[Cooperation according to French Law "hospital, patients, health and territories": Pharmacists' involvement in Aquitaine region]. / Missions de coopération introduites par la loi « hôpital, patients, santé et territoires ¼ : participation des pharmaciens d'officine en Aquitaine.

BACKGROUND: In 2009, the French Act "Hospital, Patients, Health and Territories" (loi "Hôpital, Patients, Santé et Territoires") reorganized the outpatient care pathway and defined missions aimed at improving cooperation between pharmaceutical and medical professionals. Five years later, we conducted a survey among community pharmacists in order to assess the appropriation of these missions and the way cooperation was implemented. We also aimed to investigate factors that could hamper or ease the development of these activities in order to identify actions needed to improve pharmacists' involvement. METHODS: In partnership with the local health authorities "Agence régionale de santé", we conducted a survey via an online questionnaire sent to pharmacy holders in July 2014 in Aquitaine region. Information was collected about the pharmacies, involvement in collaborative activities, and barriers to cooperation. RESULTS: Overall, 20% (249) of pharmacists responded to the survey. They owned predominantly rural pharmacies (46%) or neighborhood pharmacies (41%), with two pharmacists per pharmacy (48%). Regarding collaborative activities, the majority of pharmacists (78%) had conducted interviews with their patients taking vitamin K antagonist therapy and they were willing to continue (87%). The implication was less common concerning other actions such as referent pharmacist for nursing homes (19%) or activities relating to therapeutic educational programs for patients with chronic conditions (34%). The vast majority of respondents (85%) were not aware of opportunities to become a correspondent pharmacist. The main obstacles for engaging in these activities were the lack of time, lack of knowledge about these missions and the lack of remuneration. We identified differences in pharmacists' involvement in collaborative activities depending on selected characteristics of the pharmacies. CONCLUSION: The findings of this survey underlined pharmacists' acceptance of these missions and suggest that better information and appropriate remuneration could enhance commitment. Recent changes in the legal framework (establishment of "pharmaceutical fees", extension of the scope of pharmaceutical interviews) enable funding for collaborative practices between medical practitioners and pharmacists, thus encouraging better coordination in the patient care pathway.

[Exception drugs status: specific characteristics and the role in the proper use of drugs]. / Les médicaments d'exception: spécificité et rôle dans le cadre du bon usage des médicaments.

BACKGROUND: In 1994, the French health care system established a special status for certain costly drugs reimbursed for ambulatory use: exception drugs. Drugs with this status are reimbursed only when prescribed for specified indications. The purpose of this study was to identify the specific characteristics of drugs with the exception status, and to understand the role of this status in proper use of drugs. METHODS: Drugs included in the study were analyzed using three types of data: administrative, clinical and economic. RESULTS: For most of the drugs, prescription was restrictive. For five of them, the sickness fund accepted reimbursements for fewer indications than mentioned in the marketing authorisation. For the majority, reimbursement was 100%. The exception drugs were indicated for the treatment of 15 diseases. Eighty percent of expenditures for exception drugs concerned ten drugs. CONCLUSION: The characteristics considered in the study did not enable a specific description of the inherent features of exception drugs. This special status was established for the purpose of economic efficiency. Currently, its role in ensuring proper use of drugs is questionable.

[The French system of evaluation of dependence: establishment in a legal system]. / Le système français d'évaluation de la pharmacodépendance et de l'abus: consécration juridique.

The French system of evaluation of dependence has been defined in the French Public Health Code by decree 99-249 of 31 March 1999. It was created by health authorities 10 years earlier and concerns dependence and abuse, which were previously just submitted to control under the designation of non-conforming use and misuse. The consultative function of the narcotics and psychotropics commission has been reinforced and its mission extended to include evaluation. Cooperation with different actors has been organized. This is based on the complexity of the methods of evaluation and the impact of decisions concerning control and/or information. The same principles organize the cooperation of this system at the European and international levels.

Benzodiazepine use in patients hospitalized in a department of internal medicine: frequency and clinical correlates.

PURPOSE: Misuse and overuse of benzodiazepines (BZD) are common. Several studies have shown that benzodiazepines are frequently used in hospitalized patients, but fewer studies have been conducted to investigate whether BZD use increases during the hospital stay or whether patients have already taken BZD before admission. OBJECTIVE: To assess the prevalence of benzodiazepine use in hospitalized patients and to determine characteristics associated with this use. METHODS: Prospective study over a 4-month period based on all admissions to a department of internal medicine. The main outcome was the prevalence of benzodiazepine use at admission, during hospital stay and at discharge. RESULTS: Of 444 patients admitted, 147 (33%) used at least one benzodiazepine which was in 75% of the cases, short-elimination half-life BZD used as hypnotic. Of 105 (23.6%) patients using BZD at admission, 23 (5.2%) stopped BZD during hospital stay or when leaving hospital. The in-hospital prevalence of BZD use was 30% (133 patients). In 28 (6.3%) patients without BZD at baseline, BZD was introduced during the hospital stay then stopped at discharge in 18 (4%) patients. The prevalence of BZD use at discharge was 23.9% (106 patients). In multivariate analyses, BZD use was significantly associated with number of drugs taken during hospitalization (OR: 1.13; 95% CI: 1.03-1.24), and current neuropsychiatric diseases (OR: 2.12; 95% CI: 0.86-5.23), but not with gender, age or length of stay. CONCLUSION: Prevalence of BZD use appeared to be fairly high among hospitalized patients. There were very few new BZD users during hospital stay, most of whom were stopped at discharge. Most treatments were started before hospital, and continued during and after hospital stay without clear reevaluation.

Determination of buprenorphine in plasma by liquid chromatography: application to heroin-dependent subjects.

A rapid, sensitive, precise and accurate HPLC assay with UV detection was developed for the determination of buprenorphine (BN) in human plasma. This method involved a two-step extraction in the presence of clothiapine as internal standard. The compounds were chromatographied on a reversed-phase Spherisorb C8 column with a mobile phase consisting of 0.06 M KH2PO4/Na2HPO4 pH 6.4-acetonitrile-triethylamine-Pic B5 (520:480:0.5:15, v/v) and detected at 214 nm. The recovery of BN was greater than 94% with an intra-day relative standard deviation < or = 4.8% and an inter-day relative standard deviation < or = 14.6% at any studied level. Studies of drug stability during sample storage at -20 degrees C and at +4 degrees C did not show any significative degradation of BN. This method was successfully applied to explore the overdose state of heroin-dependent subjects treated by high-dose BN.

Abuse of prescription medicines in southwestern France.

BACKGROUND: Few quantitative data are available concerning abuse of medicine in the general population, although dependence on prescription medicines involves a significant proportion of the population. Falsified prescription forms can be used as an indicator of abuse. METHODS: Community pharmacists in a representative network were asked to report any falsified prescription form presented over a 1-year period. Sales data were used to express results as abuse rate and abuse rate ratio. RESULTS: Two-thirds of the 130 pharmacies in the network reported at least 1 falsified prescription. The reported incidence of falsified prescriptions was 2.3 per 10 000 inhabitants. A total of 392 falsified prescription forms was collected. The abuse rate ratios were 171 (95% CI 140 to 210) for dextroamphetamine-phenobarbital in combination, 168 (95% CI 131 to 216) for fenozolone, 67 (95% CI 53 to 84) for buprenorphine, and 40.5 (95% CI 33 to 50) for clobenzorex. CONCLUSIONS: These results show the efficiency of a method for detecting falsified prescriptions forms using community pharmacists. The abuse of medicines already known for their addictive potential can be estimated and alerts can also be detected.