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1.
Am J Health Syst Pharm ; 76(6): 381-386, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31361838

RESUMO

PURPOSE: A novel value-based approach to evaluate costly specialty drugs for formulary addition was developed. SUMMARY: In February 2016, Stanford Health Care launched the specialty drug subcommittee (SDSC), a subcommittee of the pharmacy and therapeutics committee, responsible for the formulary review of specialty pharmaceuticals. A process was developed for value-based review that includes not only consideration of clinical trial data and institutional acquisition costs but also internal patient outcomes and a cost-effectiveness model using internal financial data. A Markov model was developed to assess the value of trabectedin, which was approved for formulary addition in April 2016, relative to the addition of dacarbazine. The economic model and internal patient outcome analysis were presented to the prescribing oncologist and the SDSC for review. Internal data revealed that fewer patients than had been estimated received trabectedin, with outcomes significantly worse than those observed in the clinical trial leading to Food and Drug Administration approval. In the cost-effectiveness model, trabectedin had higher costs and poorer outcomes compared with dacarbazine. Based on the economic model, low utilization, and real-world outcomes, trabectedin was removed from formulary and a restrictive treatment pathway for nonformulary use, developed by the primary prescriber, was implemented. This process has since been applied to 11 more specialty drugs. CONCLUSION: Internal cost-effectiveness models in combination with real-world patient outcomes data can be effective formulary management tools. Engagement and collaboration with the requesting provider are key to developing thoughtful treatment pathways.


Assuntos
Análise Custo-Benefício , Farmacoeconomia , Formulários Farmacêuticos como Assunto , Assistência Farmacêutica/organização & administração , Comitê de Farmácia e Terapêutica/organização & administração , Centros Médicos Acadêmicos/organização & administração , Ensaios Clínicos como Assunto , Dacarbazina/economia , Dacarbazina/uso terapêutico , Aprovação de Drogas/economia , Custos de Medicamentos , Revisão de Uso de Medicamentos/métodos , Revisão de Uso de Medicamentos/organização & administração , Humanos , Comunicação Interdisciplinar , Cadeias de Markov , Modelos Econômicos , Neoplasias/tratamento farmacológico , Neoplasias/economia , Trabectedina/economia , Trabectedina/uso terapêutico , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration
2.
Int J Clin Pharm ; 41(3): 741-750, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31006832

RESUMO

Background Medicine use review by pharmacists has the potential to improve anticoagulation therapy management in patients on warfarin. Objective To develop, implement and evaluate a pharmacist-led medication use review service for patients on warfarin. Setting Six community pharmacies in Malta. Method Patients (N = 100) aged 18 or older and on warfarin were recruited through pre-selected community-pharmacies. These patients were then invited to attend two sessions: a review session (t1) and a follow-up session after 2 months (t2). During the medication use review session, medication reconciliation was performed (a) to detect drug-related problems using the DOCUMENT classification system, (b) to develop an individualised care plan for each patient and (c) to recommend an action for each identified problem for physician, pharmacist or patient consideration. At t2, the degree of acceptance of the recommendations was determined by assessing the number of drug-related problems for which action was taken to address the problem. International normalisation ration (INR) control was evaluated by calculating the percentage Time in Therapeutic Range (TTR) at t1 and t2 using the Rosendaal linear interpolation method. Main outcome measures Frequency and type of drug-related problems detected; percentage of accepted recommendations; and INR control. Results A total of 481 drug-related problems were identified; 40% (n = 190) were related to warfarin treatment. Need for monitoring (30%; n = 145), lack of compliance (20%; n = 97) and need for patient education (19%; n = 90) were the top three problems identified. There was a significant correlation between frequency of the problems and number of chronic medications (Spearman Correlation 0.583, p < 0.001), number of comorbidities (Spearman Correlation 0.327, p = 0.001) and older age (Spearman Correlation 0.285, p = 0.04). A total of 475 recommendations were followed-up; 49% (n = 234) were referred for consideration by the physician. The percentage of recommendations accepted (84%; n = 397) was significantly higher than the percentage of recommendations not accepted (16%; n = 78) (p < 0.001). The time in therapeutic range improved significantly from 68.7% at t1 to 79.8% at t2 (p = 0.01). Conclusions The high percentage of accepted recommendations and the improvement in INR control indicate that a pharmacist-led medication use review service in community pharmacy contributes to improving anticoagulation therapy management in patients on warfarin.


