Development and evaluation of a blended learning training programme for pharmacy technicians' continuing education.

OBJECTIVES: The role of the pharmacy technician (PT) has expanded in recent years, requiring new competencies, better communications skills and high-level knowledge about drugs. The objective of this study is to develop and evaluate a blended learning programme for PTs' continuing professional development. METHODS: A blended learning programme designed to enhance knowledge, skills and attitudes was created using a six-step approach to curriculum development for medical education. The first part included three short microlearning videos to improve knowledge; the second consisted of a 1.5 hour 'edutainment' session for groups of 5-6 PTs to deepen their knowledge and practice skills. Impacts on knowledge, degree of certainty and self-perceived competence were evaluated before training (pre-test), after the microlearning (post-test 1) and after the edutainment session (post-test 2). RESULTS: The three microlearnings were entitled 'Communication', 'Cut-crush a tablet/open a capsule' and 'Pharmacy website'. The edutainment session used team-based learning, game-based learning, peer instruction and simulation. Twenty-six PTs of mean±SD age 36±8 years participated. Pre-test and post-test 1 evaluation scores showed significant overall improvements in mean knowledge (9.1/18 vs 12.1/18, p<0.001), mean degree of certainty (3.4/5 vs 4.2/5, p<0.001) and mean self-perceived competence (58.6/100 vs 72.3/100, p<0.001). After post-test 2, mean knowledge (12.1/18 vs 13.1/18, p=0.010) and mean self-perceived competence (72.3/100 vs 81.1/100, p=0.001) scores had improved, but not mean degree of certainty (4.2/5 vs 4.4/5, p=0.105). All participants found the blended learning programme suitable for their continuing professional development. CONCLUSIONS: The present study showed the positive effects of using our blended learning programme to improve PTs' knowledge, degree of certainty and self-perceived competence, to their great satisfaction. This pedagogical format will be integrated into PTs' continuing professional development and include other educational topics.

Swiss-Meds: An App Fostering Medication Adherence of Swiss Patient.

Medication adherence is a widely recognized problem that is linked to overuse of healthcare system and negative health outcomes. Among the causes of non-adherence, forgetfulness plays a central role. mHealth interventions are particularly interesting to support medication adherence. Unfortunately, there is a lack of information about the quality and effectiveness of the app available on the market. In this article, we present the design and evaluation of an app for the Swiss market. The app was developed with a user-centered approach and was evaluated by both experts and end-users. The app functions include facilitated medication data entry through barcode scanning, and access to educational materials for specific drugs. Although the evaluation by experts and end-users revealed usability issues, such as the inability to customize the app, and a low evaluation of the performance (subjective assessment), it also found that the app contained most of the core functionalities that are expected for a medication adherence app. These are promising results, and will guide the future development of the app to respond to both experts and user expectations.

SMART-MEDS: Development of a Medication Adherence App for Acute Coronary Syndrome Patients based on a Gamified Behaviour Change Model.

Patient adherence to medications is crucial for reducing cardiovascular risk after an acute coronary syndrome (ACS). Although causes for low adherence are diverse, forgetfulness and lack of awareness about treatment importance are accountable for many cases. As a result, medication reminder apps have attempted to tackle this problem. In our work, we present the development of an app with gamification mechanisms to foster adherence and to support the behavior change processes of the Health Access Process Approach (HAPA) theoretical framework. To design our intervention, we relied on a user-centric approach. We listed the main factors related to high and low adherence from the Medication Adherence Reasons Scale (MAR-Scale) and identified functionalities that could address it. We focused in particular on forgetfulness, knowledge and beliefs about medication as the main barriers for adherence. We implemented a quiz and storytelling as gamification strategies to help motivate patients complete their medication journal and to maintain adherence on the long-term.

Development and Validation of a Clostridium difficile Health-related Quality-of-Life Questionnaire.

GOALS AND BACKGROUND: Patients with Clostridium difficile infection (CDI) can experience long-term symptoms and poor quality of life due to the disease. Despite this, a health-related quality of life (HRQOL) instrument specific for patients with CDI does not exist. The aim of this study was to develop and validate a disease-specific instrument to assess HRQOL in patients with CDI. STUDY: A systematic literature review was conducted to identify HRQOL instruments and questions related to general health (n=3) or gastrointestinal disease (n=12) potentially related to CDI HRQOL. Removing duplicate questions and using direct patient or clinician interviews, a 36-item survey was developed. The survey was then tested using 98 patients with CDI and compared with the RAND Short-Form 36 (SF-36) Health Survey. Psychometric analysis techniques were used to identify domains and remove redundant items. RESULTS: Exploratory factor analysis identified 3 major domains (physical, mental, and social) with 4 associated subdomains. Survey overall and domain scores displayed good internal consistency (Cronbach α coefficient >0.87) and concurrent validity evidenced by significant correlation with SF-36 scores. The C. difficile survey scores were better able than the SF-36 to discriminate quality-of-life score differences in patients with primary versus recurrent CDI and increasing time since last episode of CDI. The final version contained 32 items related to the physical, mental, and social health of CDI patients. CONCLUSION: The properties of the newly developed Cdiff32 should make it appropriate to assess changes over time in HRQOL in patients with CDI.

