Ginger (Zingiber officinale) Root Extract During Pregnancy: A Clinical Feasibility Study.

There is almost no experience with concentrated ginger extracts during pregnancy. The purpose of this trial was to include 50 pregnant women in a clinical feasibility study with EXT.GR10, a 10 × concentrated ethanolic extract of ginger root. The primary objective was to detect complications in the mother during pregnancy and malformations or complications in the newborn at delivery. The secondary purpose was to evaluate the satisfaction of the patients. In total, 51 pregnant women were included in this observational study. They could freely use ginger tablets with a maximum of 2 tablets of 50 mg EXT.GR10 a day in case of gastrointestinal discomfort. Tablets were taken by 44 patients. Stillbirth, prematurity, hypertension, and gestational diabetes occurred. There were no serious complications at birth. In the newborn, 4 cases of dysplasia of the hip were seen and 2 minor malformations. There was no relation between events affecting mother and child and the number of EXT.GR10 tablets taken. About ⅔ of patients appreciated the effects of ginger. This is the first clinical study with the EXT.GR10 extract. Based on this feasibility study, a follow-up clinical trial is planned with a fixed minimum of exposure to EXT.GR10 during the first trimester of pregnancy.

Development of a tool to assess the completeness of drug information sources for health care professionals: A Delphi study.

The aim of this study was to create a standard set of essential drug information items as a tool to assess the completeness of any type of drug information source, regardless of its length, using a Delphi consensus panel of European health care professionals. A compilation of drug-related information items was performed by searching several resources for health care professionals and a final list of 162 items was obtained. Fifty-seven experts in drug information from 23 different European countries were invited to participate in a three-round Delphi technique to obtain consensus on items considered essential and non-essential content of information. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively. Of the 57 experts invited, 32 completed the first round, 27 the second, and 29 the third. Consensus was achieved for 28.3% of the items in the first round, 49.3% in the second, and 58.3% in the third. The final cumulative consensus was 67.7% (n = 126) for items considered essential and 16.1% (n = 30) for items considered non-essential. The final tool obtained to assess the completeness of drug information sources was composed by 126 essential items grouped into 11 sections. This tool allows for the comparison of different information sources for the same medicine and the information content for different medicines in the same source.

Impact of training on pharmacists' counseling of patients starting antidepressant therapy.

OBJECTIVE: To measure the impact of a one-day depression-related training program on pharmacists' counseling of unannounced "mystery shoppers" (MS) starting antidepressant therapy. METHODS: Clustered RCT pharmacies; intervention group pharmacists received communication skills training related to depression (n=21); control pharmacists did not (n=19). Eight months after training, the 40 community pharmacies were visited by MS with a first prescription for antidepressants. The pharmacy interactions were recorded and analyzed using the Roter Interaction Analysis System (RIAS). Mann-Whitney U tests were used to evaluate the impact of training on pharmacy interactions and MS evaluations of the pharmacists' skills and attitudes. RESULTS: Interactions of intervention group pharmacists were significantly longer and consisted of more education and counseling statements about lifestyle and psychosocial concerns. Intervention group pharmacists asked more questions about medical condition and therapeutic regimen, as well as socioemotional concerns. MS gave more socioemotional information to intervention group pharmacists and were more positive in their assessment of these pharmacists' skills and attitudes (p values<0.05). CONCLUSION: Pharmacist training in depression care can positively affect the quality of patient care. PRACTICE IMPLICATIONS: Postgraduate training in depression related services is a worthwhile approach to improve the quality of pharmaceutical care.

Information on antidepressants for psychiatric inpatients: the divide between patient needs and professional practice.

