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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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Abdullah-Koolmees H, Nawzad S, Egberts TCG, Vuyk J, Gardarsdottir H, Heerdink ER. The effect of non-adherence to antipsychotic treatment on rehospitalization in patients with psychotic disorders. Ther Adv Psychopharmacol 2021; 11:20451253211027449. [PMID: 34262690 PMCID: PMC8246479 DOI: 10.1177/20451253211027449] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/05/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND AIMS Many patients with psychotic disorders are non-adherent to antipsychotic (AP) medication(s), potentially contributing to rehospitalization. It is unknown whether non-adherence in different phases of AP use is associated with rehospitalization. The aim of this study was to assess the association between non-adherence to APs and rehospitalization in patients with psychotic disorders. Non-adherence was assessed specifically for the initiation, continued drug use and early discontinuation of AP use. METHODS A retrospective follow-up study was performed. Adult patients were included at discharge if they suffered from schizophrenia, psychotic, or bipolar I disorder; had been hospitalized in a psychiatric hospital for ⩾7 days; and were treated with oral APs. Patients discharged between January 2006 and December 2009 from Altrecht Mental Health Care were included. Non-adherence was studied in the three phases of medication use: initiation, continued drug use (implementation) and (early) discontinuation after discharge until the end of follow up or until patients were rehospitalized. Cox regression analysis was used to assess the strength of the association between non-adherence for the different phases of AP use and rehospitalization during follow up and expressed as relative risk (RR) with 95% confidence intervals (CI). RESULTS A total of 417 patients were included. Patients who did not initiate their APs compared with those who did in the first month (RR = 1.62, 95% CI: 1.19-2.19) and between the first and third month after discharge (RR = 1.70, 95% CI: 1.04-2.79) had the highest risk for rehospitalization during follow up. Overall, patients who did not initiate their AP medication within the first year after discharge had a RR of 2.70 (95% CI: 1.97-3.68) for rehospitalization during follow up compared with those that initiated their AP. CONCLUSION Not initiating APs right after discharge was associated with an increased risk of rehospitalization. Interventions should aim to promote the initiation of APs soon after discharge to minimize the risk of rehospitalization.
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Affiliation(s)
- H Abdullah-Koolmees
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Postbus 85500, Utrecht 3508 GA, The Netherlands
| | - S Nawzad
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T C G Egberts
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - J Vuyk
- Division of Willem Arntsz, Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - H Gardarsdottir
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - E R Heerdink
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Minnema LA, Giezen TJ, Egberts TCG, Leufkens HGM, Gardarsdottir H. Adverse events related to biologicals used for patients with multiple sclerosis: a comparison between information originating from regulators and information originating from the scientific community. Eur J Neurol 2020; 27:1250-1256. [PMID: 32298524 PMCID: PMC7384026 DOI: 10.1111/ene.14259] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/24/2019] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
Background and purpose Clinical decision making is facilitated by healthcare professionals’ and patients’ adequate knowledge of the adverse events. This is especially important for biologicals used for treating multiple sclerosis (MS). So far, little is known about whether different information sources report adverse events consistently. Methods Biologicals authorized by the European Medicines Agency for the treatment of MS were included in this study. Information on adverse events derived from phase 3 clinical trials from European Public Assessment Reports (EPARs) and from scientific publications was compared. Results In the study, eight biologicals used for the treatment of MS were included for which the EPAR and/or scientific publication reported a total of 707 adverse events. Approximately one‐third of the adverse events was reported in both the EPAR and scientific publication, one‐third was only reported in the EPAR and one‐third only in the scientific publication. Serious adverse events and adverse events that regulators classified as ‘important identified risk’ were significantly more often reported in both sources compared to adverse events not classified as such (respectively, 38% vs. 30% and 49% vs. 30%). Adverse events only reported in the EPAR or in the scientific publication were, in general, not described in the benefit–risk section or abstract, which were considered to be the most important sections of the documents. Conclusions This study showed that there is substantial discordance in the reporting of adverse events on the same phase 3 trials between EPARs and scientific publications. To support optimal clinical decision making, both documents should be considered.
