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Kaya M, Nakamura K, Nagamine M, Suyama Y, Nakajo M, Uchida R, Hagikura K, Kanda A, Sugiyama K, Sugiyama R, Nakagaki S, Kimura M. A retrospective study comparing interventions by oncology and non-oncology pharmacists in outpatient chemotherapy. Cancer Rep (Hoboken) 2021; 4:e1371. [PMID: 33739629 PMCID: PMC8388162 DOI: 10.1002/cnr2.1371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The differences in the clinical pharmacy services (CPS) provided by oncology and non-oncology pharmacists have not been sufficiently explained. AIM This study aimed to demonstrate the differences in direct CPS provided by oncology and non-oncology pharmacists for patients and physicians, and to assess the potential impact of these services on medical costs. METHODS We retrospectively examined CPS provided by oncology and non-oncology pharmacists for outpatients who underwent chemotherapy between January and December 2016. RESULTS In total, 1177 and 1050 CPS provided by oncology and non-oncology pharmacists, respectively, were investigated. The rates of interventions performed by oncology and non-oncology pharmacists for physicians-determined treatment were 18.5% and 11.3%, respectively (p < .001). The rates of oncology and non-oncology pharmacist interventions accepted by physicians were 84.6 and 78.8%, respectively (p = .12). Level 4 and Level 5 interventions accounted for 64.6% of all oncology pharmacist interventions and 53.0% of all non-oncology pharmacist interventions (p = .03). The rates of improvement in symptoms from adverse drug reactions among patients resulting from interventions by oncology and non-oncology pharmacists were 89.4 and 72.1%, respectively (p = .02). Conservative assessments of medical cost impact showed that a single intervention by an oncology and by a non-oncology pharmacist saved ¥6355 and ¥3604, respectively. CONCLUSION The results of the present study suggested that CPS by oncology pharmacists enable safer and more effective therapy for patients with cancer and indirectly contribute to reducing health care fees.
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Affiliation(s)
- Michihiro Kaya
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Kazuyo Nakamura
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Makiko Nagamine
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Yukako Suyama
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Michiaki Nakajo
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Ryo Uchida
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Kakeru Hagikura
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Ai Kanda
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Kyohei Sugiyama
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Rina Sugiyama
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Shigeru Nakagaki
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Midori Kimura
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
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Bekele F, Tsegaye T, Negash E, Fekadu G. Magnitude and determinants of drug-related problems among patients admitted to medical wards of southwestern Ethiopian hospitals: A multicenter prospective observational study. PLoS One 2021; 16:e0248575. [PMID: 33725022 PMCID: PMC7963049 DOI: 10.1371/journal.pone.0248575] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Drug-related problem (DRP) is an event involving drugs that can impact the patient's desired goal of therapy. In hospitalized patients, DRPs happen during the whole process of drug use such as during prescription, dispensing, administration, and follow-up of their treatment. Unrecognized and unresolved DRPs lead to significant drug-related morbidity and mortality. Several studies conducted in different hospitals and countries showed a high incidence of DRPs among hospitalized patients. Despite the available gaps, there were scanties of studies conducted on DRPs among patients admitted to medical wards in Ethiopia. Therefore, this study assessed the magnitude of drug-related problems and associated factors among patients admitted to the medical wards of selected Southwestern Ethiopian hospitals. PATIENTS AND METHODS A multicenter prospective observational study was conducted at medical wards of Mettu Karl Hospital, Bedele General Hospital and Darimu General Hospital. Adult patients greater than 18 years who were admitted to the non-intensive care unit (ICU) of medical wards and with more than 48 h of length of stay were included. Identified DRPs were recorded and classified using the pharmaceutical care network Europe foundation classification system and adverse drug reaction was assessed using the Naranjo algorithm of adverse drug reaction probability scale. Hill-Bone Compliance to High Blood Pressure Therapy Scale was used to measure medication adherence. Multivariable logistic regression was used to analyze the associations between the dependent variable and independent variables. RESULT Of the 313 study participants, 178 (56.9%) were males. The prevalence of actual or potential DRPs among study participants taking at least a single drug was 212 (67.7%). About 125 (36.63%) patients had one or more co-morbid disease and the average duration of hospital stay of 7.14 ± 4.731 days. A total of 331 DRPs were identified with an average 1.06 DRP per patient. The three-leading categories of DRPs were unnecessary prescription of drugs 92 (27.79%), non-adherence (17.22%) and dose too high (16.92%). The most common drugs associated with DRPs were ceftriaxone (28.37%), cimetidine (14.88%), and diclofenac (14.42%). The area of residence (AOR = 2.550, 95CI%: 1.238-5.253, p = 0.011), hospital stay more than 7 days (AOR = 9.785, 95CI%: 4.668-20.511, p≤0.001), poly pharmacy (AOR = 3.229, 95CI%: 1.433-7.278, p = 0.005) were predictors of drug-related problem in multivariable logistic regression analysis. CONCLUSION The magnitude of drug therapy problems among patients admitted to the medical wards of study settings was found to be high. Therefore, the clinical pharmacy services should be established in hospitals to tackle the DTPs in this area. Additionally, healthcare providers of hospitals also should create awareness for patients seeking care from health facilities of the importance of rational drug usage.
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Affiliation(s)
- Firomsa Bekele
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
- * E-mail:
| | - Tesfaye Tsegaye
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Efrem Negash
- Department of Public Health, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Science, Wollega University, Nekemte, Ethiopia
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Clementz A, Jost J, Lacour A, Ratsimbazafy V, Tchalla A. [Do clinical pharmacy activities have an impact on the re-hospitalization rate of elderly patients admitted in an Elderly Emergency Medicine (EMM) unit for fall?]. Geriatr Psychol Neuropsychiatr Vieil 2021; 19:53-61. [PMID: 33692015 DOI: 10.1684/pnv.2021.0916] [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] [Indexed: 06/12/2023]
Abstract
UNLABELLED To evaluate the effect of clinical pharmacy interventions on the unplanned rehospitalizations rates of elderly people admitted for fall to the elderly emergency medicine (EEM) unit in a teaching hospital. DESIGN AND MEASURES This was a longitudinal, comparative pilot study. Patients aged at least 75 who were admitted to the EEM unit for a fall and who had at least two chronic diseases and who were being treated with two or more medications were included from February 1, 2018 to June 30, 2018 and followed by 90 days. The main outcomes were the unplanned rehospitalizations rate at Limoges Teaching Hospital within the 90 days (primary outcome), 30 days and 72 hrs. The estimated cost-saving was also assessed. RESULTS We included 252 patients. The mean age was 88.4 ± 5.8 years and the average baseline number of medications was 8.3 ± 3.4. In total, 158 pharmaceutical interventions were performed, reflecting an acceptance rate of 94.9%. We found a significant reduction of the rate of unplanned rehospitalizations at 90-day (OR = 0.45 (0.26-0.79) p = 0.005). These results were still consistent at 30-day (p = 0.035) and 72 hours (p = 0.041). We found a cost-saving of 37,770 euros related to 21 avoided rehospitalizations. CONCLUSIONS Our results highly emphasize the positive effects of clinical pharmacy services on the prevention of unplanned rehospitalizations of old adults admitted for fall.
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Affiliation(s)
- Alice Clementz
- Pharmacie à usage intérieur, CHU de Limoges, Limoges, France
| | - Jérémy Jost
- Pharmacie à usage intérieur, CHU de Limoges, Limoges, France, Université de Limoges ; IFR 145 GEIST ; Institut d'épidémiologie neurologique et de neurologie tropicale; Inserm, UMR 1094 Neuroépidemiologie tropicale, Limoges, France
| | - Aurore Lacour
- CHU de Limoges, Pôle HU gérontologie clinique, Limoges, France
| | - Voa Ratsimbazafy
- Pharmacie à usage intérieur, CHU de Limoges, Limoges, France, Université de Limoges ; IFR 145 GEIST ; Institut d'épidémiologie neurologique et de neurologie tropicale; Inserm, UMR 1094 Neuroépidemiologie tropicale, Limoges, France
| | - Achille Tchalla
- CHU de Limoges, Pôle HU gérontologie clinique, Limoges, France, Université de Limoges ; IFR 145 GEIST ; Laboratoire de recherche sur le vieillissement et la santé digitale ; UR Unilim VieSante, Limoges, France
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Mogul A, Laughlin E, Lynch S. A Co-Curricular Activity to Introduce Pharmacy Students to the Concepts of Innovation and Entrepreneurship. Am J Pharm Educ 2020; 84:ajpe7805. [PMID: 32934385 PMCID: PMC7473219 DOI: 10.5688/ajpe7805] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/15/2020] [Indexed: 05/22/2023]
Abstract
Objective. To develop, implement, and evaluate a co-curricular activity in which second-year Doctor of Pharmacy (PharmD) students developed an idea for a new clinical pharmacy service. Methods. A brief co-curricular activity based on the television series SharkTank was developed to encourage innovation and entrepreneurship. Second-year pharmacy students worked in assigned teams and were allowed one hour to develop an innovative clinical service to solve a pharmacy-related problem. Students then "pitched" their idea to a panel of four faculty members who served as the "sharks" and graded the teams using a rubric. The rubric which was employed was mapped to the Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes. A pre- and post-activity survey was administered to students to gather information about changes in their perceptions of innovation and entrepreneurship in pharmacy. Results. Student groups received higher scores on their ability to present background information and the need for their clinical service and lower scores in areas such as tracking outcomes and predicting challenges. On the post-activity survey, 96.7% of students agreed that the activity gave them a better understanding of pharmacists' roles in establishing new clinical services, and 86.7% stated they intend to actively seek out new clinical pharmacy service opportunities in their future career. Conclusion. Results of the survey demonstrate that students understand the importance of innovation and entrepreneurship in pharmacy practice, and almost all students felt that the activity gave them an even better understanding of the pharmacist's role in clinical service development. This activity can serve as a blueprint for schools of pharmacy looking to incorporate creative and fun methods of exposing PharmD students to innovation and entrepreneurship activities.
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Affiliation(s)
- Amanda Mogul
- Binghamton University, School of Pharmacy and Pharmaceutical Sciences, Johnson City, New York
| | - Elizabeth Laughlin
- Binghamton University, School of Pharmacy and Pharmaceutical Sciences, Johnson City, New York
| | - Sarah Lynch
- Binghamton University, School of Pharmacy and Pharmaceutical Sciences, Johnson City, New York
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Tortajada-Goitia B, Morillo-Verdugo R, Margusino-Framiñán L, Marcos JA, Fernández-Llamazares CM. Survey on the situation of telepharmacy as applied to the outpatient care in hospital pharmacy departments in Spain during the COVID-19 pandemic. Farm Hosp 2020; 44:135-140. [PMID: 32646343 DOI: 10.7399/fh.11527] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE To analyze the status of the implementation and development of telepharmacy as applied to the pharmaceutical care of outpatients treated at hospital pharmacy services in Spain during the COVID-19 pandemic. METHOD Six weeks after the beginning of the confinement period, an online 10- question survey was sent to all members of the Spanish Society of Hospital Pharmacists. A single response per hospital was requested. The survey included questions on the provision of remote pharmaceutical care prior to the onset of the health crisis, patient selection criteria, procedures for home delivery of medications and the means used to deliver them, the number of patients who benefited from telepharmacy, and the number of referrals made. Finally, respondents were asked whether a teleconsultation was carried out before sending patients their medication and whether these deliveries were recorded. RESULTS A total of 39.3% (n = 185) of all the hospitals in the National Health System (covering all of Spain's autonomous regions) responded to the survey. Before the beginning of the crisis, 83.2% (n = 154) of hospital pharmacy services did not carry out remote pharmaceutical care activities that included telepharmacy with remote delivery of medication. During the study period, 119,972 patients were treated, with 134,142 deliveries of medication being completed. Most hospitals did not use patient selection criteria. A total of 30.2% of hospitals selected patients based on their personal circumstances. Home delivery and informed delivery (87%; 116,129 deliveries) was the option used in most cases. The means used to deliver the medication mainly included the use of external courier services (47.0%; 87 hospitals) or the hospital's own transport services (38.4%; 71 hospitals). As many as 87.6% of hospitals carried out teleconsultations prior to sending out medications and 59.6% recorded their telepharmacy activities in the hospital pharmacy appointments record. CONCLUSIONS The rate of implementation of telepharmacy in outpatient care in Spain during the study period in the pandemic was high. This made it possible to guarantee the continuity of care for a large number of patients.
