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AIMS: We translated the ABC adherence taxonomy (i.e. 7 terms and their corresponding definitions) published by Vrijens et al. (2012) into French and German without changing the original meaning with the aim to promote a standardised taxonomy for medication adherence to French- and German-speaking researchers and clinicians. METHODS: A Delphi survey was performed. To generate round 1, we identified French and German synonyms for the 7 adherence terms through a literature search in PubMed. Investigators translated the original English definitions into French and German. Panellists were members of ESPACOMP-the International Society for Patient Medication Adherence; experts suggested by ESPACOMP members and first authors of medication adherence publications in French and German. Google forms were used to create online questionnaires. Delphi rounds were performed until consensus was reached. The consensus was defined according to the acceptance rate as moderate consensus (50-75%), consensus (>75-95%), and strong consensus (>95%). RESULTS: The literature search resulted in 4-6 (French) and 4-7 (German) items per English term. Delphi rounds were launched between November 2016 and April 2018. Three rounds sufficed to reach consensus on all terms and definitions from 26 French-speaking and 25 German-speaking panellists. Preferred terms for medication adherence are adhésion médicamenteuse (82%) in French and Medikamentenadhärenz (88%) in German. CONCLUSION: The use of a common terminology for medication adherence with translations in French and German will contribute to standardise the vocabulary, to harmonise research projects and ultimately ease comparison of study results among researchers and clinicians.
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Adesão à Medicação , Consenso , Técnica Delphi , Humanos , Inquéritos e QuestionáriosRESUMO
AIMS: The aim of this study was to assess whether a pharmacist intervention associating medication reconciliation at discharge with a link to the community pharmacist reduces drug-related problems (DRP) in adult patients during the 7 days after hospital discharge in 22 university or general hospitals in France. METHODS: We conducted a cluster randomised cross-over superiority trial with hospital units as the cluster unit. The primary outcome was a composite of any kind of DRP (prescription/dispensation, patient error or gap due to no medication available) during the 7 days after discharge, assessed by phone with the patient and community pharmacist. Among secondary outcomes, we studied self-reported unplanned hospitalisations at day 35 after discharge and severe iatrogenic problems. RESULTS: A total of 1092 patients were enrolled in 48 units (538 in the experimental periods and 554 in the control periods). Three patients refused to have their data analysed and were excluded from the analyses. As compared with usual care, the pharmacist intervention led to a lower proportion of patients with at least one DRP (44.0% vs 50.6%; odds ratio [OR] 0.77, 95% confidence interval [CI] 0.61-0.98) and severe iatrogenic problems (5.2% vs 8.7%; OR 0.57, 95% CI 0.35-0.93) but no significant difference in unplanned hospitalisations at day 35 (5.8% vs 4.5%; OR 1.46, 95% CI 0.91-2.35). CONCLUSION: Medication reconciliation associated with communication between the hospital and community pharmacist may decrease patient exposure to DRP and severe iatrogenic problems but not unplanned hospitalisation. However, this intervention could be recommended in health policies to improve drug management.
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Reconciliação de Medicamentos , Alta do Paciente , Farmacêuticos , Serviço de Farmácia Hospitalar , Estudos Cross-Over , Feminino , França/epidemiologia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Preparações FarmacêuticasRESUMO
BACKGROUND: Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit. METHODS: A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. RESULTS: Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers' perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 ; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 . Overall cost saving was 3218. CONCLUSIONS: PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.
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Assistência Farmacêutica/economia , Assistência Farmacêutica/organização & administração , Idoso , Antineoplásicos/administração & dosagem , Prescrições de Medicamentos , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos ProspectivosRESUMO
Multiple health behaviour change (MHBC) represents one of the best ways to prevent reoccurrence of cardiovascular events. However, few individuals with cardiovascular diseases engage in this process. The present study examined the role of compensatory health beliefs (CHB; i.e., belief that a healthy behaviour compensates an unhealthy one) as a drag to engagement in this process. Some studies have shown that CHBs predict intention to engage in healthy behaviours, but no study has investigated CHBs in individuals who actually need to change multiple health behaviours. The goal was to better understand the role of CHBs in intentions formation process among individuals with cardiac diseases in an MHBC context. One hundred and four patients completed a questionnaire at the beginning of their cardiac rehabilitation program. Results showed that: (1) CHBs negatively predicted intentions (2) but only for participants with high self-efficacy or low risk perception; (3) CHBs predictions differed depending on the nature of the compensating behaviour, and were more predictive when medication intake was the compensating one. Findings only partially confirmed previous research conducted on healthy individuals who were not in an MHBC process, and emphasized the importance of considering CHBs for individuals in this process.
