Enhancing Patient Adherence to Newly-Prescribed Medicine for Chronic Diseases: A Comprehensive Review and Cost-Effective Approach to Implementing the New Medicine Service in Community Pharmacies in Poland.

New Medicine Service (NMS) components are an important element to improve patient compliance with medical recommendations. NMS provides support to patients prescribed new medicines, helping them to manage long-term conditions. The purpose of this service is to provide patients with advice, guidelines, and educational materials regarding the use of new medicines to increase patient compliance and therapy safety. The NMS has already been introduced in many European countries. This review aims to identify the benefits and potential barriers to implementing the NMS in community pharmacies and to suggest solutions that would increase its effectiveness. Previous studies have primarily shown that the NMS improves patient compliance with therapy, accelerating the expected effects of the therapy. Pharmacist support during implementation of a new drug therapy substantially increases patient safety. As the experience of numerous countries shows, both pharmacists and patients express positive opinions on this service. Therefore, it seems that NMS should be an indispensable part of pharmaceutical patient care in any healthcare system. This article aims to review the implementation of the New Medicine Service (NMS) for community pharmacists in Poland and the provision of a cost-effective approach to improve patient adherence to newly-prescribed medicine for chronic diseases.

Teleconsultation as a Modern Form of Health Care Service in the Case of Poland: Assessment of Its Potential Use from the Perspective of Health Care Providers and Patients.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has facilitated access to health care services through telemedicine in Poland, where it has not been a common approach so far. Therefore, the aim of this study was to evaluate telemedicine as a form of health care provision in the Polish health care system. Methods: An online questionnaire was distributed to 2,318 patients and health care workers. Questions included telemedical services usage, attitude toward telemedical consultations, who should decide about the nature of the consultation, advantages and disadvantages of telemedicine, the possibility of teleconsultations remaining available after the pandemic, and the subjective perception of overuse of remote consultations by doctors. Results: In general, respondents approved of teleconsultations (3.62 on 1-5 scale) but specific clinical situations gained higher and lower scores-among the highest ranking were prescription renewal (4.68), interpretation of examination results (4.15), and treatment continuation/follow-up (3.81). Among least ranking were consulting children 2-6 years old (1.93) and children younger than 2 years old (1.55) as well as consulting acute symptoms (1.47). Health care workers rated their general attitude significantly higher than nonhealth care workers toward telemedicine consults (3.91 vs. 3.34, p < 0.001) and toward 12 out of 13 specific clinical situations and settings (p < 0.001). The only exception was "consulting acute symptoms," which received exactly the same rating within both groups (1.47, p = 0.99). Most respondents agreed that teleconsultations should remain an option for contacting a physician regardless of the epidemic situation. Each group declared that they should be the one to decide about the consultation form. Conclusions: Results of this study could help optimize and facilitate telemedical consultation usage after the COVID-19 pandemic.

Predictors of excessive short-acting ß2-agonist use and asthma exacerbations: a retrospective analysis of a Polish prescription database.

Introduction: Despite being linked to unfavourable outcomes, short-acting ß2-agonists (SABAs) are still overused by a substantial proportion of patients with asthma. Aim: To analyse the prevalence and predictors of SABA overuse and exacerbations in patients with asthma in a nationwide database of prescription purchase records. Material and methods: The prevalence of excessive SABA use (≥ 12 canisters) and overuse (≥ 3 canisters) was analysed among patients aged 18-64 years who purchased asthma medications in 2018. Predictors of excessive SABA use and SABA overuse were examined by quasi-Poisson regression. Negative binomial regression was used to study the association of excessive SABA use or overuse to the risk of asthma exacerbation defined as a prescription for oral corticosteroids. Results: Of 91,763 patients with asthma, 42,189 (46%) were SABA users (mean age, 47 years; 58% female). Among them, 34% purchased ≥ 3 SABA canisters, and 6% purchased ≥ 12 canisters. The risk (risk ratio, 95% CI) of excessive SABA use was lower in patients with concomitant prescriptions for inhaled corticosteroids (0.41, 0.34-0.48) or inhaled corticosteroids and long-acting ß2-agonists (0.52, 0.47-0.56), women (0.63, 0.58-0.68), and those in secondary care (0.60, 0.44-0.66); older age was associated with a higher risk of excessive SABA use (1.06, 1.03-1.10). Excessive SABA use was the strongest predictor of asthma exacerbations among all patients (3.24, 2.84-3.70) and in those with ≥ 1 exacerbation (1.60, 1.50-1.71). Conclusions: Excessive SABA use is highly prevalent in asthma management, is associated with lack of prescriptions for inhaled corticosteroids, and substantially increases the exacerbation risk.

