Medication adherence to inflammatory bowel disease medications in Aotearoa New Zealand and correlation with health outcomes: A nationwide database analysis.

AIMS: Inflammatory bowel disease (IBD) management entails long-term medication therapy. Worse disease outcomes and reduced quality of life might arise from poor medication adherence (MA). This study is the first to investigate patients with IBD's adherence across Aotearoa New Zealand and its relationship with disease outcomes. METHODS: Dispensing claims data (Pharmaceutical Collection) were used to calculate (3- and 5-year) adherence, using daily polypharmacy possession ratio. Using hospitalization data (National Minimum Dataset), the relationship between adherence and the numbers of hospitalizations and corticosteroid dispensings was investigated. RESULTS: In total, 4654 patients (53% female; 55% Crohn's disease [CD], 45% ulcerative colitis [UC]; median age-at-first-dispensing, 43 years) and 3148 patients (54% female; 55% CD, 44% UC; median age-at-first-dispensing, 44 years) were in the 3- and 5-year cohorts, respectively. The 3- and 5-year cohorts had mean 4.6 and 4.2 IBD-related hospitalizations and 6.9 and 9.2 corticosteroid dispensings, respectively. Average adherence estimates were 77.4% (95% confidence interval: 76.9-78.0%) and 74.9% (95% confidence interval: 74.1-75.6%; 3 and 5 years), while 54% and 51% of patients, respectively, had good adherence (MA ≥ 80%). There was no correlation between adherence and the numbers of hospitalizations (Pearson's R = -.0007; P = .65 and R = -.04; P = .02 [3 and 5 years]) and corticosteroid dispensings (R = .08; P = <.0001 and R = .08; P = <.0001, respectively). CONCLUSION: MA of Aotearoa New Zealand patients with IBD is moderately high but just over half of patients meet the adherent threshold. There was no correlation between adherence and hospitalizations or corticosteroid dispensings; hence, research into longitudinal adherence patterns and associated factors is needed.

Using electronic health records in analysing medication adherence in southern New Zealand patients with inflammatory bowel diseases.

AIMS: Electronic health records (EHRs) are widely used in medication adherence (MA) assessment. Poor adherence in patients with inflammatory bowel diseases (IBD) can lead to worse disease outcomes and increased health costs. This study explores the suitability of southern New Zealand EHRs for estimating adherence, and the relationship between adherence and corticosteroid dispensings (indicating negative disease outcomes). METHODS: Medication dispensing EHR data of former Southern District Health Board IBD patients were analysed to estimate 3-year adherence, using daily polypharmacy possession ratio. The correlation with the number of corticosteroid dispensings was investigated. RESULTS: Of 248/1,290 (19%) consenting patients, only 108/248 (44%) had sufficient data available (46%/54% Crohn's disease/ulcerative colitis; 57% female; 89.8%/0.9% NZ European/Maori; mean 5.1 corticosteroid dispensings). Mean adherence was 83.2% (95% confidence interval [CI] 80.0-86.4; standard deviation [SD]:16.7), with 69% of patients having MA ≥80% (good adherence). Median adherence was 13% higher for males versus females (96% vs 83%; p=0.0001). There was no correlation between adherence and the number of corticosteroid dispensings (Pearson's r=0.11; p>0.05). These findings should be considered with caution as the data were not obtained from all pharmacies and the quantum/nature of missing data is unknown. CONCLUSIONS: The patients' adherence seems high, with no correlation with corticosteroid dispensings demonstrated. Useful EHR data are available but need optimisation for adherence assessments.

Clinical pharmacist facilitators in primary care: a descriptive study of their roles and services provided in general practices of southern New Zealand.

INTRODUCTION Internationally, the inclusion of pharmacists into general practice as clinical pharmacy facilitators has improved patient outcomes. However, clinical pharmacists are relatively new to southern New Zealand general practices and their range of services has not been studied. AIMS To describe the implementation of clinical pharmacist services in general practices in the Southern region; to examine the tasks conducted by clinical pharmacy facilitators; and to determine the characteristics of patients who access this service. METHODS The establishment and development of the clinical pharmacy facilitator role was determined by documentation held within the local Primary Health Organisation. The activities performed by clinical pharmacy facilitators were collected from patient medical records for the period 31 March 2015 to 31 March 2018. To describe the characteristics of patients receiving these services, a retrospective case note review of patients seen by the facilitators was conducted. RESULTS The clinical pharmacy facilitator role was initiated with three pharmacists in three geographical locations across the region. Within 18 months, the number of facilitators was increased to eight. As a result of collaboration with the general practice team, 42% of referrals came from general practitioners directly. Overall, 2621 medicine-related problems were identified in 2195 patients. Dosage adjustment was the most common recommendation made by pharmacy facilitators. They consulted mostly older patients and patients taking five or more medicines. DISCUSSION With effective collaboration, clinical pharmacy facilitators can play a key role in optimisation of medicines therapy.

Pharmacist-only trimethoprim: pharmacist satisfaction on their training and the impact on their practice.

