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Haegens LL, Huiskes VJB, Bekker CL, van den Bemt BJF. Effect of a smart temperature logger on correctly storing biological disease-modifying antirheumatic drugs at home: a pre-post study. Eur J Hosp Pharm 2024:ejhpharm-2023-004028. [PMID: 38383141 DOI: 10.1136/ejhpharm-2023-004028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Biological disease-modifying antirheumatic drugs (bDMARDs) require specific storage temperatures, but are frequently stored outside the recommended range of 2-8°C. As incorrect storage may affect therapy effectiveness and consequently lead to higher disease activity, compliance with recommended storage temperatures should be improved. eHealth interventions can provide insight into storage temperatures and alerts in case of deviations from recommended temperatures. Therefore, this study aims to assess the effect of a smart temperature logger on correctly storing bDMARDs at home by patients with rheumatic diseases. METHODS A pre-post study was performed in a hospital in the Netherlands. The baseline period consisted of 12 weeks of storage temperature measurement with a passive temperature logger, and the intervention period consisted of 12 weeks of storage temperature measurement with a smart temperature logger. This smart logger included a smartphone application which provided insight into storage temperatures and real-time alerts when exceeding recommended temperatures. The main outcome measure was the difference in the number of patients who stored their bDMARDs correctly between baseline and intervention. Secondary outcomes were the difference in the proportion of measurement time within 2-8°C between baseline and intervention, the distribution of measurement time among temperature categories, and the patient's acceptance measured using a questionnaire based on the Technology Acceptance Model. RESULTS In total, 48 participants (median age 55 years (IQR 47-64), 53% male) were analysed. The proportion of participants correctly storing bDMARDs increased from 18.8% (n=9) during baseline to 39.6% (n=19) during intervention (p=0.004). The median proportion of measurement time between 2-8°C improved by 6% (IQR 0-34%) (p<0.0001). Technology acceptance was scored as moderate. CONCLUSIONS Temperature monitoring and real-time feedback with a smart temperature logger shows potential to improve at-home storage of bDMARDs, provided that continuous connection is realised to ensure real-time alerts and data collection.
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Affiliation(s)
- Lex L Haegens
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Victor J B Huiskes
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands
- Department of Pharmacy, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands
- Department of Pharmacy, Radboudumc, Nijmegen, Gelderland, The Netherlands
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Smale EM, van den Bemt BJF, Heerdink ER, Desar IME, Egberts TCG, Bekker CL. Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs: The ROAD Study. JAMA Oncol 2024; 10:87-94. [PMID: 37971730 PMCID: PMC10654927 DOI: 10.1001/jamaoncol.2023.4865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/08/2023] [Indexed: 11/19/2023]
Abstract
Importance New strategies targeting waste are required to improve financial and ecologic sustainability of expensive therapies, such as oral anticancer drugs, that frequently remain unused by patients. Redispensing unused oral anticancer drugs seems to be a promising strategy when drug quality is guaranteed. Objectives To determine the waste reduction and net cost savings attained by redispensing oral anticancer drugs that go unused by patients compared with the standard practice of disposal. Design, Settings, and Participants The ROAD study was a prospective single-group intervention conducted in the outpatient pharmacies of 4 hospitals in the Netherlands from February 1, 2021, to February 1, 2023, with 12-month follow-up of each patient. Patients with cancer and who had a prescription for an oral anticancer drug that could be stored at room temperature were included. Of 2426 eligible patients, 602 did not consent and 601 did not respond. Data analyses were performed from August 25, 2022, to April 19, 2023. Intervention Participants received oral anticancer drugs for use at home in special packaging (ie, sealed packaging with time-temperature indicator), to be returned to the pharmacy should these remain unused. The pharmacy ensured quality of returned drugs based on authenticity, appearance, remaining shelf life and adequate storage temperature. Drugs fulfilling quality requirements were redispensed to other patients. Main Outcome and Measure Total waste reduction and mean net annual cost savings per patient compared with the standard practice of disposal. Optimization of cost savings was explored by introducing variations in the quality assurance procedure and patient population. All analyses used the average exchange rate for 2021 €1 = US $1.18. Results Of 1223 patients with cancer who consented, 1071 participated (median [IQR] age, 70 [62-75] years; 622 [58.1%] were male). In all, 171 patients (16.0%; 95% CI, 13.8%-18.3%) returned 335 unused oral anticancer drug packages. Of the returned drugs, 228 packages were redispensed, which reduced waste by 68.1% (95% CI, 67.7%-68.5%) compared with the standard practice (disposal). Redispensing unused oral anticancer drugs comprised 2.4% (95% CI, 2.2%-2.5%) of total drug costs, providing mean net annual cost savings of US $680 (95% CI, $524-$837) up to $1591 (95% CI, $1226-$2002) per participant. Conclusions and Relevance The findings of this multicenter intervention study indicate that redispensing unused oral anticancer drugs is associated with waste reduction and cost savings, which in turn may improve the affordability and sustainability of cancer treatment. Trial Registration World Health Organization International Clinical Trials Registry Platform Identifier: NL9208.
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Affiliation(s)
- Elisabeth M. Smale
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, the Netherlands
| | - Eibert R. Heerdink
- Department of Clinical Pharmacy, Division of Laboratory, Genetics and Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Faculty of Science, Utrecht, the Netherlands
- Research Group Innovations of Pharmaceutical Care, Utrecht University of Applied Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ingrid M. E. Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Toine C. G. Egberts
- Department of Clinical Pharmacy, Division of Laboratory, Genetics and Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Faculty of Science, Utrecht, the Netherlands
| | - Charlotte L. Bekker
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
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Hogervorst S, Vervloet M, Janssen R, Koster E, Adriaanse MC, Bekker CL, van den Bemt BJF, Bouvy M, Heerdink ER, Hugtenburg JG, van Woerkom M, Zwikker H, van de Steeg-van Gompel C, van Dijk L. Implementing medication adherence interventions in four Dutch living labs; context matters. BMC Health Serv Res 2023; 23:1030. [PMID: 37752529 PMCID: PMC10523767 DOI: 10.1186/s12913-023-10018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Despite the abundant availability of effective medication adherence interventions, uptake of these interventions into routine care often lacks. Examples of effective medication adherence interventions include telephone counseling, consult preparation and the teach-back method. Assessing context is an important step in understanding implementation success of interventions, but context is often not reported or only moderately described. This study aims to describe context-specific characteristics in four living labs prior to the implementation of evidence-based interventions aiming to improve medication adherence. METHODS A qualitative study was conducted within four living labs using individual interviews (n = 12) and focus groups (n = 4) with project leaders and involved healthcare providers. The four living labs are multidisciplinary collaboratives that are early adopters of medication adherence interventions in the Dutch primary care system. Context is defined as the environment or setting in which the proposed change is to be implemented. Interview topics to assess context were formulated based on the 'inner setting' and 'outer setting' domains of the Consolidated Framework for Implementation Research (CFIR). Interviews were recorded and transcribed verbatim. Transcripts were deductively analyzed. RESULTS A total of 39 community pharmacists, pharmacy technicians, general practitioners and a home care employee participated in the (focus group) interviews. All four living labs proved to be pharmacy-driven and characterized by a high regard for innovation by staff members, a positive implementation climate, high levels of leadership engagement and high compatibility between the living labs and the interventions. Two living labs were larger in size and characterized by more formal communication. Two living labs were characterized by higher levels of cosmopolitanism which resulted in more adaptable interventions. Worries about external policy, most notably lack of reimbursement for sustainment and upscaling of the interventions, were shared among all living labs. CONCLUSIONS Contextual characteristics of four living labs that are early adopters of medication adherence interventions provide detailed examples of a positive implementation setting. These can be used to inform dissemination of medication adherence interventions in settings less experienced in implementing medication adherence interventions.