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Reabilitação Cardíaca , Doenças Cardiovasculares , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Intenção , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , AutoeficáciaRESUMO
INTRODUCTION: The objectives of this work were: 1) to develop and validate a questionnaire to understand several dimensions of the use of CAM practitioners in France and 2) to evaluate the test-retest reliability of each of its items. PURPOSE OF RESEARCH: Development and validation (face validity): A questionnaire was created and then analyzed by 7 experts, including 3 social scientists. Before finalization, the questionnaire was tested on a sample of 43 individuals via cognitive interviews. Test-retest reliability: 322 individuals completed the questionnaire twice (at least 9 days apart). The reliability of the 107 categorical variables that compose the questionnaire was assessed by unweighted Gwet's AC1 coefficient. RESULTS: A short and clear questionnaire, suitable for collecting the targeted information, was methodically developed. In total, excluding descriptive items characterizing the population, the questionnaire includes 114 items, 107 of which are closed and 7 open. 107 of these items are conditional. The average filling time was less than 3 minutes. Of the 107 categorical items, 1 item was associated with moderate test-retest reliability, 9 items with good reliability and 97 with very good reliability. CONCLUSION: A reliable and valid questionnaire to evaluate the use of CAM practitioners in France is available. It may allow the collection of data necessary to assess the public health issue that this phenomenon represents.
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INTRODUCTION: The objectives of this work were: 1) to develop and validate a questionnaire to understand several dimensions of the use of CAM practitioners in France and 2) to evaluate the test-retest reliability of each of its items.Purpose of research: Development and validation (face validity): A questionnaire was created and then analyzed by 7 experts, including 3 social scientists. Before finalization, the questionnaire was tested on a sample of 43 individuals via cognitive interviews. Test-retest reliability: 322 individuals completed the questionnaire twice (at least 9 days apart). The reliability of the 107 categorical variables that compose the questionnaire was assessed by unweighted Gwet's AC1 coefficient. RESULTS: A short and clear questionnaire, suitable for collecting the targeted information, was methodically developed. In total, excluding descriptive items characterizing the population, the questionnaire includes 114 items, 107 of which are closed and 7 open. 107 of these items are conditional. The average filling time was less than 3 minutes. Of the 107 categorical items, 1 item was associated with moderate test-retest reliability, 9 items with good reliability and 97 with very good reliability. CONCLUSION: A reliable and valid questionnaire to evaluate the use of CAM practitioners in France is available. It may allow the collection of data necessary to assess the public health issue that this phenomenon represents.
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Terapias Complementares/normas , Psicometria/normas , Inquéritos e Questionários/normas , Terapias Complementares/métodos , França , Humanos , Psicometria/métodos , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: Adverse events during hospitalization are a major worry considering their frequency and their burden. Many could be avoided by immediate identification of at-risk patients at admission and adapted prevention. The complexity of a patient's medication regimen immediately available at admission is a good indicator of the complexity of the patient's condition. This study aims to determine whether the electronic Medication Regimen Complexity Index (MRCI) at admission is associated with complications during hospitalization. DESIGN: We performed a multilevel logistic regression model, adjusted for age and sex. SETTING: Premier Perspective™ database, a clinical and financial information system from 417 US hospitals. PARTICIPANTS: Adults hospitalized for more than 3 days in a medical ward and included in Premier's Perspective™ database for 2006. INTERVENTION(S): Multilevel logistic regression. MAIN OUTCOME MEASURE: Association of the MRCI and complications during hospitalization, defined as in-hospital death, hospital-acquired infection, pressure ulcers; and need for highly technical healthcare, identified as the secondary introduction of catecholamines. RESULTS: In total, 1 592 383 admissions were included. The median MRCI at admission was 13 [interquartile range: 9-19]. The higher the MRCI, the higher the adjusted odds ratio of the following: in-hospital mortality, hospital-acquired infections, pressure ulcers and the secondary introduction of catecholamines. CONCLUSIONS: Our results suggested that the MRCI at admission was correlated with patient complexity, independent of age. Considering that patients with complex conditions pose a heavier workload for staff, measuring MRCI at admission could be used to allocate resources in medical wards at an institutional level. The MRCI might be a useful tool to assess the management of care.