BACKGROUND: Medicine information is an integral part of patient care and a patient right. In particular, patients with a mental health diagnosis have a need for information on medicines. OBJECTIVE: This study aims to describe the current practice on information provision on antidepressants to inpatients in psychiatric hospitals. METHODS: A qualitative study was conducted consisting of semi-structured interviews with health care professionals (n=46) and patients (n=17) in 11 Flemish psychiatric hospitals. Two topic guides were designed for conducting the interviews with these respective stakeholders. The issues addressed in the topic guides related to: organization of information provision in the hospital, information on demand of the patient, information provision by health care professionals, information for relatives, evaluation of provided information, interdisciplinary contacts on information provision and satisfaction on current practice of information provision. The interviews were analysed according to the five stages of the framework analysis. RESULTS: Psychiatrists and nurses are the key players to provide information on antidepressants. Their approach depends on patient characteristics and mental state. Information is provided mainly orally. Health care professionals consider non-verbal cues of patients to verify if information has been understood. Health care professionals reported lack of time and lack of interdisciplinary contacts as negative aspects. Patients indicated that health care professionals take too little initiative to provide medicine information. CONCLUSIONS: Patients are informed about their antidepressants through various pathways. Although the awareness is present of the importance of the individual approach and efforts are done to tailor information to the individual patient, improvement is still possible. Tailoring communication; assessing patient needs and preferences; matching of health care professional style and patient needs; and achieving concordance, is a complex and challenging task for health care professionals in mental health care.

A depression training session with consumer educators to reduce stigmatizing views and improve pharmacists' depression care attitudes and practices.

OBJECTIVE: To measure the impact of a depression training day for pharmacists that included a 75-minute session with a consumer educator. DESIGN: The training day included interactive lectures on depression; the effects and side effects of and indications for the use of antidepressants; adherence issues; non-drug treatment options for depression; and basic skills in communication. Pharmacists also participated in a session with a consumer educator and in counseling exercises that included role playing. ASSESSMENT: The study used a randomized, clustered, comparative design to measure pharmacists' stigma, attitudes, and current practice related to the provision of pharmaceutical care to people with depression. Mean scores for depression-care practice after the training session were significantly higher in the intervention group than in the control group. Analysis of the changes between baseline and postintervention measures in both the control and intervention groups confirmed a significant difference in the change in both social distance and practice but no significant difference in the change in attitude between the 2 groups of pharmacists. CONCLUSION: A continuing-education depression training day for pharmacists that involve consumer educators may improve the care delivered in the community pharmacy to people with depression.

Information on antidepressants for psychiatric inpatients: the divide between patient needs and professional practice / Información sobre antidepresivos para pacientes psiquiátricos hospitalizados: el espacio entre las necesidades del paciente y la práctica profesional

Background: Medicine information is an integral part of patient care and a patient right. In particular, patients with a mental health diagnosis have a need for information on medicines. Objective: This study aims to describe the current practice on information provision on antidepressants to inpatients in psychiatric hospitals. Methods: A qualitative study was conducted consisting of semi-structured interviews with health care professionals (n=46) and patients (n=17) in 11 Flemish psychiatric hospitals. Two topic guides were designed for conducting the interviews with these respective stakeholders. The issues addressed in the topic guides related to: organization of information provision in the hospital, information on demand of the patient, information provision by health care professionals, information for relatives, evaluation of provided information, interdisciplinary contacts on information provision and satisfaction on current practice of information provision. The interviews were analysed according to the five stages of the framework analysis. Results: Psychiatrists and nurses are the key players to provide information on antidepressants. Their approach depends on patient characteristics and mental state. Information is provided mainly orally. Health care professionals consider non-verbal cues of patients to verify if information has been understood. Health care professionals reported lack of time and lack of interdisciplinary contacts as negative aspects. Patients indicated that health care professionals take too little initiative to provide medicine information. Conclusions: Patients are informed about their antidepressants through various pathways. Although the awareness is present of the importance of the individual approach and efforts are done to tailor information to the individual patient, improvement is still possible. Tailoring communication; assessing patient needs and preferences; matching of health care professional style and patient needs; and achieving concordance, is a complex and challenging task for health care professionals in mental health care (AU)