Assuntos
Serviços Comunitários de Farmácia/normas , Revisão de Uso de Medicamentos/normas , Reconciliação de Medicamentos/normas , Farmacêuticos/normas , Papel Profissional , Varfarina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Revisão de Uso de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Seguimentos , Humanos , Coeficiente Internacional Normatizado/métodos , Coeficiente Internacional Normatizado/normas , Masculino , Malta/epidemiologia , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Varfarina/administração & dosagem
3.
Int J Clin Pharm ; 41(3): 757-766, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31028596

RESUMO

Background Older age and inappropriate prescribing is related to a greater rate of emergency department visits and hospitalisations. Objective To assess the efficacy of an interprofessional collaboration programme in which a review of the medication of older patients seen in the emergency observation unit was carried out. Setting Emergency departments at four Spanish hospitals. Method Randomised, controlled study. Patients over 65 years of age presenting to the emergency department were randomised to a control or an intervention group. In the intervention group, a pharmacist reviewed the patients' chronic medication and identified any potentially inappropriate prescriptions based on the STOPP/START criteria. Each case was discussed with the emergency specialist and a recommendation to modify the treatment was sent to the general practitioner. Main outcome measure Rate of emergency visits and hospital admissions. Results The adjusted rate ratio of emergency visits and hospital admissions was 0.808 (95% CI 0.617 to 1.059) at 3 months, 0.888 (95% CI 0.696 to 1.134) at 6 months and 0.954 (95% CI 0.772 to 1.179) at 12 months. There was a statistically significant reduction at 3 months in two of the hospitals that participated in the study [adjusted rate ratio at 3 months was 0.452 (95% CI 0.222 to 0.923) in hospital 3 and 0.567 (95% CI 0.328 to 0.983) in hospital 4]. Conclusion Overall, the intervention did not reduce the number of emergency visits and hospital admissions. However, a significant effect was observed in centres were a high acceptance rate of treatment recommendations was achieved.


Assuntos
Revisão de Uso de Medicamentos/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Serviço Hospitalar de Emergência/tendências , Prescrição Inadequada/tendências , Reconciliação de Medicamentos/tendências , Farmacêuticos/tendências , Idoso , Idoso de 80 Anos ou mais , Revisão de Uso de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Masculino , Reconciliação de Medicamentos/métodos , Espanha/epidemiologia , Resultado do Tratamento
4.
Geriatr Gerontol Int ; 19(7): 667-672, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30968552

RESUMO

AIM: The present study aimed to evaluate drug costs per resident at Japanese intermediate care facilities for older adults (called Roken) in relation to drug utilization after admission to these facilities. The payment, including coverage of drugs, is mainly determined by the resident's long-term care needs. METHODS: A nationwide drug utilization survey was carried out. The participants were 1324 residents of 350 Roken (up to five individuals per facility) who were admitted in 2015 and agreed to participate in this study. Drug costs per resident per month at admission and 2 months later were calculated for drugs prescribed for regular use. Associations between characteristics of the residents and drug costs were examined. RESULTS: A wide variation in drug costs with a long right tail was observed. Median drug costs were $77 (interquartile range $34-147) at admission, and $46 (interquartile range $19-98) in month 2. There was no apparent association between the level of long-term care needs and drug costs, adjusting for sex, age and main place of residence before admission. Anti-dementia drugs accounted for the largest portion of total drug costs at admission (15.4%) and in month 2 (12.4%). The average drug cost per user was also the highest for anti-dementia drugs ($90.2 per user per month), followed by drugs for Parkinson's disease ($70.3). The proportion of generic drugs across all drug classes examined increased after admission. CONCLUSIONS: These findings might suggest that implementation of the bundled payment scheme would be effective for the reduction of medication costs in institutional long-term care. Geriatr Gerontol Int 2019; 19: 667-672.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos/métodos , Assistência de Longa Duração , Nootrópicos/uso terapêutico , Instituições de Cuidados Especializados de Enfermagem , Idoso , Controle de Custos/métodos , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Japão , Assistência de Longa Duração/economia , Assistência de Longa Duração/métodos , Masculino , Instituições de Cuidados Especializados de Enfermagem/economia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos
5.
Int J Clin Pharm ; 41(3): 691-699, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31020598