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Affiliation(s)
- L A Minnema
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands
| | - T J Giezen
- Medicines Evaluation Board, Utrecht, The Netherlands.,Foundation Pharmacy for Hospitals in Haarlem, Haarlem, The Netherlands.,Spaarne Gasthuis, Haarlem, The Netherlands
| | - T C G Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - H Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Sino CGM, Sietzema M, Egberts TCG, Schuurmans MJ. Medication management capacity in relation to cognition and self-management skills in older people on polypharmacy. J Nutr Health Aging 2014; 18:44-9. [PMID: 24402388 DOI: 10.1007/s12603-013-0359-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the medication management capacity of independently living older people (≥75 years) on polypharmacy (≥ 5 medications) in relation to their cognitive- and self-management skills. DESIGN Cross-sectional study. SETTING Two homecare organizations in the Netherlands. PARTICIPANTS Homecare clients aged 75 and older on polypharmacy (N=95). MEASUREMENTS The primary outcome measure was medication management capacity, quantified as the number of 'yes' answers (range = 0-17) on the Medication Management Capacity (MMC) questionnaire. Other measures included self-management ability (assessed with the SMAS30) and cognitive skills (assessed with the clock drawing test). RESULTS Overall, 48.4% (n= 46) of the participants were able to manage their medication by themselves at home. About 40% of the participants were unable to state the names of their medications, even with the aid of a medication list, and about 25% reported having problems with opening medication packages. Correlations were found between self-management ability (Rs = 0.473; p < 0.001), cognitive skills (Rs = 0.372; p < 0.001), and age (Rs = 0.216; p < 0.005) and Medication Management Capacity score. Self-management ability and medication management support were significantly associated with medication management capacity. CONCLUSION A considerable proportion of independently living older people who receive home care and regularly use five or more medications lack the knowledge and skills needed to independently manage their own medications. Cognition and self management ability were related to medication management capacity. Self-management ability and medication management support were predictors of medication management capacity.
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Affiliation(s)
- C G M Sino
- Carolien GM Sino, HU University of Applied Science Utrecht, Research Centre for Innovation in Health Care. The Netherlands. P.O. box 85182, 3508 AD Utrecht. www.innovationsinhealthcare.research.hu.nl. Tel: +31(0)88481 5079. Fax: +31(0)88481 0608 E-mail:
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Haelst IMMV, Klei WAV, Doodeman HJ, Kalkman CJ, Egberts TCG. Selective serotonin reuptake inhibitors and intraoperative blood pressure. Am J Hypertens 2012; 25:223-8. [PMID: 22012207 DOI: 10.1038/ajh.2011.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The influence of selective serotonin reuptake inhibitors (SSRIs) on blood pressure is poorly understood. We hypothesized that if SSRIs have an influence on blood pressure, this might become manifest in changes in intraoperative blood pressure. We aimed to study the association between perioperative use of SSRIs and changes in intraoperative blood pressure by measuring the occurrence of intraoperative hyper- and hypotension. METHODS We conducted a retrospective observational follow-up study among patients who underwent elective primary total hip arthroplasty. The index group included users of SSRIs. The reference group included a random sample (ratio 1:3) of nonusers of an antidepressant agent. The outcome was the occurrence of intraoperative hypo- and hypertensive episodes (number, mean and total duration, and area under the curve (AUC)). The outcome was adjusted for confounding factors using regression techniques. RESULTS The index group included 20 users of an SSRI. The reference group included 60 nonusers. Users of SSRIs showed fewer intraoperative hypotensive episodes, a shorter mean and total duration, and a smaller AUC when compared to the reference group. After adjustment for confounders, SSRI use was associated with a significantly shorter total duration of hypotension: mean difference of -29.4 min (95% confidence interval (CI) -50.4 to -8.3). Two users of an SSRI and two patients in the reference group had a hypertensive episode. CONCLUSIONS Continuation of treatment with SSRIs before surgery was associated with a briefer duration of intraoperative hypotension.
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Goedhard LE, Stolker JJ, Nijman HLI, Egberts TCG, Heerdink ER. Trials assessing parmacotherapeutic management of aggression in psychiatric patients: comparability with clinical practice. Pharmacopsychiatry 2010; 43:205-9. [PMID: 20589596 DOI: 10.1055/s-0030-1254091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In a previous review of randomized controlled trials (RCTs) on the pharmacotherapeutic management of aggression, it was shown that there is only weak evidence of effectiveness. In the present study we aim to determine comparability of patients included in these RCTs and patients of psychiatric long-stay wards. METHODS Exclusion criteria that were used in at least 20% of the RCTs were applied to a sample of aggressive inpatients from clinical practice, in order to find what proportion of these patients would be eligible to participate in the reviewed, high quality RCTs. RESULTS Only 30% of aggressive psychiatric patients as seen in clinical practice would be eligible to participate in a typical randomized controlled trial based on the most frequently applied exclusion criteria. DISCUSSION The low comparability of patients included in RCTs with those seen in clinical practice may decrease the generalizability of the findings form RCTs to clinical practice.