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Affiliation(s)
| | - Ramón Morillo-Verdugo
- Hospital Universitario Virgen de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla. Spain..
| | | | - José Antonio Marcos
- Pharmacy Department, Hospital Universitario Virgen Macarena, Sevilla. Spain..
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Sheehan AH, Sprunger TL, Viswesh V, Gettig JP, Boyle J. The Current Landscape of College-Sponsored Postgraduate Teaching and Learning Curriculum Programs. Am J Pharm Educ 2020; 84:ajpe7803. [PMID: 32773833 PMCID: PMC7405296 DOI: 10.5688/ajpe7803] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/18/2019] [Indexed: 06/11/2023]
Abstract
Objective. To describe the landscape of teaching and learning curriculum (TLC) programs sponsored by US schools and colleges of pharmacy and evaluate their adoption of best practice recommendations. Methods. A 28-item electronic survey instrument was developed based on best practice recommendations published by the American Association of Colleges of Pharmacy (AACP), American Society of Health-System Pharmacists (ASHP), and American College of Clinical Pharmacy (ACCP) for the conduct of TLC programs. The survey instrument was electronically distributed to 137 accredited colleges and schools of pharmacy in the United States. Results. Eighty-eight institutions responded, resulting in a response rate of 64%. Sixty-one TLC programs were included in the final analysis. Seventy-five percent of TLC programs reported using best practice recommendations; however, 10% of respondents indicated they were not aware of the published recommendations. Inconsistencies among programs were noted in required teaching experiences, participant evaluation, and ongoing programmatic assessment. Conclusion. Most institutions offering TLC programs are aware of published best practice guidelines and have adopted a majority of the published best practices. However, considerable variability exists across the country. Development of a formal external validation process for TLC programs is necessary to ensure consistent quality.
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Affiliation(s)
| | - Tracy L. Sprunger
- Butler College of Pharmacy and Health Sciences, Indianapolis, Indiana
| | | | - Jacob P. Gettig
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois
| | - Jaclyn Boyle
- Northeast Ohio Medical University, Rootstown, Ohio
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Roberto G, Spini A, Bartolini C, Moscatelli V, Barchielli A, Paoletti D, Giorgi S, Fabbri A, Bocchia M, Donnini S, Gini R, Ziche M. Real word evidence on rituximab utilization: Combining administrative and hospital-pharmacy data. PLoS One 2020; 15:e0229973. [PMID: 32163477 PMCID: PMC7067445 DOI: 10.1371/journal.pone.0229973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/17/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To describe patterns of utilization, survival and infectious events in patients treated with rituximab at the University Hospital of Siena (UHS) to explore the feasibility of combining routinely collected administrative and hospital-pharmacy data for examining the real-world use of intravenous antineoplastic drugs. METHODS A retrospective, longitudinal cohort study was conducted using data from the Hospital Pharmacy of Siena (HPS) and the Regional Administrative Database of Tuscany (RAD). Patients aged ≥18 years with ≥1 rituximab administration recorded between January 2012 and June 2016 were identified in the HPS database. Anonymized patient-level data were linked to RAD. Rituximab utilization during the first year of treatment was described using HPS. Hospital diagnoses of adverse infectious events that occurred during the first year of follow-up and four-year survival were observed using RAD. RESULTS A total of 311 new users of rituximab were identified: 264 patients received rituximab for non-Hodgkin's lymphoma (NHL) and 47 were treated for chronic lymphocytic leukemia (CLL). Among new users with one complete year of follow-up (n = 203) over 95% received rituximab as the first-line treatment, and approximately 70% of them received 5-8 doses. No patient in the CLL group received >8 administrations. Four-year survival was approximately 70% in both CLL and NHL patients. Sepsis was the most frequent infectious event observed (5.1%). CONCLUSION HPS and RAD provided complementary information on rituximab utilization, demonstrating their potential for future pharmacoepidemiological studies on antineoplastic medications administered in the Italian hospital setting. Overall, this general description of the real-world utilization of rituximab in patients treated for NHL and CLL at UHS was in line with treatment guidelines and current knowledge on the rituximab safety profile.
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MESH Headings
- Administration, Intravenous
- Administrative Claims, Healthcare/statistics & numerical data
- Adolescent
- Adult
- Aged
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Databases, Factual/statistics & numerical data
- Drug Utilization/statistics & numerical data
- Female
- Follow-Up Studies
- Humans
- Infections/chemically induced
- Infections/epidemiology
- Infections/immunology
- Italy/epidemiology
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Longitudinal Studies
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/mortality
- Male
- Middle Aged
- Pharmacy Service, Hospital/statistics & numerical data
- Retrospective Studies
- Rituximab/administration & dosage
- Rituximab/adverse effects
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
| | - Andrea Spini
- Department of Medical Science, Surgery and Neuroscience, University of Siena, and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | | | - Davide Paoletti
- Farmacia Oncologica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Silvano Giorgi
- Farmacia Oncologica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Monica Bocchia
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Sandra Donnini
- Department of Life sciences, University of Siena, Siena, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | - Marina Ziche
- Department of Medical Science, Surgery and Neuroscience, University of Siena, and Azienda Ospedaliera Universitaria Senese, Siena, Italy
- * E-mail:
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Ali H, Rafi SMT, Ikram R, Zafar F, Naeem S, Rehman H, Nawab A, Baloch SA, Mallick N. Exploration of clinical management system: Career ladders, working model and reforms; a cross sectional estimate from Karachi, Pakistan. Pak J Pharm Sci 2020; 33:821-826. [PMID: 32863257] [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
Clinical and hospital pharmacy services are not just medical and pharmaceutical sciences but also occupy significant placement in healthcare system. Pakistan is a developing state with a huge prerequisite for changes in the general wellbeing framework, specially hospital and clinical aspect of pharmaceutical services. The principal intention of this study is to analyze the services offered by different pharmacies in hospitals of Karachi in terms of infrastructure and personnel service qualities. The study was conducted in a cross sectional way that included stratified sampling technique. Reactions were broken down utilizing descriptive and inferential insights of measurements. The fundamental result procedures incorporated the scope of hospital pharmacy services, the general recruitment of clinical drug specialists (pharmacist), the product and equipment used in hospital pharmacy services, the background of staff (educational), acquisition of proficient training mode, practical involvement and experience. The clinical pharmacy facilities coverage mutually on the departmental scale (median =22.43%) and patient scale (median =17.25%) do not comply the 100% coverage that is obligatory for standard practices. In addition, 48.65% of the pooled hospitals data has shown absence of distinct administration rules for hospital and clinical pharmacists, and 45.33% lacks the use of rational drug software. It is concluded that important parameters like drug monitoring, medication records keeping; appropriate drug information software's and quality assurance in hospitals still need attention for better patient outcomes.
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Affiliation(s)
- Huma Ali
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Rahila Ikram
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Farya Zafar
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Sadaf Naeem
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Hina Rehman
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Amber Nawab
- Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan
| | - Saba A Baloch
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
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Paolella D, Cherry E, Jolly JA, DeClercq J, Choi L, Zuckerman A. Closing the Gap: Identifying Rates and Reasons for Nonadherence in a Specialty Population. J Manag Care Spec Pharm 2019; 25:1282-1288. [PMID: 31663457 PMCID: PMC10398139 DOI: 10.18553/jmcp.2019.25.11.1282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/05/2022]
Abstract
BACKGROUND Adherence to specialty and nonspecialty medications is often calculated using pharmacy claims data. However, specialty medication regimens are complex and may require periods of intentional gaps in therapy. Common adherence calculations are insufficient in identifying reasons for gaps in therapy. Because adherence reporting is a growing measure of quality care for specialty pharmacy accreditation and payer and manufacturer contracts, a better understanding of the rates and reasons for nonadherence within a specialty population is needed. OBJECTIVE To identify rates and reasons for misidentified and true nonadherence in patients who are prescribed specialty medications. METHODS A single center, retrospective cohort study was conducted using pharmacy claims data between March 2017 and February 2018. Medication adherence was calculated using proportion of days covered (PDC). Electronic medical records of a random 10% sample of nonadherent patients (PDC < 80%) were manually reviewed to identify reasons for nonadherence. Patients were then classified as either (a) misidentified as nonadherent (i.e., a provider-directed discontinuation or disruption of treatment that varies from the prescribed administration schedule or transfer of the prescription to an external pharmacy) or (b) truly nonadherent (discontinuation or disruption of treatment that varies from the prescribed administration instruction that is not directed or recommended by the provider or health care team). RESULTS Of the 7,488 included prescription records from 18 specialty areas, 1,059 met criteria for nonadherence. 105 prescription records (representing 105 unique patients) were manually reviewed; most of these patients (58%) were truly nonadherent, driven by inability to contact patients for refills (59%). However, 40% were misidentified as nonadherent, most due to provider-directed medication holding (69%). Two percent of patients were nonadherent for unknown reasons. CONCLUSIONS Many patients classified as nonadherent based on pharmacy claims experienced gaps in therapy due to medically appropriate reasons. Methods to better measure and identify true nonadherence are needed to efficiently and adequately affect specialty medication adherence behavior. DISCLOSURES This study received funding support from CTSA Award No. UL1 TR002243 from the National Center for Advancing Translational Sciences. Study findings and conclusions are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. Zuckerman reports research support from Sanofi and Gilead Sciences, unrelated to this study. The other authors have nothing to disclose. A poster based on the data from this study was presented at AMCP Nexus 2018 on October 24, 2018, in Orlando, FL.
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Affiliation(s)
| | - Elizabeth Cherry
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacob A. Jolly
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua DeClercq
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leena Choi
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Autumn Zuckerman
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
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Darcissac C, Duvert L, Hoegy D, Chappuy M, Pivot C, Janoly-Dumenil A. [Prospective risk analysis in a retrocession unit: Focus on drug dispensation process]. Ann Pharm Fr 2019; 78:12-20. [PMID: 31564422 DOI: 10.1016/j.pharma.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/25/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Failure mode effect analysis (FMEA) improves safety in the drug life cycle. As the drug dispensation by hospital's pharmacy can be at risk, the FMEA tool has been used to evaluate and enhance the process. METHODS After detailing the process, a first FMEA has been run in 2015. Corrective actions were implemented every time criticality indexes (CI) were above 15. One year later, we have evaluated potential impacts of these actions by running a new FMEA. RESULTS In 2015, 11 failure modes were prioritized (CI>15) and the total CI for the overall process was 397. Corrective actions were implemented and one year later this amount has decreased by 14% (340) with 6 failure modes still prioritized. Thus, thanks to the FMEA, risks could be identified in year "y", they were taken into account and corrected and then effectively reassessed in year "y+1". CONCLUSION This study showed us the interest of performing FMEA analysis in the drug dispensation process by hospital. The renewal of this risk analysis after a year helped us to monitor corrective actions, to evaluate their effectiveness and to improve safety. Finally, FMEA seems to be an effective way to steer the drug dispensation process.
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Affiliation(s)
- C Darcissac
- Pharmacie hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
| | - L Duvert
- Pharmacie hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - D Hoegy
- Pharmacie hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Claude-Bernard Lyon 1, 6, avenue Rockefeller, 69008 Lyon, France; EA 4129 parcours santé systémique, faculté de médecine Laënnec, 7-11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France
| | - M Chappuy
- Pharmacie hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - C Pivot
- Pharmacie hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - A Janoly-Dumenil
- Pharmacie hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Claude-Bernard Lyon 1, 6, avenue Rockefeller, 69008 Lyon, France; EA 4129 parcours santé systémique, faculté de médecine Laënnec, 7-11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France
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11
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Leroy V, Freyssenge J, Renard F, Tazarourte K, Négrier C, Chamouard V. Access to treatment among persons with hemophilia: A spatial analysis assessment in the Rhone-Alpes region, France. J Am Pharm Assoc (2003) 2019; 59:797-803. [PMID: 31405805 DOI: 10.1016/j.japh.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/23/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES In France, only hospital pharmacies can dispense clotting factor concentrates to persons with hemophilia, which limits the access to care for the treatment and the prevention of bleeding episodes. Moreover, the cost of clotting factor concentrates may restrain the maintenance of sufficient stocks in hospital pharmacies. The aim of this study was to investigate the accessibility of clotting factor concentrates to persons with hemophilia in the context of long-term prophylaxis and emergency treatment in the Rhone-Alpes region of France. METHODS A geographic information system was used for evaluating accessibility of clotting factor concentrates. Persons with hemophilia and hospital pharmacies were geolocalized with the use of postal data, and the evaluation of accessibility was based on the road network. RESULTS Approximately 72% of the study area was accessible in less than 30 minutes to a hospital pharmacy. Eighty-five percent of persons with hemophilia had access to clotting factor concentrates for prophylactic treatment in less than 20 minutes. Most of them were patients with severe or moderate hemophilia. Regarding emergency doses, factor VIII was accessible in less than 30 minutes in 45.6% of the study area, and factor IX in 30.5%. CONCLUSION This study highlights that spatial access to clotting factor concentrates by persons with hemophilia in the Rhône-Alpes region is good for prophylactic treatment but is more uneven for emergency doses.