RESUMO

Background Anticoagulant therapy is associated with a high risk of complications. Adherence to anticoagulant therapy protocols may lower this risk but adherence is often suboptimal. The introduction of a multidisciplinary antithrombotic team may improve adherence to anticoagulant guidelines among physicians. Objective To determine the effect of hospital-based multidisciplinary antithrombotic stewardship on adherence to anticoagulant guidelines among prescribing physicians. Setting This prospective non-randomised before-and-after study was conducted in patients hospitalized between October 2015 and December 2017 and treated with anticoagulant therapy. Method A multidisciplinary antithrombotic team focusing on education, medication reviews, drafting of local anticoagulant therapy protocols, patient counseling and medication reconciliation at admission and discharge was implemented in two Dutch hospitals. Main outcome measure Primary outcome was the proportion of the admitted patients in which the prescribing physician did adhere to the anticoagulant guidelines. Results The study comprised 1886 patients, of which 941 patients were included in the usual care period and 945 patients in the intervention period. Multivariable logistic regression analysis indicated that adherence was observed significantly more often during the intervention period (adjusted odds ratio [ORadj] 1.58, 95% confidence interval [95% CI] 1.21-2.05). Detailed analysis identified that the significantly higher overall adherence in the intervention period was attributed to dosing of LMWHs (odds ratio [OR] 1.58, 95% CI 1.16-2.14). Conclusion This study shows that introduction of a multidisciplinary antithrombotic stewardship leads to a significantly higher overall adherence to anticoagulant guidelines among prescribing physicians, mainly based on the improvement of dosing of low-molecular-weight-heparins.


Assuntos
Anticoagulantes/uso terapêutico , Revisão de Uso de Medicamentos/normas , Fibrinolíticos/uso terapêutico , Fidelidade a Diretrizes/normas , Equipe de Assistência ao Paciente/normas , Serviço de Farmácia Hospitalar/normas , Idoso , Anticoagulantes/efeitos adversos , Revisão de Uso de Medicamentos/métodos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Prospectivos
6.
Pharm. pract. (Granada, Internet) ; 17(1): 0-0, ene.-mar. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184606

RESUMO

Background: Optimisation of drug therapy is important in the older population and may be facilitated by medication assessment tools (MATs). Objective: The purpose of the study was to evaluate whether appropriateness of drug therapy and clinical pharmacist intervention documentation improved following implementation of a previously developed MAT for the long-term management of atrial fibrillation (MAT-AF). Methods: Adherence to MAT-AF review criteria and clinical pharmacist intervention documentation was assessed by the researcher pre-MAT implementation in 150 patients aged ≥60 years admitted to a rehabilitation hospital with a diagnosis of atrial fibrillation. MAT-AF was introduced as a clinical tool in the hospital for identification of pharmaceutical care issues in atrial fibrillation patients. Adherence to MAT-AF and pharmacist intervention documentation were assessed by the researcher post-MAT implementation for a further 150 patients with the same inclusion criteria. Logistic regression analysis and measurement of odds ratio was used to identify differences in adherence to MAT-AF pre- and post-MAT implementation. The differences between two population proportions z-test was used to compare pharmacist intervention documentation pre- and post-MAT implementation. Results: Adherence to MAT-AF criteria increased from 70.9% pre-implementation to 89.6% post-implementation. MAT-AF implementation resulted in a significant improvement in prescription of anticoagulant therapy (OR 4.07, p<0.001) and monitoring of laboratory parameters for digoxin (OR 10.40, p<0.001). Clinical pharmacist intervention documentation improved significantly post-implementation of MAT-AF (z-score 20.249, p<0.001). Conclusions: Implementation of MAT-AF within an interdisciplinary health care team significantly improved the appropriateness of drug therapy and pharmacist intervention documentation in older patients with atrial fibrillation