Antecedentes: La información sobre medicamentos es parte integral de la atención al paciente y un derecho del paciente. En particular, los pacientes con diagnóstico de enfermedad mental necesitan información sobre los medicamentos. Objetivo: Este estudio intenta describir la práctica actual de provisión de información sobre antidepresivos a pacientes psiquiátricos hospitalizados. Métodos: Se realizó un estudio cualitativo consistente en entrevistas semi-estructuradas con profesionales de la salud (n=46) y pacientes (n=17) en 11 hospitales psiquiátricos flamencos. Se diseñaron dos guías de asuntos para realizar las entrevistas con los respectivos decisores. Los asuntos tratados en las guías estaban relacionados con: la organización de la provisión de información en el hospital, información a demanda del paciente, provisión de información por los profesionales de la salud, información para familiares, evaluación de la información proporcionada, contactos interdisciplinarios en la provisión de información, y satisfacción con la práctica actual de provisión de información. Las entrevistas se analizaron de acuerdo a los cinco etapas del análisis contextual. Resultados: Los psiquiatras y enfermeras son los actores principales en la provisión de información sobre antidepresivos. Su abordaje depende de las características del paciente y de su estado mental. La información se proporciona fundamentalmente oral. Los profesionales de la salud tienen en cuenta señales no verbales para verificar si la información fue entendida. Los profesionales reportaron falta de tiempo y falta de contactos interdisciplinarios como aspectos negativos. Los pacientes indicaron que los profesionales de la salud tienen demasiado poca iniciativa en proporcionar información sobre medicamentos. Conclusiones: Los pacientes están informados sobre sus antidepresivos por varios caminos. Aunque existe una conciencia de la importancia del abordaje individual y se realizan esfuerzos para adaptar la información a cada paciente, es posible mejorar. Adaptar la comunicación; evaluar las necesidades y las preferencias del paciente; alcanzar la concordancia son tareas complejas y desafiantes para los profesionales de la salud en cuidados de salud mental (AU)

Differentiated information on antidepressants at hospital discharge: a hypothesis-generating study.

OBJECTIVES: This hypothesis-generating study examined the clinical, humanistic and economic impact of providing differentiated medication information depending on the patient's information desire as compared with undifferentiated information to patients with a major depressive episode at hospital discharge. METHODS: A longitudinal multi-centre study with quasi-experimental design comprised two experimental groups ((un)differentiated antidepressant information) and one 'no information' group. Patients were followed up for 1 year assessing adherence, economic outcomes (i.e. costs of medicines, consultations, productivity loss and re-admissions), clinical outcomes (i.e. depressive, anxiety and somatic symptoms and side effects) and humanistic outcomes (i.e. quality of life, satisfaction with information). A linear model for repeated measures was applied to assess differences over time and between groups. KEY FINDINGS: Ninety-nine patients participated. Still participating 1 year later were 78. No beneficial effect was observed for adherence. Lower productivity loss (P = 0.021) and costs of consultations with healthcare professionals (P = 0.036) were observed in the differentiated group. About one-third of patients were re-admitted within 1 year following discharge. Patients in the 'no information' group had significantly more re-admissions than patients in the undifferentiated group (P = 0.031). CONCLUSIONS: The hypothesis of differentiated information could be supported for economic outcomes only. Future medication therapy intervention studies should apply a more rigorous study design.

Preventing COPD exacerbations with macrolides: a review and budget impact analysis.

Long-term treatment with macrolides has recently been shown to reduce COPD exacerbations in doses lower than bactericidal doses. This article aims to critically review the international literature relating to the long-term effectiveness and safety of macrolides and to estimate the budget impact of preventing exacerbations with azithromycin in Belgium. Controlled clinical studies focusing on the prevention of COPD exacerbations with long-term macrolide treatment were identified in PubMed, EMBASE, Controlled Trials Registry of the Cochrane Library, and Social Science and Citation Index. The budget impact of preventing exacerbations with azithromycin in Belgium over a one-year period was calculated as the difference between the additional expenditure of annual treatment with azithromycin and the savings in hospital expenditure arising from fewer COPD exacerbations in patients with GOLD stages II-IV. Prevalence and resource use data were derived from the literature and unit cost data from Belgian sources. The literature review suggests that long-term treatment of COPD patients with azithromycin, erythromycin or clarithromycin is effective and safe, and reduces exacerbations and related hospitalizations. However, uncertainty remains about the specific patient population that is most likely to benefit from long-term macrolide treatment, the optimal dose and duration of macrolide treatment, and the potential impact of long-term macrolide treatment on resistance. The budget impact analysis demonstrated that annual hospital savings of €950 million resulting from fewer exacerbations outweighed additional expenditure on azithromycin of €595 million, implying that the prevention of COPD exacerbations with azithromycin is a cost saving strategy in Belgium.

