1
|
Weidmann AE, Watson EW. Novel opportunities for clinical pharmacy research: development of a machine learning model to identify medication related causes of delirium in different patient groups. Int J Clin Pharm 2024:10.1007/s11096-024-01707-z. [PMID: 38594470 DOI: 10.1007/s11096-024-01707-z] [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: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 04/11/2024]
Abstract
The advent of artificial intelligence (AI) technologies has taken the world of science by storm in 2023. The opportunities of this easy to access technology for clinical pharmacy research are yet to be fully understood. The development of a custom-made large language model (LLM) (DELSTAR) trained on a wide range of internationally recognised scientific publication databases, pharmacovigilance sites and international product characteristics to help identify and summarise medication related information on delirium, as a proof-of-concept model, identified new facilitators and barriers for robust clinical pharmacy practice research. This technology holds great promise for the development of much more comprehensive prescribing guidelines, practice support applications for clinical pharmacy, increased patient and prescribing safety and resultant implications for healthcare costs. The challenge will be to ensure its methodologically robust use and the detailed and transparent verification of its information accuracy.
Collapse
Affiliation(s)
- Anita Elaine Weidmann
- Department of Clinical Pharmacy, Institute of Pharmacy, Innsbruck University, Innrain 80, 6020, Innsbruck, Austria.
| | - Edward William Watson
- Department of Media and Learning Technology, Innsbruck University, Innrain 52, 6020, Innsbruck, Austria
| |
Collapse
|
2
|
Macé F, De Vriese C, Nelissen-Vrancken M, Ruggli M, Brülhart M, Peyron C. General practitioners-community pharmacists pharmacotherapy discussion groups: Analysis of their implementation through a series of case studies. Explor Res Clin Soc Pharm 2023; 12:100331. [PMID: 37772034 PMCID: PMC10523268 DOI: 10.1016/j.rcsop.2023.100331] [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: 06/24/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
Background The evolution of primary care practice has led to the implementation of pharmacotherapy discussion groups between general practitioners and community pharmacists (PPPDGs) in some countries. The aim of these groups is to improve drug prescribing practices and strengthen interprofessional relationships. Objective To gain more insight into factors involved in successful implementation of PPPDGs. Methods PPPDG implementation in three countries (Belgium, the Netherlands, Switzerland), was analyzed in a series of case studies. A grid describing different evaluation criteria was completed by stakeholders in their respective country. The data collection was followed by a literature review. Results Various models were used to implement PPPDGs within each country and different dynamics were encountered. PPPDGs lead to positive effects on the quality and cost-effectiveness of drug prescribing and on the collaboration between general practitioners (GPs) and community pharmacists (CPs). Factors involved in implementation were also identified, such as expectations of GPs and CPs, configuration of the implemented model, and the role of CPs in the healthcare organization. Conclusions This study provides insight into the factors involved in successful implementation of PPPDGs in Belgium, the Netherlands and Switzerland. The findings can be used by healthcare professionals to improve the safety, cost-effectiveness of drug prescriptions and systems in primary care. This study offers a starting point for further research in the field.