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Affiliation(s)
- Stijn Hogervorst
- Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marcia Vervloet
- Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | - Ruby Janssen
- Hogeschool Utrecht, Lectorate Innovations in Healthcare Processes in Pharmacology, Utrecht, The Netherlands
| | - Ellen Koster
- Utrecht Institute of Pharmaceutical Sciences, Divison of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Marcel C Adriaanse
- Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Marcel Bouvy
- Utrecht Institute of Pharmaceutical Sciences, Divison of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Eibert R Heerdink
- Utrecht Institute of Pharmaceutical Sciences, Divison of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Jacqueline G Hugtenburg
- Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Menno van Woerkom
- Dutch Institute for Rational Use of Medicine (IVM), Utrecht, the Netherlands
| | - Hanneke Zwikker
- Dutch Institute for Rational Use of Medicine (IVM), Utrecht, the Netherlands
| | | | - Liset van Dijk
- Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of PharmacoTherapy, Epidemiology and Economics (PTEE), Faculty of Mathematics and Natural Sciences, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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Verweij L, Metsemakers SJJPM, Ector GICG, Rademaker P, Bekker CL, van Vlijmen B, van der Reijden BA, Blijlevens NMA, Hermens RPMG. Improvement, Implementation, and Evaluation of the CMyLife Digital Care Platform: Participatory Action Research Approach. J Med Internet Res 2023; 25:e45259. [PMID: 37713242 PMCID: PMC10541637 DOI: 10.2196/45259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/16/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The evaluation of a continuously evolving eHealth tool in terms of improvement and implementation in daily practice is unclear. The CMyLife digital care platform provides patient-centered care by empowering patients with chronic myeloid leukemia, with a focus on making medication compliance insightful, discussable, and optimal, and achieving optimal control of the biomarker BCR-ABL1. OBJECTIVE The aim of this study was to investigate to what extent the participatory action research approach is suitable for the improvement and scientific evaluation of eHealth innovations in daily clinical practice (measured by user experiences) combined with the promotion of patient empowerment. METHODS The study used iterative cycles of planning, action, and reflection, whereby participants' experiences (patients, health care providers, the CMyLife team, and app suppliers) with the platform determined next actions. Co-design workshops were the foundation of this cyclic process. Moreover, patients filled in 2 sets of questionnaires for assessing experiences with CMyLife, the actual use of the platform, and the influence of the platform after 3 and at least 6 months. Data collected during the workshops were analyzed using content analysis, which is often used for making a practical guide to action. Descriptive statistics were used to characterize the study population in terms of information related to chronic myeloid leukemia and sociodemographics, and to describe experiences with the CMyLife digital care platform and the actual use of this platform. RESULTS The co-design workshops provided insights that contributed to the improvement, implementation, and evaluation of CMyLife and empowered patients with chronic myeloid leukemia (for example, simplification of language, and improvement of the user friendliness of functionalities). The results of the questionnaires indicated that (1) the platform improved information provision on chronic myeloid leukemia in 67% (33/49) of patients, (2) the use of the medication app improved medication compliance in 42% (16/38) of patients, (3) the use of the guideline app improved guideline adherence in 44% (11/25) of patients, and (4) the use of the platform caused patients to feel more empowered. CONCLUSIONS A participatory action research approach is suited to scientifically evaluate digital care platforms in daily clinical practice in terms of improvement, implementation, and patient empowerment. Systematic iterative evaluation of users' needs and wishes is needed to keep care centered on patients and keep the innovation up-to-date and valuable for users.
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Affiliation(s)
- Lynn Verweij
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Peter Rademaker
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas van Vlijmen
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bert A van der Reijden
- Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
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Haegens LL, Huiskes VJB, van der Ven J, van den Bemt BJF, Bekker CL. Factors Influencing Preferences of Patients With Rheumatic Diseases Regarding Telehealth Channels for Support With Medication Use: Qualitative Study. JMIR Form Res 2023; 7:e45086. [PMID: 37471137 PMCID: PMC10401190 DOI: 10.2196/45086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/04/2023] [Accepted: 05/04/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Patients with rheumatic diseases are known to experience drug-related problems at various times during their treatment. As these problems can negatively influence patients' health, they should be prevented or resolved as soon as possible, for which patients might benefit from additional support. Telehealth has the potential to continuously provide information and offers the possibility to easily contact a health care provider in order to support patients with medication use. Knowledge of factors influencing the patient's preference for telehealth channels can improve the actual use of telehealth channels. OBJECTIVE This study aims to identify factors that influence the preferences of patients with rheumatic diseases regarding telehealth channels for support with medication use. METHODS A qualitative study with face-to-face interviews was performed among patients with an inflammatory rheumatic disease in the Netherlands. A total of 4 telehealth channels were used: a frequently asked questions page, a digital human, an app for SMS text messaging with health care providers, and an app for video-calling with health care providers. Using a semistructured interview guide based on domains of the Capability, Opportunity, Motivation, and Behavior (COM-B) model, participants were questioned about (1) their general opinion on the 4 telehealth channels, (2) factors influencing preference for individual telehealth channels, and (3) factors influencing preference for individual telehealth channels in relation to the other available channels. Interviews were recorded, transcribed, and categorically analyzed. RESULTS A total of 15 patients were interviewed (female: n=8, 53%; male: n=7, 47%; mean age 55, SD 16.8 years; median treatment duration of 41, IQR 12-106 months). The following 3 categories of factors influencing patient preference regarding telehealth channels were identified: (1) problem-related factors included problems needing a visual check, problems specifically related to the patient, and urgency of the problem; (2) patient-related factors included personal communication preference and patient characteristics; and (3) channel-related factors included familiarity with the telehealth channel, direct communication with a health care provider, methods of searching, and conversation history. CONCLUSIONS Preference for telehealth channels is influenced by factors related to the problem experienced, the patient experiencing the problem, and telehealth channel characteristics. As the preference for telehealth channels varies between these categories, multiple telehealth channels should be offered to enable patients to tailor the support with their medication use to their needs.
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Affiliation(s)
- Lex L Haegens
- Department of Research and Innovation, Sint Maartenskliniek, Ubbergen, Netherlands
| | | | - Jeffrey van der Ven
- Department of Research and Innovation, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Bart J F van den Bemt
- Department of Research and Innovation, Sint Maartenskliniek, Ubbergen, Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
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Haegens LL, Huiskes VJB, Smale EM, Bekker CL, van den Bemt BJF. Drug-related problems reported by patients with rheumatic diseases: an observational study. BMC Rheumatol 2023; 7:7. [PMID: 37069634 PMCID: PMC10111673 DOI: 10.1186/s41927-023-00326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/15/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Drug-related problems can negatively influence treatment outcome and well-being for patients with rheumatic diseases. Thus, it is important to support patients in preventing or resolving drug-related problems as quickly as possible. To effectively develop interventions for this purpose, knowledge on the frequency and character of drug-related problems is needed. Therefore, this study aims to quantify and characterize drug-related problems reported by patients with inflammatory rheumatic diseases along their treatment process. METHODS A prospective observational study was conducted in a Dutch outpatient pharmacy. Adult patients with rheumatic diseases that were prescribed medication by a rheumatologist were questioned about experienced DRPs by telephone 4 times in 8 weeks using a structured interview-guide. Patient-reported DRPs were scored on uniqueness (i.e., if a specific DRP was reported in multiple interviews by one individual, this was counted as one unique DRP) and were categorized using a classification for patient-reported DRPs and analysed descriptively. RESULTS In total, 52 participants (median age 68 years (interquartile range (IQR) 62-74), 52% male) completed 192 interviews with 45 (87%) participants completing all 4 interviews. The majority of patients (65%) were diagnosed with rheumatoid arthritis. Patients reported a median number of 3 (IQR 2-5) unique DRPs during interview 1. In subsequent interviews, patients reported median numbers of 1 (IQR 0-2), 1 (IQR 0-2) and 0 (IQR 0-1) unique DRPs for interviews 2-4 respectively. Participants reported a median number of 5 (IQR 3-9) unique DRPs over all completed interviews. Unique patient-reported DRPs were most frequently categorized into (suspected) side effects (28%), medication management (e.g., medication administering or adherence) (26%), medication concerns (e.g., concerns regarding long-term side-effects or effectiveness) (19%) and medication effectiveness (17%). CONCLUSIONS Patients with rheumatic diseases report various unique DRPs with intervals as short as two weeks. These patients might therefore benefit from more continuous support in-between contact moments with their healthcare provider.
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Affiliation(s)
- Lex L Haegens
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands.
| | - Victor J B Huiskes
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands
| | - Elisabeth M Smale
- Department of Pharmacy, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands.
- Department of Pharmacy, Radboudumc, Nijmegen, Gelderland, The Netherlands.