Length of stay after reaching clinical stability drives hospital costs associated with adult community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia (CAP) has a considerable clinical and economic impact. The aim of this study was to identify drivers of hospital costs associated with CAP in 2 Belgian hospitals. Specifically, the influence of patient characteristics, quality indicators, and other treatment aspects on hospital costs was explored. METHODS: The following were registered for patients admitted with a confirmed diagnosis of CAP in a large university hospital (Universitaire Ziekenhuizen Leuven, UZL) and a medium-sized secondary care hospital (Ziekenhuis Oost-Limburg, ZOL) in Belgium: the pneumonia severity index (PSI), time to clinical stability, length of stay, antibiotic therapy, outcomes, compliance with validated quality indicators, and the different costs (pharmacy, laboratory, and radiology, and total). Regression analysis was used to identify influential variables. RESULTS: Between October 2007 and June 2010, 803 patients were included, with a median total cost of €4794.57. The length of stay after clinical stability and time to clinical stability had the highest influence on the total cost (+6.3% and +4.9% per additional day, respectively; p < 0.0001). Other important drivers of higher costs were total therapy duration, PSI score, age, and admission to intensive care. Patients treated with moxifloxacin had significantly, but limited, lower costs. Quality indicator compliance, including guideline-compliant antibiotic treatment and therapy streamlining, had little influence. CONCLUSIONS: The most important driver of hospital costs associated with CAP was the time between clinical stability and actual hospital discharge. In order to substantially decrease the costs of CAP treatment, this period should be rigorously evaluated for possible intervention targets that would allow costs in CAP treatment to be decreased in a substantial manner.

Pharmaceutical care for people with depression: Belgian pharmacists' attitudes and perceived barriers.

BACKGROUND: In the past three decades, the role of pharmacists has evolved toward working with other health professionals and the public in a patient-centered model of practice, which is called pharmaceutical care. This model has been implemented for most physical illnesses but in relation to mental health, pharmacists' role is still evolving. OBJECTIVE: The objective of this study was to evaluate pharmacists' attitudes, current practice, perceived barriers and training needs concerning pharmaceutical care for people with depression. SETTING: All pharmacists attending obligatory regional meetings of the Surplus Network (a Flemish community pharmacy chain) during April and May 2009. METHOD: Written survey consisting of questions on (1) pharmacists' attitude and current practice in depression care and pharmaceutical care for people with other illnesses; (2) potential barriers in providing pharmaceutical care for people with depression; and (3) training needs. Paired samples T tests and Wilcoxon-tests were used to analyze the data. MAIN OUTCOME MEASURE: Attitude and current practice in depression care versus care for other illnesses. RESULTS: Although the results show no difference in the attitude of pharmacists toward providing care for people with depression versus other illnesses (p = 0.315), pharmacists report to provide significantly less care to people with depression compared to people with other illnesses (p < 0.05). Perceived barriers toward providing depression care were the lack of information about the person and their treatment, the fact that depression is a difficult condition, the lack of education in mental health and the lack of time and privacy in the pharmacy. These, and the reported training needs, may limit the self-efficacy of pharmacists and hence influence current practice. CONCLUSION: In spite of pharmacists' positive attitude toward depression care, current practice displays actionable flaws. Barriers and training needs should be addressed in order to improve pharmaceutical care for people with depression.

Divergent intentions to use antibiotic guidelines: a theory of planned behavior survey.

