmacists) on patients using medical narcotics for cancer pain in September 2021. RESULTS The percentage of patients who received a pharmaceutical intervention and whose drug costs were reduced by pharmacist intervention was significantly higher in the BCPPP group than in the non-BCPPP group. Although there was no significant difference between the two groups in drug cost reduction per patient per month (BCPPP group: $0.89 [-$64.91 to $106.76] vs. non-BCPPP group $0.00 [-$1,828.95 to $25.82]; P = 0.730), the medical economic benefit of pharmacist intervention in avoiding or reducing adverse drug reactions was higher in the BCPPP group ($103.18 [$0.00 to $628.03]) than in the non-BCPPP group ($0.00 [$0.00 to $628.03]) (P = 0.070). The total medical economic benefit-the sum of these-was significantly higher in the BCPPP group ($88.82 [-$14.62 to $705.37]) than in the non-BCPPP group ($0.66 [-$1,200.93 to $269.61]) (P = 0.006). CONCLUSION Pharmacological intervention for patients with cancer using medical narcotics may have a greater medical economic benefit when managed by BCPPPs than by non-certified pharmacists in Japan.
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Affiliation(s)
- Takehiro Kawashiri
- Department of Clinical Pharmacy and Pharmaceutical Care, Graduate School of Pharmaceutical Sciences, Kyushu University
- Clinical Research Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS)
| | - Hideki Sugawara
- Department of Pharmacy, Kagoshima University Hospital
- Clinical Research Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS)
| | - Katsuya Makihara
- Department of Pharmacy, Yodogawa Christian Hospital
- Clinical Research Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS)
| | - Rintaro Ohno
- Department of Pharmacy, Saiseikai Utsunomiya Hospital
| | | | | | - Mayako Uchida
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts
- Clinical Research Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS)
| | - Hisamitsu Takase
- Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital
- Clinical Research Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS)
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Ueki D, Suzuki S, Ohta T, Shinohara A, Ohashi Y, Konuma D, Ryushima Y, Udagawa R, Motoshige H, Ieoka M, Taji A, Kogure Y, Hiraike M, Uoi M, Ino K, Kawasaki T, Yamaguchi M. Cancer-Chemotherapy-Related Regimen Checks Performed by Pharmacists of General Hospitals Other than Cancer Treatment Collaborative Base Hospitals: A Multicenter, Prospective Survey. PHARMACY 2023; 12:1. [PMID: 38392922 PMCID: PMC10891652 DOI: 10.3390/pharmacy12010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 02/25/2024] Open
Abstract
Although prescription review is an important role for pharmacists in anticancer drug therapy, there are no guidelines in Japan that specify what pharmacists should check for in chemotherapy regimens. This prospective multicenter survey aimed to investigate the implementation of chemotherapy regimen checks by pharmacists in general hospitals by focusing on 19 recommended confirmation items designed to enhance chemotherapy safety. This study involved 14 hospitals within the National Hospital Organization in different regions of Japan. The top five cancers in Japan (gastric, colorectal, lung, breast, and gynecological) were targeted and specific chemotherapy regimens were analyzed. This study assessed the amount of time required for regimen checks, the number of confirmation items completed, the number and the content of inquiries raised regarding prescriptions, and the pharmacists' opinions using a questionnaire that had a maximum score of 10 points. Pharmacists checked 345 and 375 chemotherapies of patients in the control group (CG) and recommended items group (RIG), respectively. The mean time periods required for completing a chemotherapy regimen check were 4 min and 14 s (SD ±1 min and 50 s) and 6 min and 18 s (SD, ±1 min and 7 s) in the CG and RIG, respectively. The mean of the recommended items for the CG = 12.4 and for the RIG = 18.6. The items that the pharmacists did not confirm included urine protein (sixty-nine cases, 18.4%), allergy history (four cases, 1%), previous history (two cases, 0.5%), and a previous history of hepatitis B virus (sixty-nine cases, 18.4%). The number of inquiries for a doctor's prescription order was higher in the RIG than in the CG (41 vs. 27 cases). This multicenter survey demonstrated the potential effectiveness of implementing 19 recommended confirmation items in the regimen checks by pharmacists in general hospitals other than cancer treatment collaborative base hospitals.