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Hernandez I, Good CB, Gellad WF, Parekh N, He M, Shrank WH. Number of manufacturers and generic drug pricing from 2005 to 2017. Am J Manag Care 2019; 25:348-352. [PMID: 31318508 PMCID: PMC6734551] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate how changes in generic drug prices and the incidence of abrupt price increases varied with the number of manufacturers supplying each drug. STUDY DESIGN Analysis of 2005 to 2016 monthly wholesale acquisition costs (WACs) and University of Pittsburgh Medical Center Health Plan counts of pharmacy claims for National Drug Codes (NDCs) for generic drugs. METHODS Each year, NDCs were categorized according to the number of manufacturers offering each combination of active ingredient and dosage form: 1 to 3, 4 to 7, and more than 7. For every month from January 2006 to January 2017, we estimated the 12-month change in WAC (eg, 12-month change in January 2006 was calculated as the difference in WAC between January 2006 and January 2005, divided by the WAC in January 2005), before and after weighting each NDC by counts of pharmacy claims. We evaluated the proportion of NDCs that had large price increases, greater than 20%, 50%, 100%, and 500% within a year. RESULTS Before 2010, price changes were higher for drugs supplied by a lower number of manufacturers; however, after 2010, prices increased sharply, and drugs supplied by 4 to 7 manufacturers showed increases similar to or higher than those supplied by 1 to 3. In 2013, prices increased by an average of 29% for drugs supplied by 1 to 3 and 4 to 7 manufacturers, and 10% for more than 7. Price changes increased after weighting by counts of pharmacy claims, demonstrating that price increases disproportionately affected widely used drugs. The proportion of NDCs from drugs supplied by 1 to 3 manufacturers that doubled in price within a year was 3.6 times higher in 2012 to 2015 than in 2005 to 2009 (4.6% vs 1.3%, respectively). CONCLUSIONS Increases in generic drug prices are concerning because they affected widely used drugs and suggest that generic drug prices may be increasingly insensitive to competition.
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Affiliation(s)
- Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 3501 Terrace St, 637 Salk Hall, Pittsburgh, PA 15261.
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13
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Rigter IM, Bos JM, Kemper EM. [Availability in hospitals of medicines for acute cases]. Ned Tijdschr Geneeskd 2019; 163:D3950. [PMID: 31141322] [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: 06/09/2023]
Abstract
Availability in hospitals of medicines for acute cases In acute situations it is important that essential medication is readily available. In this comment we discuss various challenges in determining the assortment of medicines that should be available, and the logistic and administrative obstacles for pharmacists when delivering unregistered medicines such as artesunate. With centralization of (emergency) care, we must ask ourselves whether every hospital pharmacy should have a wide range of medicines in stock. Regional and national agreements on the availability of essential medication for acute situations are essential, and establishing these should be a joint responsibility of physicians and pharmacists.
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Affiliation(s)
| | | | - E Marleen Kemper
- Amsterdam UMC, Ziekenhuisapotheek, Amsterdam
- Contact: E.M. Kemper
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14
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Foster AR, Gatewood SS, Kaefer TN, Goode JVKR. Decision-maker and staff perceptions of the pharmacist's role in transitions of care programs. J Am Pharm Assoc (2003) 2019; 59:S101-S105. [PMID: 31080151 DOI: 10.1016/j.japh.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To identify perceptions of decision-makers and staff at a local hospital about the pharmacist's role in transitions of care (TOC) programs. SETTING Independent community pharmacy located inside a local community hospital. PRACTICE DESCRIPTION Pharmacy personnel offer a bedside delivery service to hospital patients and have professional relationships with administration. PRACTICE INNOVATION Pharmacy personnel intend to expand the bedside delivery service to a comprehensive TOC program. Researchers believed it would be important to gather the perceptions of pharmacist's role in TOC programs from nonpharmacist clinicians and administration to successfully develop the program. EVALUATION This project would identify perceptions to help develop a TOC program. METHODS A 22-question survey was developed after consulting with key staff and informed by literature regarding TOC and pharmacists' roles in patient care services. Collected demographic information included primary department, number of years worked at the institution, and involvement in TOC. After an 8-week survey distribution period, descriptive statistics were performed on the data collected. RESULTS A total of 13 decision-makers and staff responded to the survey with a response rate of 87%. Eleven of 12 respondents (92%) thought that pharmacists should be involved in TOC and can be the communication link between patients and other health care providers to ensure continuity of care. All of the participants thought that pharmacists should provide medication reconciliation and patient and caregiver education through TOC services. The participants were less likely to think that pharmacists should offer follow-up care after discharge. CONCLUSION Participants agreed that pharmacists should be involved in TOC services but had varied perceptions on the pharmacist's specific role. Decision-maker and staff perceptions identified in this study will be used to develop the pharmacist's role in a TOC program at the institution.
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Yailian AL, Revel E, Tardy C, Fontana A, Estublier C, Decullier E, Dussart C, Chapurlat R, Pivot C, Janoly-Dumenil A. Assessment of the clinical relevance of pharmacists' interventions performed during medication review in a rheumatology ward. Eur J Intern Med 2019; 59:91-96. [PMID: 30482636 DOI: 10.1016/j.ejim.2018.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pharmacists contribute to reduce the number of medication errors during medication review. Nevertheless, few French studies report the potential clinical impact of pharmacists' interventions performed after detecting drug-related problems. The objective was to evaluate the clinical relevance of pharmacists' interventions in a rheumatology ward from medical and pharmaceutical perspectives. METHOD The analysis was conducted on pharmacists' interventions performed between January 1 and December 31, 2015 in a French teaching hospital. Similar pharmacists' interventions were grouped in one item and they were analysed according to 11 drug categories. The clinical significance of pharmacists' interventions was considered independently by a pharmacist and a rheumatologist using a validated French scale that categorises drug-related problems from minor to catastrophic. The agreement between the two professionals was analysed using the weighted kappa coefficient. RESULTS Of 1313 prescriptions reviewed, 461 pharmacists' interventions (171 items) were formulated for drug-related problems with an acceptance rate of 67.2%. Of the 418 interventions selected for clinical significance analysis, 235 interventions (56.2%) for the physician and 400 interventions (95.7%) for the pharmacist were at least significant. The two professionals evaluated equally the clinical relevance of 90 items (50.6%). The categories with the most similarities were the analgesics/anti-inflammatory drugs (78.1%), the antidiabetics (75.0%) and the anticoagulants (71.4%). The agreement was estimated by a weighted kappa coefficient of 0.29. CONCLUSION This work highlights the positive clinical relevance of pharmacists' interventions in rheumatology and the importance of medico-pharmaceutical collaboration to prevent medication errors.
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Affiliation(s)
- Anne-Laure Yailian
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; Claude Bernard University Lyon 1, EA 4129 P2S Parcours Santé Systémique, 7-11 rue Guilllaume Paradin, 69008 Lyon, France.
| | - Elsa Revel
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France
| | - Cléa Tardy
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France
| | - Aurélie Fontana
- Department of Rheumatology, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; INSERM UMR 1033, Claude Bernard University Lyon 1, Laennec Faculty of Medicine, 7-11 rue Guillaume Paradin, 69008 Lyon, France
| | - Charline Estublier
- Department of Rheumatology, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; INSERM UMR 1033, Claude Bernard University Lyon 1, Laennec Faculty of Medicine, 7-11 rue Guillaume Paradin, 69008 Lyon, France
| | - Evelyne Decullier
- Department of Medical Information, Evaluation and Research, Clinical Research Unit, Hospices Civils de Lyon, 162 avenue Lacassagne, 69003 Lyon, France
| | - Claude Dussart
- Claude Bernard University Lyon 1, EA 4129 P2S Parcours Santé Systémique, 7-11 rue Guilllaume Paradin, 69008 Lyon, France
| | - Roland Chapurlat
- Department of Rheumatology, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; INSERM UMR 1033, Claude Bernard University Lyon 1, Laennec Faculty of Medicine, 7-11 rue Guillaume Paradin, 69008 Lyon, France
| | - Christine Pivot
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France
| | - Audrey Janoly-Dumenil
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; Claude Bernard University Lyon 1, EA 4129 P2S Parcours Santé Systémique, 7-11 rue Guilllaume Paradin, 69008 Lyon, France; Claude Bernard University Lyon 1, Faculty of Pharmacy, 8 avenue Rockefeller, 69008 Lyon, France
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Williams M, Jordan A, Scott J, Jones MD. Operating a patient medicines helpline: a survey study exploring current practice in England using the RE-AIM evaluation framework. BMC Health Serv Res 2018; 18:868. [PMID: 30454023 PMCID: PMC6245845 DOI: 10.1186/s12913-018-3690-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 03/07/2018] [Accepted: 11/05/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patient medicines helplines provide a means of accessing medicines-related support following hospital discharge. However, it is unknown how many National Health Service (NHS) Trusts currently provide a helpline, nor how they are operated. Using the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), we sought to obtain key data concerning the provision and use of patient medicines helplines in NHS Trusts in England. This included the extent to which the delivery of helplines meet with national standards that are endorsed by the Royal Pharmaceutical Society (standards pertaining to helpline access, availability, and promotion). METHODS An online survey was sent to Medicines Information Pharmacists and Chief Pharmacists at all 226 acute, mental health, specialist, and community NHS Trusts in England in 2017. RESULTS Adoption: Fifty-two percent of Trusts reported providing a patient medicines helpline (acute: 67%; specialist: 41%; mental health: 29%; community: 18%). Reach: Helplines were predominantly available for discharged inpatients, outpatients, and carers (98%, 95% and 93% of Trusts, respectively), and to a lesser extent, the local public (22% of Trusts). The median number of enquiries received per week was five. IMPLEMENTATION For helpline access, 54% of Trusts reported complying with all 'satisfactory' standards, and 26% reported complying with all 'commendable' standards. For helpline availability, the percentages were 86% and 5%, respectively. For helpline promotion, these percentages were 3% and 40%. One Trust reported complying with all standards. Maintenance: The median number of years that helplines had been operating was six. Effectiveness: main perceived benefits included patients avoiding harm, and improving patients' medication adherence. CONCLUSIONS Patient medicines helplines are provided by just over half of NHS Trusts in England. However, the proportion of mental health and community Trusts that operate a helpline is less than half of that of the acute Trusts, and there are regional variations in helpline provision. Adherence to the national standards could generally be improved, although the lowest adherence was regarding helpline promotion. Recommendations to increase the use of helplines include increasing the number of promotional methods used, the number of ways to contact the service, and the number of hours that the service is available.