P-glycoprotein: a clue to vitamin K antagonist stabilization.

BACKGROUND: Acenocoumarol is a vitamin K antagonist used in some European countries. As warfarin, this drug is characterized by a narrow therapeutic index and a large interindividual variability. AIM: The objective of this study was to assess the involvement of ABCB1 polymorphisms on acenocoumarol treatment. MATERIALS & METHODS: An observational cohort study was conducted to assess whether there is an association between the presence of the allelic variants of the ABCB1 gene coding for P-glycoprotein and acenocoumarol stabilization and daily doses during the first 35 days of treatment. RESULTS: One hundred and fifteen patients met the inclusion criteria. The results of the clinical study showed that carriers of ABCB1 c.3435TT were more rapidly stabilized than wild-type patients (HR: 2.97, 95% CI: 1.23-7.18; p = 0.02). The same tendency was observed for the ABCB1 c.2677GT and 2677TT genotypes compared with ABCB1 c.2677GG. The ABCB1 c.2677TT genotype was also associated with a significant increase in doses of acenocoumarol (p = 0.03), the same tendency was observed with the ABCB1 c.3435TT genotype compared with the wild-type patients. CONCLUSION: These data suggest that ABCB1 polymorphisms could be involved in the response to acenocoumarol treatment.

Role of P-glycoprotein in the uptake/efflux transport of oral vitamin K antagonists and rivaroxaban through the Caco-2 cell model.

Vitamin K antagonists (VKAs) are prescribed worldwide and remain the oral anticoagulant of choice. These drugs are characterized by a narrow therapeutic index and a large inter- and intra-individual variability. P-glycoprotein could contribute to this variability. The aim of this study was to investigate the involvement of P-gp in the transport of acenocoumarol, phenprocoumon and warfarin using an in vitro Caco-2 cell monolayer model. These results were compared with those obtained with rivaroxaban, a new oral anticoagulant known to be a P-gp substrate. The transport of these four drugs was assessed at pH conditions 6.8/7.4 in the presence or absence of the P-gp inhibitor cyclosporine A (10 µM) and the more potent and specific P-gp inhibitor valspodar (5 µM). Analytical quantification was performed by LC/MS. With an efflux ratio of 1.7 and a significant decrease in the efflux (Papp B-A), in the presence of P-gp inhibitors at a concentration of 50 µM, acenocoumarol can be considered as a weak P-gp substrate. Concerning phenprocoumon, the results suggest that this molecule is a poor P-gp substrate. The P-gp inhibitors did not affect significantly the transport of warfarin. The efflux of rivaroxaban was strongly inhibited by the two P-gp inhibitors. In conclusion, none of the three VKAs tested are strong P-gp substrates. However, acenocoumarol can be considered as a weak P-gp substrate and phenprocoumon as a poor P-gp substrate.

Impact of CYP2C9 polymorphisms on the vulnerability to pharmacokinetic drug-drug interactions during acenocoumarol treatment.

AIM: The objective of this study was to investigate the impact of CYP2C9 polymorphisms and drug-drug interactions on the risk of overanticoagulation in patients treated with acenocoumarol, a vitamin K antagonist. MATERIALS & METHODS: A prospective observational study was performed on patients starting acenocoumarol (n = 115). CYP2C9 genotypes were assessed. Data on International Normalized Ratio, comedications and doses of acenocoumarol were collected during the first 35 days of therapy. Overanticoagulation was defined as the occurrence of at least one International Normalized Ratio ≥4. RESULTS: The presence of a CYP2C9 inhibitor or a CYP2C9 polymorphisms statistically increased the risk of overanticoagulation (hazard ratio [HR]: 2.8, p < 0.001 and HR: 1.7, p = 0.04, respectively). The presence of CYP2C9 polymorphisms almost tripled the risk of overanticoagulation (HR: 2.91, p = 0.01) in the presence of a clinically significant drug-drug interaction. CONCLUSION: These findings support the fact that CYP2C9 genotyping could be useful to identify patients requiring closer monitoring, especially when a drug-drug interaction is expected.

[Introduction of acenocoumarol using an algorithm for prescription]. / Introduction de l'acénocoumarol à l'aide d'un algorithme de prescription.

Anticoagulant therapy is indicated in many clinical situations. The handling of vitamin K antagonists (VKA) is difficult and their therapeutic range is narrow, requiring close biological monitoring of INR. Introduction of VKA is a particularly critical period. Algorithms for initiation of oral anticoagulant therapy have been proposed but they are generally designed for warfarin, which has a longer half life as compared to acenocoumarol. In this article, algorithms for the prescription of acenocoumarol are proposed, taking into account the patient's age, weight and initial Quick value. The goal of these algorithms, combined with frequent monitoring of INR, is to limit the bleeding risk during the introduction of anticoagulant therapy.