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Hospitalização , Medicamentos sob Prescrição/administração & dosagem , Qualidade da Assistência à Saúde/organização & administração , Idoso , Catecolaminas/administração & dosagem , Catecolaminas/uso terapêutico , Infecção Hospitalar/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medicamentos sob Prescrição/uso terapêutico , Úlcera por Pressão/epidemiologia , Estudos RetrospectivosRESUMO
Patients have to be informed about the risks and benefits of medicinal products derived from human plasma. No study has examined the patient's perspective yet. Our objective was to assess perceived benefits and risks of immunoglobulins administration from the patient's point of view. Thirty-four patients receiving subcutaneous or intravenous immunoglobulins for chronic disorders at a single university hospital were asked to complete a survey. Although the level of comfort was high, the results revealed variable and incomplete knowledge, in particular about the nature of the treatment. Greater efforts should be made by health professionals to provide information to patients about plasma-derived medicinal products.
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Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas/administração & dosagem , Consentimento Livre e Esclarecido , Educação de Pacientes como Assunto/métodos , Feminino , Hospitais Universitários , Humanos , Imunoglobulinas/efeitos adversos , Imunoglobulinas Intravenosas/efeitos adversos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
Introduction : following the 2009-2013 Cancer Plan, the experimental oncology nursing coordination (IDEC) showed a positive impact on the fluidity of care pathways. The 2014-2019 cancer plan guides their mission to complex cases. The objective of this study is to build a tool to facilitate the recruitment of patients likely to experience a complex path. Method : two phases have formed this research. The first one collected the elements of the dimensions that can predict the complexity of the care path, by focus group. The second consisted of reduction and selection of priority items and to estimate their importance by the Delphi method. Results : from the 12 selected items, two are recognized as a significant risk scoring, seven probably correlated with a complex pathway and three unrelated to the complexity of the pathways. Discussion : later this instrument would be validated by a test sample to evaluate its psychometric properties, metrological and feasibility.
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Procedimentos Clínicos/organização & administração , Neoplasias/enfermagem , Cuidados de Enfermagem/organização & administração , Comorbidade , Procedimentos Clínicos/normas , Prova Pericial , Grupos Focais , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia , Papel do Profissional de Enfermagem , PrognósticoRESUMO
INTRODUCTION: To evaluate the economic impact of automated-drug dispensing systems (ADS) in surgical intensive care units (ICUs). A financial analysis was conducted in three adult ICUs of one university hospital, where ADS were implemented, one in each unit, to replace the traditional floor stock system. METHOD: Costs were estimated before and after implementation of the ADS on the basis of floor stock inventories, expired drugs, and time spent by nurses and pharmacy technicians on medication-related work activities. A financial analysis was conducted that included operating cash flows, investment cash flows, global cash flow and net present value. RESULTS: After ADS implementation, nurses spent less time on medication-related activities with an average of 14.7 hours saved per day/33 beds. Pharmacy technicians spent more time on floor-stock activities with an average of 3.5 additional hours per day across the three ICUs. The cost of drug storage was reduced by 44,298 and the cost of expired drugs was reduced by 14,772 per year across the three ICUs. Five years after the initial investment, the global cash flow was 148,229 and the net present value of the project was positive by 510,404. CONCLUSION: The financial modeling of the ADS implementation in three ICUs showed a high return on investment for the hospital. Medication-related costs and nursing time dedicated to medications are reduced with ADS.
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Unidades de Terapia Intensiva/economia , Sistemas de Medicação no Hospital/economia , Automação/economia , Automação/métodos , Redução de Custos , Análise Custo-Benefício , Custos Hospitalares/estatística & dados numéricos , Hospitais Universitários/economia , Hospitais Universitários/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Sistemas de Medicação no Hospital/organização & administraçãoRESUMO
Advances in lung transplantation allow the women of childbearing age to consider becoming mothers. When planning to become pregnant, a therapeutic drug management of immunosuppressive drugs and associated therapies is required. It must take into account teratogenic and fetotoxic drugs, as well as pharmacokinetic changes encountered during pregnancy. Increasingly data are currently available on the management of immunosuppressive drugs and associated therapies during pregnancy. We report the case management of drug therapy before and during pregnancy in two patients after a lung or heart-lung transplantation. To prevent the emergence of complications for mother and child, a literature review has been necessary to manage drug therapies of each patient.