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/tratamento farmacológico , Conduta do Tratamento Medicamentoso/organização & administração , Prescrição Inadequada/estatística & dados numéricos , Revisão de Uso de Medicamentos/métodos , Assistência Farmacêutica/organização & administração , Infarto do Miocárdio/prevenção & controle , Reconciliação de Medicamentos/métodos , Auditoria Clínica/métodos
7.
Am J Health Syst Pharm ; 76(4): 225-235, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715186

RESUMO

Purpose: The purpose of this project was to develop a set of valid and feasible quality indicators used to track opioid stewardship efforts in hospital and emergency department settings. Methods: Candidate quality indicators were extracted from published literature. Feasibility screening excluded quality indicators that cannot be reliably extracted from the electronic health record or that are irrelevant to pain management in the hospital and emergency department settings. Validity screening used an electronic survey of key stakeholders including pharmacists, nurses, physicians, administrators, and researchers. Stakeholders used a 9-point Likert scale to rate the validity of each quality indicator based on predefined criteria. During expert panel discussions, stakeholders revised quality indicator wording, added new quality indicators, and voted to include or exclude each quality indicator. Priority ranking used a second electronic survey and a 9-point Likert scale to prioritize the included quality indicators. Results: Literature search yielded 76 unique quality indicators. Feasibility screening excluded 9 quality indicators. The validity survey was completed by 46 (20%) of 228 stakeholders. Expert panel discussions yielded 19 valid and feasible quality indicators. The top 5 quality indicators by priority were: the proportion of patients with (1) naloxone administrations, (2) as needed opioids with duplicate indications, and (3) long acting or extended release opioids if opioid-naïve, (4) the average dose of morphine milligram equivalents administered per day, and (5) the proportion of opioid discharge prescriptions exceeding 7 days. Conclusion: Multi-professional stakeholders across a health system participated in this consensus process and developed a set of 19 valid and feasible quality indicators for opioid stewardship interventions in the hospital and emergency department settings.


Assuntos
Analgésicos Opioides/uso terapêutico , Revisão de Uso de Medicamentos/normas , Serviço Hospitalar de Emergência/normas , Pessoal de Saúde/normas , Serviço de Farmácia Hospitalar/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Analgésicos Opioides/efeitos adversos , Revisão de Uso de Medicamentos/métodos , Humanos , Serviço de Farmácia Hospitalar/métodos , Inquéritos e Questionários/normas
9.
Acta Clin Belg ; 74(2): 126-136, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30698077

RESUMO

OBJECTIVES: The Ghent Older People's Prescriptions community Pharmacy Screening (GheOP3S-) tool was recently developed as an explicit screening method to detect Potentially Inappropriate Prescribing (PIP) in the community pharmacy. We aimed to validate the GheOP3S-tool as an effective screening method for PIP. METHODS: All patients admitted to the acute geriatric ward of the Sint-Vincentius hospital (Belgium) were consecutively screened for inclusion (≥70 years,≥5 drugs chronically). PIP prevalence was evaluated by applying the GheOP3S-tool on the complete medication history. For each PIP-item, clinical relevance of the detected item, relevance of proposed alternative and subsequent acceptance by the treating geriatrician and a general practitioner were evaluated. Additionally, contribution to the current admission and preventability was assessed by the geriatrician. The completeness of a PIP-screening with the GheOP3S-tool was evaluated through comparison with the adapted Medication Appropriateness Index (aMAI). RESULTS: We detected 250 GheOP3S-items in 57 of 60 included patients (95%) (median: four PIP-items per patient; IQR: 3-5). Both the geriatrician and the general practitioners scored the clinical relevance of the detected items 'serious' or 'significant' in over 70% of cases. Proposed alternative treatment plans were accepted for 79% of the PIP-items (n = 198). The aMAI detected 536 items, of which 145 were also detected by the GheOP3S-tool. A total of 119 PIP-items were additionally detected by the GheOP3S-tool. CONCLUSION: The clinical relevance of the PIP-items detected with the GheOP3S-tool is high, likewise the acceptance rate of proposed alternatives.


