Development of a prescriptive appropriateness project in RSAs affiliated with Local health authority of Vercelli: repercussions on the correct use of the drug and on the economic sustainability of the SSN.

Law 405/2001, DGR of 30 July 2012, n. 45-4248 and the DGR of 2 August 2013, n. 85-6287 provide that ASLs guarantee the direct distribution of drugs from the Company's Therapeutic Handbook (PTA) necessary for the treatment of patients in residential and semi-residential care. In this context, some critical issues have emerged such as: long dispensing times with repercussions of "extemporaneous" prescriptions in the area by GPs and consequent disbursements under contract (CONV) and distribution on behalf (DPC), poorly controlled stocks of medicines within the structures, lack of appropriateness of therapies, significant increase in costs. The final objective is to describe the process of supplying and managing medicines for guests hospitalized in facilities for the elderly and disabled (here in after RSA) and identify strategies to optimize appropriateness pathways. METHODS In 2022, there were 46 RSAs present in ASL VC, of which 31 were enrolled in the project and for which a retrospective descriptive study was conducted. Each RSA sends an Excel and a PDF (stamped and signed by the GP) of the drug request to the SC Farmaceutica Territoriale (SFT). The request indicates: date of completion, GP, tax code/patient name, surname, drug, quantity, dosage, AIFA note, any notes. The SFT checks the requests for quantity (packages requested/indicated dosage) and quality (prescriptive appropriateness) and forwards them to the Hospital Pharmacy for processing. RESULTS From 2019 to 2022, enrollment grew from 18 to 31 RSAs and guests from 1,387 to 1,678 with an average age of 83.84 (± 11.64); at the same time, there was a reduction in the average number of drugs given to patients from 62.5 to 47.3 and in prescriptions per patient from 32.8 to 31.7. Over the years the percentage of checks carried out by the SFT has increased from 2% to 5%. The most frequent inappropriatenesses were: lack of known AIFA (22.5%), missing PT (12.3%), drugs outside PTA (11.2%), expired PT (9.3%), absence of diagnosis (6.5%). The gross per capita affiliated pharmaceutical expenditure of €163.83 in 2019 fell to €136.97 in 2022 (-19%). The DPC increased from €27.83 to €38.80 in relation to the expansion of the drugs included in the PHT. DISCUSSION The project guarantees, through prescriptive appropriateness paths, a more controlled and punctual supply of the drug with a consequent reduction in the expenditure paid by the NHS. It also highlights the importance of the figure of the pharmacist, as a drug specialist, for the correct management and organization of procedures aimed at obtaining favorable results such as the deprescribing of drugs. CONCLUSION The project will continue with the enlistment of other RSAs and the proposal to include the pharmacist in the Supervisory Commission which inspects the structures to evaluate the management of the drug on site to guarantee the protection of patient health.

Potentially inappropriate prescriptions for poly-treated patients in long-term care facilities: retrospective pharmacoutilization analysis.

BACKGROUND This study aimed to investigate, among elderly patients in long-term care (LTC) facilities, potentially inappropriate drug prescriptions, potentially interactions and verify whether they can be traced back to hospitalisations or accesses to the Emergency Department (ED). The study data were acquired by means of a case report form investigating the medication management process in LTCs. MATERIAL AND METHODS Analysis of pharmacutilisation in LTCFs patients aged ≥65 years on polypharmacy or excessive polypharmacy, January-July 2023. Data was extracted from a database (DB) containing the monthly prescriptions of medicines supplied by direct distribution (DD) to LTCs. The prevalence of PIMs was evaluated by applying the Beers and STOPP criteria to the medication profile of each patient. RESULTS The overall prevalence of polypharmacy and hyperpolypharmacy was 83% and 17%, respectively. PIMs were defined using Beers and STOPP criteria. The most frequent PIMs were proton pump inhibitors (19% e 15%), antiplatelets agent (17% e 13%) and non-associated sulfonamides (14% e 12%). Of the 1,921 PIMs, 121 were contraindicated or very serious (6%) and 1,800 were major (94%).The most common medicaments involved in drug-drug interaction are furosemide (21%), sertraline (19%), pantoprazole (16%) e trazodone (15%). LTCs participating in the study (56%) excluded polypharmacy as a cause of access to the ED and ADRs. Therefore no case was ever reported (100%). CONCLUSIONS Polypharmacy or excessive polypharmacy among elderly patients may increase PIMs and ADRs. A constant review of the therapeutic regimens and deprescribing decrease inappropriate use of medications and interactions, ADRs, and accesses to the ED with consequent reduction of pharmaceutical spending.

Monitoring of the territorial consumption of antibiotics in local health authority of Vercelli as a measure to contrast AMR.

In 2022 the Italian Ministry of Health published the National Antibiotic Resistance Plan (PNCAR) 2022 - 2025 which provides the strategic guidelines and operational indications for dealing with the emergency of antimicrobial resistance (AMR). ESAC recorded, in the year 2021, an average consumption of 16.4 DDD/1000 inhab. res. die, with a statistically significant decrease in the period 2012 -2021 for class J01, on total territorial and hospital consumption. Italy is one of the countries with the highest consumption of antibiotics, it ranks 9th with a total hospital and territorial consumption of 17.53 DDD/1000 inhab. res. die. The present study aims to monitor the territorial consumption of antibiotics in ASL VC through the analysis of synthetic indicators and ESAC indicators, comparing them with regional and national values. Through the IQVIA database, a retrospective descriptive study was conducted on the consumption of antibiotics (ATC J01), for the period 2020 - 2022, measuring the synthetic indicators of consumption (DDD1,000 inhab. res. die) and costs (value1,000 inhab. res. die). Subsequently, a second analysis was carried out by measuring the ESAC indicators for the year 2022, comparing them with the previous year or period. With regard to consumption, while a reduction (average -7%) was observed for contracted pharmaceuticals (CONV) in 2021 compared to 2020, followed by an increase in 2022 (average +31%); for private purchase (PRIV), consumption remained constant in 2021 and then increased in 2022 (average +40%). The same trend was observed for the costs of the J01 class. The ESAC indicators show a mild improvement for ASL VC (variable for regional and national level), except for the use of 3rd and 4th generation cephalosporins which recorded an increase in 2022. The reduction in the consumption of antibiotics in 2021, followed by an increase in 2022 can be partly explained by the pandemic period that has just ended which led to the return to the community with the resumption of infectious agents in circulation. It therefore becomes essential to pay particular attention to antibiotic stewardship activities, both in the hospital and on the territory. (community).