Predicting drug shortages using pharmacy data and machine learning.

Drug shortages are a global and complex issue having negative impacts on patients, pharmacists, and the broader health care system. Using sales data from 22 Canadian pharmacies and historical drug shortage data, we built machine learning models predicting shortages for the majority of the drugs in the most-dispensed interchangeable groups in Canada. When breaking drug shortages into four classes (none, low, medium, high), we were able to correctly predict the shortage class with 69% accuracy and a kappa value of 0.44, one month in advance, without access to any inventory data from drug manufacturers and suppliers. We also predicted 59% of the shortages deemed to be most impactful (given the demand for the drugs and the potential lack of interchangeable options). The models consider many variables, including the average days of a drug supply per patient, the total days of a drug supply, previous shortages, and the hierarchy of drugs within different drug groups and therapeutic classes. Once in production, the models will allow pharmacists to optimize their orders and inventories, and ultimately reduce the impact of drug shortages on their patients and operations.

Management of antipsychotic-induced weight gain: prospective naturalistic study of the effectiveness of a supervised exercise programme.

OBJECTIVE: To determine the potential effectiveness of a behavioural weight control programme including physical exercise in the prevention of antipsychotic-induced weight gain and associated comorbid conditions in outpatients with schizophrenia and mood disorders. METHODS: A prospective, comparative, open and naturalistic study was carried out for a total of 110 patients with schizophrenia, schizoaffective or bipolar disorders (DSM-IV), on treatment with atypical antipsychotics. Of these, 59 patients participated in an 18 month weight control programme that included an educational activity about dietary and physical activity counselling as well as a structured, supervised, facility-based exercise programme. The control group consisted of 51 patients with the same baseline characteristics who did not receive the clinical programme. Anthropometric measurements, plasma lipid-lipoprotein profile, and fasting plasma glucose concentrations were assessed at 11 time-points over the study. In addition, serum concentrations of prolactin, thyrotropin-stimulating hormone (TSH), and glycated haemoglobin (HbA1c) were assessed at four time-points. Finally, the Clinical Global Impression scale (CGI), the Brief Psychiatric Rating Scale (BPRS) and the Short Form (SF)-36 Health Survey were used. RESULTS: The adherence rate of patients was 85%, both in the active and in the control group. Whereas the control group experienced a significant increase in bodyweight (4.1%), body mass index (BMI; 5.5%) and waist circumference (WC; 4.2%), the active group significantly reduced their bodyweight (-3.5%), BMI (-4.4%), and WC (-4.6%) at the study end-point. In addition, a significant increase in low-density lipoprotein (LDL)-cholesterol (14.8%) and in triglyceride concentrations (12.3%) was observed at month 18 in the control group. In contrast, high-density lipoprotein-cholesterol (HDL) significantly increased (21.4%), and LDL cholesterol (-13.7%), triglycerides (-26.2%), total cholesterol (-12.1%), fasting glucose concentrations (-12.0%), and HbA1c (-11.4%) significantly decreased compared to baseline in the active group. No significant changes were observed regarding serum concentrations of prolactin and TSH during the study. In regard to the changes observed in psychological measures, no between-group differences were seen in the clinical ratings of CGI and BPRS. However, the SF-36 showed that physical health was improved only for subjects in the active group at months 12 and 18 compared to baseline (p<0.05), and mental health was significantly improved for both groups at months 12 and 18 compared to baseline. CONCLUSION: Bodyweight and metabolic risk profile in patients receiving atypical antipsychotic medications can be effectively managed with a weight control programme including physical activity.