Background In 2012, in a first for the developed world, New Zealand reclassified trimethoprim to allow specially trained pharmacists to supply the medicine without a prescription to women with cystitis fitting specific criteria. Objective This study explored pharmacists' views of the training and screening tool, impact on practice, and the pharmacists' perceptions of views of patients and doctors. Methods Structured interviews were conducted with 28 New Zealand pharmacists trained to supply trimethoprim. These pharmacists were selected to represent geographical spread as well as urban, suburban and rural. The key areas for investigation were: satisfaction about training, appropriateness of training, opinions on the screening tool, impact on clinical practice and perception of others. Audio recorded interviews were thematically analyzed. Results Of 40 pharmacies invited, 28 pharmacists agreed to participate. Most pharmacists were positive about being able to supply trimethoprim, the training and increased clinical focus of their practice. The content of the training was considered appropriate, as was the screening tool, which was well utilised during consultations. Minor suggestions on the training and consultation materials were provided. Some pharmacists reported that referral to the doctor without supply in a minority of trimethoprim consultations, frustrated some women. Frequency of supplies varied considerably by pharmacists from none supplied to weekly supplies. Some pharmacists questioned the exclusion to supply for women who had taken antibiotics in the last six months. Many women had reportedly appreciated the easier access in the pharmacy compared with doctor access, especially at weekends, but sometimes misunderstood the role of the pharmacist in the supply. While pharmacists reported that some doctors had been negative about pharmacist-supply, others were informing women about the service from the pharmacist. Conclusion Pharmacist supply of trimethoprim using mandated training and a screening tool or algorithm for supply is workable and well-accepted by pharmacists. Minor changes have been recommended. Further research is needed to understand perspectives of other stakeholders (women, doctors and practice nurses) and outcomes for patients.

General practitioners' perceptions of pharmacists' new services in New Zealand.

BACKGROUND: In recent years, the pharmacy profession has moved towards more patient-oriented services. Some examples are medication review, screening and monitoring for disease, and prescribing. The new services are intended to be in close collaboration with general practitioners (GPs) yet little is known of how GPs in New Zealand perceive these new services. Objective To examine GPs' perceptions of pharmacists' new services. SETTING: Study was undertaken at GPs' practices in two localities in New Zealand. METHODS: Qualitative, face to face, semi-structured interviews were undertaken of 18 GPs. The cohort included GPs with less/more than 20 years of practice, and GPs who had experience of working in localities where some patients had undergone a medication review (Medicines Use Review, MUR) by community pharmacists. GPs were asked to share their perceptions about pharmacists providing some new services. Data were thematically analysed with constant comparison using NVivo 8 software. Using a business strategic planning approach, themes were further analysed and interpreted as the services' potential Strengths, Weaknesses, Opportunities and Threats (SWOTs). MAIN OUTCOMES MEASURE: GPs' perceptions of pharmacists' new services. RESULTS: GPs were more supportive of pharmacists' playing active roles in medication review and less supportive of pharmacists practising screening-monitoring and prescribing. Discussions Pharmacists' knowledge and skills in medication use and the perceived benefits of the services to patients were considered the potential strengths of the services. Weaknesses centred around potential patient confusion and harm, conflict and irritation to GPs' practice, and the potential to fragment patient-care. Opportunities were the possibilities of improving communication, and having a close collaboration and integration with GPs' practice. Apparent threats were the GPs' perceptions of a related, and not renumerated, increase in their workloads, and the perception of limited benefit to patients. CONCLUSION: Pharmacists should exploit their own strengths and the potential opportunities for these services, and reduce any weaknesses and threats. A possible strategic plan should include increased effective communication, piloting services, and the integration of some services into medical practices.

Distribution of fibroblast growth factor-2 (FGF-2) within model excisional wounds following topical application.

OBJECTIVE: To characterise the magnitude and distribution of fibroblast growth factor-2 (FGF-2) following topical application in hypromellose gel and film formulations or a solution in an animal wound model, in order to assess the potential of this route for treatment of chronic wounds. METHOD: Topical formulations of FGF-2 were applied to punch biopsy wounds, and FGF-2 levels within the wound measured. Each 12 mm diameter wound received 0.3 microg FGF-2 in solution, a 7% (w/w) hypromellose gel, a dried hypromellose film on Melolin-backing or a saline control. After 2, 5 or 8 h the wounds were horizontally dissected into four sections (surface granulation, subcutaneous fat, superficial muscle and deep muscle) which were then analysed for FGF-2 concentration using ELISA. Confocal microscopy was used to evaluate the distribution of FGF-2 within the wound. KEY FINDINGS: There were significant differences in the mean FGF-2 levels with respect to formulation and time following application (P < 0.05). FGF-2 penetrated faster into tissue when formulated as a solution than as a gel or a film. There did not appear to be a significant difference between the gel and the film with respect to total concentrations achieved in the tissue, although confocal microscopy showed differences in FGF-2 distribution within the wound. CONCLUSIONS: Delivery of FGF-2 to wounds in a solution gave the greatest increase in tissue FGF-2 concentration when measured by ELISA and visualised using confocal microscopy. Gel and film formulations prolonged the release of FGF-2 into the wound, although FGF-2 levels were not significantly different from controls when measured by ELISA. Confocal microscopy highlighted the differences in the penetration and distribution of the FGF-2 within the wound when released from different formulations.