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Affiliation(s)
- Matt Williams
- Department of Pharmacy & Pharmacology, University of Bath, 5 West, Claverton Down, Bath, BA2 7AY UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath, BA2 7AY UK
| | - Jenny Scott
- Department of Pharmacy & Pharmacology, University of Bath, 5 West, Claverton Down, Bath, BA2 7AY UK
| | - Matthew D. Jones
- Department of Pharmacy & Pharmacology, University of Bath, 5 West, Claverton Down, Bath, BA2 7AY UK
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de Barra M, Scott CL, Scott NW, Johnston M, de Bruin M, Nkansah N, Bond CM, Matheson CI, Rackow P, Williams AJ, Watson MC. Pharmacist services for non-hospitalised patients. Cochrane Database Syst Rev 2018; 9:CD013102. [PMID: 30178872 PMCID: PMC6513292 DOI: 10.1002/14651858.cd013102] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND This review focuses on non-dispensing services from pharmacists, i.e. pharmacists in community, primary or ambulatory-care settings, to non-hospitalised patients, and is an update of a previously-published Cochrane Review. OBJECTIVES To examine the effect of pharmacists' non-dispensing services on non-hospitalised patient outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases and two trial registers in March 2015, together with reference checking and contact with study authors to identify additional studies. We included non-English language publications. We ran top-up searches in January 2018 and have added potentially eligible studies to 'Studies awaiting classification'. SELECTION CRITERIA Randomised trials of pharmacist services compared with the delivery of usual care or equivalent/similar services with the same objective delivered by other health professionals. DATA COLLECTION AND ANALYSIS We used standard methodological procedures of Cochrane and the Effective Practice and Organisation of Care Group. Two review authors independently checked studies for inclusion, extracted data and assessed risks of bias. We evaluated the overall certainty of evidence using GRADE. MAIN RESULTS We included 116 trials comprising 111 trials (39,729 participants) comparing pharmacist interventions with usual care and five trials (2122 participants) comparing pharmacist services with services from other healthcare professionals. Of the 116 trials, 76 were included in meta-analyses. The 40 remaining trials were not included in the meta-analyses because they each reported unique outcome measures which could not be combined. Most trials targeted chronic conditions and were conducted in a range of settings, mostly community pharmacies and hospital outpatient clinics, and were mainly but not exclusively conducted in high-income countries. Most trials had a low risk of reporting bias and about 25%-30% were at high risk of bias for performance, detection, and attrition. Selection bias was unclear for about half of the included studies.Compared with usual care, we are uncertain whether pharmacist services reduce the percentage of patients outside the glycated haemoglobin target range (5 trials, N = 558, odds ratio (OR) 0.29, 95% confidence interval (CI) 0.04 to 2.22; very low-certainty evidence). Pharmacist services may reduce the percentage of patients whose blood pressure is outside the target range (18 trials, N = 4107, OR 0.40, 95% CI 0.29 to 0.55; low-certainty evidence) and probably lead to little or no difference in hospital attendance or admissions (14 trials, N = 3631, OR 0.85, 95% CI 0.65 to 1.11; moderate-certainty evidence). Pharmacist services may make little or no difference to adverse drug effects (3 trials, N = 590, OR 1.65, 95% CI 0.84 to 3.24) and may slightly improve physical functioning (7 trials, N = 1329, mean difference (MD) 5.84, 95% CI 1.21 to 10.48; low-certainty evidence). Pharmacist services may make little or no difference to mortality (9 trials, N = 1980, OR 0.79, 95% CI 0.56 to 1.12, low-certaintly evidence).Of the five studies that compared services delivered by pharmacists with other health professionals, no studies evaluated the impact of the intervention on the percentage of patients outside blood pressure or glycated haemoglobin target range, hospital attendance and admission, adverse drug effects, or physical functioning. AUTHORS' CONCLUSIONS The results demonstrate that pharmacist services have varying effects on patient outcomes compared with usual care. We found no studies comparing services delivered by pharmacists with other healthcare professionals that evaluated the impact of the intervention on the six main outcome measures. The results need to be interpreted cautiously because there was major heterogeneity in study populations, types of interventions delivered and reported outcomes.There was considerable heterogeneity within many of the meta-analyses, as well as considerable variation in the risks of bias.
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Affiliation(s)
- Mícheál de Barra
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Claire L Scott
- NHS Education for ScotlandScottish Dental Clinical Effectiveness ProgrammeDundee Dental Education CentreSmall's WyndDundeeUKDD1 4HN
| | - Neil W Scott
- University of AberdeenMedical Statistics TeamPolwarth BuildingForesterhillAberdeenScotlandUKAB 25 2 ZD
| | - Marie Johnston
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Marijn de Bruin
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Nancy Nkansah
- University of CaliforniaClinical Pharmacy155 North Fresno Street, Suite 224San FranciscoCaliforniaUSA93701
| | - Christine M Bond
- University of AberdeenDivision of Applied Health SciencesPolwarth BuildingForesterhillAberdeenUKAB25 2ZD
| | | | - Pamela Rackow
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - A. Jess Williams
- Nottingham Trent UniversitySchool of PsychologyNottinghamEnglandUK
| | - Margaret C Watson
- University of BathDepartment of Pharmacy and Pharmacology5w 3.33Claverton DownBathUKBA2 7AY
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Bao Z, Ji C, Hu J, Luo C, Fang W. Clinical and economic impact of pharmacist interventions on sampled outpatient prescriptions in a Chinese teaching hospital. BMC Health Serv Res 2018; 18:519. [PMID: 29973200 PMCID: PMC6031100 DOI: 10.1186/s12913-018-3306-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/20/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited studies have evaluated the effectiveness of pharmacist interventions on outpatient prescription. The goal of this study was to evaluate the clinical and economic impacts of pharmacist interventions on randomly sampled outpatient prescriptions. METHOD Outpatient prescriptions of our hospital were sampled automatically and reviewed by pharmacists since 2011. Pharmacists intervened in inappropriate prescriptions (IPs) real-timely, and summarized and analyzed the information monthly. Cost-benefit analysis was performed to estimate the economic benefit of the pharmacist intervention. RESULTS From 2011 to 2016, pharmacists reviewed 101,271 prescriptions and intervened in 5155 prescriptions. With the interventions of pharmacists, the number of IPs decreased from 1845 to 238, while the inappropriate percentage decreased from 12.60 to 1.22%. The inappropriate rates of different departments and the types decreased annually. IPs were mainly from the Department of Medicine and Department of Surgery and category 1 (Non-indicated medications) in all years. The benefit-to-cost ratios of pharmacist interventions were always more than 1. In the same years, the benefit-to-cost ratios in public payments were higher than those with insurance and self-payment. CONCLUSION This form of pharmacist intervention constitutes a method that showed positive clinical and economic benefits and is worth expanding in large hospitals. Pharmacists should pay more attention on prescriptions in department of surgery or prescriptions with public payments.
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Affiliation(s)
- Zhiwei Bao
- Department of Pharmacy, Jiangsu Jianhu People’s Hospital, Yancheng, 224700 China
| | - Chunmei Ji
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Jing Hu
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Can Luo
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Wentong Fang
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
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Valero-García S, Poveda-Andrés JL. Hazardous drugs levels in compounding area surfaces of Hospital Pharmacies Services: multicentric study. Farm Hosp 2018; 42:152-158. [PMID: 29959839 DOI: 10.7399/fh.10935] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Hazardous drugs presence at Hospital Pharmacies has been demonstrated in numerous studies. This study aims to analyze the presence and levels of hazardous drugs at Spanish Hospital Pharmacies and the influence of different aspects on them. METHOD We developed a cross test at Hospital Pharmacies hazardous drugs compounding surfaces of ten Spanish hospitals. An independent laboratory determined cyclophosphamide, iphosphamide and 5-fluorouracile levels in samples recovered. Annual number of hazardous drugs compounded, as well as the number of preparations developed the testing day was registered. We also registered cleaning and decontamination processes and the drug transfer device used at each hospital. RESULTS 204 samples were analyzed. Hazardous drugs presence was confirmed in all participant hospitals. We observed a 49%, 23% and 10% of positive samples for cyclophosphamide, iphosphamide and 5-fluorouracile. Median levels (first-third quartile) of cyclophosphamide, iphosphamide and 5-fluorouracile were 0.05 ng/cm2 (0.03-0.23), 0.03 ng/cm2 (0.03- 0.06) y 0.31 ng/cm2 (0.3- 0.59) respectively. CONCLUSIONS Present study confirms hazardous drugs presence at Spanish Hospital Pharmacies departments. We observed a significant variability between participant hospitals, as well as between tested locations. Samples with more positive results were cabine airfoils and floors in front of them. The number of preparations had no influence on results observed. Variability observed points outs the need to standardized compounding hazardous drugs processes.
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Abstract
Over a million smokers are admitted to hospitals in the UK each year. The extent to which tobacco dependence is identified and addressed in this population is unclear. Data on 14,750 patients from 146 hospitals collected for the British Thoracic Society smoking cessation audit were analysed to determine smoking prevalence, attempts to ask smokers about quitting, and referrals to smoking cessation services. Associations with hospital organisational factors were assessed by logistic regression. Overall hospital smoking prevalence was 25%. Only 28% of smokers were asked whether they would like to quit, and only one in 13 smokers was referred for treatment of tobacco dependence. There was a higher chance of smokers being asked about quitting in organisations with smoke-free sites, dedicated smoking cessation practitioners, regular staff training, and availability of advanced pharmacotherapy. Treatment of tobacco dependence in smokers attending UK hospitals is poor and could be associated with organisational factors.
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Affiliation(s)
| | | | - Laura Searle
- Quality Improvement and Clinical Audit, British Thoracic Society, London, UK
| | - Anna Lewis
- Cwm Taf University Health Board, Wales, Abercynon, UK
| | - Sanjay Agrawal
- Institute for Lung Health, Glenfield Hospital, Leicester, UK
| | - on behalf of the British Thoracic Society
- Sherwood Forest Hospitals, Nottinghamshire, UK
- North Middlesex Hospital, London, UK
- Quality Improvement and Clinical Audit, British Thoracic Society, London, UK
- Cwm Taf University Health Board, Wales, Abercynon, UK
- Institute for Lung Health, Glenfield Hospital, Leicester, UK
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Santos TR, Penm J, Baldoni AO, Ayres LR, Moles R, Sanches C. Hospital pharmacy workforce in Brazil. Hum Resour Health 2018; 16:1. [PMID: 29301559 PMCID: PMC5755413 DOI: 10.1186/s12960-017-0265-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/15/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study aims to describe the distribution of the hospital pharmacy workforce in Brazil. METHODS Data were acquired, during 2016, through the Brazilian National Database of Healthcare Facilities (CNES). The following variables were extracted: hospital name, registry number, telephone, e-mail, state, type of institution, subtype, management nature, ownership, presence of research/teaching activities, complexity level, number of hospital beds, presence of pharmacists, number of pharmacists, pharmacist specialization. All statistical analyses were performed by IBM SPSS v.19. RESULTS The number of hospitals with a complete registry in the national database was 4790. The majority were general hospitals (77.9%), managed by municipalities (66.1%), under public administration (44.0%), had no research/teaching activities (90.5%), classified as medium complexity (71.6%), and had no pharmacist in their team (50.6%). Furthermore, almost 60.0% of hospitals did not comply with the minimum recommendations of having a pharmacist per 50 hospital beds. The Southeast region had the highest prevalence of pharmacists, with 64.4% of hospitals having a pharmaceutical professional. This may have occurred as this region had the highest population to hospital ratio. Non-profit hospitals were more likely to have pharmacists compared to those under public administration and private hospitals. CONCLUSION This study mapped the hospital pharmacy workforce in Brazil, showing a higher prevalence of hospital pharmacists in the Southeast region, and in non-profit specialized hospitals.
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Affiliation(s)
- Thiago R Santos
- Federal University of Sao Joao del Rei, Campus Centro-Oeste Dona Lindu, Av. Sebastião Gonçalves Coelho, 400 - Chanadour, Divinópolis, MG, CEP 35.501-296, Brazil
| | - Jonathan Penm
- Hospital Pharmacy Section, International Pharmaceutical Federation, The Hague, The Netherlands
- Faculty of Pharmacy, University of Sydney, Camperdown, NSW, Australia
| | - André O Baldoni
- Federal University of Sao Joao del Rei, Campus Centro-Oeste Dona Lindu, Av. Sebastião Gonçalves Coelho, 400 - Chanadour, Divinópolis, MG, CEP 35.501-296, Brazil
| | - Lorena Rocha Ayres
- Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Rebekah Moles
- Hospital Pharmacy Section, International Pharmaceutical Federation, The Hague, The Netherlands
- Faculty of Pharmacy, University of Sydney, Camperdown, NSW, Australia
| | - Cristina Sanches
- Federal University of Sao Joao del Rei, Campus Centro-Oeste Dona Lindu, Av. Sebastião Gonçalves Coelho, 400 - Chanadour, Divinópolis, MG, CEP 35.501-296, Brazil.