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Affiliation(s)
- Daisuke Ueki
- Department of Pharmacy, National Hospital Organization Tokyo National Hospital, Tokyo 204-8585, Japan
| | - Shinya Suzuki
- Department of Pharmacy, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - Takahiro Ohta
- Department of Pharmacy, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
| | - Akira Shinohara
- Department of Pharmacy, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - Yasukata Ohashi
- Department of Pharmacy, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Daisuke Konuma
- Department of Pharmacy, National Hospital Organization Chiba Medical Center, Chiba 260-8606, Japan
| | - Yasuaki Ryushima
- Department of Pharmacy, National Hospital Organization Saitama Hospital, Saitama 351-0102, Japan
| | - Ryoko Udagawa
- Department of Pharmacy, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hironori Motoshige
- Department of Pharmacy, National Hospital Organization Hokkaido Medical Center, 5-7 Yamanote, Nishi-ku, Sapporo 063-0005, Japan
| | - Masahiro Ieoka
- Department of Pharmacy, National Hospital Organization Hamada Medical Center, Matsue 697-8511, Japan
| | - Akihiro Taji
- Department of Pharmacy, National Hospital Organization Osaka Minami Medical Center, Osaka 586-8521, Japan
| | - Yuuki Kogure
- Department of Pharmacy, National Hospital Organization Higashihiroshima Medical Center, Hiroshima 739-0041, Japan
| | - Mikako Hiraike
- Department of Pharmacy, National Hospital Organization Kumamoto Medical Center, Kumamoto 860-0008, Japan
| | - Miyuki Uoi
- Department of Pharmacy, National Hospital Organization Kyusyu Cancer Center, Fukuoka 811-1395, Japan
| | - Kazuhiko Ino
- Department of Pharmacy, National Hospital Organization Tokyo National Hospital, Tokyo 204-8585, Japan
| | - Toshikatsu Kawasaki
- Department of Pharmacy, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - Masakazu Yamaguchi
- Department of Pharmacy, Cancer Institute Hospital, Tokyo 135-8550, Japan
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Suzuki S, Uchida M, Sugawara H, Suga Y, Nakagawa T, Takase H. Multicenter prospective observational study on hospital pharmacist interventions to reduce inappropriate medications. Front Pharmacol 2023; 14:1195732. [PMID: 37456737 PMCID: PMC10343951 DOI: 10.3389/fphar.2023.1195732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background: In Japan, the involvement of hospital pharmacists in inappropriate medications (IMs) practices has not been sufficiently reported. Therefore, this prospective study described the interventions of hospital pharmacists in discontinuing inappropriate drugs or reducing drug doses. Methods: We conducted a prospective, multicenter, observational study to investigate the intervention of hospital pharmacists in inappropriate prescriptions for inpatients in September 2018. Fifty pharmacists from 45 hospitals in Japan participated in this study. IMs were defined as medications that pharmacists deemed inappropriate for patient treatment. The subjects of the study were patients who interacted with the participating pharmacists. Results: During the study period, the median number of beds in hospitals where the 50 participating pharmacists worked was 380, and the average number of beds for which the pharmacists were responsible was 49. The enrolled hospital pharmacists recommended that doctors discontinue or reduce the doses of their regular drugs for 347 out of 1,415 (24.5%) patients. Among the 391 pharmacists' recommendations to reduce IMs for 347 patients, physicians accepted 368 (94.1%) recommendations, and 523 drugs were discontinued as a result. Pharmacist intervention also led to improvements in hypnotic sedation, delirium, and hypotension. The most common reasons for IMs identified by pharmacists were "long-term administration of irresponsible or aimless medications" (44.5%), "adverse effects caused by medications" (31.5%), and "medications-mediated duplication of the pharmacological effect" (15.3%). Approximately 90% of pharmacists' suggestions to reduce medications were accepted for each reason. The average number of regular medications used by patients involved in drug reduction was 8.2, and the average number of medications reduced was 1.7. A sub-analysis showed that patients using opioids tended to take more medications, and these patients were able to reduce the amount of medications taken. Interventions by pharmacists certified in palliative pharmacies tended to reduce adverse drug events. Conclusion: This was the first multicenter prospective observational study conducted in Japan to demonstrate hospital pharmacist intervention's effectiveness in promoting appropriate prescription and, consequently, a reduction in the number of medications in use and polypharmacy.