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Djodikromo MF, Hermens RP, Bemt BJVD, Smit Y, Govers TM, Bekker CL, Blijlevens NM. Patient-guided dose reduction of tyrosine kinase inhibitors in chronic myeloid leukaemia (RODEO study): study protocol for a prospective, multicentre, single-arm trial. BMC Cancer 2023; 23:231. [PMID: 36899295 PMCID: PMC10007754 DOI: 10.1186/s12885-023-10697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Dose reduction of tyrosine kinase inhibitors (TKI) in patients with chronic myeloid leukaemia (CML) with an optimal response to TKIs may support cost-effective medication use by maintaining therapeutic effectiveness while reducing adverse events and medication costs. As the choice for dose reduction depends on patients' individual needs and preferences, a patient-centred approach is warranted. Therefore, a study to evaluate the effectiveness of patient-guided dose reduction in patients with CML who are in a major or deep molecular response is designed. METHODS This study is a prospective, multicentre, single-arm study. 147 patients with CML (aged ≥ 18 years) in chronic phase, who are treated with imatinib, bosutinib, dasatinib, nilotinib or ponatinib, and have reached at least major molecular response (defined as having BCR-ABL levels < 0.1% for an uninterrupted period of 6 months) are eligible. Patients will use an online patient decision aid and a shared decision making consultation will be held, after which patients who choose to will receive a personalised, lower TKI dose. Primary outcome is the proportion of patients with intervention failure at 12 months after dose reduction, defined as patients who have restarted their initial dose due to (expected) loss of major molecular response. For this, BCR-ABL1 levels will be analysed from blood samples drawn at baseline, 6 weeks after dose reduction and 3-monthly thereafter. Secondary outcomes include the proportion of patients with intervention failure at 6 and 18 months after dose reduction. Other outcomes include differences before and after dose reduction regarding the number and severity of patient-reported side effects; quality of life; beliefs about medicines; and medication adherence. Patients' level of decisional conflict and regret after choosing dose reduction will be assessed, as will the decisional process experienced by patients and healthcare providers. DISCUSSION Outcomes of this trial using a personalised approach will provide clinical and patient-reported data to guide future dose reduction of TKIs in CML. If the strategy appears to be effective, it may be implemented as another valid option to offer next to standard of care to prevent potential unnecessary exposure to higher TKI doses in this selected group of patients. TRIAL REGISTRATION EudraCT number 2021-006581-20.
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Affiliation(s)
- Melissa F Djodikromo
- Department of Haematology, Radboud university medical center, Nijmegen, The Netherlands
| | - Rosella Pmg Hermens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center Nijmegen, Nijmegen, The Netherlands
| | | | - Yolba Smit
- Department of Haematology, Radboud university medical center, Nijmegen, The Netherlands
| | - Tim M Govers
- Department of medical imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands.
| | - Nicole Ma Blijlevens
- Department of Haematology, Radboud university medical center, Nijmegen, The Netherlands
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Smale EM, van Vlijmen B, Colen HBB, van den Heuvel MM, Desar IME, van den Bemt BJF, Bekker CL. Feasibility of an Individualized Dispensing Program for Patients Prescribed Oral Anticancer Drugs to Prevent Waste. JCO Oncol Pract 2023; 19:e618-e629. [PMID: 36626700 DOI: 10.1200/op.22.00553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Waste of oral anticancer drugs (OACDs) causes financial and environmental burdens. This study evaluates the feasibility of an individualized dispensing program to prevent waste of OACDs. METHODS Adult patients were dispensed individualized quantities of niraparib, abiraterone, enzalutamide, ruxolitinib, osimertinib, or imatinib as standard care, during the first 6 months of treatment. The first 50 patients participated in an feasibility evaluation conform five domains of Bowen's Framework. (1) implementation: reach (eligible patients included) and protocol fidelity (executions following protocol) assessed from pharmacy data, (2) acceptability: rated from 1 to 10 and agreement with theoretical framework acceptability domains via a survey among patients and pharmacy technicians, (3) practicality: program's costs, (4) effect: compared with previous practice (full package supply per month), defined as difference in unused OACD unit doses and net cost-savings, and (5) demand: potential scale-up of the program by including more OACDs. RESULTS Participants' median age was 67 (interquartile range [IQR], 58-71) years, and 76% was male. (1) Implementation: reach and protocol fidelity were 89% and 90%, respectively. (2) Acceptability was high among patients (median, 9; IQR, 8-9) and pharmacy technicians (median, 7; IQR, 6-8). All acceptability domains were agreed on. (3) Practicality: program costs were €4,289. (4) Effect: unused OACD unit doses were reduced by 34%, causing net cost-savings of €693 per discontinued patient. (5) Demand: the program could be scaled up to seven times by including all OACDs. CONCLUSION Individualized dispensing for patients prescribed OACDs is feasible for preventing waste in terms of implementation, acceptability, practicality, effect, and demand.
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Affiliation(s)
- Elisabeth M Smale
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Bas van Vlijmen
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Hadewig B B Colen
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Michel M van den Heuvel
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Department of Pharmacy, Sint Maartenskliniek, Ubbergen, the Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Pouls BPH, Bekker CL, Gundogan F, Hebing RCF, van Onzenoort HAW, van de Ven LI, Vonkeman HE, Tieben R, Vriezekolk JE, van Dulmen S, Van den Bemt B. Gaming for Adherence to Medication using Ehealth in Rheumatoid arthritis (GAMER) study: a randomised controlled trial. RMD Open 2022; 8:rmdopen-2022-002616. [PMID: 36410776 PMCID: PMC9680317 DOI: 10.1136/rmdopen-2022-002616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the effect on adherence to disease modifying anti-rheumatic drugs (DMARDs) in participants with rheumatoid arthritis (RA) of a serious game that targeted implicit attitudes toward medication. Methods A multicentre randomised controlled trial (RCT) was performed with adults with RA that used DMARDs and possessed a smartphone/tablet. Control and intervention groups received care as usual. The intervention group played the serious game at will during 3 months. Game play data and online questionnaires Compliance Questionnaire on Rheumatology (CQR), Beliefs about Medicine Questionnaire (BMQ), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI) were collected. Primary outcome was DMARD implementation adherence operationalised as the difference in proportion of non-adherent participants (<80% taking adherence) between intervention and control group after 3 months using a Chi-squared test. Two sample t-tests and Wilcoxon rank-sum test were performed to test for differences on secondary outcomes. Results Of the 110 intervention participants that started the study, 87 participants (79%) installed the game and had a median playtime of 9.7 hours at 3 months. Overall, 186 participants completed the study. Adherence in intervention group (63%) and control group (54%) did not differ significantly (p=0.13) at 3 months. Neither were there differences oberved in CQR continuous score, beliefs about medication (BMQ) or clinical outcomes (HAQ and RADAI). Conclusion A serious game aimed at reinterpreting attitudes toward medication failed to show an effect on adherence to DMARDs or clinical outcomes in patients with RA. The game was played frequently indicating that it can be an effective channel for reaching patients. Trial registration number NL7217.
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Affiliation(s)
- Bart P H Pouls
- Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands,Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Fatma Gundogan
- Pharmacy, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, Gelderland, The Netherlands
| | - Renske CF Hebing
- Pharmacy, Amsterdam Rheumatology and immunology Centre Reade, Amsterdam, Noord Holland, The Netherlands
| | - Hein AW van Onzenoort
- Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands,Pharmacy, Amphia Hospital, Breda, North Brabant, The Netherlands
| | | | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands,Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Rob Tieben
- Research, Development and Innovation, Game Solutions Lab, Eindhoven, The Netherlands
| | - Johanna E Vriezekolk
- Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands
| | - Sandra van Dulmen
- Healthcare Communication, Netherlands Institute for Health Services Research, Utrecht, The Netherlands,Department of Primary and Community Care Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Bart Van den Bemt
- Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands,Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
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10
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van Herpen-Meeuwissen LJM, Djodikromo MF, Maat B, van den Bemt BJF, Bekker CL, van Onzenoort HAW. Inpatients Self-Administration of Medication: Stakeholders' views and prerequisites. J Clin Nurs 2022; 32:2709-2721. [PMID: 35596267 DOI: 10.1111/jocn.16369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To identify stakeholders' views on inpatient Self-Administration of Medication and corresponding prerequisites for successful implementation. BACKGROUND Self-Administration of Medication allows capable patients to manage their medication regimen throughout hospitalisation. It is assumed to facilitate continuity of care, increase medication safety and patient empowerment. To enable sustainable implementation stakeholders should support it. Knowledge about stakeholders' views regarding Self-Administration of Medication is currently lacking. DESIGN A qualitative study was conducted among stakeholders using semi-structured interviews. METHODS Using purposive and snowball sampling fourteen representatives from Dutch healthcare associations, organisations and authorities were interviewed between April and July 2019. These stakeholders were asked to reflected on Self-Administration of Medication and its implementation. Data were examined using inductive thematic content analysis and reported following the COREQ checklist. RESULTS Most stakeholders were positive towards Self-Administration of Medication and foresaw benefits in terms of the following: improvements to patient-centred care, contributions to sustainable use of healthcare assets and the need and opportunity for change. Critical concerns included reflecting potential risks for patient safety, concerns about implementation feasibility and questions regarding implementation necessity. Stakeholders highlighted prerequisites pertaining to the implementation process in which the following two themes emerged: (1) initiate a supported change and (2) perform research for best practices and identification of benefits. Other prerequisites concerned distinct levels within healthcare including individual patients (i.e. adequate communication), hospital organisation (i.e. to establish a workflow to secure medication safety) and healthcare system (i.e. to facilitate multidisciplinary collaboration in healthcare). CONCLUSION Stakeholders were predominantly positive about Self-Administration of Medication. For successful and sustainable implementation of Self-Administration of Medication, prerequisites identified in this study should be met. RELEVANCE TO CLINICAL PRACTICE This study provided knowledge about stakeholders' views which could foster implementation and evaluation of Self-Administration of Medication, which may, in turn, promote effective deployment and patient empowerment.
