Investigation of the hospital pharmacy profession in Europe.

OBJECTIVE: From 1995, the European Association of Hospital Pharmacists (EAHP) has regularly investigated the progress of the hospital pharmacy profession in Europe, and identified key barriers and drivers of this. The most recent 'Investigation of the Hospital Pharmacy Profession in Europe' was conducted from November 2022 to March 2023. METHODS: The online questionnaire was sent to all hospital pharmacies in EAHP member countries. The investigation was drafted using the same questions as the 2015 baseline survey. Where possible and relevant, responses were compared with the data from previous surveys that monitored the implementation of the EAHP statements. Keele University, Centre for Medicines Optimisation, School of Pharmacy and Bioengineering, UK analysed the data. RESULTS: The overall number of responses was 653, with a better response rate of 19% compared with 14% in 2018 statements survey. The findings indicated that participating hospital pharmacies have similar characteristics to previous surveys. Section 1 (Introductory statements and governance), section 2 (Selection, procurement and distribution), section 3 (Production and compounding), section 5 (Patient safety and quality assurance) questions were generally answered positively, with results ranging from 52% to 90%. However, results for section 4 (Clinical pharmacy services) returned lower levels of positivity, with responses from 8 of the 15 questions being less than 60%. When asked what is preventing hospital pharmacists from achieving implementation of these activities, most answers were limited capacity, not considered to be a priority by managers, or other healthcare professionals do this. The last section focused on self-assessment and action planning, with fewer than 50% of positive responses; COVID-19 preparedness and vaccines with mixed positive and negative responses. Furthermore, implementation of the falsified medicines directive impacted the medication handling processes in 50% or more of the answers. Regarding sustainability, the majority (59%) of respondents felt a greater focus should be on sustainability from an organisational or management perspective. CONCLUSION: Results offer valuable insights into the hospital pharmacy profession throughout Europe. While there have been improvements in certain areas, challenges remain, particularly in implementing clinical pharmacy services. The findings provide a foundation for further dialogue, advocacy, and strategic planning to advance the role of hospital pharmacists and enhance patient care in Europe's healthcare systems.

Results of EAHP's 2023 shortages survey.

AIMS AND OBJECTIVE: The aim of the European Association of Hospital Pharmacists (EAHP)'s 2023 shortages survey was to collect data on causes and mitigation strategies of shortages of medicines and medical devices and their impact on patient care. The survey targeted hospital pharmacists (HPs), physicians (PHYs), nurses (NRS) and other healthcare professionals (OHCPs). A separate set of questions addressed patients (PTNs). METHODS: A 49-question survey was carried out by a team at EAHP, collecting information from European HPs, PTNs, NRS, PHYs and OTHCs on shortages of medicines and medical devices in their respective countries. The survey ran from 27 February to 19 May 2023. The results were analysed by EAHP. RESULTS: There were 1497 HP responses to the 2023 survey. While 95% (n=1429) of HPs and 86% (n=127) of OHCPs consider medicine shortages an ongoing problem, 84% (n=48) of PHYs and 68% (n=15) of NRS also agreed. Shortages of active pharmaceutical ingredients (77%, n=1148), manufacturing (67%, n=1007) and supply chain problems (50%, n=752) are major causes of shortages according to HPs as well as NRS and OHCPs; PHYs (49%, n=18) consider pricing to be the driver. More than 60% (n=765) of HPs, 55% (n=11) of NRS, 57% (n=30) of PHYs and 46% (n=56) of OHCPs experienced shortages of medical devices in 2022. Antimicrobials were most affected, according to all respondent groups, followed by analgesics, anaesthetics, cardiovascular and paediatric medicines. HPs (59%, n=269), NRS (57%, n=4), OHCPs (56%, n=37) and PHYs (54%, n=14) consider delays in care as the main consequence of medication shortages. CONCLUSIONS: Shortages of medicines and medical devices affect healthcare services and patient care. Increased transparency and access to information regarding ongoing and emerging shortages as well as better preparedness of healthcare professionals is crucial to their effective management.

Procurement.

EAHP's position paper advocates for the involvement of hospital pharmacists in procurement. The immediate concern of any hospital pharmacist is to ensure that every patient within the hospital receives the medications needed. For this reason, hospital pharmacists have a direct stake in the efficient functioning of the medicines' supply chain. The position touches on pharmaceutical tendering which is a complex process that involves different stakeholders and steps that are regulated at national level leading to diverse solutions in the different European countries. In addition, these processes are guided by publications of other international actors such as the World Health Organisation (WHO) and the Organisation for Economic Co-operation and Development (OECD). The second part focuses on the role of hospital pharmacists in procurement which due to their knowledge and skills are specialists in the field of all medicines' procurement. Hospital pharmacists should lead in all phases of the procurement processes and practices to ensure the continuity of the supply of cost-effective and quality medicines to patients.

eHealth and mHealth.