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Affiliation(s)
- L E Goedhard
- Altrecht Institute for Mental Health Care, Den Dolder, The Netherlands
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Arbouw MEL, Movig KLL, Koopmann M, Poels PJE, Guchelaar HJ, Egberts TCG, Neef C, van Vugt JPP. Glycopyrrolate for sialorrhea in Parkinson disease: a randomized, double-blind, crossover trial. Neurology 2010; 74:1203-7. [PMID: 20385892 DOI: 10.1212/wnl.0b013e3181d8c1b7] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sialorrhea affects approximately 75% of patients with Parkinson disease (PD). Sialorrhea is often treated with anticholinergics, but central side effects limit their usefulness. Glycopyrrolate (glycopyrronium bromide) is an anticholinergic drug with a quaternary ammonium structure not able to cross the blood-brain barrier in considerable amounts. Therefore, glycopyrrolate exhibits minimal central side effects, which may be an advantage in patients with PD, of whom a significant portion already experience cognitive deficits. OBJECTIVE To determine the efficacy and safety of glycopyrrolate in the treatment of sialorrhea in patients with PD. METHODS We conducted a 4-week, randomized, double-blind, placebo-controlled, crossover trial with oral glycopyrrolate 1 mg 3 times daily in 23 patients with PD. The severity of the sialorrhea was scored on a daily basis by the patients or a caregiver with a sialorrhea scoring scale ranging from 1 (no sialorrhea) to 9 (profuse sialorrhea). RESULTS The mean (SD) sialorrhea score improved from 4.6 (1.7) with placebo to 3.8 (1.6) with glycopyrrolate (p = 0.011). Nine patients (39.1%) with glycopyrrolate had a clinically relevant improvement of at least 30% vs 1 patient (4.3%) with placebo (p = 0.021). There were no significant differences in adverse events between glycopyrrolate and placebo treatment. CONCLUSIONS Oral glycopyrrolate 1 mg 3 times daily is an effective and safe therapy for sialorrhea in Parkinson disease. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that glycopyrrolate 1 mg 3 times daily is more effective than placebo in reducing sialorrhea in patients with Parkinson disease during a 4-week study.
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Affiliation(s)
- M E L Arbouw
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands
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Liem TBY, Krediet TG, Fleer A, Egberts TCG, Rademaker CMA. Variation in antibiotic use in neonatal intensive care units in the Netherlands. J Antimicrob Chemother 2010; 65:1270-5. [DOI: 10.1093/jac/dkq107] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Swen JJ, Wilting I, Goede ALD, Grandia L, Mulder H, Touw DJ, Boer AD, Conemans JMH, Egberts TCG, Klungel OH, Koopmans R, Weide JVD, Wilffert B, Guchelaar HJ, Deneer VHM. Pharmacogenetics: From Bench to Byte. Clin Pharmacol Ther 2008; 83:781-7. [DOI: 10.1038/sj.clpt.6100507] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wilting I, Smals OM, Holwerda NJ, Meyboom RH, de Bruin ML, Egberts TCG. QTc prolongation and torsades de pointes in an elderly woman taking fluoxetine. Am J Psychiatry 2006; 163:325. [PMID: 16449492 DOI: 10.1176/appi.ajp.163.2.325] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
INTRODUCTION Opioid-induced constipation is a common problem and can cause serious complications. It is widely advised that laxatives should be started concurrently with opiates, unless there is a clear indication not to do so. OBJECTIVE This study was undertaken to estimate how often laxatives were started concurrently with opiates and to describe the effect of pharmacy-based interventions to promote the use of laxatives in patients starting opioids. METHODS Twenty-six community pharmacies identified all patients who received a first prescription for a strong opioid during January and February of 1998, 1999 or 2000. Pharmacists collected information on patient, drug and prescriber characteristics (age, gender, use of opiates and laxatives). A separate questionnaire was used to collect data on pharmacy-based interventions to promote the simultaneous prescribing of laxatives with the opiates. RESULTS Overall, 37% of the patients receiving an opioid started taking laxatives within 5 days. The percentage of patients who received laxatives simultaneously with opioids increased from 31% in 1998 to 35% in 1999 and 42% in 2000. In 117 (43%) of the opioid prescriptions, pharmacy-based intervention had taken place before the prescription date. Of these, 48.7% was accompanied by a laxative. Opioid prescriptions (n=152) without a pharmacy based intervention were accompanied in 27.6%. After adjustment for covariates (including time trends), pharmacy-based intervention increased the probability of concomitant laxative use 1.9 [95% CI 1.1-3.3] times. DISCUSSION This study shows that the widely used guideline to start a laxative when prescribing an opioid is not always followed in daily practice. In addition, we showed that pharmacy-based intervention contributed to increasing laxative use in patients receiving opioids.
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Affiliation(s)
- M L Bouvy
- SIR Institute for Pharmacy Practice Research, Theda Mansholtstraat 5B, JE Leiden, The Netherlands.
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