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Affiliation(s)
- Loes J M van Herpen-Meeuwissen
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Melissa F Djodikromo
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Barbara Maat
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Bartholemeus J F van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Hendrikus A W van Onzenoort
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands
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11
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Pouls BP, Bekker CL, van Dulmen S, Vriezekolk JE, van den Bemt BJ. A Serious Puzzle Game to Enhance Adherence to Antirheumatic Drugs in Patients With Rheumatoid Arthritis: Systematic Development Using Intervention Mapping. JMIR Serious Games 2022; 10:e31570. [PMID: 35179510 PMCID: PMC8900908 DOI: 10.2196/31570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/08/2021] [Accepted: 11/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background Patients’ implicit attitudes toward medication need and concerns may influence their adherence. Targeting these implicit attitudes by combining game-entertainment with medication-related triggers might improve medication adherence in patients with rheumatoid arthritis (RA). Objective The aim of this study was to describe the systematic development of a serious game to enhance adherence to antirheumatic drugs by using intervention mapping. Methods A serious game was developed using the intervention mapping framework guided by a multidisciplinary expert group, which proceeded along 6 steps: (1) exploring the problem by assessing the relationship between medication adherence and implicit attitudes, (2) defining change objectives, (3) selecting evidence-based behavior change techniques that focused on adjusting implicit attitudes, (4) designing the intervention, (5) guaranteeing implementation by focusing on intrinsic motivation, and (6) planning a scientific evaluation. Results Based on the problem assessment and guided by the Dual-Attitude Model, implicit negative and illness-related attitudes of patients with RA were defined as the main target for the intervention. Consequently, the change objective was “after the intervention, participants have a more positive attitude toward antirheumatic drugs.” Attention bias modification, evaluative conditioning, and goal priming were the techniques chosen to implicitly target medication needs. These techniques were redesigned into medication-related triggers and built in the serious puzzle game. Thirty-seven patients with RA tested the game at several stages. Intrinsic motivation was led by the self-determination theory and addressed the 3 needs, that is, competence, autonomy, and relatedness. The intervention will be evaluated in a randomized clinical trial that assesses the effect of playing the serious game on antirheumatic drug adherence. Conclusions We systematically developed a serious game app to enhance adherence to antirheumatic drugs among patients with RA by using the intervention mapping framework. This paper could serve as a guideline for other health care providers when developing similar interventions.
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Affiliation(s)
- Bart Ph Pouls
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Bart Jf van den Bemt
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
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12
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Smale EM, Egberts TCG, Heerdink ER, van den Bemt BJF, Bekker CL. Key factors underlying the willingness of patients with cancer to participate in medication redispensing. Res Social Adm Pharm 2021; 18:3329-3337. [PMID: 34973931 DOI: 10.1016/j.sapharm.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Redispensing medication unused by patients to other patients could reduce the environmental burden of medication waste. Simultaneously, associated financial loss could be reduced, particularly for expensive medication such as oral anticancer drugs. An important determinant for successful medication redispensing is patient participation. OBJECTIVE(S) To identify key factors underlying the willingness of patients with cancer to participate in the redispensing of unused oral anticancer drugs. METHODS Semi-structured interviews via telephone or video call were conducted with adult patients diagnosed with cancer from two Dutch hospitals. The interview guide was framed using the COM-B model for behavioural change, to elicit patients' capability, opportunity and motivation to participate in medication redispensing. Questions were related to patients' willingness to accept redispensed medication, reasons thereof, perceived concerns and needs. Inductive thematic analysis was applied. RESULTS Seventeen patients (aged 38-82 years, 71% female), with nine different types of cancer participated. The majority of participants supported medication redispensing. Four categories of key factors underlying the willingness of patients with cancer to participate in medication redispensing were identified. First, the driver for participation was having positive societal impact, relating to affordability and sustainability of healthcare. Second, having trust in product quality was a requirement, influenced by preconceived beliefs, quality assurance and patients' knowledge of this process. Third, a facilitator for participating in medication redispensing was adequate provision of information. This concerned awareness of medication waste, information about medication redispensing, support from healthcare providers and other patients, and insight into medication dispensing history. Last, a convenient process for returning unused medication to pharmacies would facilitate participation in medication redispensing. CONCLUSIONS The willingness of patients with cancer to participate in medication redispensing relates to a drive for achieving positive societal impact, provided that medication is of high quality, there is adequate information provision and a convenient process.
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Affiliation(s)
- E M Smale
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - T C G Egberts
- Department of Clinical Pharmacy, Division of Laboratory, Pharmacy and Genetics, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, P.O. Box 80082, 3508, TB, Utrecht, the Netherlands
| | - E R Heerdink
- Department of Clinical Pharmacy, Division of Laboratory, Pharmacy and Genetics, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, P.O. Box 80082, 3508, TB, Utrecht, the Netherlands; Research Group Innovations of Pharmaceutical Care, Utrecht University of Applied Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - B J F van den Bemt
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands; Department of Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500, GM, Nijmegen, the Netherlands
| | - C L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
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13
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Cornelissen N, Karapinar-Çarkit F, Heer SEND, Uitvlugt EB, Hugtenburg JG, van den Bemt PMLA, van den Bemt BJF, Bekker CL. Application of intervention mapping to develop and evaluate a pharmaceutical discharge letter to improve information transfer between hospital and community pharmacists. Res Social Adm Pharm 2021; 18:3297-3302. [PMID: 34690086 DOI: 10.1016/j.sapharm.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Insufficient information transfer is a major barrier in the transition from hospital to home. This study describes the systematic development and evaluation of an intervention to improve medication information transfer between hospital and community pharmacists. OBJECTIVE To develop and evaluate an intervention to improve the medication information transfer between hospital and community pharmacists based on patients', community and hospital pharmacists' needs. METHODS The intervention development and evaluation was guided by the six-step Intervention Mapping (IM) approach: (1) needs assessment to identify determinants of the problem, with a scoping review and focus groups with patients and healthcare providers, (2) formulation of intervention objectives with an expert group, (3) inventory of communication models to design the intervention, (4) using literature review and qualitative research with pharmacists and patients to develop the intervention (5) pilot-testing of the intervention in two hospitals, and (6) a qualitative evaluation of the intervention as part of a multicenter before-after study with hospital and community pharmacists. RESULTS Barriers in the information transfer are mainly time and content related. The intervention was designed to target a complete, accurate and timely medication information transfer between hospital and community pharmacists. A pharmaceutical discharge letter was developed to improve medication information transfer. Hospital and community pharmacists were positive about the usability, content, and comprehensiveness of the pharmaceutical discharge letter, which gave community pharmacists sufficient knowledge about in-hospital medication changes. However, hospital pharmacists reported that it was time-consuming to draft the discharge letter and not always feasible to send it on time. The intervention showed that pharmacists are positive about the usability, content and comprehensiveness. CONCLUSION This study developed an intervention systematically to improve medication information transfer, consisting of a discharge letter to be used by hospital and community pharmacists supporting continuity of care.