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Rejeição de Enxerto/prevenção & controle , Transplante de Coração , Imunossupressores/uso terapêutico , Transplante de Pulmão , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/prevenção & controle , Cesárea , Contraindicações , Fibrose Cística/complicações , Feminino , Retardo do Crescimento Fetal/etiologia , Feto/efeitos dos fármacos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Imunossupressores/efeitos adversos , Imunossupressores/farmacocinética , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Pravastatina/farmacocinética , Pravastatina/uso terapêutico , Pré-Eclâmpsia/cirurgia , Gravidez , Complicações na Gravidez/metabolismo , Gravidez em Diabéticas/tratamento farmacológico , Adulto JovemRESUMO
Advances in lung transplantation allow the women of childbearing age to consider becoming mothers. When planning to become pregnant, a therapeutic drug management of immunosuppressive drugs and associated therapies is required. It must take into account teratogenic and fetotoxic drugs, as well as pharmacokinetic changes encountered during pregnancy. Increasingly data are currently available on the management of immunosuppressive drugs and associated therapies during pregnancy. We report the case management of drug therapy before and during pregnancy in two patients after a lung or heart-lung transplantation. To prevent the emergence of complications for mother and child, a literature review has been necessary to manage drug therapies of each patient.
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OBJECTIVE: To describe the perceptions of French patients, caregivers and healthcare professionals on stroke and secondary preventive medications. METHOD: A qualitative study was conducted, based on four predetermined topics: stroke, secondary prevention medications, patient's experience, relationship between patient/caregiver and healthcare team. RESULTS: Twenty-six interviews were conducted. Difficulties in taking medications, lack of knowledge on stroke and medication benefits, fear of over medication were identified as barriers for adherence in patients. Doubts about generic drugs were expressed by caregivers. Healthcare professionals reported lack of knowledge and absence of clinical symptoms as barriers. On the other hand, support from caregivers and healthcare professional support is essential for compliance in all participants. Patients and caregivers expressed that fear of recurrence was a facilitator for treatment compliance. CONCLUSION: This study highlights the barriers and facilitators for stroke treatment adherence and underlines the similarities and differences between the perceptions of patients, caregivers and healthcare professionals. These results must be integrated into the future French educational programs to improve medication adherence.
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Adesão à Medicação/psicologia , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Atitude do Pessoal de Saúde , Cuidadores/psicologia , Feminino , França , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente , Pesquisa Qualitativa , Prevenção Secundária , Reabilitação do Acidente Vascular Cerebral , Adulto JovemRESUMO
BackgroundThe COVID-19 pandemic has had a major impact on the organisation of health services worldwide. In the first wave, many therapeutic options were explored, exposing patients to significant iatrogenic risk. In a context in which patient management was not well defined by clear recommendations and in which healthcare professionals were under great stress, was it still relevant to maintain pharmaceutical care or did it bring an additional factor of disorganisation? OBJECTIVE: The aim of our study was to compare the relevance of pharmaceutical care practices before and during the COVID-19 crisis. METHODS: A retrospective, comparative, observational analysis was conducted in two medical units in a French university hospital that were receiving patients with COVID-19 and benefiting from pharmaceutical care prior to the crisis. This study compared clinical pharmacy performance between two 1.5-month periods before and during the COVID-19 crisis. Performance was assessed according to the CLEO scale, rating the clinical, economic and organisational impacts of the accepted pharmaceutical interventions (PIs) performed in these units. RESULTS: Of the 675 accepted PIs carried out in the two medical units over the entire study period, PIs performed during the COVID-19 period had a greater significant clinical impact (72% vs 56%, pË0.0001), a more positive economic impact (38% vs 23%, pË0.0001) and a more favourable organisational impact (52% vs 20%, pË0.0001) than those performed prior to the COVID-19 period. CONCLUSIONS: The health crisis generated important changes in care practices. Our study demonstrates the sustained relevance of pharmaceutical care during a health crisis. This local experience confirms the major interest in improving the integration of pharmaceutical expertise within French healthcare teams.