Epidemiologic Benefits of Pneumococcal Vaccine Introduction into Preventive Vaccination Programs.

Vaccination against pneumococci is one of the most effective methods of preventing pneumococcal diseases. Currently, 10- and 13-valent conjugate vaccines (PCV10 and PCV13) and 23-valent polysaccharide vaccine (PPSV23) are used. Only the conjugate vaccines are used in children. The PCV can be used both in children and adults, but children can receive only PCV. A side effect of vaccination was that bacterial serotypes not included in a vaccine started increasingly emerging in pneumococcal infections, replacing the serotypes eliminated by the vaccine. The basic vaccination schedule consists of three or four doses, according to the country's recommendation. In Poland, it consists of two primary doses followed by a supplementary dose of the PCV-10, with some modifications in case of specific risk factors. The use of preventive vaccinations has helped reduce antibiotic resistance, as serotypes characterized by a rapid acquisition of drug resistance are included in the vaccine serologic spectrum, making their environment prevalence decrease. The research is currently underway on conjugate vaccines that contain a greater number of bacterial serotypes and on more universal vaccines that would eliminate the emergence of new serotypes.

Serum Vitamin D and Immunogenicity of Influenza Vaccination in the Elderly.

Vaccination is the most effective preventive measure that reduces the risk of influenza and post-influenza complications. It prevents influenza-related hospitalizations and deaths in 50-60% and about 80% of patients aged over 65, respectively. There is the clinical plausibility of the association between serum vitamin D (VIT D) content and viral respiratory infections. In this study, we addressed the issue of a vitamin D modulatory effect on the immune response to seasonal influenza vaccination in elderly persons. The study comprised 96 participants aged 60-75 during the 2016/17 epidemic season. After the determination of the baseline content of VIT D and anti-hemagglutinin antibodies (H1, H3, and HB), participants were vaccinated with a trivalent vaccine. The content of the anti-hemagglutinin antibodies was rechecked 4-5 weeks afterward, showing inappreciable alterations. The negative findings of this study make the influence of serum VIT D content on the immunogenicity of influenza vaccination highly unlikely in elderly persons.

Biological drugs in the treatment of atopic dermatitis - current recommendations of the Polish Dermatological Society, the Polish Society of Allergology, the Polish Pediatric Society and the Polish Society of Family Medicine.

Atopic dermatitis (AD) is secondary to genetic, immunological and microbiological disorders as well as epidermal barrier defects, which are the main targets of therapy. The disease proceeds with periodic exacerbations. Its development and course are influenced by numerous environmental and individual factors. In recent decades, in industrialized countries, there has been a threefold increase in the incidence of AD. There is also an increasing number of cases resistant to topical treatment. Effective treatment of AD should provide control of clinical symptoms, prevent exacerbations and improve the quality of life of patients. The multifactorial etiopathogenesis and various endotypes and phenotypes of AD justify the tendency to optimize and personalize the therapy. Currently, we recommend the use of dupilumab for the treatment of patients from 12 years of age with moderate and severe atopic dermatitis, who do not respond to topical treatment.

Atopic dermatitis. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society, Polish Society of Allergology, Polish Pediatric Society and Polish Society of Family Medicine. Part I. Prophylaxis, topical treatment and phototherapy.

Atopic dermatitis is a chronic and recurrent inflammatory dermatosis with concomitant intensive pruritus, and is diagnosed both in children and adults. Atopic dermatitis-patients are predisposed to have bacterial, viral and fungal skin infections; they also suffer from an increased risk of developing food allergies (especially, at an infantile age), allergic rhinitis, or bronchial asthma (a so-called atopic march). Currently, an increasing atopic dermatitis incidence constitutes a serious medical problem that regards not only dermatology and allergology, but also paediatrics, and family medicine. The basis for atopic dermatitis treatment and prophylaxis is restoration of epidermal barrier functions by means of tailored emollients. Atopic dermatitis therapies should effectively eliminate clinical symptoms of the disease, prevent exacerbations as well as complications, and improve patients' quality of life.

Atopic dermatitis. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society, Polish Society of Allergology, Polish Pediatric Society and Polish Society of Family Medicine. Part II. Systemic treatment and new therapeutic methods.

The treatment goal in atopic dermatitis is eliminating clinical symptoms of the disease, preventing exacerbations and complications, as well as improving patients' quality of life. In cases of severe atopic dermatitis and lack of response it is recommended to introduce systemic therapy. Patients ofter require multi-specialist consultations, and occasionally hospitalization. It is not recommended to use acupuncture, acupressure, bioresonance, homeopathy, or Chinese herbs in the treatment of atopic dermatitis.