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Affiliation(s)
- Nicky Cornelissen
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
| | - Selma En-Nasery-de Heer
- Amsterdam UMC, Location Vumc, Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Elien B Uitvlugt
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
| | - Jacqueline G Hugtenburg
- Amsterdam UMC, Location Vumc, Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Patricia M L A van den Bemt
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy. University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Pharmacy, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands.
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands.
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14
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Pouls BPH, Bekker CL, Gaffo AL, van den Bemt BJF, Flendrie M. Tele-monitoring flares using a smartphone app in patients with gout or suspected gout: a feasibility study. Rheumatol Adv Pract 2021; 5:rkab100. [PMID: 34988359 PMCID: PMC8713010 DOI: 10.1093/rap/rkab100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023] Open
Abstract
Objectives Gout flares are painful and disabling. We developed a smartphone application (app) for patients to tele-monitor gout flares surveyed by clinicians. The aim of this study was to assess patient acceptability and technical and clinical feasibility. Methods Adult patients with either established gout or high suspicion thereof were recruited if they possessed a smartphone and reported a recent arthritis attack. A smartphone application was used to identify gout flares by asking during 90 consecutive days: (1) what is your pain score (0–10); (2) are your joints warm; (3) are your joints swollen; and (4) are you currently experiencing a gout flare? The clinician was alerted via email if a flare occurred. Patient acceptability was assessed using the technology acceptance model. Technical feasibility consisted of reported technical issues and clinical feasibility of actions taken by the clinician regarding gout flare alerts. Results Twenty-nine included patients completed the study. The mean age of participants was 57 years, and all but one were male. The adherence rate was 96% (110 of 2910 queries were missed). Patients had a positive attitude toward app use, found the app very easy to use (mean usability score 81 out of 100) and were neutral to positive on its usefulness. There were four minor technical issues. A total of 100 gout flare alerts were generated that led to 18 proactive contacts with patients. Conclusion A smartphone app to monitor gout flares was developed and tested, showing high adherence, good acceptability and clinical feasibility for established gout patients. Trial registration Netherlands Trial Register, https://www.trialregister.nl, NL6435.
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Affiliation(s)
- Bart P H Pouls
- Correspondence to: Bart P. H. Pouls, Department of Rheumatology Research, Sint Maartenskliniek, Hengstdal 3, 6500GM Nijmegen, The Netherlands. E-mail:
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Angelo L Gaffo
- Division of Rheumatology, University of Alabama Medical Centre
- Division of Rheumatology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Bart J F van den Bemt
- Department of Rheumatology Research, Sint Maartenskliniek
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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15
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Bekker CL, Aslani P, Chen TF. The use of medication adherence guidelines in medication taking behaviour research. Res Social Adm Pharm 2021; 18:2325-2330. [PMID: 34393079 DOI: 10.1016/j.sapharm.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
Medication nonadherence continues to be a serious issue in a range of long-term medical conditions and has been studied extensively over the past few decades. However, despite the plethora of research studies on medication adherence, poor methodological rigour in many studies has contributed to limited generalisability of the positive findings, limited impact on patients' medication adherence, and inability to compare between studies. This paper focuses on current guidelines designed specifically for research on medication adherence. It discusses key elements to consider during study design, selection of adherence measurements, and reporting on medication adherence research, to ensure a higher quality of research in medication adherence. Overall, there appears to be variations in adherence terminology reported in the literature despite improvements in defining medication taking behaviour and the availability of taxonomies. In addition, limited guidance exists on how best to measure adherence. Recommendations are provided on appropriate adherence measures for the adherence behaviour being investigated, including careful consideration of adherence concepts, validity of adherence instruments, appropriate instrument selection, definition of nonadherence threshold, and how to report medication adherence. Improving adherence research requires greater clarity and standardisation of descriptions of nonadherence behaviour, increased methodological rigour in study designs, better selection of adherence measurements, and comprehensive reporting.
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Affiliation(s)
- Charlotte L Bekker
- Radboud University Medical Center, Research Institute for Health Sciences, Department of Pharmacy, Nijmegen, the Netherlands.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Timothy F Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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16
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Bekker CL, Bossina S, de Vera MA, Bartlett SJ, de Wit M, March L, Shea B, Evans V, Richards D, Tong A, Tugwell P, Tymms K, Scholte-Voshaar M, Kelly A, van den Bemt BJF. Patient Perspectives on Outcome Domains of Medication Adherence Trials in Inflammatory Arthritis: An International OMERACT Focus Group Study. J Rheumatol 2021; 48:1480-1487. [PMID: 33993113 DOI: 10.3899/jrheum.201568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the perspectives of patients with inflammatory arthritis (IA) on outcome domains of trials evaluating medication adherence interventions. METHODS Adult patients (≥ 18 yrs) with IA taking disease-modifying antirheumatic drugs from centers across Australia, Canada, and the Netherlands participated in 6 focus groups to discuss outcome domains that they consider important when participating in medication adherence trials. We analyzed the transcripts using inductive thematic analysis. RESULTS Of the 38 participants, 23 (61%) had rheumatoid arthritis and 21 (55%) were female. The mean age was 57.3 ± (SD 15.0) years. Improved outcome domains that patients wanted from participating in an adherence trial were categorized into 5 types: medication adherence, adherence-related factors (supporting adherence; e.g., medication knowledge), pathophysiology (e.g., physical functioning), life impact (e.g., ability to work), and economic impact (e.g., productivity loss). Three overarching themes reflecting why these outcome domains matter to patients were identified: how taking medications could improve patients' emotional and physical fitness to maintain their social function; how improving knowledge and confidence in self-management increases patients' trust and motivation to take medications as agreed with minimal risk of harms; and how respect and reassurance, reflecting health care that values patients' opinions and is sensitive to patients' individual goals, could improve medication-taking behavior. CONCLUSION Patients value various outcome domains related to their overall well-being, confidence in medication use, and patient-healthcare provider relationships to be evaluated in future adherence trials.
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Affiliation(s)
- Charlotte L Bekker
- C.L. Bekker, PhD, Radboud University Medical Centre, Research Institute for Health Sciences, Nijmegen, the Netherlands;
| | - Sacha Bossina
- S. Bossina, MSc, Department of Rheumatology, Liverpool Hospital, Sydney, Australia
| | - Mary A de Vera
- M.A. de Vera, Assistant Professor, PhD, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Susan J Bartlett
- S.J. Bartlett, Professor, PhD, Department of Medicine, McGill University and Research Institute, McGill University Health Centres, Montreal, Québec, Canada, and Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Maarten de Wit
- M. de Wit, PhD, OMERACT Patient Research Partner, the Netherlands
| | - Lyn March
- L. March, Professor, PhD, Institute of Bone and Joint Research, Kolling Institute of Medical Research, and Department of Rheumatology, Royal North Shore Hospital, and Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Beverley Shea
- B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Vicki Evans
- V. Evans, Adjunct Assistant Professor, PhD, BOptom, Faculty of Health, University of Canberra, Canberra, Australia
| | - Dawn Richards
- D. Richards, PhD, Five02 Labs Inc., and Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Allison Tong
- A. Tong, Professor, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Peter Tugwell
- P. Tugwell, Professor, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Tymms
- K. Tymms, Associate Professor, MBBS, FRACP, College of Health and Medicine, Australian National University, and Department of Rheumatology, Canberra Hospital, Canberra, Australia
| | - Marieke Scholte-Voshaar
- M. Scholte-Voshaar, MSc, OMERACT Patient Research Partner, and University of Twente, Enschede, the Netherlands
| | - Ayano Kelly
- A. Kelly, Clinical Associate Lecturer, MBBS, FRACP, Department of Rheumatology, Liverpool Hospital, Sydney, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, College of Health and Medicine, Australian National University, Canberra, and South Western Clinical School, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Bart J F van den Bemt
- B.J. van den Bemt, Professor, PharmD, Radboud University Medical Centre, Research Institute for Health Sciences, and Sint Maartenskliniek, Nijmegen, the Netherlands. The authors declare no conflicts of interest relevant to this article
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Kälvemark Sporrong S, Kaae S, Nørgaard LS, Møllebæk M, Waaseth M, Cantarero Arevalo L, Ljungberg Persson C, Bekker CL, Falby Lindell J, Druedahl L. Challenges in qualitative social pharmacy research: Reflections based on a conference workshop. Res Social Adm Pharm 2021; 18:2254-2258. [PMID: 33622614 DOI: 10.1016/j.sapharm.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/27/2022]
Abstract
A methodological debate within social pharmacy is ongoing regarding how to apply a qualitative approach. This paper emanates from a workshop at the Nordic Social Pharmacy Conference in 2019, named 'How do we know it's good? A workshop on quality criteria in qualitative social and clinical pharmacy research', that addressed this debate. The aim of this paper is twofold (1) to present the main key points raised during the workshop and (2) based on these inputs to contribute to the ongoing discussion on qualitative methodology within social pharmacy research. This paper starts with what was discussed at the workshop and further elaborated are some of the challenges with conducting qualitative research within social pharmacy. These include methodological and disciplinary competence and insecurity, reflections on the consequences of that many social pharmacy researchers come from a natural science background and how this (possibly) shapes the practice of qualitative research within the field. For example, how concepts like transparency and saturation, together with checklists and quality criteria are understood and used. Finally, we make suggestions for the next step for qualitative research in social pharmacy.