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Affiliation(s)
- Shinya Suzuki
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
- Research Promotion Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS), Osaka, Japan
| | - Mayako Uchida
- Research Promotion Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS), Osaka, Japan
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women’s College of Liberal Arts, Kyoto, Japan
| | - Hideki Sugawara
- Research Promotion Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS), Osaka, Japan
- Department of Pharmacy, Kagoshima University Hospital, Kagoshima, Japan
| | - Yukio Suga
- Research Promotion Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS), Osaka, Japan
- Department of Clinical Drug Informatics, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan
| | - Takayuki Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
- Department of Clinical Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical Sciences, Wakayama Medical University, Wakayama, Japan
| | - Hisamitsu Takase
- Research Promotion Committee, Japanese Society for Pharmaceutical Palliative Care and Sciences (JSPPCS), Osaka, Japan
- Department of Pharmacy, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan
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Hiramatsu H, Kobayashi R, Fujii H, Uno M, Masuda C, Mabuchi S, Hirashita T, Hayashi T, Iguchi K, Teramachi H, Ibuka H, Ohashi T, Suzuki A, Yasuda K. [Reduction in Patient Waiting Times in Pharmacies by a Protocol to Minimize Inquiries to Doctors under an Agreement between a Hospital and Community Pharmacies]. YAKUGAKU ZASSHI 2023; 143:757-763. [PMID: 37661441 DOI: 10.1248/yakushi.23-00021] [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] [Indexed: 09/05/2023]
Abstract
Cooperative care between hospitals and community pharmacies is important to safe and effective pharmacotherapy for outpatients. We developed a protocol comprising three agreements about alternative drugs and dosing schedules with the aim of minimizing inquiries about prescriptions to doctors. The protocol was implemented under an agreement between core hospitals in Gifu City and community pharmacy members of the Gifu City Pharmaceutical Association from October 2019. Here, we examined the impact of this protocol on patient waiting time in pharmacies. Before introduction of the protocol, median patient waiting time for questionable prescriptions requiring an inquiry to a doctor was significantly longer than that for prescriptions not requiring an inquiry (23.0 min vs. 10.0 min, p<0.001). After introduction of the protocol, median time for prescriptions which were questionable but nevertheless under the protocol did not require an inquiry to a doctor was significantly reduced compared with those which were questionable and still did require an inquiry (15.0 min vs. 24.0 min, p=0.038). In conclusion, introduction of a protocol aimed at minimizing inquiries about prescriptions to doctors from a community pharmacy was useful in reducing the waiting time of patients, and also likely in decreasing the working times of medical doctors and pharmacists.