Assuntos
Revisão de Uso de Medicamentos/métodos , Prescrição Inadequada , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino
10.
Basic Clin Pharmacol Toxicol ; 124(1): 18-27, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30260590

RESUMO

BACKGROUND: There are inadequate data on prescribed drug utilization in Sub-Saharan Africa (SSA). Drug utilization research (DUR) in this region is hampered by lack of access to databases that capture prescribed drug utilization such as health insurance claims, electronic medical records and disease registries. The primary objective of this MiniReview was to describe the content of the NHIS claims database in the context of the health care system in Ghana. We will also review the possibilities and limitations of analysing this novel database for drug utilization research (DUR) in Ghana. METHODS: We reviewed the history, composition of the database, coverage and health systems in Ghana. To demonstrate the application of the NHIS claims database for DUR, we reviewed the NHIS' drug formulary (NHIS medicines' list), assessed and quantified the utilization of the top 25 most commonly prescribed medicines and their distributions by age, sex, region of residence and by MDCs. RESULTS: As of December 2014, about 40% (~10.5 million) of the Ghanaian population were active beneficiaries of NHIS. There were 1.43 million unique patients in the NHIS claims database who received services from about 81 providers located in 9 out of the 10 regions in Ghana. The mean age of this sample of beneficiaries was 31 (standard deviation, 22) years, a third of whom were aged <18 years old. Nearly, 2 out of every 3 beneficiaries were females. On average, there were approximately 3 outpatient visits per beneficiary in 2015. There were about 522 unique drugs on the NHIS medicine list. Overall, analgesic was the most prescribed class of medicine (mostly paracetamol and diclofenac). Antimalarials, artemether-lumefantrine, were observed as the second most prescribed medicines followed by anti-infectives (metronidazole) and antihypertensives (amlodipine). CONCLUSION: The Ghana NHIS claims database is a great resource for DUR. This database could also be extended to facilitate pharmacoepidemiological and other health services' research especially if transformed into one of the existing standardized common data models.


Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Revisão de Uso de Medicamentos/métodos , Revisão da Utilização de Seguros/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos/estatística & dados numéricos , Gana , Humanos
11.
Basic Clin Pharmacol Toxicol ; 124(1): 62-73, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29998587

RESUMO

AIM: To explore the feasibility of the electronic assessment of potentially inappropriate medication (PIM) criteria in a large administrative database and to explore the validity of the cardiovascular subset of PIM criteria, by studying the association with relevant outcome. METHOD: A cohort study using administrative data from Stockholm County, Sweden (VAL database). Eligible for inclusion were community-dwelling older people (≥65 years), alive in Stockholm County on 31 December 2015. We applied PIM criteria pertaining to the cardiovascular medication group (first-level ATC C group), and we assessed the association between PIM use and mortality and hospitalisation. RESULTS: Patients' (n = 315 120) mean age was 74.0 years (range 65-114), and 54.7% were women. There were 111 cardiovascular PIM criteria in the repository, from which 44 were not registered or prescribed in our population. We excluded another 43 requiring information not available in the database, or duplicates, resulting in 24 applicable criteria. The prevalence of polypharmacy (≥ five medications) was 25.5% and the prevalence of at least one PIM use was 8.3%, including 2.8% underuse and 5.3% misuse. Patients with intake of ≥10 medications had 38% increased mortality risk compared to those with 0-4 medications. Unplanned hospitalisation and emergency department visits were positively associated with underuse (12% and 25%, respectively) and misuse (13% and 12%, respectively). CONCLUSION: It was feasible to select a subset of cardiovascular PIM criteria originating from different PIM lists and to apply this subset in an administrative database. Additionally, by applying this subset, we showed significant associations with clinical outcome.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Bases de Dados Factuais/estatística & dados numéricos , Revisão de Uso de Medicamentos/métodos , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Estudos de Viabilidade , Feminino , Mau Uso de Serviços de Saúde/prevenção & controle , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Prescrição Inadequada/mortalidade , Prescrição Inadequada/estatística & dados numéricos , Vida Independente , Masculino , Fatores de Risco , Suécia/epidemiologia
12.
Prim Health Care Res Dev ; 20: e10, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30208976