The Internet as a Source of Health Information and Services.

The Internet is increasingly used for health-related purposes and evolves with the ever-changing needs of patients. The aim of this study was to assess the level of reliance on the Internet as a health information source, to examine which online communication activities are the most common for health purposes, and to determine the attitudes and needs of patients in this area and the factors affecting its use. A total of 1000 adults were selected from the Polish population by random sampling. The survey was administered by the Computer-Assisted Telephone Interview (CATI). The study concluded that 76.9% of the participants used the Internet for health purposes, among whom 72.6% of active and 27.4% of passive users were distinguished. The role of the Internet as a source of health information has increased, which corresponds to a growing interest in online health services. The majority of individuals searching for health information in the Internet lived in urban areas, had a high level of education, and was professionally active. We conclude that the increased interest in the use of the Internet related to health determines the direction in which e-health should be developed in the future.

Factors affecting the choice of therapeutic regimens in asthma and chronic obstructive pulmonary disease patients and patient adherence to the therapies prescribed.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) and asthma are the most common chronic respiratory diseases worldwide. At the moment, there is no information about the preferences of Polish specialists as regards the treatment of asthma and COPD or factors influencing the choice of particular treatment regimens. AIM: To determine the treatment options most commonly used by experienced pulmonologists and allergists for asthma and COPD and to identify the factors affecting the choice of a particular therapy. MATERIAL AND METHODS: The survey included 224 doctors (pulmonologists and allergists) across Poland and concerned patients diagnosed with asthma (n = 4358) and COPD (n = 3062). RESULTS: In the case of asthma, the most common therapy applied was inhaled glucocorticosteroids and long-acting ß2 agonists. According to 27.2% of doctors, combination therapy was used in 70-80% of patients while 23.7% declared that the proportion of patients receiving such a treatment exceeded 80%. In the case of COPD, anticholinergics were most frequently prescribed when inhaled glucocorticosteroids and long-acting ß2 agonists had proved insufficient. According to 21% of specialists, the percentage of patients treated so was 41-50%, while 19% declared the use of this treatment in 71-80% of patients. CONCLUSIONS: The most common treatments for asthma and COPD in Poland are inhaled glucocorticosteroids and long-acting ß2 agonists. The main factors influencing treatment decisions are the current GINA and GOLD recommendations as well as patients' age, comorbidities, and price of treatment.

Coexistence of Chronic Bronchitis in Chronic Obstructive Lung Disease.

The incidence of chronic obstructive pulmonary disease (COPD) is on the rise worldwide. Chronic bronchitis is a frequent accompaniment of COPD, which increases the burden of COPD in affected individuals. The aim of this study was to characterize the phenotype of chronic bronchitis in COPD patients. The study was based on the survey data retrospectively retrieved from the Action Health-Lung Cancer Prophylaxis and Health Care Improvement screening program that concerned all the inhabitants, aged over 40, of the Proszowice administrative region situated in the Lesser Poland Voivodeship in southern Poland. Participants with the symptoms suggestive of a lung disease were subject to further evaluation. The findings were that 546 (13.3%) out of the 4105 individuals displayed spirometry features of COPD. Symptoms of chronic bronchitis were present in 92 (16.8%) out of the COPD afflicted persons. Chronic bronchitis was commoner in current smokers and its incidence increased with increasing severity of airway obstruction. In multivariate analysis, chronic bronchitis was independently related to lower FEV1, FVC, FEV1/FVC, and to dyspnea. In regression model, factors related to increased risk of chronic bronchitis were current smoking, asthma, and lower lung function. We conclude that COPD with coexisting chronic bronchitis is linked to severer dyspnea and worse lung function. Current smoking, asthma, and lower lung function are related to increased risk of chronic bronchitis accompanying COPD.

Knowledge Regarding Influenza and Influenza Vaccination in General Population: Results of a National Survey in Poland.

For the past 10 years, influenza vaccination coverage rate in Poland remains at a low 3% threshold. This low rate may be related to the unsatisfactory knowledge of vaccination, influenza, and misperception of health risks in the general population. To examine these issues, we used an online questionnaire consisting of 12 closed questions. The basic knowledge on influenza and vaccination was examined. The questionnaire was completed by 1669 persons, mostly young women. Generally, 73% of respondents passed the threshold of 70% correct answers, but important gaps in their knowledge were identified concerning the persons at risk of developing the infection (7.9% of correct answers) and the timing of vaccination (8.4% of correct answers). Although most respondents did identify the etiologic agent correctly (91.1% knew influenza is caused by a virus), only 12.3% knew that the vaccines registered in Poland contain fragments of viruses or its antigens, while 63.1% thought the vaccines contain live bacteria. In conclusion, the knowledge on influenza vaccination is deficient in the general population. Education on immunization should be prioritized to increase vaccination coverage rate in Poland.