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Affiliation(s)
| | | | | | - Mika Uno
- Gifu City Pharmaceutical Association
- Tanpopo Pharmacy
| | - Chiho Masuda
- Gifu City Pharmaceutical Association
- Tanpopo Pharmacy
| | - Syoko Mabuchi
- Gifu City Pharmaceutical Association
- Tanpopo Pharmacy
| | | | - Takako Hayashi
- Department of Pharmacy, Japanese Red Cross Gifu Hospital
| | - Kazuhiro Iguchi
- Gifu City Pharmaceutical Association
- Gifu Pharmaceutical University Pharmacy
| | - Hitomi Teramachi
- Gifu City Pharmaceutical Association
- Gifu Pharmaceutical University Pharmacy
| | | | | | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital
| | - Kimio Yasuda
- Gifu City Pharmaceutical Association
- Faculty of Pharmacy, Gifu University of Medical Science
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Tanaka R, Satoh Y, Suga Y, Nakagawa J, Miyazaki M, Hagiwara R, Uchida M, Takase H. Japanese Nationwide Comparative Survey of Medication Guidance Provided by Certified and Uncertified Palliative Care Pharmacists. J NIPPON MED SCH 2023; 90:449-459. [PMID: 38246616 DOI: 10.1272/jnms.jnms.2023_90-613] [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] [Indexed: 01/23/2024]
Abstract
BACKGROUND As members of a medical team, pharmacists are expected to provide optimal patient-centered, evidence-based pharmacotherapy. In Japan, in consideration of the importance of palliative care, a system was initiated for certifying palliative care pharmacists in 2010. However, no studies have evaluated the usefulness of board certification in palliative pharmacy. Therefore, we surveyed the status of medication guidance for the physical and psychological symptoms of patients receiving palliative care and compared the medication guidance provided by certified and uncertified pharmacists. METHODS The survey was conducted in February and March 2022. Pharmacists registered as members of the Japanese Society of Pharmaceutical Palliative Care and Sciences were surveyed by using a web-based questionnaire and 209 pharmacists responded: the certified pharmacist group comprised 123 (58.9%) pharmacists and the uncertified pharmacist group comprised 86 (41.1%) pharmacists. RESULTS The certified pharmacist group provided better and more frequent medication guidance, according to responses to four of the six items related to pain relief. Three items were related to non-pain symptom relief, and one of the four items was related to psychiatric symptom relief (P < 0.05). The study showed that the certified pharmacist group received a better rating than the uncertified pharmacist group for involvement in palliative pharmacotherapy leading to improvement of patient quality of life (P < 0.05). CONCLUSION As compared with uncertified pharmacists, certified pharmacists intervened more proactively and provided a broader range of palliative care.
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Affiliation(s)
- Rei Tanaka
- Department of Pharmacy, Shizuoka Cancer Center
- Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | | | - Yukio Suga
- Department of Clinical Pharmacy and Healthcare Science, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University
| | - Junichi Nakagawa
- Department of Pharmacy, Daisan Hospital, The Jikei University School of Medicine
| | | | | | - Mayako Uchida
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts
| | - Hisamitsu Takase
- Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital
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Ziaie S, Mehralian G, Talebi Z. Evaluation of medication reconciliation process in internal medicine wards of an academic medical center by a pharmacist: errors and risk factors. Intern Emerg Med 2022; 17:377-386. [PMID: 34342787 DOI: 10.1007/s11739-021-02811-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Medication reconciliation based on complete medication histories has been introduced to minimize medication errors and its associated healthcare costs in the transitions of care. In this study, to evaluate the routine process of medication reconciliation in an academic medical center, medication history taken at the time of admission by physicians and the first order prescribed in the hospital was compared to a comprehensive reconciliation form filled by a pharmacist using direct interview of the patients and caregivers, patient's insurance records and medication packages they brought from home. Two hundred and fifty-seven patients admitted in the internal wards of an academic medical center between June and September 2019 were investigated. In 6% of the patients, drug history was not included in the medical history form. Other patients were using 8.59 drugs in average, with a mean of 3.55 medication discrepancies in the history-taking process. Most commonly occurring errors were drug omissions (2.23 per patient on average) and incorrect frequency (0.96 per patient on average). There was a mean of 0.7 potentially harmful discrepancies for each patient. The mean number of drug discrepancies in new prescriptions from the hospital was 1.25, and almost half of patients had a potentially harmful discrepancies reordered in the hospital. There was no statistically meaningful relationship between patients' gender, physicians' gender, or the time of history taking and the total number of medication errors. History of ischemic heart disease was significantly associated with higher number of medication errors (p = 0.05). The results suggest that the medication reconciliation process in this academic center is inefficient. Using a systematic approach in medication reconciliation and gathering the best possible medication history, with a pharmacist who has better understanding of drugs' potential interactions and harmful errors can improve this process and prevent such errors in the future.
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Affiliation(s)
- Shadi Ziaie
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamhossein Mehralian
- Department of Pharmacoeconomy and Administrative Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Talebi
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, 500 12th 13 avenue, Columbus, OH, 43210, USA.