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Papastergiou J, Kheir N, Ladova K, Rydant S, De Rango F, Antoniou S, Viola R, Murillo MD, Steurbaut S, da Costa FA. Pharmacists' confidence when providing pharmaceutical care on anticoagulants, a multinational survey. Int J Clin Pharm 2017; 39:1282-1290. [PMID: 29139019 PMCID: PMC5694509 DOI: 10.1007/s11096-017-0551-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 05/17/2017] [Accepted: 10/21/2017] [Indexed: 02/07/2023]
Abstract
Background Guidelines on the management of orally anticoagulated patients are continuously evolving, leading to an increased need for pharmacists to be fully integrated in care provision. Objective To identify self-reported gaps in confidence among practicing pharmacists in the area of anticoagulation. Setting Pharmacists in different work settings in different countries. Method Cross-sectional international survey from October 2015 till November 2016 among pharmacists working in different settings to assess their level of confidence when delivering anticoagulants as well as to identify possible educational needs regarding this medication class. Validation of the survey was ensured. Results Responses from 4212 pharmacists originating from 18 countries were obtained. Pharmacists' level of confidence was significantly higher (p < 0.001) when advising patients on vitamin K antagonists (VKAs) versus non-vitamin K antagonists (NOACs). In general, hospital pharmacists displayed higher confidence levels compared to community pharmacists when advising patients on anticoagulation (p < 0.001). Two distinct patterns of confidence levels emerged relating to basic and advanced pharmaceutical care. Confidence levels when providing advanced pharmaceutical care were significantly higher for Oceania and lower for South America (p < 0.005). Conclusions Pharmacists felt more confident in supporting patients receiving VKAs compared to the more recently introduced NOACs. With the increasing use of NOACs and the risks pertaining to anticoagulation therapy, it is essential to invest in education for pharmacists to address their knowledge gaps enabling them to confidently support patients receiving oral anticoagulants.
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Affiliation(s)
- John Papastergiou
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M4J 1L2, Canada
- School of Pharmacy, University of Waterloo, 755 Danforth Avenue, Toronto, ON, M4J 1L2, Canada
| | - Nadir Kheir
- College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar
| | - Katerina Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovskeho 1203, 500 05, Hradec Kralove, Czech Republic
| | - Silas Rydant
- Pharmaceutical Care Division (Meduca), Royal Pharmacists Association of Antwerp (KAVA), Lange Leemstraat 187, 2018, Antwerpen, Belgium
| | - Fabio De Rango
- Shoppers Drug Mart 1271, 2501 Third Line, Oakville, ON, L6M 5A9, Canada
| | - Sotiris Antoniou
- Barts Health Centre; Barts Health NHS Trust, London, UK
- UCL Partners, London, UK
| | - Reka Viola
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikrautca 8, Szeged, 6724, Hungary
| | - Maria Dolores Murillo
- Farmacia Fernández Vega C.B., C/Par nº 26 Urbanización Club de Golf. Alcalá de Guadaira, Sevilla, 41500, Spain
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology& Clinical Pharmacy (KFAR), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal.
- Portuguese Pharmaceutical Society (PPS), Rua da Sociedade Farmacêutica, 18, 1169-075, Lisboa, Portugal.
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Yao D, Xi X, Huang Y, Hu H, Hu Y, Wang Y, Yao W. A national survey of clinical pharmacy services in county hospitals in China. PLoS One 2017; 12:e0188354. [PMID: 29190816 PMCID: PMC5708790 DOI: 10.1371/journal.pone.0188354] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 11/05/2017] [Indexed: 12/03/2022] Open
Abstract
Background Clinical pharmacy is not only a medical science but also an elaborate public health care system firmly related to its subsystems of education, training, qualification authentication, scientific research, management, and human resources. China is a developing country with a tremendous need for improvements in the public health system, including the clinical pharmacy service system. Objectives The aim of this research was to evaluate the infrastructure and personnel qualities of clinical pharmacy services in China. Setting Public county hospitals in China. Materials and method A national survey of clinical pharmacists in county hospitals was conducted. It was sampled through a stratified sampling strategy. Responses were analyzed using descriptive and inferential statistics. The main outcome measures include the coverage of clinical pharmacy services, the overall staffing of clinical pharmacists, the software and hardware of clinical pharmacy services, the charge mode of clinical pharmacy services, and the educational background, professional training acquisition, practical experience, and entry path of clinical pharmacists. Results The overall coverage of clinical pharmacy services on both the department scale (median = 18.25%) and the patient scale (median = 15.38%) does not meet the 100% coverage that is required by the government. In 57.73% of the sample hospitals, the staffing does not meet the requirement, and the size of the clinical pharmacist group is smaller in larger hospitals. In addition, 23.4% of the sample hospitals do not have management rules for the clinical pharmacists, and 43.1% do not have rational drug use software, both of which are required by the government. In terms of fees, 89.9% of the sample hospitals do not charge for the services. With regard to education, 8.5% of respondents are with unqualified degree, and among respondents with qualified degree, 37.31% are unqualified in the major; 43% of respondents lack the clinical pharmacist training required by the government. Most respondents (93.5%) have a primary or medium professional title. The median age and work seniority of respondents are 31 and four years, respectively. Only 18.5% of respondents chose this occupation by personal consideration or willingness. Conclusions The main findings in this research include the overall low coverage of clinical pharmacy services, the low rate of clinical pharmacy service software, hardware, and personnel as well as a wide variance in educational training of pharmacists at county hospitals.
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Affiliation(s)
- Dongning Yao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Xiaoyu Xi
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing City, Jiangsu Province, China
| | - Yuankai Huang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing City, Jiangsu Province, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yuanjia Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yitao Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
- * E-mail: (YW); (WY)
| | - Wenbing Yao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing City, Jiangsu Province, China
- * E-mail: (YW); (WY)
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Abstract
OBJECTIVE To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS This study considered pre- (January-August 2013) and post- (October 2013-October 2014) intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$) and US dollars (USD). RESULTS The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444) during the first year. The initial investment (R$ 206,065; USD 88,592) would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers.
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Affiliation(s)
| | - José Luiz Alvim-Borges
- Instituto de Ensino e Pesquisa, Hospital Sirio-Libanes (HSL), Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Cristiana Maria Toscano
- Departamento de Saude Coletiva, Instituto de Patologia Tropical e Saude Publica, Universidade Federal de Goias, Goiania, GO, BR
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Li Z, Cheng B, Zhang K, Xie G, Wang Y, Hou J, Chu L, Zhao J, Xu Z, Lu Z, Sun H, Zhang J, Wang Z, Wu H, Fang X. Pharmacist-driven antimicrobial stewardship in intensive care units in East China: A multicenter prospective cohort study. Am J Infect Control 2017; 45:983-989. [PMID: 28596021 DOI: 10.1016/j.ajic.2017.02.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 01/15/2017] [Revised: 01/17/2017] [Accepted: 02/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antimicrobial stewardship programs, particularly pharmacist-driven programs, help reduce the unnecessary use of antimicrobial agents. The objective of this study was to assess the influence of pharmacist-driven antimicrobial stewardship on antimicrobial use, multidrug resistance, and patient outcomes in adult intensive care units in China. METHOD We conducted a multicenter prospective cohort study with a sample of 577 patients. A total of 353 patients were included under a pharmacist-driven antimicrobial stewardship program, whereas the remaining 224 patients served as controls. The primary outcome was all-cause hospital mortality. RESULTS The pharmacist-driven antimicrobial stewardship program had a lower hospital mortality rate compared with the nonpharmacist program (19.3% vs 29.0%; P = .007). Furthermore, logistic regression analysis indicated that the pharmacist-driven program independently predicted hospital mortality (odds ratio, 0.57; 95% confidence interval, 0.36-0.91; P = .017) after adjustment. Meanwhile, this strategy had a lower rate of multidrug resistance (23.8% vs 31.7%; P = .037). Moreover, the strategy optimized antimicrobial use, such as having a shorter duration of empirical antimicrobial therapy (2.7 days; interquartile range [IQR], 1.7-4.6 vs 3.0; IQR, 1.9-6.2; P = .002) and accumulated duration of antimicrobial treatment (4.0; IQR, 2.0-7.0 vs 5.0; IQR, 3.0-9.5; P = .030). CONCLUSIONS Pharmacist-driven antimicrobial stewardship in an intensive care unit decreased patient mortality and the emergence of multidrug resistance, and optimized antimicrobial agent use.
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Affiliation(s)
- Zhongwang Li
- Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Baoli Cheng
- Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kai Zhang
- Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guohao Xie
- Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yan Wang
- Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jinchao Hou
- Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lihua Chu
- Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jialian Zhao
- Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhijun Xu
- Intensive Care Unit, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhongqiu Lu
- Emergency Intensive Care Unit, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huaqin Sun
- Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Jian Zhang
- Intensive Care Unit, Hangzhou Normal University Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Zhiyi Wang
- Emergency Intensive Care Unit, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haiya Wu
- Intensive Care Unit, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiangming Fang
- Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Abstract
Medication errors threaten patient safety by requiring admission, readmission, and/or a longer hospital stay, and can even be fatal. Near-misses indicate the potential for medication errors to have occurred. Therefore, reporting near-misses is a first step in preventing medication errors. The aim of this study was to estimate the reporting rate of near-misses among pharmacists in Korean hospitals, and to identify the factors that contributed to reporting medication errors.We surveyed 245 pharmacists from 32 hospital pharmacies for medication errors, including near-misses. We asked them to describe their experiences of near-misses in dispensing, administration, and prescribing, and to indicate the percentage of near-misses that they reported. Additionally, we asked questions related to the perception of medication errors and barriers to reporting medication errors. These questions were grouped into 4 categories: protocol and methods of reporting, incentives and protections for reporters, attitude related to reporting, and fear. Descriptive statistics and logistic regression were conducted to analyze the data.Five or more near-misses per month were experienced by 14.8%, 4.3%, and 43.9% of respondents for dispensing, administration, and prescribing errors, respectively. The percentages of respondents who stated that they reported all near-misses involving dispensing errors, administration errors, and prescribing errors were 43.7%, 57.4%, and 37.1%, respectively. Unclear reporting protocols and the absence of harm done to patients were significant factors contributing to the failure to report medication errors (P < .05).Advances can still be made in the frequency of reporting near-misses. Clear and standardized policies and procedures are likely to increase the reporting rates.
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Affiliation(s)
- Hee-Jin Kang
- Big Data Steering Department, National Health Insurance Service, Wonju-si, Gangwon-do
| | - Hyekyung Park
- School of Pharmacy, Sungkyunkwan University, Jangan-gu, Suwon-si, Gyeonggi-do
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Gwanak-gu, Seoul, Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Jangan-gu, Suwon-si, Gyeonggi-do
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González-Martín C, Saavedra-Quirós V, Ruiz-Gutiérrez J, García-Sanz E, Sánchez-Guerrero A. [Shortages in medicinal products in a tertiary care hospital in Spain]. Rev Calid Asist 2017; 32:289-291. [PMID: 29017752 DOI: 10.1016/j.cali.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Affiliation(s)
- C González-Martín
- Servicio de Farmacia, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España.
| | - V Saavedra-Quirós
- Servicio de Farmacia, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| | - J Ruiz-Gutiérrez
- Pharmacy, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, Reino Unido
| | - E García-Sanz
- Servicio de Farmacia, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| | - A Sánchez-Guerrero
- Servicio de Farmacia, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
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28
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Noparatayaporn P, Sakulbumrungsil R, Thaweethamcharoen T, Sangseenil W. Comparison on Human Resource Requirement between Manual and Automated Dispensing Systems. Value Health Reg Issues 2017. [PMID: 28648307 DOI: 10.1016/j.vhri.2017.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study was conducted to compare human resource requirement among manual, automated, and modified automated dispensing systems. METHODS Data were collected from the pharmacy department at the 2100-bed university hospital (Siriraj Hospital, Bangkok, Thailand). Data regarding the duration of the medication distribution process were collected by using self-reported forms for 1 month. The data on the automated dispensing machine (ADM) system were obtained from 1 piloted inpatient ward, whereas those on the manual system were the average of other wards. Data on dispensing, returned unused medication, and stock management processes under the traditional manual system and the ADM system were from actual activities, whereas the modified ADM system was modeled. The full-time equivalent (FTE) of each model was estimated for comparison. RESULTS The result showed that the manual system required 46.84 FTEs of pharmacists and 132.66 FTEs of pharmacy technicians. By adding pharmacist roles on screening and verification under the ADM system, the ADM system required 117.61 FTEs of pharmacists. Replacing counting and filling medication functions by ADM has decreased the number of pharmacy technicians to 55.38 FTEs. After the modified ADM system canceled the return unused medication process, FTEs requirement for pharmacists and pharmacy technicians decreased to 69.78 and 51.90 FTEs, respectively. CONCLUSIONS The ADM system decreased the workload of pharmacy technicians, whereas it required more time from pharmacists. However, the increased workload of pharmacists was associated with more comprehensive patient care functions, which resulted from the redesigned work process.