Collapse
Affiliation(s)
- Florent Macé
- Economics Laboratory of Dijon, University of Burgundy, Dijon, France
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Martine Ruggli
- President of pharmaSuisse, Swiss Society of Pharmacists, Berne-Liebefeld, Switzerland
| | - Mélanie Brülhart
- Project manager Quality Circles, Swiss Society of Pharmacists, pharmaSuisse, Berne-Liebefeld, Switzerland
| | - Christine Peyron
- Economics Laboratory of Dijon, University of Burgundy, Dijon, France
| |
Collapse
|
3
|
Ogaji DS, Nwaejike D, Ebiekuraju O. Quality of Drug Prescribing and Dispensing Practices in Primary Healthcare Centres in an Urban Local Government Area in Nigeria. West Afr J Med 2023; 40:925-934. [PMID: 37767782] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Irrational drug use remains a major issue in developing countries; hence this study used the World Health Organization and the International Network for the Rational Use of Drugs (WHO/INRUD) core drug indicators to assess the quality of prescribing and dispensing practices in Primary Health Centres (PHCs) in Obio-Akpor Local Government Area (LGA) in Nigeria. METHODS This descriptive cross-sectional study which covered 10 PHCs in Obio-Akpor LGA comprised a review of prescription records and a survey of patients and prescribers. A systematic random sample approach was used to retrieve 1300 prescriptions from August to October 2021 to evaluate prescribing indicators while direct observation of 325 consecutive patient encounters in the PHCs was used to evaluate the patient-care indicators. Twenty-three prescribers in the 10 PHCs who were available and willing to participate in the study, completed the self-administered questionnaire for assessment of the factors affecting prescribing practices. Descriptive and inferential analyses were done using the Statistical Package for the Social Sciences and p-values d" 0.05 were considered statistically significant. RESULTS From the 1300 retrieved prescriptions, a total of 3805 medications were prescribed for the 1300 encounters giving 2.9 (± 0.5) as the mean medications prescribed per encounter. Prescriptions in generic forms were 69.9% and 75.6% of drugs prescribed were from the Nigeria essential medicine list for PHCs. Encounters with antibiotics and injectables included in the prescriptions were 62.6% and 22.3% respectively. Antimalarial, antihypertensive, and antidiabetic medications were prescribed in 43.8 %, 9.6 %, and 1.7 % of the cases, respectively. Most (91.6 %) of the recommended drugs were dispensed, 98.2% of the drugs dispensed were appropriately labelled, and 95.5 % of the patients had an adequate understanding of their drug doses. The pharmacy stocked 88.7% of the key medications, and all PHCs had a copy of the EDL. CONCLUSION There was evidence of irrational drug use practices in PHCs in Obio-Akpor LGA. This calls for the implementation of periodic training for PHC workers, the promotion of effective monitoring and adherence to the policy of rational drug use in PHCs.
Collapse
Affiliation(s)
- D S Ogaji
- Department of Preventive and Social Medicine, University of Port Harcourt, East-West Road, Choba, Port Harcourt, Rivers State, Nigeria
- African Centre of Excellence in Public Health and Toxicological Research, University of Port Harcourt, East-West Road, Choba, Port Harcourt, Rivers State, Nigeria
| | - D Nwaejike
- Department of Preventive and Social Medicine, University of Port Harcourt, East-West Road, Choba, Port Harcourt, Rivers State, Nigeria
| | - O Ebiekuraju
- Department of Preventive and Social Medicine, University of Port Harcourt, East-West Road, Choba, Port Harcourt, Rivers State, Nigeria
| |
Collapse
|
4
|
Schmitz K, Lenssen R, Rückbeil M, Berning D, Thomeczek C, Brokmann JC, Jaehde U, Eisert A. The WHO High 5s project: medication reconciliation in a German university hospital. A prospective observational cohort study. Z Evid Fortbild Qual Gesundhwes 2022; 168:27-32. [PMID: 35148970 DOI: 10.1016/j.zefq.2021.11.006] [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] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ensuring medication accuracy during transitions in care is one of the five highly prevalent patient safety problems focused on within the World Health Organization High 5s Project. Medication reconciliation is a standardized patient care process that can be used to address this problem. The aim of the current study is to implement medication reconciliation in a German university hospital. METHODS The study was conducted at the Emergency Department of the University Hospital Aachen, Germany. All discrepancies between the Best Possible Medication History and the Admission Medication Order were documented and classified as documentation errors or medication errors. The type of error was also recorded. A negative binomial regression model was used to test several factors influencing the number of discrepancies. RESULTS The medications of 105 patients were reconciled. The mean number of discrepancies per patient was 4.6± 3.6, with a total of 298 medication errors and 189 documentation errors. The most common type of medication error was the omission of a drug (n=208; 69.8 %). In the negative binomial regression analysis, the care status (p=0.0015) as well as the number of preadmission drugs (p=0.0007) were significantly associated with medication errors. DISCUSSION A high number of discrepancies was detected and analysed. Patients admitted from nursing homes were less likely to have discrepancies in their medication reconciliation, perhaps because a structured documentation system for medications is already in place at nursing homes including error prone products (special dosage forms or food supplements). CONCLUSIONS In this study, medication reconciliation was implemented at a German full-care university hospital. The actual number of discrepancies observed strongly indicates the need for medication reconciliation at hospital admission.