RESUMO

AimThis study aimed to assess the consistency and replicability of these process measures during provision of the Italian Medicines Use Review (I-MUR). BACKGROUND: Medication review is a common intervention provided by community pharmacists in many countries, but with little evidence of consistency and replicability. The I-MUR utilised a standardised question template in two separate large-scale studies. The template facilitated pharmacists in recording medicines and problems reported by patients, the pharmaceutical care issues (PCIs) they found and actions they took to improve medicines use. METHODS: Community pharmacists from four cities and across 15 regions were involved in the two studies. Patients included were adults with asthma. Medicines use, adherence, asthma problems, PCIs and actions taken by pharmacists were compared across studies to assess consistency and replicability of I-MUR.FindingsThe total number of pharmacists and patients completing the studies was 275 and 1711, respectively. No statistically significant differences were found between the studies in the following domains: patients' demographic, patients' perceived problems, adherence, asthma medicines used and healthy living advice provided by pharmacists. The proportion of patients in which pharmacists identified PCIs was similar across both studies. There were differences only in the incidence of non-steroidal anti-inflammatory drug use, the frequency of potential drug-disease interactions and in the types of advice given to patients and GPs. CONCLUSIONS: The use of a standardised template for the I-MUR may have contributed to a degree of consistency in the issues found, which suggests this intervention could have good replicability.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Asma/tratamento farmacológico , Serviços Comunitários de Farmácia , Revisão de Uso de Medicamentos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Revisão de Uso de Medicamentos/métodos , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Farmacêuticos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
13.
Pharmacoepidemiol Drug Saf ; 27(12): 1335-1343, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30394649

RESUMO

PURPOSE: The aim of this study was to use national health databases to assemble a pregnancy cohort for undertaking medicine utilisation and safety studies in New Zealand. METHOD: Pregnancies conceived between January 2005 and March 2015 were identified in the National Maternity Collection, the National Minimum Dataset, the Mortality Collection, and the Laboratory Claims Collection. Pregnancy start and end dates were calculated and used in conjunction with the National Health Index number to merge the records from the four collections to create the New Zealand Pregnancy Cohort. Records of live born and stillborn infants identified in the National Maternity Collection and the Mortality Collection that were linkable with a cohort member formed the baby cohort. RESULTS: The cohort consists of 941 468 pregnancies to 491 272 women. One-third of the pregnancies, predominantly early pregnancy losses and terminations, were not found in the National Maternity Collection. Records of 632 090 live born or stillborn infants are linked with 623 099 pregnancies. CONCLUSIONS: The New Zealand Pregnancy Cohort is a comprehensive collection of virtually all pregnancies which ended in a live or stillbirth and many, though not all, which ended as early pregnancy losses or terminations in New Zealand over the past decade, and better represents the pregnant population than a cohort generated from the National Maternity Collection alone would do. This cohort will be valuable for investigating patterns of medicine use during pregnancy in New Zealand and developing a fuller understanding of potential impacts of foetal exposure in early pregnancy.


Assuntos
Revisão de Uso de Medicamentos/métodos , Farmacoepidemiologia/métodos , Complicações na Gravidez/tratamento farmacológico , Resultado da Gravidez , Medicamentos sob Prescrição/administração & dosagem , Adolescente , Adulto , Estudos de Coortes , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Idade Materna , Pessoa de Meia-Idade , Nova Zelândia , Estudos Observacionais como Assunto , Gravidez , Medicamentos sob Prescrição/efeitos adversos , Adulto Jovem
14.
Crit Care ; 22(1): 233, 2018 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-30244674