Role of vascular endothelial growth factor in inducing production of angiopoetin-1 - in vivo study in Fisher rats.

The aim of the study was to investigate how an intramuscular injection of plasmids with genes coding various pro-angiogenic factors: angiopoetin-1 (ANGPT1), vascular endothelial growth factor (VEGF165) and hepatic growth factor (HGF), influences the production of ANGPT1. 40 Healthy Fisher rats received i.m. injections containing plasmids encoding pro-angiogenic genes in thigh muscles. They were divided into four equal groups. The first group received the plANGPT1 plasmid and the second group- the pIRES/ANGPT1/VEGF165 bicistronic plasmid. The pIRES/VEGF165/HGF bicistronic plasmid was administered to the third group and an empty plasmid (control group) to the fourth group. The animals were euthanized after 12 weeks. In each group, the number of vessels stained with the anti-ANGPT1 antibody was assessed under an optical microscope. The anti-ANGPT1 antibodies stained the vessels in all the groups. There were on average 14.1 ±2.3 vessels in the the plANGPT1 group, 32.5 ±10.5 in the pl/RESANGPT1/VEGF group and 30.8 ±13.3 in the plRES/HGV/VEGF group. There were on average 7.3 ±2.3 stained vessels (p < 0.0001) in the control group . The VEGF plays a role in the induction of the production of ANGPT1. The administration of plasmids only encoding ANGPT1 does not induce its production.

[Bronchipret TE® in therapy of acute infections of the respiratory tract]. / Bronchipret TE® w leczeniu ostrych zakazen ukladu oddechowego.

Bronchipret TE® exhibits multidirectional anti-inflammatory effects as demonstrated in vitro and in vivo studies. It has been disclosed that the drug has the ability to activate the bronchial cleaning mechanism, inhibit the respiratory tract remodeling process by reducing the number of goblet cells, inhibiting enzyme activity and proinflammatory mediators. These mechanisms cause the administration of medication to cause acute bronchitis patients to shorten and alleviate the course of the disease with rapid cough elimination. Use of Bronchipret TE® is in accordance with the recommendations of the European Guideline Committee's and the German Respiratory Society.

efficacy of dry extract of ivy leaves in the treatment of productive cough.

OBJECTIVE: Introduction: Coughing is a physiological, spontaneous defense mechanism against irritants that stimulate respiratory mucosa. Productive cough should be not suppressed; instead, mucus-dissolving agents are recommended. One of the expectorants, which increases the excretion volume, is the herbal medicine derived from ivy leaves. The ivy extract contains triterpene saponins, which have secretory properties. The aim of this study was to determine the effectiveness and safety of the treatment with the medicinal product Hedussin®, containing dry ivy extract, in the therapy of productive cough in the course of the respiratory tract infection. PATIENTS AND METHODS: Material and methods:This was a non-randomized, non-interventional, multicenter, open-label, post-authorization effectiveness study (PAES). The study group consisted of 464 patients aged 2-12 years with productive cough. The study was supported by a questionnaire that included: the type of cough etiological factor, Bronchitis Severity Score (BSS), temperature, and prescription of antibiotic therapy. Effectiveness and safety of the therapy with Hedussin® was assessed at the follow-up visit. RESULTS: Results and conclusion: Improvement in cough was reported in 93.3% subjects; improvement in chest pain on coughing was reported in 84.7%, in wheezing - in 90.0%, in dyspnoea - in 88.7%, and in auscultation changes - in 94.8%. In addition, decline or normalization of body temperature was found in 96.0% of subjects. No adverse drug reactions were reported in the study population. The non-antibiotic treated group showed similar proportions. The results of this study support the efficacy of Hedussin® prescribed for the treatment of productive cough in the course of respiratory tract infections. Hedussin® was well tolerated by sick children aged 2-12 years.

Status of etoricoxib in the treatment of rheumatic diseases. Expert panel opinion.

Pain is one of the most disabling symptoms of rheumatoid diseases. Patients with pain secondary to osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS) or gout require effective analgesic treatment, and the physician's task is to select a drug that is best suited for an individual patient. The choice of pharmacotherapy should be based both on drug potency and clinical efficacy, and its safety profile, particularly in the elderly population, as the number of comorbidities (and hence the risk of treatment complications and drug interactions) rises with age. In cases involving a high risk of gastrointestinal complications or concerns about hepatotoxicity, with a low cardiovascular risk, the first-line nonsteroidal anti-inflammatory drugs to consider should be coxibs including etoricoxib.