Collapse
Affiliation(s)
- Katharina Schmitz
- Pharmacy of the University Hospital RWTH Aachen, Aachen, Germany; Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, Bonn, Germany.
| | - Rebekka Lenssen
- Pharmacy of the University Hospital RWTH Aachen, Aachen, Germany
| | - Marcia Rückbeil
- Department of Medical Statistics, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniel Berning
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | | | | | - Ulrich Jaehde
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, Bonn, Germany
| | - Albrecht Eisert
- Pharmacy of the University Hospital RWTH Aachen, Aachen, Germany; Institute of Clinical Pharmacology of the University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
5
|
Kirsch V, Matthes J. A simulation-based module in pharmacology education reveals and addresses medical students' deficits in leading prescription talks. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:2333-2341. [PMID: 34522985 PMCID: PMC8514349 DOI: 10.1007/s00210-021-02151-w] [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: 07/19/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
Although doctor-patient communication is essential for drug prescription, the literature reveals deficits in this area. An educational approach at the Cologne medical faculty aims at identifying and addressing those deficits in medical students.Fifth-year medical students first conducted a simulated prescription talk spontaneously. Subsequently, the conversation was discussed with peer students. A pharmacist moderated the discussion based upon a previously developed conversation guide. Afterwards, the same student had the conversation again, but as if for the first time. Conversations were video-recorded, transcribed and subjected to quantitative content analysis. Four days after the simulation, the students who conducted the talk, those who observed and discussed it, and students who did neither, completed a written test that focused on the content of an effective prescription talk.Content analysis revealed clear deficits in spontaneously led prescription talks. Even essential information as on adverse drug reactions were often lacking. Prescription talks became clearly more informative and comprehensive after the short, guided peer discussion. With regard to a comprehensive, informative prescription talk, the written test showed that both the students who conducted the talk and those who only observed it performed clearly better than the students who did not participate in the educational approach.Deficits regarding prescription talks are present in 5th year medical students. We provide an approach to both identify and address these deficits. It thus may be an example for training medical students in simulated and clinical environments like the EACPT recommended to improve pharmacology education.
Collapse
Affiliation(s)
- Verena Kirsch
- Center of Pharmacology, Institute II, University of Cologne, Gleueler Strasse 24, 50931, Cologne, Germany
| | - Jan Matthes
- Center of Pharmacology, Institute II, University of Cologne, Gleueler Strasse 24, 50931, Cologne, Germany.