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Affiliation(s)
- Prapaporn Noparatayaporn
- Social and Administrative Pharmacy International Graduate Program, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand; Department of Pharmacy, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungpetch Sakulbumrungsil
- Social and Administrative Pharmacy International Graduate Program, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
| | | | - Wunwisa Sangseenil
- Department of Pharmacy, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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De Weerdt E, De Rijdt T, Simoens S, Casteels M, Huys I. Time spent by Belgian hospital pharmacists on supply disruptions and drug shortages: An exploratory study. PLoS One 2017; 12:e0174556. [PMID: 28350827 PMCID: PMC5370124 DOI: 10.1371/journal.pone.0174556] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/10/2017] [Indexed: 12/02/2022] Open
Abstract
Introduction Supply problems of drugs are an increasing and worldwide problem, also in Belgium. Hospital pharmacists try to manage drug supply problems to minimize the impact on patient care. This study aims to quantify in a detailed manner how much time employees of 17 Belgian hospital pharmacies spend on drug supply problems. Methods During six months, employees of Belgian hospital pharmacies filled in the daily time spent on drug supply problems using a template containing all steps which can be executed to manage drug supply problems. Additionally, Belgian hospital pharmacists were asked to report the drugs which experienced drug supply problems together with the solution for this problem. Results Hospital pharmacists spent a median of 109 minutes a week on drug supply problems, with a minimum of 40 minutes per week and a maximum of 216 minutes per week. Fifty-nine percent of the total time spent on drug supply problems was executed by hospital pharmacists, 27% by pharmacy technicians; the rest was performed by logistic or administrative personnel. About one third of the total time spent was invested in gathering information on the supply problem. About two third of the supply disruptions caused drug shortages, meaning there was a need to switch to another (generic) therapeutic alternative. For most drug shortages, a Belgian generic medicine could be found. However in some cases, the alternative had to be ordered abroad or for some drug shortages, no alternative was available. Conclusion These exploratory results on time spent by hospital pharmacists on drug supply problems in Belgium highlight the economic impact of drug supply problems for hospital pharmacies. A fully reliable, daily updated list on the federal agencies websites would be a major help to hospital pharmacists.
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Affiliation(s)
- Elfi De Weerdt
- KU Leuven, Dept. Pharmaceutical and Pharmacological Sciences, Herestraat, Leuven, Belgium
- * E-mail:
| | - Thomas De Rijdt
- University Hospitals Leuven, Pharmacy department, UZ Herestraat, Leuven, Belgium
| | - Steven Simoens
- KU Leuven, Dept. Pharmaceutical and Pharmacological Sciences, Herestraat, Leuven, Belgium
| | - Minne Casteels
- KU Leuven, Dept. Pharmaceutical and Pharmacological Sciences, Herestraat, Leuven, Belgium
| | - Isabelle Huys
- KU Leuven, Dept. Pharmaceutical and Pharmacological Sciences, Herestraat, Leuven, Belgium
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Abstract
Background: It is unclear to what extent hospitals use guidelines or protocols in treating acute decompensated heart failure (ADHF) and whether nesiritide is included in these guidelines or protocols. Objective: To assess the formulary status of currently used drugs, therapeutic guidelines, and perceptions about the appropriateness of treatment of ADHF in community hospitals. Methods: A Web-based survey of pharmacy directors at community hospitals that were part of a national group purchasing organization was conducted. Results: One hundred seven hospitals participated in the survey (response rate 47.1%). Diuretics such as furosemide and bumetanide were more commonly included (100% and 94.4%, respectively) on hospital formularies than was torsemide (69.2%). Dopamine and dobutamine were more common (94.4% each) on the formulary than was milrinone (68.2%), Nitroprusside and nitroglycerin were listed on the formularies of more than 90% of participating institutions, while nesiritide was listed on the formularies in only 48.6% of hospitals and was placed on restricted status in 36.4% of hospitals. Guidelines for care of patients with ADHF were used in the emergency department (ED), inpatient care units, and outpatient clinics in 18.6%, 43.0%, and 8.5% of hospitals, respectively. Overall, ADHF care, including general treatment as well as specific use of nesiritide, was deemed appropriate in the majority of patients, but nearly twice as many respondents perceived the management of ADHF and specific use of nesiritide as inappropriate in the ED compared with inpatient treatment. Only 41.1% of the respondents reported following Braunwald recommendations for the use of nesiritide. Conclusions: A sizable percentage of responding community hospitals do not have guidelines for treatment of ADHF despite the existence of such guidelines in the literature. There are opportunities for improvement in the general treatment of ADHF as well as for the use of nesiritide in ADHF, especially in the ED or observation unit versus inpatient units.
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Affiliation(s)
- Vikrant Vats
- Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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Rubio M, Pédeboscq S, Ekouevi D, Zalabadi K, Chêne G, Bonarek M, Pometan JP. The adherence to antiretroviral treatment evaluated from a hospital pharmacy: importance of the protease inhibitors pharmacological class. Int J STD AIDS 2016; 16:379-82. [PMID: 15949070 DOI: 10.1258/0956462053888826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/18/2022]
Abstract
The goal of this study was to develop an evaluation method of antiretroviral treatment adherence from a hospital pharmacy and to identify one or more factors that influenced this adherence, such as patient or treatment characteristics. The HIV patients included in this study were based, for the major part, in Saint-André hospital and collected their medication from this hospital pharmacy. They were all delivered a renewable prescription that should have comprised two successive delivery stamps. A total of 186 patients was included. For the adherence analysis, the delay between two successive deliveries was measured. We have specified three different categories of patients: adherent, non-adherent and intermediate, according to a definition of adherence accepted by many authors. We have demonstrated that the only antiretroviral therapeutic class associated with poor adherence was the protease inhibitors, in particular nelfinavir, which requires food to be taken at the time of administration. This can pose difficulties for those patients who lunch at their workplace and consequently affect adherence. This study allowed us to demonstrate that a less subjective adherence evaluation can be easily carried out from a hospital pharmacy.
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Affiliation(s)
- M Rubio
- Pharmacy Department, Saint-André Hospital, Bordeaux, France
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Itokazu GS, Glowacki RC, Schwartz DN, Wisniewski MF, Rydman RJ, Weinstein RA. Antimicrobial Consumption Data From Pharmacy and Nursing Records: How Good Are They? Infect Control Hosp Epidemiol 2016; 26:395-400. [PMID: 15865276 DOI: 10.1086/502557] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To determine whether randomly selected intravenous (IV) antimicrobial doses dispensed from an inpatient pharmacy were administered.Design:This was a prospective, cross-sectional study in which dose administration was confirmed by direct observation and by assessment of the medication administration record (MAR). A retrospective analysis of the return rate of unused IV antimicrobial doses was performed subsequently.Setting:Medical and surgical intensive care units (ICUs) and non-ICUs of a 550-bed urban public teaching hospital.Participants:Hospitalized patients with an order in the pharmacy database for an IV antimicrobial during 9 non-consecutive weekdays in June 1999.Results:Of 397 doses, 221 (55.7%) assessed by bedside observation and 238 (59.9%) assessed by MAR review were classified as administered; 139 doses (35.0%) were dispensed but changes in the drug order or the patient's status prevented their administration. In the subsequent assessment, of 745 IV antimicrobial doses dispensed during 24 hours, 322 (43.2%) were returned to the pharmacy unused; 423 (56.8%) of the doses—consistent with our prior observations—were presumably administered.Conclusions:Because computerized pharmacy data may overestimate actual antimicrobial consumption, such data should be validated when used in studies of hospital antimicrobial use. Dispense-return analysis offers a simple validation method.
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Affiliation(s)
- Gail S Itokazu
- John H. Stroger, Jr Hospital of Cook County, Division of Infectious Diseases, 637 S. Wood St., Durand Building - Room 110, Chicago, IL 60612, USA.
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Boyé F, Sallerin B, Ah Kang F, Arnaud A, Kantambadouno JB, Amar J, Chamontin B, Bouhanick B. [Place of clinical pharmacist in the management of drugs in patients with hypertension]. Ann Cardiol Angeiol (Paris) 2015; 64:216-21. [PMID: 26051854 DOI: 10.1016/j.ancard.2015.04.003] [Citation(s) in RCA: 3] [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: 04/21/2015] [Accepted: 04/28/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To synthesize pharmacists' interventions made in the department of internal medicine and hypertension of university hospital of Toulouse and assess the impact on medication orders. METHODS This is a single-center, prospective study using pharmacists' interventions recorded between September 2013 and March 2014 on the Act-IP(©) website of the French Society of Clinical Pharmacy. The clinical pharmacist is present everyday in the unit to establish the medication reconciliation of new patients (the process of comparing a patient's medication orders to all of the medications that the patient has been taking), and analysis of medication orders. When a risk of iatrogenic drug is identified, a therapeutic change is proposed to the prescriber. RESULTS A total of 2491 medication orders were analyzed for 7 months, leading to 39 pharmacists' interventions (1.6 pharmacists' interventions per 100 medication orders). The most commonly identified drug-related problems were improper administration (33%, n=13), not prescribed drug (21%, n=8), non-conformity to guidelines (18%, n=7), supratherapeutic dose (15%, n=6), and 13% (n=5) targeted prescribed treatment not administered, underdosing, incorrect administration or drug interaction. The most relevant molecules were atorvastatin (10%), bromazepam (8%) and levothyroxine (8%) and only 2 interventions targeted antihypertensive drugs. The rate of physicians' acceptance was 92%. CONCLUSION Pharmacists' interventions mainly concern the co-prescriptions of antihypertensive drugs and very few antihypertensive drugs. The clinical pharmacist contributes to preventing iatrogenic in patients with hypertension with a very good acceptance by the clinician.
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Affiliation(s)
- F Boyé
- Pôle pharmacie, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
| | - B Sallerin
- Pôle pharmacie, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - F Ah Kang
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - A Arnaud
- Pôle pharmacie, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - J B Kantambadouno
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - J Amar
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - B Chamontin
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - B Bouhanick
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
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Morante M, Matoses-Chirivella C, Rodríguez-Lucena FJ, del Moral JM, Ruiz-García M, Navarro-Ruiz A. [Pharmaceutical intervention in duration of antimicrobial treatment at hospital ambit--Author's response]. Rev Esp Quimioter 2015; 28:165-166. [PMID: 26033005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Maria Morante
- María Morante Hernández, Servicio de Farmacia, Hospital General Universitario de Elche, Camino de la Almazara, s/n, 03203, Elche (Alicante), Spain.
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González-Castillo J, Martín-Sánchez FJ. [Comment on "The need to implement biomarker strategies to optimize the start and duration of antibiotic treatment"]. Rev Esp Quimioter 2015; 28:164-165. [PMID: 26033004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Juan González-Castillo
- Juan González del Castillo, Servicio de Urgencias. Hospital Clínico San Carlos. Calle Profesor Martín-Lagos s/n, 28040 Madrid, Spain.
