A cluster randomized trial to measure the impact on nonsteroidal anti-inflammatory drug and proton pump inhibitor prescribing in Italy of distributing cost-free paracetamol to osteoarthritic patients.

BACKGROUND: Paracetamol is recommended as first-line treatment for pain control in osteoarthritis because it has fewer side effects than do other therapeutic options, including nonsteroidal anti-inflammatory drugs (NSAIDs). Prescribing proton pump inhibitors (PPIs) as gastric bleeding prophylaxis in chronic NSAID users is also common, although not recommended. In Italy, paracetamol is not reimbursed by the National Health System. The aim of this trial was to test whether the availability to osteoarthritis patients of free paracetamol would decrease their use of NSAIDs and, as a secondary objective, whether opioid and PPI consumption would also decrease. METHODS: Eight general practitioners (GPs) (59 patients) were randomized to usual care and 8 (58 patients) to the experimental arm, where prescribed paracetamol was directly distributed for free by the local hospital. After 6 months, paracetamol was also available for free in the control arm. The main outcome was the pre/post difference in average NSAID and PPI consumption. Differences between experimental and control arms in pre/post differences are reported, as registered by the drug prescription information system. RESULTS: Average NSAID consumption decreased non-significantly, from 6.79 to 2.16 defined daily dose (DDD) in the experimental arm and from 3.19 to 2.97 DDD in the control group (p = 0.067). No changes were observed for PPIs (from 11.27 to 14.65 DDD and from 9.74 to 12.58 DDD in experimental and control arms, respectively, p = 0.788) or opioids (from 1.61 to 1.14 DDD and from 1.41 to 1.56 DDD in experimental and control arms, respectively, p = 0.419). When the intervention was extended to the control arm, no decrease in NSAID consumption was observed (from 2.46 to 2.43 DDD, p = 0.521). CONCLUSIONS: Removing small economic barriers had small or no effect on the appropriateness of opioid or PPI prescribing to patients with osteoarthritis; a reduction in NSAID consumption cannot be ruled out. TRIAL REGISTRATION NUMBER: NCT02691754 (Approved February 24, 2016).

[Pharmaceutical preparations in the hospital. Analysis and in-house development of an automated system of management.] / Attività galenica in ospedale. Studio e sviluppo di un applicativo di gestione.

INTRODUCTION: In the past couple of years, the demand of galenic compounds has risen sharply. In order to plan the activity, our team designed and set up a database which stores all the necessary information related to drugs and ingredients. This allows our internal Galenic Laboratory to better manage the pharmaceutical prescriptions for the hospital and the outpatients, optimizing the use of raw materials. METHODS: The application is based on the interconnection of prescription-related aspects (patients' and prescriber's details and prescription information). The prescription name is linked to the list of substances, which allows to monitor the stock levels. Inserting the daily dosage into the system, our personnel can calculate the monthly supply of the medicine. Each prescription contains specific warnings on printable labels. A printed sheet, inclusive of label and checks on the final preparation, is produced for each prescription. RESULTS: After a testing phase, the application gradually replaced our traditional process of pharmaceutical activity management, allowing for a more accurate scheduling of the medicine requests. The worksheet and its specific label are automatically generated. Then a prediction scheme is generated for the ordinary programmable galenic activity. CONCLUSIONS: The project successfully achieved the following goals: 1) automate the information flow related to preparations; 2) improve the response time in terms of drug preparation and delivery; 3) minimize the number of emergencies.