| |
Collapse
|
6
|
Campbell C, Braund R, Morris C. A mixed methods study on medicines information needs and challenges in New Zealand general practice. BMC Fam Pract 2021; 22:150. [PMID: 34246231 PMCID: PMC8272906 DOI: 10.1186/s12875-021-01451-7] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Medicines are central to healthcare in aging populations with chronic multi-morbidity. Their safe and effective use relies on a large and constantly increasing knowledge base. Despite the current era of unprecedented access to information, there is evidence that unmet information needs remain an issue in clinical practice. Unmet medicines information needs may contribute to sub-optimal use of medicines and patient harm. Little is known about medicines information needs in the primary care setting. The aim of this study was to investigate the nature of medicines information needs in routine general practice and understand the challenges and influences on the information-seeking behaviour of general practitioners. METHODS A mixed methods study involving 18 New Zealand general practitioner participants was undertaken. Quantitative data were collected to characterize the medicines information needs arising during 642 consultations conducted by the participants. Qualitative data regarding participant views on their medicines information needs, resources used, challenges to meeting the needs and potential solutions were collected by semi-structured interview. Integration occurred by comparison of results from each method. RESULTS Of 642 consultations, 11% (n = 73/642) featured at least one medicines information need. The needs spanned 14 different categories with dosing the most frequent (26%) followed by side effects (15%) and drug interactions (14%). Two main themes describing the nature of general practitioners' medicines information needs were identified from the qualitative data: a 'common core' related to medicine dose, side effects and interactions and a 'perplexing periphery'. Challenges in the perplexing periphery were the variation in information needs, complexity, 'known unknowns' and 'unknown unknowns'. Key factors affecting general practitioners' strategies for meeting medicines information needs were trust in a resource, presence of the patient, how the information was presented, scarcity of time, awareness of the existence of a resource, and its accessibility. CONCLUSIONS General practitioners face challenges in meeting wide-ranging medicines information needs in patients with increasingly complex care needs. Recognising the challenges and factors that influence resource use in practice can inform optimisation of medicines information support resources. Resources for general practitioners must take into account the complexity and time constraints of real-world practice. An individually responsive approach involving greater collaboration with pharmacists and specialist medicines information support services may provide a potential solution.
Collapse
Affiliation(s)
- Chloë Campbell
- School of Pharmacy, University of Otago, Dunedin, New Zealand.
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
- Pharmaceutical Society of New Zealand, Wellington, New Zealand.
| | - Rhiannon Braund
- School of Pharmacy, University of Otago, Dunedin, New Zealand
- New Zealand Pharmacovigilance Centre, University of Otago, Dunedin, New Zealand
| | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| |
Collapse
|
7
|
Emgård M, Mwangi R, Mayo C, Mshana E, Nkini G, Andersson R, Msuya SE, Lepp M, Muro F, Skovbjerg S. Tanzanian primary healthcare workers' experiences of antibiotic prescription and understanding of antibiotic resistance in common childhood infections: a qualitative phenomenographic study. Antimicrob Resist Infect Control 2021; 10:94. [PMID: 34176486 PMCID: PMC8237496 DOI: 10.1186/s13756-021-00952-5] [Citation(s) in RCA: 9] [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: 01/06/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background Antibiotic resistance is a threat to global child health. Primary healthcare workers play a key role in antibiotic stewardship in the community, but few studies in low-income countries have described their experiences of initiating antibiotic treatment in children. Thus, the present study aimed to describe primary healthcare workers’ experiences of antibiotic prescription for children under 5 years of age and their conceptions of antibiotic resistance in Northern Tanzania. Methods A qualitative study involving individual in-depth interviews with 20 prescribing primary healthcare workers in Moshi urban and rural districts, Northern Tanzania, was performed in 2019. Interviews were transcribed verbatim, translated from Kiswahili into English and analysed according to the phenomenographic approach. Findings Four conceptual themes emerged during the analysis; conceptions in relation to the prescriber, the mother and child, other healthcare actors and in relation to outcome. The healthcare workers relied mainly on clinical examination and medical history provided by the mother to determine the need for antibiotics. Confidence in giving advice concerning non-antibiotic treatment varied among the participants and expectations of antibiotic treatment were perceived to be common among the mothers. Antibiotic resistance was mainly perceived as a problem for the individual patient who was misusing the antibiotics. Conclusions To increase rational antibiotic prescription, an awareness needs to be raised among Tanzanian primary healthcare workers of the threat of antibiotic resistance, not only to a few individuals, but to public health. Guidelines on childhood illnesses should be updated with advice concerning symptomatic treatment when antibiotics are not necessary, to support rational prescribing practices and promote trust in the clinician and mother relationship. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00952-5.