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Abstract
OBJECTIVES To examine the impact of rural residence and primary care site on use of clinical pharmacy services (CPS) and to describe the use of clinical telepharmacy within the Veterans Health Administration (VHA) health care system. METHODS Using 2011 national VHA data, the frequency of patients with CPS encounters was compared across patient residence (urban or rural) and principal site of primary care (medical center, urban clinic, or rural clinic). The likelihood of CPS utilization was estimated with random effects logistic regression. Individual service types (e.g., anticoagulation clinics) and delivery modes (e.g., telehealth) were also examined. RESULTS Of 3,040,635 patients, 711,348 (23.4%) received CPS. Service use varied by patient residence (urban: 24.9%; rural: 19.7%) and principal site of primary care (medical center: 25.9%; urban clinic: 22.5%; rural clinic: 17.6%). However, in adjusted analyses, urban-rural differences were explained primarily by primary care site and less so by patient residence. Similar findings were observed for individual CPS types. Telehealth encounters were common, accounting for nearly one-half of patients receiving CPS. Video telehealth was infrequent (<0.2%), but more common among patients of rural clinics than those receiving CPS at medical centers (odds ratio [OR] = 9.7; 95% CI 9.0-10.5). CONCLUSION We identified a potential disparity between rural and urban patients' access to CPS, which was largely explained by greater reliance on community clinics for primary care than on medical centers. Future research is needed to determine if this disparity will be alleviated by emerging organizational changes, including expanding telehealth capacity and integrating pharmacists into primary care teams, and whether lessons learned at VHA translate to other settings.
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Liu J, Zhou Z, Yang S, Feng B, Zhao J, Liu H, Huang H, Fang Y. Factors that affect adverse drug reaction reporting among hospital pharmacists in Western China. Int J Clin Pharm 2015; 37:457-64. [PMID: 25832677 DOI: 10.1007/s11096-015-0065-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 03/21/2014] [Accepted: 01/07/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospital pharmacists can make a considerable contribution to the spontaneous reporting system of adverse drug reactions. The factors that influence adverse drug reaction reporting among hospital pharmacists remain largely unknown in China. OBJECTIVE This study aims to identify factors that affect hospital pharmacist-led adverse drug reaction reporting in Xi'an, and to obtain suggestions from pharmacists about how to improve the current adverse drug reaction reporting system. SETTING Hospital settings throughout Xi'an, a region of Western China. METHOD A matched case-control study was conducted on a population of 2,814 hospital pharmacists in Xi'an during 2011. Cases included all pharmacists who had reported at least one adverse drug reaction between 2008 and 2010 and agreed to participate in the study (186/204; 91.2 %); controls (n = 372) were pharmacists who had not reported any adverse drug reaction during the same period. A self-administered questionnaire was distributed to the participants. Logistic regression was performed to evaluate the association between indicator variables and the outcome of having reported at least one adverse drug reaction. MAIN OUTCOME MEASURE Pharmacists' knowledge, attitude and practice towards adverse drug reaction reporting and factors affecting reporting. RESULTS Higher professional title (adjusted OR 1.44; 95 % CI 1.07-1.94; p = 0.018), having received training about adverse drug reaction reporting (1.64; 1.04-2.57; p = 0.032), better knowledge about reporting (1.53; 1.12-2.08; p = 0.007), "lack of access to adverse drug reaction reporting form" (0.29; 0.12-0.72; p = 0.008) was independently associated with adverse drug reaction reporting. Clinical pharmacists were more likely to report an adverse drug reaction than dispensary pharmacists (1/adjusted OR 5.26; p < 0.001), pharmacy administrators (5.00; p = 0.003), and other technicians (5.56; p = 0.001). CONCLUSIONS Higher professional title, having received training, mastering knowledge about reporting, and being a clinical pharmacist were positive predictors of pharmacist-led adverse drug reaction reporting. Lack of access to reporting forms was a negative predictor. Continuous training and establishing incentive mechanisms are needed to promote adverse drug reaction reporting among hospital pharmacists.
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Affiliation(s)
- Jun Liu
- Department of Pharmacy Administration, School of Pharmacy, Health Science Center, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an, 710061, People's Republic of China
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Fountain JS, Sly B, Holt A, MacDonell S. Availability of antidotes, antivenoms, and antitoxins in New Zealand hospital pharmacies. N Z Med J 2015; 128:23-33. [PMID: 25820500] [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: 06/04/2023]
Abstract
AIM To assess the adequacy of the types and quantities of antidotes, antivenoms and antitoxins held by New Zealand hospital pharmacies. METHODS A list of 61 antidotes, antivenoms, antitoxins and their various forms was developed following literature review and consideration of national pharmaceutical listings. An Internet-accessible survey was then developed, validated and, during the period 28 February to 7 April 2014, sent to 24 hospital pharmacies nationally for completion. Results were assessed and compared with published guidelines for adequate stocking of antidotes in hospitals that provide emergency care. RESULTS The response rate for the survey was 100%. Wide variation in stock levels were reported with only N- acetylcysteine and octreotide held in adequate quantities by all hospitals to manage a single patient for 24 hours. While archaic compounds were still stocked, newer and more effective pharmaceuticals were not. The national replacement cost for expiring drugs was estimated at $171,024, with smaller, more isolated facilities facing the greatest expense and difficulty in achieving timely resupply. CONCLUSION Shortcomings in the types and quantities of antidotes, antivenoms and antitoxins held by New Zealand hospital pharmacies were recognised. This situation may be improved through national rationalisation of pharmaceutical storage and supply, and implementation of a national antidote database.
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Affiliation(s)
- John S Fountain
- National Poisons Centre, Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand.
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Schep LJ, Slaughter RJ. Availability and quantity of antidotes in New Zealand. N Z Med J 2015; 128:20-22. [PMID: 25820499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Leo J Schep
- National Poisons Centre, University of Otago, PO Box 913, Dunedin, New Zealand.
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Awodele O, Fadipe AO, Adekoya M, Adeyemi OO. Prescribing Pattern of Non-Steroidal Anti-Inflammatory Drugs at the Outpatient Pharmacy Department of a University Teaching Hospital in Nigeria. Ghana Med J 2015; 49:25-9. [PMID: 26339081 PMCID: PMC4549814 DOI: 10.4314/gmj.v49i1.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Non-steroidal Anti-inflammatory Drugs (NSAID), are among the most widely used and misused of all drugs. Though they provide symptomatic relief from pain and swelling in chronic joint diseases, they may cause renal impairment, especially in combination with other nephrotoxic agents. OBJECTIVES This study aimed to investigate the prescription pattern of NSAID in the Out-patient Pharmacy Department of Lagos University Teaching Hospital (LUTH), Nigeria. DESIGN A total of 3800 prescriptions containing NSAIDs were analyzed for information on drug name, the number of NSAIDs per prescription, the presence of ACE inhibitors and diuretics alongside NSAIDs and NSAIDs prescribed in generic or brand names. RESULTS The results showed that Aspirin was the most frequently prescribed NSAID (62.2%) and 68.4% of the NSAIDs prescriptions studied were written in generic names. The total number of drugs per prescription was in most cases 3 or greater (84.6%). There were statistically significant (p ≤ 0.05) associations between the individual NSAID prescribed and whether they were prescribed in generics or brand names; individual NSAID prescribed and the frequency of co-prescription with an ACE inhibitor and a diuretic; types of NSAID prescribed and the cost in Naira. CONCLUSION Though most of the prescribers complied with WHO standard in their prescriptions vis a vis generic prescription, avoidance of polypharmacy and avoidance of drug interactions and contraindications, there is obvious need for interventional measures or strategies to improve rational prescribing for some of the prescribers tailored towards rational prescription and use of drugs.
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Affiliation(s)
- O Awodele
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria
| | - A O Fadipe
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria
| | - M Adekoya
- Department of Pharmacy, Lagos University Teaching Hospital, PMB 12003, Idi-Araba, Lagos, Nigeria
| | - O O Adeyemi
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria
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Duong M, Golzi A, Peytavin G, Piroth L, Froidure M, Grappin M, Buisson M, Kohli E, Chavanet P, Portier H. Usefulness of Therapeutic Drug Monitoring of Antiretrovirals in Routine Clinical Practice. HIV Clinical Trials 2015; 5:216-23. [PMID: 15472796 DOI: 10.1310/nxju-9erq-adww-uc5x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Clinical trials have shown that therapeutic drug monitoring (TDM) of antiretrovirals (ARV) improves patient care. However, little is known about the usefulness of TDM in routine practice. METHOD We reviewed all the trough concentrations of protease inhibitors and nonnucleoside reverse transcriptase inhibitors that were performed for therapeutic failure, suspected drug toxicity, or routine purposes. RESULTS Between 1998 and 2001, 146 TDMs were done in 109 HIV patients. Of the 48 patients with therapeutic failure, 62% had resistance to ARV with adequate ARV concentrations, 16% had insufficient drug exposure without any ARV resistance mutations, and 16% combined both resistance and suboptimal drug concentrations. Subsequent therapeutic interventions (increasing adherence and/or changing HAART) resulted in an undetectable viral load in 37.5% of the patients (14/48). Five (24%) of 21 patients with suspected drug toxicity had high drug concentrations associated with side effects. In all the cases, adverse events regressed after reduction of drug dosage. Of the 77 TDMs done for routine purposes, 26% were outside the therapeutic range. CONCLUSION The data show that TDM of ARVs in the clinical setting provides important information that can be used to improve the management of HIV patients receiving antiretroviral therapy.
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Affiliation(s)
- Michel Duong
- Division of Infectious Diseases, University Hospital, Dijon, France.
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Mayer F, Kirchmayer U, Di Martino M, Agabiti N, Fusco D, Davoli M. [Impact of a Decree on ACE inhibitors/ARBs in cardiovascular secondary prevention in the Lazio Region (Central Italy): a pre-post analysis]. Epidemiol Prev 2015; 39:19-27. [PMID: 25855543] [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: 06/04/2023]
Abstract
OBJECTIVES to evaluate the effect of the 2010 legal decree (DCA) in the Lazio Region (Central Italy), promoting appropriateness on use of agents acting on the renin-angiotensin system, and limiting use of angiotensin II receptor blockers (ARBs) within this drug group to levels below 30%. SETTING AND PARTICIPANTS two cohorts of incident patients with diagnosis of cardiovascular disease (CVD) were enrolled from the regional hospital information system: the first cohort included patients discharged during the 12 months before DCA (35,917 patients), and the second one patients discharged during the 12 months after DCA (35,491 patients). DESIGN the first prescriptions of angiotensin- converting enzyme inhibitors (ACEIs) and ARBs in the 30 days after discharge were collected from the drug claims registry. The trends of monthly prescription proportions for the two drug groups were compared through a segmented regression analysis. MAIN OUTCOMES MEASURES comparison between the pre- and post-DCA periods, distinguishing between prescription made by hospital physicians and by general practitioners, and between naïve and prevalent users. RESULTS proportion of patients with CVD treated with ACEIs/ARBs after discharge was 50% in both pre-DCA (35,917 patients) and post-DCA (35,491 patients) cohorts, with the same share of ACEIs (60%) and ARBs (40%). ARB proportions met the threshold only for hospital prescriptions. Among naïve users, the target was met for both hospital physicians and general practitioners. CONCLUSIONS the specific DCA has not led to an overall improvement in the appropriateness of prescribing of ACEIs/ARBs in secondary cardiovascular prevention. However, there is a suitable prescription choice for naïve patients and when the drug is dispensed in hospital pharmacies.
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Affiliation(s)
- Flavia Mayer
- Dipartimento di epidemiologia, Sistema sanitario regionale del Lazio, Roma.
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Tosato M, Landi F, Martone AM, Cherubini A, Corsonello A, Volpato S, Bernabei R, Onder G. Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study. Age Ageing 2014; 43:767-73. [PMID: 24637848 DOI: 10.1093/ageing/afu029] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [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] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Beers criteria and screening tool of older person's prescriptions (STOPP) criteria are widely used to assess potentially inappropriate drug use (PIDU). OBJECTIVE the aims of the present study are (i) to assess the prevalence of PIDU based on 2012 Beers criteria and STOPP criteria and (ii) to determine the impact of PIDU, as defined by these criteria, on health outcomes among older in-hospital patients. DESIGN prospective observational study. SETTING AND SUBJECTS a total of 871 in-hospital patients participating to the CRIteria to Assess Appropriate Medication Use among Elderly Complex Patients project. METHODS outcome measures were (i) adverse drug reactions (ADR); (ii) decline in functional status; (iii) combined outcome (ADR or declined in functional status). RESULTS the prevalence of PIDU was 58.4% applying Beers criteria, 50.4% applying STOPP criteria and 75.0% combining both sets of criteria. PIDU defined based on STOPP criteria was significantly associated with ADR [odds ratio (OR) 2.36; 95% confidence interval (CI) 1.10-5.06], and decline in physical function (OR: 2.00; 95% CI: 1.10-3.64), while, despite a positive trend, no significant association was observed for Beers criteria or the combination of both criteria. The combined outcome was significantly associated with PIDU defined based on Beers (OR: 1.74; 95% CI: 1.06-2.85), STOPP criteria (OR: 2.14; 95% CI: 1.32-3.47) or both (OR 2.02; 95% CI: 1.06-3.84). CONCLUSIONS PIDU is common in hospitalised older adults and the combination of Beers and STOPP criteria might lead to the identification of a larger number of cases of PIDU than the application of a single set of criteria. STOPP criteria significantly predict all in-hospital outcomes considered, while Beers criteria were significantly associated with the combined outcome only.