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Pharmacists and physicians have complementary roles. Indeed, pharmacists have specific knowledge of medications and a particular relationship with patients, especially in the community. Integration of pharmacists within medical teams, based on the North-American model, helps to ensure close collaboration founded on mutual trust and face-to-face contacts. This role of the pharmacist is appreciated by physicians, notably because it helps them to verify their prescriptions. It is essential to determine patients' relationships with their medications, through a knowledge of their treatment history. The French educational model of clinical pharmacy, based on the fifth hospital year, is inspired by this experience. The challenge is now to prove the benefits both for patients, physicians and nurses, of integrating a pharmacist within the medical team. This educational model helps to develop the pharmacist's role within the community and facilitates relationships between the hospital and the community.
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Continuidade da Assistência ao Paciente/organização & administração , Conduta do Tratamento Medicamentoso/organização & administração , Monitorização Fisiológica , Farmacêuticos , Papel Profissional , Continuidade da Assistência ao Paciente/normas , Hospitalização , Humanos , Anamnese/métodos , Anamnese/normas , Conduta do Tratamento Medicamentoso/normas , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Educação de Pacientes como Assunto/organização & administração , Estudantes de Farmácia , Recursos HumanosRESUMO
The success of cost containment with generic drugs is based on consumer's willingness to accept substitution. This investigation reveals 3 major themes that can explain attitudes of patients towards generics: 1) personal beliefs and knowledge (coming from the media issues, family, friends) are fragmented and sometimes erroneous, with a background of suspicion on the quality of the generics; 2) relation with the prescriber (indirectly pharmacist) is central to build up patient's trust; suspicious professionals generate an anxious patient; 3) previous experience from the consumer with generics. Starting from patients' experiences and beliefs allows to anticipate their resistance to the generic and to adapt drug prescription choices.
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Medicamentos Genéricos , Conhecimentos, Atitudes e Prática em Saúde , Metformina , HumanosRESUMO
We assessed the use of evidence-based practice (EBP) among pharmacists working in community pharmacies in France and the factors linked to this practice. During 3 months in 2018, an online survey was sent to over 7000 active pharmacists and posted on pharmacists' social media sites. In total, 595 pharmacists completed the questionnaire. The responders were on average younger than the general population of community pharmacists. The 40-item questionnaire described four fictional clinical cases reflecting typical situations (conventional medicine and complementary and alternative medicine) encountered daily by community pharmacists. Multiple-choice responses were proposed and scored according to whether they reflected EBP. A high total score indicated behaviour in line with EBP. We observed 344/595 participants with a positive EBP score (57.8% [53.7-61.8%]). Univariate and multivariate analyses were used to evaluate factors that might explain adherence to EPB (the pharmacy's characteristics, the pharmacist's status, the mode of continuing education and sources of information). The majority relied on pharmaceutical industry and other biased and/or non-evidence-based sources, particularly concerning information on homeopathic products. The consultation of independent reviews, health agency recommendations and peer-reviewed scientific journals was associated with evidence-based decisions. In contrast, reliance on pharmaceutical industry documents, personal experience and informal handbooks was linked to lower EBP scores. The level of EBP use by French community pharmacists needs to be improved to ensure that good-quality, science-based advice is given to customers.
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BACKGROUND: Antipsychotic drugs (APs) expose users to several adverse effects. Some reports describe an increased risk of venous thromboembolism for particular drugs in this family. PURPOSE: To examine the association between the risks of pulmonary embolism (PE) and AP use and assess any dose-effect relationships. METHODS: This is a retrospective analysis of data in 'Premier's Perspective' a large US hospital database for 2006. Adults in the AP group had at least one prescription of AP. Logistic regression analysis was performed to detect association between PE and AP use. The dose-effect relationship was assessed according to quantities and administration routes. Analyses were adjusted for potential confounders: age, sex, the components of the Charlson co-morbidity index, diagnoses of infection, sepsis, inflammatory bowel disease, psychotic disorders and hospital inpatient or outpatient status. RESULTS: Among 28,723,771 adults included in 2006, 450,951 (1.6%) were prescribed AP. Haloperidol was most commonly prescribed (157,667 patients or 35.0%), but atypical APs represented over 78% of prescriptions. The risk of PE was higher in AP users than in the total population (OR = 1.17 [95%CI 1.13-1.21]; p < 0.001) and depended on the type of AP used: clozapine was associated with the highest risk. Risk seemed correlated to higher doses. LIMITATIONS: Non-hospital prescription data were unavailable, potentially underestimating the number of patients exposed. The relative timing of AP prescription and PE was not available. Results did not include deep vein thrombosis. CONCLUSION: This study suggests an increased risk of PE with AP treatment, varying with type of AP and dependent on dose.