Collapse
Affiliation(s)
- Matilda Emgård
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Rose Mwangi
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Celina Mayo
- Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Ester Mshana
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Gertrud Nkini
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Sia E Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Margret Lepp
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Østfold University College, Fredrikstad, Norway.,School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia
| | - Florida Muro
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania.,Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Susann Skovbjerg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| |
Collapse
|
8
|
Kirsch V, Matthes J. Aspects of Medication and Patient participation-an Easy guideLine (AMPEL). A conversation guide increases patients' and physicians' satisfaction with prescription talks. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1757-67. [PMID: 34106304 DOI: 10.1007/s00210-021-02107-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022]
Abstract
Patients want more information and active participation in medical decisions. Information and active participation correlate with increased adherence. A conversation guide, combining patient-relevant drug information with steps of shared decision-making, was developed to support physicians in effective and efficient prescription talks. Six GP trainees in community-based primary care practices participated in a controlled pilot study in sequential pre-post design. Initially, they conducted 41 prescription talks as usual, i.e., without knowing the guide. Then, they conducted 23 talks considering the guide (post-intervention phase). Immediately after the respective talk, patients filled in a questionnaire on satisfaction with the information on medication and physician–patient interaction, and physicians about their satisfaction with the talk and the application of the guide. Patients felt better informed after guide-based prescription talks (e.g., SIMS-D in median 10 vs. 17, p < 0.05), more actively involved (KPF-A for patient activation 2.9 ± 0.8 vs. 3.6 ± 0.8, p < 0.05), and more satisfied with the physician–patient interaction. Physicians rated the guide helpful and feasible. Their satisfaction with the conversation was significantly enhanced during the post-intervention phase. The evaluation of the duration of the talk was not influenced. Enhanced patients’ and physicians’ satisfaction with prescription talks encourages further examinations of the conversation guide. We invite physicians to try our guide in everyday medical practice.
Collapse
|
9
|
Kleiber N, Gariépy-Assal L, Coulombe J, Marcoux S, Essouri S, McCuaig C, Powell J, Soulez G, Dubois J. Off-Label Use and Safety of Drug Use in Vascular Anomalies. Dermatology 2021; 237:649-657. [PMID: 33823514 DOI: 10.1159/000515980] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Off-label drug use is associated with an increased risk of adverse drug reactions. It is common in pediatrics and in rare diseases, which are two characteristics applying to vascular anomalies (VA). OBJECTIVES The aim of this work was to quantify off-label drug use in VA and assess its safety. METHODS A review was conducted to extract a list of drugs used in VA management. A drug was considered to have significant safety concerns if a black box warning was present or if a serious adverse drug reaction (SADR) was reported in at least 1% of the patients (SADR is defined as a noxious and unintended response to a drug that occurs at any dose and results in hospitalization, prolongation of existing hospitalization, congenital malformation, persistent or significant disability or incapacity, life-threatening condition, or death). The labelling status and safety of each drug was assessed based on the product monograph, Micromedex, and the FDA data. RESULTS We found that 98.9% of the inventoried drugs were used off-label or unlicensed for VA management. Only the oral solution of propranolol hydrochloride (Hemangeol®) for the treatment of infantile hemangiomas is approved. Significant safety issues concerned 73% of the drugs and were more frequent among systemic than locally delivered drugs. CONCLUSIONS Off-label drug use in VA is the rule and not the exception. Significant safety concerns are common. It is necessary to carefully weigh risk and benefits for every patient when using systemic and local treatments carrying safety concerns. Patients should be openly informed and involved in the decision-making process.