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Franco J, de Souza RN, Lima TDM, Moriel P, Visacri MB. Role of clinical pharmacist in the palliative care of adults and elderly patients with cancer: A scoping review. J Oncol Pharm Pract 2022; 28:664-685. [PMID: 35019805 DOI: 10.1177/10781552211073470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We conducted this scoping review to map and summarize scientific evidence on the role of clinical pharmacists in the palliative care of adults and elderly patients with cancer. DATA SOURCES A literature search was performed in MEDLINE, PubMed Central, Embase, Web of Science, Scopus, and BVS/BIREME for studies published until November 22nd, 2020. Studies that reported work experiences adopted by clinical pharmacists in the palliative care of adults and elderly patients with cancer were included. Two independent authors performed study selection and data extraction. Any disagreements were resolved by discussion with the third and fourth authors. The pharmacist interventions identified in the included studies were described based on key domains in the DEPICT v.2. DATA SUMMARY A total of 586 records were identified, of which 14 studies fully met the eligibility criteria. Most of them were conducted in the United States of America (n = 5) and Canada (n = 5) and described the workplace of the pharmacist in clinic/ambulatory (n = 10). Clinical pharmacists performed several activities and provided services, highlighting medication review (n = 12), patient and caregivers education (n = 12), medication histories and-or medication reconciliation (n = 6). The pharmacist interventions were mostly conducted for patients/caregivers (n = 13), by one-on-one contact (n = 14), and by face-to-face (n = 13). Pharmacists were responsible mainly for change or suggestion for change in therapy (n = 12) and patient counselling (n = 12). Pharmacist interventions were well accepted by the clinical team. Overall, studies showed that pharmacists, within an interdisciplinary team, had significant impacts on measured outcomes. CONCLUSIONS In recent years, there have been advances in the role of the pharmacist in palliative care of patients with cancer and there are great opportunities in this field. They play an important role in managing cancer pain and other symptoms, as well as resolving drug related problems. We encourage more research to be carried out to strengthen this field and to benefit patients with advanced cancer with higher quality of life.
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Affiliation(s)
- Julia Franco
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Rafael N de Souza
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Tácio de M Lima
- Department of Pharmaceutical Sciences, 67825Federal Rural University of Rio de Janeiro, Seropédica, RJ, Brazil
| | - Patricia Moriel
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Marília B Visacri
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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OUP accepted manuscript. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:427-433. [DOI: 10.1093/ijpp/riac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 04/03/2022] [Indexed: 11/13/2022]
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10
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Ishida T, Yamaoka K, Suzuki A, Nakata Y. Effectiveness of polypharmacy reduction policy in Japan: nationwide retrospective observational study. Int J Clin Pharm 2021; 44:357-365. [PMID: 34748135 DOI: 10.1007/s11096-021-01347-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
Background Polypharmacy is an important global health issue. In Japan, an amended policy has been implemented since April 2016 to offer incentives that allow claiming a payment of approximately 22.5 US$ per patient to hospitals and clinics that succeed to reduce two or more medications. However, there is no evidence on the nationwide effectiveness of polypharmacy reduction policy. Aim To evaluate the effectiveness of the polypharmacy reduction policy in Japan using nationwide outpatient prescription fee reimbursement claims data in Open Data of the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Method This nationwide retrospective observational study was conducted over 3 years (April 2015 to March 2018). The primary outcome was the polypharmacy reduction ratio calculated by the polypharmacy proportion. Factors associated with policy effectiveness were identified by performing a multiple linear regression analysis using independent variables. Results After implementing the new policy, a 7.3 % polypharmacy reduction ratio was observed, particularly in the elderly (8.2 %). Multiple linear regression analysis revealed that the proportion of elderly residents (aged ≥65 years), number of hospitals per 100,000 residents, and number of clinics per 100,000 residents were statistically significantly associated with this reduction. Conclusion The polypharmacy reduction policy indicated an association with polypharmacy reduction in Japan. The proportion of elderly residents and availability of hospitals and clinics are important factors to enhance the effectiveness of the polypharmacy reduction policy.