BACKGROUND: To improve physicians' antimicrobial practice, it is important to identify barriers to and facilitators of guideline adherence and assess their relative importance. The theory of planned behavior permits such assessment and has been previously used for evaluating antibiotic use. According to this theory, guideline use is fueled by 3 factors: attitude, subjective norm (perceived social pressure regarding guidelines), and perceived behavioral control (PBC; perceived ability to follow the guideline). The authors aim to explore factors affecting guideline use in their hospital. METHODS: Starting from their earlier observations, the authors constructed a questionnaire based on the theory of planned behavior, with an additional measure of habit strength. After pilot testing, the survey was distributed among physicians in a major teaching hospital. RESULTS: Of 393 contacted physicians, 195 completed questionnaires were received (50.5% corrected response rate). Using multivariate analysis, the overall intention toward using antibiotic guidelines was not very predictable (model R (2) = .134). Habit strength (relative weight = .391) and PBC (relative weight = .354) were the principal significant predictors. A moderator effect of respondents' position (staff member v. resident) was found, with staff members' intention being significantly influenced only by habit strength and residents' intention by PBC. Regarding previously identified barriers, education on antibiotics and guidelines was rated unsatisfactory. CONCLUSIONS: These divergent origins of influence on guideline adherence point to different approaches for improvement. As habits strongly influence staff members, methods that focus on changing habits (e.g., automated decision support systems) are possible interventions. As residents' intention seems to be guided mainly by external influences and experienced control, this may make feedback, convenient guideline formats, and guideline familiarization more suitable.

Following up patients with depression after hospital discharge: a mixed methods approach.

BACKGROUND: A medication information intervention was delivered to patients with a major depressive episode prior to psychiatric hospital discharge. METHODS: The objective of this study was to explore how patients evolved after hospital discharge and to identify factors influencing this evolution. Using a quasi-experimental longitudinal design, the quantitative analysis measured clinical (using the Hospital Anxiety and Depression Scale, the somatic dimension of the Symptom Checklist 90 and recording the number of readmissions) and humanistic (using the Quality of Life Enjoyment and Satisfaction Questionnaire) outcomes of patients via telephone contacts up to one year following discharge. The qualitative analysis was based on the researcher diary, consisting of reports on the telephone outcome assessment of patients with major depression (n = 99). All reports were analyzed using the thematic framework approach. RESULTS: The change in the participants' health status was as diverse as it was at hospital discharge. Participants reported on remissions; changes in mood; relapses; and re-admissions (one third of patients). Quantitative data on group level showed low anxiety, depression and somatic scores over time. Three groups of contributing factors were identified: process, individual and environmental factors. Process factors included self caring process, medical care after discharge, resumption of work and managing daily life. Individual factors were symptom control, medication and personality. Environmental factors were material and social environment. Each of them could ameliorate, deteriorate or be neutral to the patient's health state. A mix of factors was observed in individual patients. CONCLUSIONS: After hospital discharge, participants with a major depressive episode evolved in many different ways. Process, individual and environmental factors may influence the participant's health status following hospital discharge. Each of the factors could be positive, neutral or negative for the patient.

Empirical management of community-acquired pneumonia: impact of concurrent A/H1N1 influenza pandemic on guideline implementation.

BACKGROUND: Guideline-concordant therapies have been proven to be associated with improved health and economic outcomes in the treatment of community-acquired pneumonia (CAP). However, actual use of CAP guidelines remains poor, but using tailored interventions looks promising. Based on local observations, we assessed the impact of low-intensity interventions to improve guideline use. METHODS: Pre-and post-intervention study with segmented regression analysis in a large tertiary care centre [University Hospitals Leuven (UZL)] and a smaller secondary care control hospital [Ziekenhuis Oost-Limburg (ZOL)] from October 2007 through to June 2010 in Belgium. RESULTS: A total of 477 patients were included in UZL, with 58.5% of the patients treated according to local guidelines. Guideline adherence remained stable, but a decrease (-28.6%; P = 0.021) was observed during guideline re-introduction in October 2009. Further analysis showed a high correlation with the concurrent A/H1N1 influenza pandemic (r(point-biserial) = 0.683; P = 0.045) and with suspected influenza infection (odds ratio = 2.70; P = 0.038). In ZOL, 326 patients were enrolled, with 69.3% being treated concordantly. A similar, non-significant decrease in guideline adherence was observed after October 2009. CONCLUSIONS: Our interventions did not lead to a higher proportion of CAP patients receiving guideline-compliant therapy. Instead, a compliance decrease was observed, coinciding with the peak in the A/H1N1 pandemic in the population. Similar observations could be made in ZOL. The widespread attention for this pandemic may have altered the perception of needed antibiotic therapy for pulmonary infections, bypassing our interventions and decreasing actual guideline compliance. Increased vigilance and follow-up is needed when epidemics with similar impact occur in the future.