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Affiliation(s)
- Matteo Tosato
- Centro Medicina Dell'Invecchiamento, Università Cattolica Sacro Cuore, Policlinico A. Gemelli, L.go Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Landi
- Centro Medicina Dell'Invecchiamento, Università Cattolica Sacro Cuore, Policlinico A. Gemelli, L.go Francesco Vito 1, 00168 Rome, Italy
| | - Anna Maria Martone
- Centro Medicina Dell'Invecchiamento, Università Cattolica Sacro Cuore, Policlinico A. Gemelli, L.go Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Cherubini
- Geriatrics, Italian National Research Center on Aging (INRCA), Ancona, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging (INRCA), Cosenza, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Roberto Bernabei
- Centro Medicina Dell'Invecchiamento, Università Cattolica Sacro Cuore, Policlinico A. Gemelli, L.go Francesco Vito 1, 00168 Rome, Italy
| | - Graziano Onder
- Centro Medicina Dell'Invecchiamento, Università Cattolica Sacro Cuore, Policlinico A. Gemelli, L.go Francesco Vito 1, 00168 Rome, Italy
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Puttkammer NH, Zeliadt SB, Baseman JG, Destiné R, Wysler Domerçant J, Labbé Coq NR, Atwood Raphael N, Sherr K, Tegger M, Yuhas K, Barnhart S. Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti. Rev Panam Salud Publica 2014; 36:238-247. [PMID: 25563149 PMCID: PMC4745087] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/05/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE To identify factors associated with antiretroviral therapy (ART) attrition among patients initiating therapy in 2005-2011 at two large, public-sector department-level hospitals, and to inform interventions to improve ART retention. METHODS This retrospective cohort study used data from the iSanté electronic medical record (EMR) system. The study characterized ART attrition levels and explored the patient demographic, clinical, temporal, and service utilization factors associated with ART attrition, using time-to-event analysis methods. RESULTS Among the 2 023 patients in the study, ART attrition on average was 17.0 per 100 person-years (95% confidence interval (CI): 15.8-18.3). In adjusted analyses, risk of ART attrition was up to 89% higher for patients living in distant communes compared to patients living in the same commune as the hospital (hazard ratio: 1.89, 95%CI: 1.54-2.33; P < 0.001). Hospital site, earlier year of ART start, spending less time enrolled in HIV care prior to ART initiation, receiving a non-standard ART regimen, lacking counseling prior to ART initiation, and having a higher body mass index were also associated with attrition risk. CONCLUSIONS The findings suggest quality improvement interventions at the two hospitals, including: enhanced retention support and transportation subsidies for patients accessing care from remote areas; counseling for all patients prior to ART initiation; timely outreach to patients who miss ART pick-ups; "bridging services" for patients transferring care to alternative facilities; routine screening for anticipated interruptions in future ART pick-ups; and medical case review for patients placed on non-standard ART regimens. The findings are also relevant for policymaking on decentralization of ART services in Haiti.
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Affiliation(s)
- Nancy H Puttkammer
- International Training and Education Center for Health, University of Washington, Washington, United States of America,
| | | | - Janet G Baseman
- Department of Health Services, University of Washington, Washington, United States
| | | | | | | | | | - Kenneth Sherr
- Department of Global Health, University of Washington, Washington, United States of America
| | - Mary Tegger
- International Training and Education Center for Health, University of Washington, Washington, United States of America,
| | - Krista Yuhas
- Center for AIDS Research Biometrics Core, University of Washington, Washington, United States of America
| | - Scott Barnhart
- Department of Global Health, University of Washington, Washington, United States of America
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Morante M, Matoses-Chirivella C, Rodríguez-Lucena FJ, Del Moral JM, Ruiz-García M, Navarro-Ruiz A. [Pharmaceutical intervention in duration of antimicrobial treatment at hospital ambit]. Rev Esp Quimioter 2014; 27:159-169. [PMID: 25229371] [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: 06/03/2023]
Abstract
OBJECTIVE To estimate the acceptance of the pharmaceutical intervention in controlling duration of antimicrobial therapy and to evaluate their impact on optimizing the treatment. METHODS Prospective observational study for two years in a General University Hospital. For the patients record, we followed non critical adult patients with antibiotic treatment. When the duration of antimicrobial treatment not complied with established criteria for each antibiotic and pathology, there was a communication with the physician, at which is recommended to assess the need for continue treatment. The acceptance of pharmaceutical intervention was collected and afterwards we analyzed the impact of this work by antimicrobial consumption and incidence of Clostridium difficile. RESULTS . In 122 patients the pharmacist made a pharmaceutical intervention due to prolonged antibiotic treatment. The most prevalent antibiotics were β-lactams, specifically meropenem. The intravenous administration was more frequent. In 77 cases it was decided to recommend the suspension of treatment, we conducted an orally prospective intervention at 70.15 % and the rest of interventions were written. Acceptance was 65.95 % and 65.00%, respectively. During the study period, the DDD of the antimicrobials decreased by 8.89% and expenditure on antimicrobials one 40.12%. The incidence of C. difficile was stable. CONCLUSIONS . In a hospital, a pharmaceutical counselling program on the duration of antimicrobial therapy is well accepted by the prescriber physician, but it must be improved. The route of information does not affect the degree of acceptance. These actions could involve a reduction of antimicrobial consumption.
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Affiliation(s)
- M Morante
- María Morante Hernández, Servicio de Farmacia, Hospital General Universitario de Elche, Camino de la Almazara, s/n, 03203, Elche (Alicante), Spain.
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Edo Solsona MD, Ruiz Ramos J, Montero Hernández M, Font Noguera I, Poveda Andrés JL. [Effectiveness and adequacy of tolvaptan prescription in hospitalized patients]. Farm Hosp 2014; 37:178-81. [PMID: 23789795 DOI: 10.7399/fh.2013.37.3.537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To analyse the effectiveness of the use of Tolvaptan and the adequacy of Tolvaptan prescription at a tertiary level hospital. METHODS Prospective observational study of Tolvaptan prescrip - tion from October of 2010 to December of 2011. RESULTS 30 patients (60.0% males) were included, 50.0% of which were diagnosed with heart failure and 30.0% with SIADH. Tolvaptan allowed achieving sodium levels higher than 135 mEq/L in 53.3% of the patients with a mean baseline value of 125.3±7.3 mEq/L. The median treatment duration was 5.0 days (interquartile range=3-45). A significant increase of uric acid associated to Tolvaptan treatment was observed. The prescription was in agreement to what has been established in GFT in 63.3% of the cases. CONCLUSIONS Tolvaptan increases sodium levels by 7.5 mEq/L, both in SIADH-associated hyponatremia and in heart failure, with an appropriate safety profile.
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Díaz Gómez E, Lázaro López A, Horta Hernández A. [Analysis of pharmaceutical intervention in outpatients pharmacy department]. Farm Hosp 2014; 37:295-9. [PMID: 24010690 DOI: 10.7399/fh.2013.37.4.588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To analize the pharmaceutical interventions made in outpatients pharmacy department of a secondary hospital. METHODS Retrospective and observational study of pharmaceutical interventions made from October 1st 2010 to December 31st 2011. RECORDED DATA: Number of patients, age at the end of the study, diagnostic, prescribing departments, drug-related problems (DRP), negative outcomes associated with medication (NOM), type of pharmaceutical interventions. RESULTS 231 DRP were found and a pharmaceutical intervention was performed for each DRP in 184 different patients. The main DRPs detected were: drugs interactions (26%), prescription mistakes (15, 6%) and non-compliance (15, 6%). Only 26 (11,2%) DRP caused a NOM. Most interventions were: recommendating treatment changes (35,6%), promoting the monitorization of the effectiveness of treatment (34,6%) and increasing adherence (15,6%). CONCLUSION The pharmacist activity allows individualized monitoring and is crucial to avoid NOM.
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Bülow C, Winther M, Schjerling L, Bjeldbak-Olesen M, Tomsen DV. [Different models are used to obtain medication history and medication review in Danish hospitals]. Ugeskr Laeger 2014; 176:V11120680. [PMID: 25095860] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of the article is to characterize the models used by pharmacists to obtain medication history and medication review in Danish hospitals. The models are characterized based on the sources used to create an overview of the patient's medication as well as the time spent per patient. Currently pharmacists perform medication review at 16 departments. The sources frequently used are the patient journal (81%) and clinical data (81%). The patient contributes to the medication review in 25%.
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Affiliation(s)
- Cille Bülow
- Region Hovedstadens Apotek, Apoteksenhed Nord, Dyrehavevej 29, 3400 Hillerød.
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Andrews LB, Bridgeman MB, Dalal KS, Abazia D, Lau C, Goldsmith DF, St John D. Implementation of a pharmacist-driven pain management consultation service for hospitalised adults with a history of substance abuse. Int J Clin Pract 2013; 67:1342-9. [PMID: 24246213 DOI: 10.1111/ijcp.12311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 08/28/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pain management in adult patients with concomitant substance use disorders (SUDs) presents a clinical challenge in the absence of objective assessment criteria. Effective pain management is dependent on the clinician's ability to differentiate true pain symptoms from manipulative behaviours. Successful strategies for achieving effective pain control in these patients include implementing a multidisciplinary team approach, use of non-opioid and non-pharmacologic alternatives, and judicious use of opioid analgesics. OBJECTIVE To describe the implementation of a pharmacist-driven pain management service for patients with concomitant SUDs. METHODS In an urban teaching hospital located in Trenton, New Jersey, United States, a clinical pharmacist-led pain management service evolved to provide formal consultation. Standardised assessment and treatment approaches were developed to assure consistency. Multidisciplinary education was provided to the medical staff. MAIN OUTCOME MEASURE The study describes a variety of patterns associated with the program from its pilot period through the first 6 years of service, including opioid utilisation, volume and source of consultations, and multidisciplinary perceptions regarding the program's impact. RESULTS The establishment of a pharmacist-led pain management consult service successfully addressed patient's needs while modifying drug-seeking behaviours. A significant decrease in opioid usage was noted during the program's pilot period and sustained over time. The program's success has extended the pharmacist's role beyond the program's initial scope to address general pain management needs and to address educational needs of the medical staff. Today, clinical pharmacists are utilised most often for refractory cases for which the most appropriate method of pain management may not be clear.
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Affiliation(s)
- L B Andrews
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, New Jersey
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Zeng W. A price and use comparison of generic versus originator cardiovascular medicines: a hospital study in Chongqing, China. BMC Health Serv Res 2013; 13:390. [PMID: 24093493 PMCID: PMC3851002 DOI: 10.1186/1472-6963-13-390] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 03/01/2013] [Accepted: 10/01/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Developed countries use generic competition to contain pharmaceutical expenditure. China, as a developing and transitional country, has not yet deemed an increase in the use of generic products as important; otherwise, much effort has been made to decrease the drug prices. This paper aims to explore dynamically the price and use comparison of generic and originator drugs in China, and estimate the potential savings of patients from switching originator drugs to generics. METHODS A typical hospital in Chongqing, China, was selected to examine the price and use comparisons of 12 cardiovascular drugs from 2006 to 2011. RESULTS The market share of the 12 generic medicines studied in this paper was 34.37% for volume and 31.33% for value in the second half of 2011. The price ratio of generic to originator drugs was between 0.34 and 0.98, and the volume price index of originators to generics was 1.63. The potential savings of patients from switching originator drugs to generics is 65%. CONCLUSION The market share of the generics was lowering and the weighted mean price kept increasing in face of the strict price control. Under the background of hospitals both prescribing and dispensing medicines, China's comprehensive healthcare policy makers should take measures from supply and demand sides to promote the consumption of generic medicines.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, No,66 Xuefu Road, Nan'an District, Chongqing 400074, China.
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