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Affiliation(s)
- S Kälvemark Sporrong
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark; Department of Pharmacy, Uppsala University, Box 580, 751 23, Uppsala, Sweden.
| | - S Kaae
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
| | - L S Nørgaard
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
| | - M Møllebæk
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
| | - M Waaseth
- Department of Pharmacy, The Arctic University of Norway, 9037, Tromsø, Norway.
| | - L Cantarero Arevalo
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
| | - C Ljungberg Persson
- School of Public Health and Community Medicine, University of Gothenburg, Avid Wallgrens Backe, Hus 7, 405 30, Gothenburg, Sweden.
| | - C L Bekker
- Department of Pharmacy, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, the Netherlands.
| | - J Falby Lindell
- Department of Nordic Studies and Linguistics and University of Copenhagen Research Centre for Control of Antibiotic Resistance (UC-CARE), University of Copenhagen, Øster Farimagsgade, 1014, Copenhagen, Denmark.
| | - L Druedahl
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
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Pouls BPH, Vriezekolk JE, Bekker CL, Linn AJ, van Onzenoort HAW, Vervloet M, van Dulmen S, van den Bemt BJF. Effect of Interactive eHealth Interventions on Improving Medication Adherence in Adults With Long-Term Medication: Systematic Review. J Med Internet Res 2021; 23:e18901. [PMID: 33416501 PMCID: PMC7822716 DOI: 10.2196/18901] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/06/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Medication nonadherence leads to suboptimal treatment outcomes, making it a major priority in health care. eHealth provides an opportunity to offer medication adherence interventions with minimal effort from health care providers whose time and resources are limited. Objective The aim of this systematic review is twofold: (1) to evaluate effectiveness of recently developed and tested interactive eHealth (including mHealth) interventions on medication adherence in adult patients using long-term medication and (2) to describe strategies among effective interventions. Methods MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of included articles. Eligible studies fulfilled the following inclusion criteria: (1) randomized controlled trial with a usual care control group; (2) a total sample size of at least 50 adult patients using long-term medication; (3) applying an interactive eHealth intervention aimed at the patient or patient’s caregiver; and (4) medication adherence as primary outcome. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies were performed by 2 researchers (BP and BvdB or JV) independently. A best evidence synthesis was performed according to the Cochrane Back Review Group. Results Of the 9047 records screened, 22 randomized clinical trials were included reporting on 29 interventions. Most (21/29, 72%) interventions specified using a (mobile) phone for calling, SMS text messaging, or mobile apps. A majority of all interactive interventions (17/29) had a statistically significant effect on medication adherence (P<.05). Of these interventions, 9 had at least a small effect size (Cohen d ≥ 0.2) and 3 showed strong odds for becoming adherent in the intervention group (odds ratio > 2.0). Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS text messages or interactive voice response, mobile app, and calls as mode of providing adherence tele-feedback. Intervention strategies “to teach medication management skills,” “to improve health care quality by coordinating medication adherence care between professionals,” and “to facilitate communication or decision making between patients and health care providers” also showed strong evidence for a positive effect. Conclusions Overall, this review supports the hypothesis that interactive eHealth interventions can be effective in improving medication adherence. Intervention strategies that improve patients’ treatment involvement and their medication management skills are most promising and should be considered for implementation in practice.
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Affiliation(s)
- Bart P H Pouls
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Annemiek J Linn
- Amsterdam School of Communication Research, University of Amsterdam,, Amsterdam, Netherlands
| | - Hein A W van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marcia Vervloet
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bart J F van den Bemt
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
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19
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Stuijt CCM, Bekker CL, van den Bemt BJF, Karapinar F. Effect of medication reconciliation on patient reported potential adverse events after hospital discharge. Res Social Adm Pharm 2020; 17:1426-1432. [PMID: 33191157 DOI: 10.1016/j.sapharm.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although medication reconciliation (MedRec) is effective in decreasing medication discrepancies, the effectiveness on Adverse Events (AEs) is very scarce. The objective of this study was to assess the effect of MedRec by a pharmacy team on patient-reported, potential AEs post-discharge. METHODS This was a multicenter prospective intervention study with before-after design at two Dutch hospitals. Participants were patients aged ≥18 years admitted for more than 48 h using three or more prescription medications upon discharge. Patients in the control group received usual care. In the intervention period, a trained team of pharmacy staff executed medication reconciliation consisting of patient education upon admission and discharge, review of prescribed medication to identify errors, and information transfer to primary care. To address the primary outcome, the difference in proportion of patients with one or more potential AEs was measured by a structured telephone interview, two weeks after discharge between usual care and intervention group. To address the second outcome, the difference in median number of potential AEs per patient was calculated. Other outcomes assessed included the association between the intervention and patient characteristics. RESULTS In total, 221 (138 usual care and 83 intervention) patients were included. The proportion of control and intervention patients with AEs was 88.4% and 86.7% respectively (p > 0.05). The median number of potential AEs per patient was lower in the intervention group compared with usual care (1.1 vs. 2.1, p < 0.0001). Being in the intervention arm was associated with less potential AEs (RR 0.5, 95% CI [0.4-0.6]), whereas being previously admitted was associated with a higher number of potential AEs (RR 1.3, 95% CI [1.1-1.5]). The effect of the intervention on the number of potential AE was stronger among women compared with men (p = 0.04). CONCLUSION Although the intervention did not decrease the proportion of patients with AEs, a significant reduction in the median number of potential AEs after hospital discharge between the intervention and usual care group was observed.
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Affiliation(s)
| | - C L Bekker
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pharmacy, Nijmegen, the Netherlands
| | - B J F van den Bemt
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pharmacy, Nijmegen, the Netherlands; Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - F Karapinar
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands.
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20
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Bekker CL, van den Bemt BJF, Gardarsdottir H, Egberts ACG, Bouvy ML. [Reducing medication waste; a challenge for care providers and society]. Ned Tijdschr Geneeskd 2020; 164:D4812. [PMID: 33201629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Annually, in the Netherlands, at least 100 million euro is wasted on unused medication. This waste not only has considerable economic implications, but is also associated with an unnecessary burden on the environment and suboptimal care due to nonadherence to therapy. The reasons for medication wastage can be found throughout the entire pharmaceutical supply and use chain, which includes manufacturers, distributors/wholesalers, prescribers, pharmacists and patients, both in the community and hospital setting. A number of strategies are needed to minimize the waste of medication, one of which should be a preventative approach. Involvement of all stakeholders in the supply chain is a prerequisite for a successful outcome. It is important that prescribers are aware of the extent and consequences of wastage, and of the possible ways to reduce it.