Detecting pre-diabetes and the role of the pharmacist / Detección de pre-diabetes y el papel del farmacéutico

Objective: This study aims to use a pharmacoepidemiological approach to study the drug use of patients during the year prior to diabetes diagnosis (i.e. pre-diabetic patients) and control patients. Drug use might reveal cardiovascular, metabolic and/or endocrinological changes and help to identify indicators for active monitoring of Type 2 diabetes mellitus. Methods: A retrospective case-control study compared drug use of patients with a future diagnosis of diabetes (experimental patients) with patients without a diabetes diagnosis (control patients) based on community pharmacy records. An experimental patient had used oral hypoglycaemic drugs during 2005 or 2006. Experimental and control patients were matched in terms of age, gender and quarter of index date. Drugs were selected based on possible comorbidities of diabetes. Drug use was expressed as a binary variable, indicating whether or not a patient took specific drugs. Drug use was compared between experimental patients during the year prior to diagnosis and control patients using the chisquared test. Results: Our dataset covered 5,064 patients (1,688 experimental and 3,376 control patients). A higher probability of taking cardiovascular drugs was observed for specific subgroups of patients with prediabetes as compared to control patients: this trend was observed for men as well as for women, for various cardiovascular drug classes, and for different age groups (p<0.05), although it was not always statistically significant for the 29-38 age group. For each selected age and gender group, patients with pre-diabetes had a higher probability of taking a combination of a lipid-modifying agent and an antihypertensive drug than control patients (p<0.005). Conclusions: Using community pharmacy data, this study demonstrated that age and a characteristic drug use pattern could contribute to detecting pre-diabetes. There is a potential role for community pharmacists to follow up drug indicators of patients with a view to refer high-risk people for screening by a physician (AU)

Objetivo: Este estudio trata de usar un abordaje farmacoepidemiológico para estudiar el uso de medicamentos durante el año anterior al diagnóstico de diabetes (i.e. pacientes prediabéticos) y pacientes control. El uso de medicamentos podría revelar cambios cardiovasculares, metabólicos y/o endocrinos y ayudar a identificar indicadores para la monitorización activa de la diabetes mellitus tipo 2. Métodos: Un estudio caso-control retrospectivo, basado en los historiales de farmacias comunitarias, comparó el uso de medicamentos de pacientes con un diagnóstico futuro de diabetes (pacientes experimentales) con pacientes sin diagnóstico de diabetes (pacientes control). Un paciente experimental había usado medicamentos durante 2005 o 2006. Los pacientes experimentales y controles fueron emparejados en relación a edad, genero, trimestre de indexación. Los medicamentos fueron seleccionados en base a las posibles comorbilidades de la diabetes. El uso de medicamentos se expresó como una variable binaria, indicando si el paciente había o no tomado un medicamento específico. Se comparó el uso de medicamentos entre los pacientes experimentales durante el año anterior al diagnóstico y los pacientes control utilizando el test chi cuadrado. Resultados: Nuestro fichero incluyó 5.064 pacientes (1.688 experimentales y 3.376 control). En subgrupos específicos de pacientes con prediabetes, se observó una mayor probabilidad de tomar medicamentos cardiovasculares que en los pacientes control: esta tendencia apareció tanto en hombres, como en mujeres, para varios grupos terapéuticos de medicamentos cardiovasculares, y para diferentes grupos etarios (p<0,05), aunque no fue estadísticamente significativo para el grupo de 29-38 años. Para cada grupo seleccionado de edad y género, los pacientes con pre-diabetes tenían una probabilidad mayor de tomar una combinación de anti-hiperlipémico y antihipertensivo que los controles (p<0,005). Conclusiones: Utilizando datos de farmacias comunitarias, este estudio demostró que la edad y un patrón de uso de medicamentos característico puede contribuir a detectar pre-diabetes. Existe un papel potencial del farmacéutico siguiendo los indicadores de medicamentos de pacientes con vistas a remitir a los médicos personas de alto riesgo (AU)