Factors associated with knowledge of hypertension among adolescents: implications for preventive education programs in primary care.

BACKGROUND: Hypertension (HT) amongst adolescents remains a vital issue of both a medical and social nature. There is a lack of data regarding the factors influencing the awareness of the disease among the youth. The aim of this study was to evaluate the knowledge about HT among adolescents and its level corresponding to the selected demographic, environmental and medical factors. METHODS: The study was carried out among 250 adolescents of secondary schools. The authors' questionnaire poll and the psychological tests Personal Values List (PVL) and Personal Competence Scale (PCS) were performed. RESULTS: Only 13.2% of the youth surveyed displayed the "medium" level (defined below) of HT knowledge. Most of them present satisfactory knowledge about the causes of HT. The children from urban areas generally displayed better knowledge about HT than their peers from rural regions. Only the children who had had their blood pressure previously examined displayed good knowledge about HT. The most frequently indicated source of this knowledge was school; however, its level still remains low. There was no significant association between the level of global knowledge about HT and the feeling of one's own competences and considering the category "good health" an important personal value. CONCLUSIONS: Knowledge about HT among adolescents remains unsatisfactory and random, which indicates the necessity for routine education in this field, especially as it applies to HT symptoms. It seems that the consideration of such elements as blood pressure measurement and family history of HT in education programs can improve their efficiency.

Immune efficacy of first and repeat trivalent influenza vaccine in healthy subjects and hemodialysis patients.

Influenza vaccination is recommended to patients from groups at risk and to healthy persons alike. It is not completely clear whether persons vaccinated every year benefit more from the vaccination in any given season in comparison with those who are vaccinated for the first time. The aim of the study was to analyze whether influenza vaccination in previous seasons influences the response to ongoing vaccination in the healthy population and in hemodialyzed patients. The outcome measure was the production of anti-hemagglutinin antibodies in 71 hemodialyzed patients (Group A) and 63 patients of primary healthcare clinic, without chronic renal failure (Group B). The patients of these two groups were subdivided into never vaccinated before and previously vaccinated against influenza. After the current vaccination, significantly lower levels of anti-A/H1N1/ antibodies were found in the hemodialyzed compared with non-hemodialyzed previously vaccinated, but not unvaccinated, patients. The hemodialyzed patients, previously unvaccinated, had at baseline significantly lower levels of anti-A/H3N2/ and anti-B antibodies than those who were previously vaccinated; the differences were no longer significant after the current vaccination. We conclude that although antiflu immunization in previous seasons leads to higher baseline antibody titers in hemodialysis compromised patients, which is less evident in non-hemodialyzed patients, it is of little influence on the immunoresponse to current influenza vaccination, in both hemodialyzed and non-hemodialyzed patients.

Usage of medical internet and e-health services by the elderly.

Internet and e-health services have a substantial potential to support efficient and effective care for the elderly. The aim of the study was to investigate the use of Internet for health-related purposes among Polish elderly, the frequency and reasons of use, the importance of e-health services, and factors affecting their use. A total of 242 elderly at the age of ≥60 years were selected from the Polish population by random sampling. Data collection was carried out by phone interviews in October-November 2012. The study shows that the Internet was ever used by 32% of the elderly and 1/5 claimed a regular use. Among the Internet users, 81% of older people used it to obtain information about health or illness. The Internet was one of the less important sources of information (important for 27% of respondents), face to face contact with health professionals and family and friends are still the most required source of medical information (75%). Only 7% of elderly Internet users approached the family physician, specialists, or other health professionals over the Internet. Factors that positively affected the use of Internet among elderly were male gender, younger age, higher education, living with family, mobile phone use, and a subjective assessment of one's own health as good. The doctor's provision of Internet-based services was important in the opinion of approximately 1/4 of older people. We conclude that the development of information and communications technology (ICT) tools increasingly meets the evolving needs of patients in the field of e-health. More and more elderly become beneficiaries of these services.

[Expert's opinion on recommendations for water and other beverages consumption in elderly?]. / Stanowisko Grupy Ekspertów w sprawie zalecen dotyczacych spozycia wody i innych napojów przez osoby w wieku podeszlym.

The article encloses definition of water role and its body requirement, review of water balance and management in older persons regarding characteristic of this age group and concomitant disorders. Based on current literature and expert's opinion the recommendations for water consumption were expressed with estimation of insufficient apply and oversupply, evaluation of hydration state, domestic water sources in diet with accent on influence of proper hydration on comfort and good health.