Collapse
Affiliation(s)
- Niina Kleiber
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Québec, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Clinical Pharmacology Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Laurence Gariépy-Assal
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Jérôme Coulombe
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Simon Marcoux
- Clinical Pharmacology Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sandrine Essouri
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Catherine McCuaig
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Julie Powell
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Josée Dubois
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.,Department of Radiology, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| |
Collapse
|
10
|
Sennesael AL, Krug B, Sneyers B, Spinewine A. Do computerized clinical decision support systems improve the prescribing of oral anticoagulants? A systematic review. Thromb Res 2020; 187:79-87. [PMID: 31972381 DOI: 10.1016/j.thromres.2019.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/05/2019] [Revised: 12/13/2019] [Accepted: 12/28/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Serious adverse drug reactions have been associated with the underuse or the misuse of oral anticoagulant therapy. We systematically reviewed the impact of computerized clinical decision support systems (CDSS) on the prescribing of oral anticoagulants and we described CDSS features associated with success or failure. METHODS We searched Medline, Embase, CENTRAL, CINHAL, and PsycINFO for studies that compared CDSS for the initiation or monitoring of oral anticoagulants with routine care. Two reviewers performed study selection, data collection, and risk-of-bias assessment. Disagreements were resolved with a third reviewer. Potentially important CDSS features, identified from previous literature, were evaluated. RESULTS Sixteen studies were included in our qualitative synthesis. Most trials were performed in primary care (n = 7) or hospitals (n = 6) and included atrial fibrillation (AF) patients (n = 9). Recommendations mainly focused on anticoagulation underuse (n = 11) and warfarin-drug interactions (n = 5). Most CDSS were integrated in electronic records or prescribing and provided support automatically at the time and location of decision-making. Significant improvements in practitioner performance were found in 9 out of 16 studies, while clinical outcomes were poorly reported. CDSS features seemed slightly more common in studies that demonstrated improvement. CONCLUSIONS CDSS might positively impact the use of oral anticoagulants in AF patients at high risk of stroke. The scope of CDSS should now evolve to assist prescribers in selecting the most appropriate and tailored medication. Efforts should nevertheless be made to improve the relevance of notifications and to address implementation outcomes.
Collapse
Affiliation(s)
- Anne-Laure Sennesael
- Université catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Brussels, Belgium; Université catholique de Louvain, CHU UCL Namur, Department of Pharmacy, Yvoir, Belgium.
| | - Bruno Krug
- Université catholique de Louvain, CHU UCL Namur, Department of Nuclear Medicine, Yvoir, Belgium; Université catholique de Louvain, Institute of Health and Society, Brussels, Belgium
| | - Barbara Sneyers
- Université catholique de Louvain, CHU UCL Namur, Department of Pharmacy, Yvoir, Belgium
| | - Anne Spinewine
- Université catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Brussels, Belgium; Université catholique de Louvain, CHU UCL Namur, Department of Pharmacy, Yvoir, Belgium
| |
Collapse
|
11
|
Fialová D, Laffon B, Marinković V, Tasić L, Doro P, Sόos G, Mota J, Dogan S, Brkić J, Teixeira JP, Valdiglesias V, Costa S. Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies). Eur J Clin Pharmacol 2019; 75:451-466. [PMID: 30610276 DOI: 10.1007/s00228-018-2603-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 09/20/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the "age-blind" approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. METHODOLOGY A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). RESULTS Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. CONCLUSION Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.
Collapse
Affiliation(s)
- Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic. .,Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Prague, Czech Republic.