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Affiliation(s)
- Takehiro Ishida
- Graduate School of Public Health, Teikyo University, Itabashi-ku, 173-8605, Tokyo, Japan.
| | - Kazue Yamaoka
- Graduate School of Public Health, Teikyo University, Itabashi-ku, 173-8605, Tokyo, Japan
| | - Asuka Suzuki
- Graduate School of Public Health, Teikyo University, Itabashi-ku, 173-8605, Tokyo, Japan
| | - Yoshinori Nakata
- Graduate School of Public Health, Teikyo University, Itabashi-ku, 173-8605, Tokyo, Japan
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Ewig CLY, Cheng YM, Li HS, Wong JCL, Cho AHY, Poon FMH, Li CK, Cheung YT. Use of Chronic Prescription Medications and Prevalence of Polypharmacy in Survivors of Childhood Cancer. Front Oncol 2021; 11:642544. [PMID: 33869032 PMCID: PMC8047635 DOI: 10.3389/fonc.2021.642544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/04/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND As survivors of childhood cancer age, development of cancer treatment-related chronic health conditions often occur. This study aimed to describe the pattern of chronic prescription medication use and identify factors associated with polypharmacy among survivors of childhood cancer. METHODS This was a retrospective study conducted at the pediatric oncology long-term follow-up clinic in Hong Kong. Eligible subjects included survivors who were (1) diagnosed with cancer before 18 years old, (2) were at least 3 years post-cancer diagnosis and had completed treatment for at least 30 days, and (3) receiving long-term follow-up care at the study site between 2015 and 2018. Dispensing records of eligible survivors were reviewed to identify medications taken daily for ≥30 days or used on an "as needed" basis for ≥6 months cumulatively within the past 12-month period. Polypharmacy was defined as the concurrent use of ≥5 chronic medications. Multivariable log-binomial modeling was conducted to identify treatment and clinical factors associated with medication use pattern and polypharmacy. RESULTS This study included 625 survivors (mean current age = 17.9 years, standard deviation [SD] = 7.2 years) who were 9.2 [5.2] years post-treatment. Approximately one-third (n = 219, 35.0%) of survivors were prescribed at least one chronic medication. Frequently prescribed medication classes include systemic antihistamines (26.5%), sex hormones (19.2%), and thyroid replacement therapy (16.0%). Overall prevalence of polypharmacy was 5.3% (n = 33). A higher rate of polypharmacy was found in survivors of CNS tumors (13.6%) than in survivors of hematological malignancies (4.3%) and other solid tumors (5.3%) (P = .0051). Higher medication burden was also observed in survivors who had undergone cranial radiation (RR = 6.31; 95% CI = 2.75-14.49) or hematopoietic stem-cell transplantation (HSCT) (RR = 3.53; 95% CI = 1.59-7.83). CONCLUSION Although polypharmacy was observed in a minority of included survivors of childhood cancer, chronic medication use was common. Special attention should be paid to survivors of CNS tumors and survivors who have undergone HSCT or cranial radiation. These individuals should be monitored closely for drug-drug interactions and adverse health outcomes that may result from multiple chronic medications, particularly during hospitalization in an acute care setting.