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Affiliation(s)
- C L Bekker
- Radboudumc, afd. Farmacie, Nijmegen
- Contact: C. L. Bekker
| | | | | | | | - M L Bouvy
- Universiteit Utrecht, afd. Farmaco-epidemiologie
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21
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Bekker CL, Mohsenian Naghani S, Natsch S, Wartenberg NS, van den Bemt BJF. Information needs and patient perceptions of the quality of medication information available in hospitals: a mixed method study. Int J Clin Pharm 2020; 42:1396-1404. [PMID: 32857256 PMCID: PMC7603457 DOI: 10.1007/s11096-020-01125-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
Abstract
Background Providing appropriate medication information to patients is of utmost importance for optimal pharmacotherapy. (Un)intentional miscommunication and information gaps resulting in unmet needs could negatively affect patient’s ability to use their medication properly. Objective To identify the information needs and patient perceptions of the quality of medication information available in hospitals in the Netherlands. Setting Cardiology, oncology, or rheumatology department of five hospitals. Methods Adult cardiology, oncology, and rheumatology patients participated in this mixed-method study. Focus groups and individual interviews were held to identify patients’ views on the medication information and their information needs. Outcomes were used to construct a questionnaire that was used in a survey among patients to compare existing medication information with patients’ needs, and to judge the quality of the provided information. Main outcome measure Patients needs with medication information. Results Four themes derived from interviews with 44 patients: (1) Content; almost all patients acknowledged to receive insufficient information not meeting their personal needs. (2) Moment of delivery; patients were dissatisfied with the timing. (3) Method of delivery; patients highly preferred verbal and written information. (4) Contextual quality prerequisites that should be met according to patients; medication information should be accessible, comprehensive, reliable and understandable. A total of 352 patients completed the questionnaire. Almost all patients reported all items as important, whereas up to 74.6% patients were not informed. Up to half of the patients perceived verbal information from healthcare providers, written information of leaflets and folders of insufficient quality. Conclusion Patients attending Dutch hospitals have needs for extensive medication information, which should be tailored to their individual needs. According to patients the quality of medication information available in hospitals can be improved.
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Affiliation(s)
- Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Shaghayegh Mohsenian Naghani
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Stephanie Natsch
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Naomi S Wartenberg
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574 NA, Nijmegen, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574 NA, Nijmegen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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22
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Kelly A, Crimston-Smith L, Tong A, Bartlett SJ, Bekker CL, Christensen R, De Vera MA, de Wit M, Evans V, Gill M, March L, Manera K, Nieuwlaat R, Salmasi S, Scholte-Voshaar M, Singh JA, Sumpton D, Toupin-April K, Tugwell P, van den Bemt B, Verstappen S, Tymms K. Scope of Outcomes in Trials and Observational Studies of Interventions Targeting Medication Adherence in Rheumatic Conditions: A Systematic Review. J Rheumatol 2019; 47:1565-1574. [PMID: 31839595 DOI: 10.3899/jrheum.190726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Nonadherence to medications is common in rheumatic conditions and associated with increased morbidity. Heterogeneous outcome reporting by researchers compromises the synthesis of evidence of interventions targeting adherence. We aimed to assess the scope of outcomes in interventional studies of medication adherence. METHODS We searched electronic databases to February 2019 for published randomized controlled trials and observational studies of interventions with the primary outcome of medication adherence including adults with any rheumatic condition, written in English. We extracted and analyzed all outcome domains and adherence measures with prespecified extraction and analysis protocols. RESULTS Overall, 53 studies reported 71 outcome domains classified into adherence (1 domain), health outcomes (38 domains), and adherence-related factors (e.g., medication knowledge; 32 domains). We subdivided adherence into 3 phases: initiation (n = 13 studies, 25%), implementation (n = 32, 60%), persistence (n = 27, 51%), and phase unclear (n = 20, 38%). Thirty-seven different instruments reported adherence in 115 unique ways (this includes different adherence definitions and calculations, metric, and method of aggregation). Forty-one studies (77%) reported health outcomes. The most frequently reported were medication adverse events (n = 24, 45%), disease activity (n = 11, 21%), bone turnover markers/physical function/quality of life (each n = 10, 19%). Thirty-three studies (62%) reported adherence-related factors. The most frequently reported were medication beliefs (n = 8, 15%), illness perception/medication satisfaction/satisfaction with medication information (each n = 5, 9%), condition knowledge/medication knowledge/trust in doctor (each n = 3, 6%). CONCLUSION The outcome domains and adherence measures in interventional studies targeting adherence are heterogeneous. Consensus on relevant outcomes will improve the comparison of different strategies to support medication adherence in rheumatology.
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Affiliation(s)
- Ayano Kelly
- A. Kelly, Clinical Associate Lecturer, Australian National University, MBBS, FRACP, College of Health and Medicine, Australian National University, and Canberra Rheumatology, Canberra, and Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia;
| | - Luke Crimston-Smith
- L. Crimston-Smith, BN, College of Health and Medicine, Australian National University, and Canberra Rheumatology, Canberra, Australia
| | - Allison Tong
- A. Tong, PhD, Professor, K. Manera, MIPH, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Susan J Bartlett
- S.J. Bartlett, PhD, Professor, Department of Medicine, McGill University and Research Institute, McGill University Health Centres, Montreal, Quebec, Canada, and Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Charlotte L Bekker
- C.L. Bekker, PhD, Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Robin Christensen
- R. Christensen, PhD, Professor of Biostatistics and Clinical Epidemiology, Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen University Hospital, Copenhagen, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Mary A De Vera
- M.A. De Vera, PhD, Assistant Professor, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Maarten de Wit
- M. de Wit, PhD, OMERACT Patient Research Partner, the Netherlands
| | - Vicki Evans
- V. Evans, PhD, Clear Vision Consulting, Canberra, and OMERACT Patient Research Partner, and Discipline of Optometry, University of Canberra, Canberra, Australia
| | - Michael Gill
- M. Gill, BA, Dragon Claw, Sydney, Australia, and OMERACT Patient Research Partner
| | - Lyn March
- L. March, PhD, Professor, Institute of Bone and Joint Research, Kolling Institute of Medical Research, and Department of Rheumatology, Royal North Shore Hospital, and Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Karine Manera
- A. Tong, PhD, Professor, K. Manera, MIPH, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Robby Nieuwlaat
- R. Nieuwlaat, PhD, Associate Professor, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shahrzad Salmasi
- S. Salmasi, MSc, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Marieke Scholte-Voshaar
- M. Scholte-Voshaar, MSc, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands and OMERACT Patient Research Partner
| | - Jasvinder A Singh
- J.A. Singh, Professor, MD, Medicine Service, VA Medical Center, and Department of Medicine, School of Medicine, University of Alabama, and Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | - Daniel Sumpton
- D. Sumpton, MBBS, FRACP, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, and Department of Rheumatology, Concord Hospital, Sydney, Australia
| | - Karine Toupin-April
- K. Toupin-April, PhD, Associate Scientist, Children's Hospital of Eastern Ontario Research Institute, and Assistant Professor, Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- P. Tugwell, MD, Professor, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bart van den Bemt
- B. van den Bemt, PhD, Assistant Professor, Department of Pharmacy, Radboud University Medical Centre, Nijmegen, and Department of Pharmacy, Sint Maartenskliniek, Ubbergen, the Netherlands
| | - Suzanne Verstappen
- S. Verstappen, PhD, Reader, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kathleen Tymms
- K. Tymms, MBBS, FRACP, Associate Professor, College of Health and Medicine, Australian National University, and Canberra Rheumatology, and Department of Rheumatology, Canberra Hospital, Canberra, Australia
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23
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Bekker CL, Noordergraaf F, Teerenstra S, Pop G, van den Bemt BJF. Diagnostic accuracy of a single-lead portable ECG device for measuring QTc prolongation. Ann Noninvasive Electrocardiol 2019; 25:e12683. [PMID: 31350811 PMCID: PMC7050507 DOI: 10.1111/anec.12683] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/10/2019] [Accepted: 07/01/2019] [Indexed: 11/27/2022] Open
Abstract
Background To assess the diagnostic accuracy of a single‐lead portable ECG device for measuring QTc‐intervals in comparison with a standard 12‐lead ECG. Methods Adult patients visiting the cardiology outpatient clinic for a 12‐lead recording were also measured with a portable single‐lead ECG recorder (HeartcheckTM). QTc‐intervals were determined by two cardiologists. Perfect agreement was defined as a limit of ≤10 ms between the two measurement methods. Results Hundred one ECGs were recorded. QTc‐interval mean differences between the two measurement methods was substantially outside our definition of perfect agreement (‐31.9 [SD±41.3] ms). Conclusion In conclusion, the Heartcheck single‐lead ECG device is not accurate for measuring QTc‐intervals.