| | - Blanca Laffon
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Valentina Marinković
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Tasić
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Peter Doro
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Gyӧngyver Sόos
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Jorge Mota
- Centro de Investigação em Actividade Fìsica, Saúde e Lazer (CIAFEL), University of Porto, Porto, Portugal
| | - Soner Dogan
- Department of Medical Biology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Jovana Brkić
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - João Paulo Teixeira
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Vanessa Valdiglesias
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Solange Costa
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | | |
Collapse
|
12
|
Morin L, Laroche ML, Vetrano DL, Fastbom J, Johnell K. Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus. Eur J Clin Pharmacol 2018; 74:1333-42. [PMID: 29934849 DOI: 10.1007/s00228-018-2507-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/14/2018] [Indexed: 01/01/2023]
Abstract
Background Clinical guidance is needed to initiate, continue, and discontinue drug treatments near the end of life. Aim To identify drugs and drug classes most often adequate, questionable, or inadequate for older people at the end of life. Design Delphi consensus survey. Setting/participants Forty European experts in geriatrics, clinical pharmacology, and palliative medicine from 10 different countries. Panelists were asked to characterize drug classes as “often adequate,” “questionable,” or “often inadequate” for use in older adults aged 75 years or older with an estimated life expectancy of ≤ 3 months. We distinguished the continuation of a drug class that was previously prescribed from the initiation of a new drug. Consensus was considered achieved for a given drug or drug class if the level of agreement was ≥ 75%. Results The expert panel reached consensus on a set of 14 drug classes deemed as “often adequate,” 28 drug classes deemed “questionable,” and 10 drug classes deemed “often inadequate” for continuation during the last 3 months of life. Regarding the initiation of new drug treatments, the panel reached consensus on a set of 10 drug classes deemed “often adequate,” 23 drug classes deemed “questionable,” and 23 drug classes deemed “often inadequate”. Consensus remained unachieved for some very commonly prescribed drug treatments (e.g., proton-pump inhibitors, furosemide, haloperidol, olanzapine, zopiclone, and selective serotonin reuptake inhibitors). Conclusion In the absence of high-quality evidence from randomized clinical trials, these consensus-based criteria provide guidance to rationalize drug prescribing for older adults near the end of life. Electronic supplementary material The online version of this article (10.1007/s00228-018-2507-4) contains supplementary material, which is available to authorized users.
Collapse
|
13
|
Hagemi A, Plumpton C, Hughes DA. Renal transplant patients' preference for the supply and delivery of immunosuppressants in Wales: a discrete choice experiment. BMC Nephrol 2017; 18:305. [PMID: 28969602 PMCID: PMC5625806 DOI: 10.1186/s12882-017-0720-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/02/2016] [Accepted: 09/20/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prescribing policy recommendations aimed at moving immunosuppressant prescribing for renal transplant patients from primary to secondary care may result in benefits of increased safety and reduced cost. However, there is little evidence of patients' preferences for receiving their immunosuppressant therapy from hospitals compared to community dispensing. The aim of this study was to elicit patient preferences for different service configurations focusing in particular on home delivery versus collection of medication from hospital. METHODS A discrete choice experiment was administered to 265 renal transplant patients in North Wales. Respondents were presented 18 pairwise choices, labelled as either home delivery or hospital collection, and described by the attributes: frequency of supply, waiting time (for delivery or collection) and method of ordering (provider contact, patient contact via phone, patient contact electronically). Data were analysed using a random-effects logit model and marginal rates of substitution calculated based on the waiting time attribute. RESULTS A response rate of 63% was achieved, with 5332 usable observations from 150 respondents. Method of delivery (β coefficient 1.21; 95% confidence interval 1.05 to 1.38), frequency of supply (0.05; 0.03 to 0.08) waiting time (-0.00, -0.00 to -0.00), provider contact (desirable) (0.20; 0.12 to 0.27), patient contact by telephone (desirable) (0.09; 0.01 to 0.17) and patient contact electronically (undesirable) (-0.292; -0.37 to -0.21) were statistically significant (p < 0.05). Results indicate that patients are willing to increase waiting time by nearly 10 h to have a home delivery service. CONCLUSION Patients indicate a clear preference for a home delivery service. They prefer providers to make contact when new immunosuppressant supplies are required and show preference against ordering medication electronically. A policy for secondary care prescribing and hospital collection of medicines does not align with this preference.
Collapse
Affiliation(s)
- Anke Hagemi
- Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Bangor, Wales, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Holyhead Road, Bangor, Wales, LL57 2PZ, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Holyhead Road, Bangor, Wales, LL57 2PZ, UK.