RESUMO

Antimicrobials are among the most important and commonly prescribed drugs in the management of critically ill patients and beta-lactams are the most common antibiotic class used. Critically ill patient's pathophysiological factors lead to altered pharmacokinetics and pharmacodynamics of beta-lactams.A comprehensive bibliographic search in PubMed database of all English language articles published from January 2000 to December 2017 was performed, allowing the selection of articles addressing the pharmacokinetics or pharmacodynamics of beta-lactam antibiotics in critically ill patients.In critically ill patients, several factors may increase volume of distribution and enhance renal clearance, inducing high intra- and inter-patient variability in beta-lactam concentration and promoting the risk of antibiotic underdosing. The duration of infusion of beta-lactams has been shown to influence the fT > minimal inhibitory concentration and an improved beta-lactam pharmacodynamics profile may be obtained by longer exposure with more frequent dosing, extended infusions, or continuous infusions.The use of extracorporeal support techniques in the critically ill may further contribute to this problem and we recommend not reducing standard antibiotic dosage since no drug accumulation was found in the available literature and to maintain continuous or prolonged infusion, especially for the treatment of infections caused by multidrug-resistant bacteria.Prediction of outcome based on concentrations in plasma results in overestimation of antimicrobial activity at the site of infection, namely in cerebrospinal fluid and the lung. Therefore, although no studies have assessed clinical outcome, we recommend using higher than standard dosing, preferably with continuous or prolonged infusions, especially when treating less susceptible bacterial strains at these sites, as the pharmacodynamics profile may improve with no apparent increase in toxicity.A therapeutic drug monitoring-guided approach could be particularly useful in critically ill patients in whom achieving target concentrations is more difficult, such as obese patients, immunocompromised patients, those infected by highly resistant bacterial strains, patients with augmented renal clearance, and those undergoing extracorporeal support techniques.


Assuntos
beta-Lactamas/farmacologia , beta-Lactamas/farmacocinética , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Estado Terminal/terapia , Monitoramento de Medicamentos/métodos , Revisão de Uso de Medicamentos/métodos , Humanos , Infusões Intravenosas/métodos , beta-Lactamas/uso terapêutico
15.
PLoS One ; 13(8): e0201579, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30075021

RESUMO

BACKGROUND: Being aware of consumption patterns of antimicrobials is the first step in designing and implementing strategies to change behaviors and, thus, to reduce the occurrence of antimicrobial resistance. The present survey was carried out to identify and describe the use of antimicrobials without prescription in riverside dwellers of the Brazilian Amazon Basin. METHODS: A cross-sectional study was carried out from a conglomerate stratified sample in the rural municipality of Coari, Amazonas State, Brazil, between April and July 2016. The survey was conducted in the riverside dwellers' homes, and information was collected on all antimicrobials taken with and without medical or dental prescription for a 30-day period, together with indications of their use before the interview. RESULTS: A total of 492 riverside dwellers were included in the present survey; 346 (70.3%) had taken at least one medication during the previous month, and 74 (21.3% of those taking a medicine) used an antimicrobial. Two-thirds of the patients treated with an antimicrobial (49; 66.2%) obtained it without a prescription. Additionally, one-third of the antimicrobials consumed by the study sample (25) were used for non-infectious or non-bacterial conditions. DISCUSSION: The present survey showed not only that inappropriate use of antimicrobials is present in remote places such as the Amazon Basin, but also that one-third of those antimicrobials were taken to treat non-infectious or non-bacterial conditions. In addition to an unnecessary risk of adverse effects to the exposed populations, the inappropriate use of antibiotics without prescription helps to increase antibiotic-resistant strains. In the present case, this was happening near one of Latin America's most important water supplies, which could contribute to the global impact of antimicrobial resistance.


Assuntos
Antibacterianos/uso terapêutico , Revisão de Uso de Medicamentos/métodos , Medicamentos sem Prescrição , Prescrições/estatística & dados numéricos , Saúde da População Rural , Adulto , Amazona , Animais , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Tamanho da Amostra , Inquéritos e Questionários , Adulto Jovem
16.
BMC Geriatr ; 18(1): 190, 2018 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-30143003