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Affiliation(s)
- Celeste L. Y. Ewig
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yi Man Cheng
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Hoi Shan Li
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Alex Hong Yu Cho
- Department of Pharmacy, Hong Kong Children’s Hospital, Hong Kong, China
| | | | - Chi Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Department of Oncology and Hematology, The Hong Kong Children’s Hospital, Hong Kong, China
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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12
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Rahman S, Singh K, Dhingra S, Charan J, Sharma P, Islam S, Jahan D, Iskandar K, Samad N, Haque M. The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population - Public Health Implications. Ther Clin Risk Manag 2020; 16:1007-1022. [PMID: 33116550 PMCID: PMC7586020 DOI: 10.2147/tcrm.s272908] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 pandemic is inducing acute respiratory distress syndrome, multi-organ failure, and eventual death. Respiratory failure is the leading cause of mortality in the elderly population with pre-existing medical conditions. This group is particularly vulnerable to infections due to a declined immune system, comorbidities, geriatric syndrome, and potentially inappropriate polypharmacy. These conditions make the elderly population more susceptible to the harmful effects of medications and the deleterious consequences of infections, including MERS-CoV, SARS-CoV, and SARS-CoV-2. Chronic diseases among elderlies, including respiratory diseases, hypertension, diabetes, and coronary heart diseases, present a significant challenge for healthcare professionals. To comply with the clinical guidelines, the practitioner may prescribe a complex medication regimen that adds up to the burden of pre-existing treatment, potentially inducing adverse drug reactions and leading to harmful side-effects. Consequently, the geriatric population is at increased risk of falls, frailty, and dependence that enhances their susceptibility to morbidity and mortality due to SARS-CoV-2 respiratory syndrome, particularly interstitial pneumonia. The major challenge resides in the detection of infection that may present as atypical manifestations in this age group. Healthy aging can be possible with adequate preventive measures and appropriate medication regimen and follow-up. Adherence to the guidelines and recommendations of WHO, CDC, and other national/regional/international agencies can reduce the risks of SARS-CoV-2 infection. Better training programs are needed to enhance the skill of health care professionals and patient’s caregivers. This review explains the public health implications associated with polypharmacy on the geriatric population with pre-existing co-morbidities during the COVID-19 pandemic.
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Affiliation(s)
- Sayeeda Rahman
- School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados
| | - Keerti Singh
- Faculty of Medical Science, The University of the West Indies, Cave Hill Campus, Wanstead, Barbados
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad & Tobago
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Paras Sharma
- Department of Pharmacognosy, BVM College of Pharmacy, Gwalior, India
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Dilshad Jahan
- Department of Hematology, Asgar Ali Hospital, Dhaka 1204, Bangladesh
| | - Katia Iskandar
- School of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Nandeeta Samad
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health Universiti Pertahanan, Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Kem Perdana Sungai Besi, Malaysia
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13
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Wang Y, Dai Y, Yang J, Zhou H, Chen Z, Li G. A survey about the contents and features of oncology clinical pharmacy services and self-evaluations of the oncology pharmacists in China. J Clin Pharm Ther 2020; 45:1106-1113. [PMID: 32592203 DOI: 10.1111/jcpt.13191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/29/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE In China, with the increased number of oncology patients and use of novel antitumour drugs, the demand of oncology clinical pharmacy services is also growing. However, the current status of oncology clinical pharmacy services in China was seldom reported. The purpose of the study was to investigate the contents and features of oncology clinical pharmacy services and self-evaluations of the oncology pharmacists in China, and to identify related problems for further development. METHODS A 55-item online questionnaire was distributed to oncology-related clinical pharmacists in Chinese hospitals in January 2019. Pharmacists answered the questions on the WeChat platform. Data were analysed using descriptive statistics. RESULTS AND DISCUSSION The respondents of the 166 valid questionnaires were from 29 provinces (or autonomous regions or municipalities). Their average working experience for clinical pharmacy was 4.86 years. The average duration of their clinical services was 3.27 h/d. The clinical pharmacy services consist of 15 types, and their workload on each service type was summarized. Pharmacists are not frequently participating in establishing pharmacotherapy protocols, therapeutic drug monitoring and pharmacogenetic/pharmacogenomic services. About 80% (81.33%) of the pharmacists thought that other healthcare professionals knew the nature of their work. The biggest barrier for career development of the pharmacists was insufficiency of professional skills. In most cases, the clinical service accounted for <30% of the overall performance evaluation of the pharmacists. Most of the participating pharmacists were not satisfied with their current salary. The overall evaluation score for their career happiness was 6.27 out of 10. WHAT IS NEW AND CONCLUSION The value of oncology clinical pharmacists is being increasingly recognized, but advanced services need further expansion. Increasing the time serving in patient care, optimizing performance evaluation mechanisms and strengthening their skills are possible ways for pharmacists to provide superior services. This study showed the current service of oncology clinical pharmacists in most parts of China, which may provide reference for policymakers, promote international communications and shed light on future development of oncology clinical pharmacy.
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Affiliation(s)
- Yanting Wang
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanyuan Dai
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Yang
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Zhou
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Chen
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guohui Li
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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