| |
Collapse
|
14
|
Tifratene K, Manera V, Fabre R, Gros A, Thummler S, Pradier C, Robert P, David R. Antipsychotic prescribing for Alzheimer's disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study. Alzheimers Res Ther 2017; 9:34. [PMID: 28446209 PMCID: PMC5405526 DOI: 10.1186/s13195-017-0256-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/24/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Safety warnings from health authorities are currently intended to limit the use of antipsychotics (APs) in dementia-related conditions to treat neuropsychiatric symptoms, such as disturbing and/or delusional behaviors. The aim of this study is to investigate prevalence, correlates and trends of AP prescribing among people with dementia between 2010 and 2014 in the French population. METHODS AP prescribing and associated factors among individuals with AD, mixed dementia and vascular dementia in the French National Alzheimer Database between 2010 and 2014 were analyzed using multivariate generalized estimating equations models (n = 199,549). RESULTS In 2014, 7.7% of people with dementia were prescribed an AP. Compared with 2010 there was a 16% increase in AP use. Multivariate analysis showed a linear increase risk of prescription with an adjusted odds ratio (95% confidence interval) of 1.23 (1.17-1.30) in 2014 compared with 2010. Factors associated with AP prescribing were male gender, more severe cognitive decline and living in long-term care facilities. Older age and higher education were protective toward AP prescribing. The type of dementia did not have any influence on AP prescribing. CONCLUSION An increase in AP prescribing among individuals with dementia in French specialized settings over the last 5 years occurred despite safety warnings. This phenomenon suggests that alternative solutions for the management of behavioral and psychiatric symptoms in these populations are still urgently needed.
Collapse
Affiliation(s)
- Karim Tifratene
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France.,Department of Public Health, L'Archet Hospital, Nice University Hospital, Nice, France
| | - Valeria Manera
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France
| | - Roxane Fabre
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France.,Department of Public Health, L'Archet Hospital, Nice University Hospital, Nice, France
| | - Auriane Gros
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France.,Research and Resources Memory Centre, Nice University Hospital, Nice, France
| | | | - Christian Pradier
- Department of Public Health, L'Archet Hospital, Nice University Hospital, Nice, France
| | - Philippe Robert
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France.,Research and Resources Memory Centre, Nice University Hospital, Nice, France
| | - Renaud David
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France. .,Research and Resources Memory Centre, Nice University Hospital, Nice, France. .,Present address: Centre Mémoire de Ressources et de Recherche, Institut Claude Pompidou, 10 rue Molière, 06100, Nice, France.
| |
Collapse
|
15
|
Kureshee NI, Dhande PP. Awareness of Mothers and Doctors about Drug Utilization Pattern for Illnesses Encountered during Pregnancy. J Clin Diagn Res 2013; 7:2470-4. [PMID: 24392375 DOI: 10.7860/jcdr/2013/6329.3582] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/05/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Careful consideration of the benefit to the mother and risk to the foetus, is required, while prescribing drugs during pregnancy. OBJECTIVES To assess the pattern of drug utilization during pregnancy and to explore the knowledge, attitude and awareness on drug use by the antenatal mother in a tertiary care hospital setup in western India. MATERIAL AND METHODS Observational, cross-sectional study involved holding interviews on 501 pregnant women, in OPD and IPD of Obstetrics-Gynaecology Department using a pilot-based questionnaire, was done. Data from prescriptions and case-files were also collected. Drugs were classified pharmacologically and according to teratogenic potential using U.S.FDA classification. Study population was classified according to the trimester of pregnancy and educational and socioeconomic status. Intergroup comparison was done using Chi-square test. RESULTS Majority of the drugs were from Category A(71.2%) and Category B (16.5%), followed by those from Categories C(9.09%), D(1.12%) and X(0.7%). Category A drugs were significantly used more in first trimester, while Category C and D drugs were used in the last two trimesters (p<0.0001) for pregnancy associated complications. Only 24.55% of the women believed that drug use in pregnancy could be harmful to both mother and baby, while 35.52% believed that drug use could be dangerous throughout pregnancy. Patients' educational and socio-economic statuses influenced their compliance for nutritional supplements prescribed during pregnancy and their awareness on common contraceptive methods. Higher education and socioeconomic class provided information on safety of barrier contraception during pregnancy. CONCLUSION Study revealed careful prescribing behaviour of physicians. Lack of awareness on safety of drugs in pregnancy and contraceptive use advocates a need for educating and counselling women of child bearing ages.
Collapse
|