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Affiliation(s)
- Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Fauve Noordergraaf
- Department of Cardiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Group Biostatistics, Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Gheorghe Pop
- Department of Cardiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
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24
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Bekker CL, Kalicharan RW, Melis EJ, Gardarsdottir H, van den Bemt BJ, Bouvy ML, van Maarseveen EM, Egberts AC. Redispensing of unused HIV post-exposure prophylaxis for medical students. Travel Med Infect Dis 2019; 29:82-83. [DOI: 10.1016/j.tmaid.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
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25
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Bekker CL, Gardarsdottir H, Egberts ACG, Molenaar HA, Bouvy ML, van den Bemt BJF, Hövels AM. What does it cost to redispense unused medications in the pharmacy? A micro-costing study. BMC Health Serv Res 2019; 19:243. [PMID: 31014325 PMCID: PMC6481041 DOI: 10.1186/s12913-019-4065-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/05/2019] [Indexed: 11/10/2022] Open
Abstract
Background Redispensing unused medications that have been returned to outpatient pharmacies by patients may reduce waste and healthcare costs. However, little is known regarding the extra costs associated with this process, nor the price level of medications for which this is economically beneficial. The objective of this study was to assess costs associated with redispensing unused medications in the pharmacy and the price level at which redispensing becomes cost-beneficial. Methods A micro-costing study was conducted in four Dutch outpatient pharmacies for medications requiring room-temperature storage and requiring refrigeration. First, the pharmacy’s necessary additional process steps and resources for redispensing were identified. Second, time required for each process step was simulated. Third, required resources were quantified by calculating labour, purchasing and overhead costs. Lastly, a model with different scenarios was constructed to calculate the price of a medication package at which redispensing becomes cost-beneficial. Results Three main additional process steps for redispensing were identified: (1) pack medications with product quality indicators before dispensing, (2) assess quality of medications returned to the pharmacy (temperature storage, package integrity, expiry date) and (3a) restock medications fulfilling quality criteria or (3b) dispose of medications not fulfilling criteria. Total time required for all steps up to restock one medication package was on average 5.3 (SD ±0.3) and 6.8 (SD ±0.3) minutes for medications stored at room-temperature and under refrigeration, respectively, and associated costs were €5.54 and €7.61. Similar outcomes were found if a medication package would ultimately be disposed of. The price level primarily depended upon the proportion of dispensed packages returned unused to the pharmacy and fulfilling the quality criteria: if 5% is returned, of which 60% fulfils quality criteria, the price level was €101 per package for medications requiring room-temperature storage and €215 per package for those requiring refrigeration. However, if 10% is returned, of which 60% fulfils the quality criteria, the price level decreases to €53 and €109, respectively (arbitrary proportions). Conclusions Redispensing unused medications in the pharmacy is at least cost-beneficial if applied to expensive medications.
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Affiliation(s)
- Charlotte L Bekker
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574, NA, Nijmegen, the Netherlands.,Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Helga Gardarsdottir
- Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. .,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands. .,Faculty of Pharmaceutical Sciences, University of Iceland, Sæmundargata 2, 101, Reykjavík, Iceland.
| | - Antoine C G Egberts
- Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands
| | - Hendrik A Molenaar
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574, NA, Nijmegen, the Netherlands.,Faculty of Pharmaceutical Sciences, University of Iceland, Sæmundargata 2, 101, Reykjavík, Iceland.,Department of Pharmacy, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Anke M Hövels
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands
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Daliri S, Bekker CL, Buurman BM, Scholte op Reimer WJM, van den Bemt BJF, Karapinar – Çarkit F. Barriers and facilitators with medication use during the transition from hospital to home: a qualitative study among patients. BMC Health Serv Res 2019; 19:204. [PMID: 30925880 PMCID: PMC6441233 DOI: 10.1186/s12913-019-4028-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During transitions from hospital to home, up to half of all patients experience medication-related problems, such as adverse drug events. To reduce these problems, knowledge of patient experiences with medication use during this transition is needed. This study aims to identify the perspectives of patients on barriers and facilitators with medication use, during the transition from hospital to home. METHODS A qualitative study was conducted in 2017 among patients discharged from two hospitals using a semi-structured interview guide. Patients were asked to identify all barriers they experienced with medication use during transitions from hospital to home, and facilitators needed to overcome those barriers. Data were analyzed following thematic content analysis and visualized using an "Ishikawa" diagram. RESULTS In total, three focus groups were conducted with 19 patients (mean age: 70.8 (SD 9.3) years, 63% female). Three barriers were identified; lack of personalized care in the care continuum, insufficient information transfer (e.g. regarding changes in pharmacotherapy), and problems in care organization (e.g. medication substitution). Facilitators to overcome these barriers included a personal medication-counselor in the care continuum to guide patients with medication use and overcome communication barriers, and post-discharge follow-up care (e.g. home visits from healthcare providers). CONCLUSIONS During transitions from hospital to home patients experience individual-, healthcare provider- and organization level barriers. Future research should focus on personal-medication counselors in the care continuum and post-discharge follow-up care as it may overcome communication, emotional, information and organization barriers with medication use.
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Affiliation(s)
- Sara Daliri
- Faculty of Health, ACHIEVE Center of Expertise, Amsterdam University of Applied Sciences, Amsterdam, 1105 BD the Netherlands
- Department of Clinical Pharmacy, OLVG hospital, Amsterdam, 1061AE The Netherlands
| | - Charlotte L. Bekker
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, 6574 NA The Netherlands
- Department of Clinical Pharmacy, Division of Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht, 3584 CX The Netherlands
| | - Bianca M. Buurman
- Faculty of Health, ACHIEVE Center of Expertise, Amsterdam University of Applied Sciences, Amsterdam, 1105 BD the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, 1105 AZ the Netherlands
| | - Wilma J. M. Scholte op Reimer
- Faculty of Health, ACHIEVE Center of Expertise, Amsterdam University of Applied Sciences, Amsterdam, 1105 BD the Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, 1105 AZ The Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, 6574 NA The Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, 6525 GA The Netherlands
- Department of Pharmacy, University Medical Centre Maastricht, Maastricht, 6229 HX The Netherlands
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Bekker CL, Gardarsdottir H, Egberts ACG, Bouvy ML, van den Bemt BJF. Pharmacists' Activities to Reduce Medication Waste: An International Survey. Pharmacy (Basel) 2018; 6:pharmacy6030094. [PMID: 30158484 PMCID: PMC6165518 DOI: 10.3390/pharmacy6030094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/14/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022] Open
Abstract
Aim: To identify activities that pharmacists undertake to reduce medication waste, and to assess the extent to which these activities are implemented, their importance for waste-reduction and feasibility for broad implementation. Methods: A two-phase survey was conducted among community and hospital pharmacists working in different developed countries. Phase one used an open-ended questionnaire to identify activities undertaken by pharmacists. Answers were thematically analysed to construct a list of medication waste-reducing activities. In phase two, a questionnaire was disseminated among pharmacists from different countries, to assess if these activities are implemented (yes/no), their importance and feasibility (1 to 5 ranking scale). Results: In phase one, 53 pharmacists participated and 14 activities were identified. These were categorized into the pharmaceutical supply chain: prescribing, dispensing (pharmacy/patient-related) and leftover stage. In phase two, 89 pharmacists participated. Most activities were implemented by a minority of pharmacists. Reducing medication amounts in stock was most frequently implemented (dispensing stage pharmacy-related; 86%), followed by collecting unused medications (leftover stage; 77%) and performing a medication review (dispensing stage; 68%). Waste-reducing activities in the dispensing stage activities were both considered most important and feasible (ranked 4). Overall, most activities scored higher on importance than on feasibility. Conclusions: Pharmacists have various opportunities to reduce medication waste throughout the pharmaceutical supply chain, however, not all are broadly implemented. Pharmacists consider waste-reducing activities important, but they are less certain about the feasibility for implementation in practice.
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Affiliation(s)
- Charlotte L Bekker
- Department of Pharmacy, Sint Maartenskliniek, 6574 NA Nijmegen, The Netherlands.
- Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
| | - Helga Gardarsdottir
- Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands.
| | - Antoine C G Egberts
- Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands.
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands.
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, 6574 NA Nijmegen, The Netherlands.
- Department of Pharmacy, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands.
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Bekker CL, Gardarsdottir H, Melis E, Egberts TC, Bouvy ML, van den Bemt BJ. Waste of oral oncolytics and biologicals among users who discontinue therapy. Res Social Adm Pharm 2017. [DOI: 10.1016/j.sapharm.2017.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bekker CL, van den Bemt BJ, Egberts TC, Bouvy ML, Gardarsdottir H. Unused medicines returned to community pharmacies: An analysis of medication waste and possibilities for redispensing. Res Social Adm Pharm 2017. [DOI: 10.1016/j.sapharm.2017.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Bekker CL, Gardarsdottir H, Egberts TC, Bouvy ML, van den Bemt BJ. Pharmacists' activities to minimise medication waste: An international survey. Res Social Adm Pharm 2017. [DOI: 10.1016/j.sapharm.2017.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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