Both electronic health (eHealth) and mobile health (mHealth) are becoming prominent components of healthcare. In order for healthcare electronic services to be safe and effective and add genuine value to the system, the European Association of Hospital Pharmacists (EAHP) believes that these should be developed in close collaboration with healthcare professionals including hospital pharmacists, and patients. Consequently, the EAHP calls in its position paper upon national governments and health systems across Europe to work towards (1) systematic and European Union-wide achievement of electronic prescribing, administration and use of electronic medical records; (2) ensuring barcoding of medicines to the single units in primary packages to enable more widespread take-up of bedside scanning in European hospitals, thus improving patient safety; (3) appropriate regulatory oversight mechanisms for mHealth applications to ensure that they have a positive impact and adequately protect patient data; (4) provision of appropriate eHealth/mHealth training opportunities to healthcare professionals and promotion of digital health literacy; and (5) involvement of hospital pharmacists in the design, specification of parameters and evaluation of information and communication technology within the medicines processes.

Biosimilar medicines.

Biological medicines have become indispensable in the treatment of patients with serious diseases such as cancer and inflammatory diseases. Biosimilars are medicines which are developed to be similar to existing biological medicines (the 'reference product'). For the European market, they are approved by the European Medicines Agency. Owing to the rising importance of biosimilar medicines, the European Association of Hospital Pharmacists (EAHP) decided to set out its position on key issues concerning biosimilar medicines in a position paper. The topics included the role of hospital pharmacists in the uptake of biosimilar medicines in healthcare with regard to selection, procurement, logistics, information, education and collecting real-life experience (eg, in monitoring and pharmacovigilance). In addition, the paper touches on the views of the association for the naming of biosimilar medicines, extrapolation of indications, interchangeability, switching and substitution of biosimilar medicines and the provision of information about biosimilar medicines.

Enhancement of drug solubility in supramolecular and colloidal systems.

Statins, as efficient HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme-A) reductase inhibitors are widely used in the management of cardiovascular diseases. Interactions in aqueous solutions between highly lipophilic statins and cyclodextrins (CDs) in the absence and the presence of a dissolved polymer or its monomeric compound, respectively, were studied. The solubility of lovastatin and simvastatin at various temperatures and pHs were investigated by phase-solubility measurements. Surface activity of solutes in binary (CD-statin) and ternary (CD-statin-polymer) systems was studied by determining the surface tension of the solutions. For the characterization of the CD-statin inclusion complexes, stability constants for associates of different molar ratios have been calculated. It was shown that complexation may lead to improvement of the aqueous solubilities of both statins by 1-2 orders of magnitude. Especially, randomly methylated beta-cyclodextrin (RAMEB) showed outstanding solubilizing effects. In binary systems dominantly CD-statin associates of 1:1 molar ratios form, which exhibit considerable surface activity. RAMEB forms more stable complexes with these drugs than the native beta-CD, and also the surface activity of the former solutes is higher. In polymer-containing ternary systems the solubility of both statins could be further improved. The enhanced drug solubilities can be ascribed to the formation of CD-statin-polymer associates with supramolecular structure. A portion of the surface active CD-statin complexes are very likely anchored at the macromolecular chains. In these solutions, the total amounts of solutes are composed of the sum of the "free" binary and the supramolecular ternary associates.

[Colloid-physical characterization of supramolecular drug delivery systems]. / Szupramolekuláris gyógyszerhordozó rendszerek kolloidfizikai jellemzése.

Cyclodextrins are well-known biocompatible oligosaccharides capable of forming inclusion complexes with suitable guest molecules. They can be expediently used as solubilizers for hydrophobic pharmacon molecules in aqueous solutions. In this study, the effect of colloidal and non-colloidal additives on the solubility of statins is described. Two statin-derivatives (lovastatin and simvastatin), beta-cyclodextrin (-CD) and randomly methylated beta-cyclodextrin (RAMEB) were used as complexing agents. Those pharmacons are widely used in the management of cardiovascular diseases involving high or elevated blood cholesterol levels. Complexation of the highly lipophilic statin molecules with beta-CD and RAMEB was studied in the presence and the absence of dissolved polyvinyl-pyrrolidone (PVP). For the characterization of the stability of statin-CD complexes, association constant of binary associates have been calculated. It was found that inclusion complexation can beneficially enhance the solubility of both statin-derivatives. In binary statin-CD solutions predominantly associates of 1:1 molar ratio form, which show significant surface activity. In polymer-containing ternary systems, the solubility of the pharmacons can further be increased. This phenomenon can presumably be explained with the formation of statin-CD-polymer ternary associates of supramolecular structure. In such supramolecular assemblies the amphiphilic statin-CD complexes are likely bound to the macromolecules' chains. The wetting properties of solid, dried and powdered complexes were studied by immersion enthalpy measurements. Both in binary and ternary systems a significant increase in the immersion enthalpy values could be detected, which indicates that the complexes exhibit fairly hydrophilic character.

[Interactions in solution between cyclodextrins and statins]. / Ciklodextrinek es sztatinok kölcsönhatásának in vitro vizsgálatai.

Cyclodextrins (CDs) are cyclic oligosaccharides, capable of forming inclusion complexes with hydrophobic molecules in aqueous solution and therefore, of improving the bioavailability of many drugs. They are biocompatible with living cells and do not cause toxic side effects. In this study, interactions in aqueous solutions between chemically different CDs and lovastatin and simvastatin, respectively, were investigated. It was found that the solubility of both statins can be considerably increased by the CD derivatives. The influence of the chemical structure of CD and of the temperature and pH on the solubility of the statin derivatives is described. Possible ways of increasing the solubility of these cholesterol-lowering drugs and their utilization in practice are also outlined.