Constraints and perspectives of pharmacists counseling patients with depression at hospital discharge.

OBJECTIVE OF THE STUDY: This study aims to explore experiences, barriers and enabling factors during an antidepressant counseling study as well as to explore future initiatives. SETTING: 11 Flemish psychiatric hospitals. METHOD: Focus group discussions were organized. Pharmacists who could not be present at a focus group discussion answered the questions of the interview guide on paper. The focus group discussions were tape recorded, verbatim transcribed and analyzed using NVivo7-software applying a framework approach. MAIN OUTCOME MEASURE: Evaluation of barriers, enabling factors, negative and positive experiences during the study. Suggestions for future initiatives. RESULTS: For experiences, barriers and enabling factors, five categories were identified: individual patient contacts, interdisciplinary contacts, hospital management, study performance and study support. There existed differences in culture between hospitals on how they appreciated the role of the clinical pharmacist. A major difference between hospitals was the interdisciplinary relations. Negative experiences and barriers were: the absence of openness for a role for the pharmacist in the team, difficult interdisciplinary communication, the uncertainty about the time of discharge, the need of patients to tell their story and the timing of the intervention. Positive experiences and enabling factors included the individual focus of the intervention, the position of the pharmacist as a reliable health care professional, the pharmacist as the key person in this study, the integration of the pharmacist in the team, the gained knowledge and skills of the pharmacist and the professional study support. Future initiatives depend upon human and other resources. There is a demand for more information by the patient. A more structured way of working is necessary. The provision of medication information can be performed at different points in time using different formats. CONCLUSION: Participation in a clinical pharmacy study was well appreciated by the pharmacists. Future initiatives were welcomed if they remain feasible within actual job responsibilities.

Detecting pre-diabetes and the role of the pharmacist.

OBJECTIVE: This study aims to use a pharmacoepidemiological approach to study the drug use of patients during the year prior to diabetes diagnosis (i.e. pre-diabetic patients) and control patients. Drug use might reveal cardiovascular, metabolic and/or endocrinological changes and help to identify indicators for active monitoring of Type 2 diabetes mellitus. METHODS: A retrospective case-control study compared drug use of patients with a future diagnosis of diabetes (experimental patients) with patients without a diabetes diagnosis (control patients) based on community pharmacy records. An experimental patient had used oral hypoglycaemic drugs during 2005 or 2006. Experimental and control patients were matched in terms of age, gender and quarter of index date. Drugs were selected based on possible co-morbidities of diabetes. Drug use was expressed as a binary variable, indicating whether or not a patient took specific drugs. Drug use was compared between experimental patients during the year prior to diagnosis and control patients using the chi-squared test. RESULTS: Our dataset covered 5,064 patients (1,688 experimental and 3,376 control patients). A higher probability of taking cardiovascular drugs was observed for specific subgroups of patients with pre-diabetes as compared to control patients: this trend was observed for men as well as for women, for various cardiovascular drug classes, and for different age groups (p<0.05), although it was not always statistically significant for the 29-38 age group. For each selected age and gender group, patients with pre-diabetes had a higher probability of taking a combination of a lipid-modifying agent and an antihypertensive drug than control patients (p<0.005). CONCLUSIONS: Using community pharmacy data, this study demonstrated that age and a characteristic drug use pattern could contribute to detecting pre-diabetes. There is a potential role for community pharmacists to follow up drug indicators of patients with a view to refer high-risk people for screening by a physician.