RESUMO

BACKGROUND: Clinical medication reviews (CMR) are increasingly performed in older patients with polypharmacy. Studies have shown positive effects of CMR on process- and intermediate outcomes, like drug-related problems (DRPs). Little effect has been shown on clinical outcomes, like hospital admissions or health-related quality of life (HR-QoL). In particular, HR-QoL is related to the individual health-related goals and complaints of patients. The aim of this study is to investigate the effects of a CMR focused on personal goals on HR-QoL and health-related complaints in older patients with polypharmacy. METHODS: A randomised controlled trial will be performed in 35 Dutch community pharmacies aiming to include 630 patients aged 70 years and older using seven or more chronic drugs. Patients will be randomly assigned to control or intervention group by block-randomisation per pharmacy. Patients in the intervention group receive a CMR focused on patients' preferences, personal goals and health-related complaints. With every goal a goal attainment scale (GAS) will be proposed. Primary outcome measures are HR-QoL, measured with the EQ-5D-5L and EQ-VAS and the number of health-related complaints per patient measured with a written questionnaire, during a follow-up period of six months. Secondary outcomes are healthcare utilisation, number and type of drug changes, number and type of health-related goals, scores on GAS and number and type of DRPs and interventions. DISCUSSION: This study is expected to add evidence on the effects of a CMR on HR-QoL and health-related complaints in older patients with polypharmacy. New in this study is the use of personal goals measured with GAS and health-related complaints as patient-related outcome measures. TRIAL REGISTRATION: Netherlands Trial Register; NTR5713 .


Assuntos
Serviços Comunitários de Farmácia , Revisão de Uso de Medicamentos/métodos , Metas , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Serviços Comunitários de Farmácia/normas , Revisão de Uso de Medicamentos/normas , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Qualidade de Vida/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Inquéritos e Questionários
17.
BMJ Open ; 8(7): e019042, 2018 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-30030308

RESUMO

OBJECTIVE: To evaluate if a pharmacist-led medication review is effective at reducing the anticholinergic/sedative load, as measured by the Drug Burden Index (DBI). DESIGN: Randomised controlled single blind trial. SETTING: 15 community pharmacies in the Northern Netherlands. PARTICIPANTS: 157 community-dwelling patients aged ≥65 years who used ≥5 medicines for ≥3 months, including at least one psycholeptic/psychoanaleptic medication and who had a DBI≥1. INTERVENTION: A medication review by the community pharmacist in collaboration with the patient's general practitioner and patient. PRIMARY AND SECONDARY OUTCOMES MEASURES: The primary outcome was the proportion of patients whose DBI decreased by at least 0.5. Secondary outcomes were the presence of anticholinergic/sedative side effects, falls, cognitive function, activities of daily living, quality of life, hospital admission and mortality. Data were collected at baseline and 3 months follow-up. RESULTS: Mean participant age was 75.7 (SD, 6.9) years in the intervention arm and 76.6 (SD, 6.7) years in the control arm, the majority were female (respectively 69.3% and 72.0%). Logistic regression analysis showed no difference in the proportion of patients with a≥0.5 decrease in DBI between intervention arm (17.3%) and control arm (15.9%), (OR 1.04, CI 0.47 to 2.64, p=0.927). Intervention patients scored higher on the Digit Symbol Substitution Test, measure of cognitive function (OR 2.02, CI 1.11 to 3.67, p=0.021) and reported fewer sedative side effects (OR 0.61, CI 0.40 to 0.94, p=0.024) at follow-up. No significant difference was found for other secondary outcomes. CONCLUSIONS: Pharmacist-led medication review as currently performed in the Netherlands was not effective in reducing the anticholinergic/sedative load, measured with the DBI, within the time frame of 3 months. Preventive strategies, signalling a rising load and taking action before chronic use of anticholinergic/sedative medication is established may be more successful. TRIAL REGISTRATION NUMBER: NCT02317666.


Assuntos
Antagonistas Colinérgicos , Revisão de Uso de Medicamentos/métodos , Hipnóticos e Sedativos , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Antagonistas Colinérgicos/administração & dosagem , Antagonistas Colinérgicos/efeitos adversos , Feminino , Medicina Geral/métodos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Masculino , Farmacêuticos/organização & administração , Método Simples-Cego , Inquéritos e Questionários
18.
J Am Geriatr Soc ; 66(8): 1613-1620, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29972691

RESUMO

OBJECTIVES: To identify medication review interventions for older adults that involve community pharmacists and evidence of outcomes of these interventions. DESIGN: Systematic review. MEASUREMENTS: Cinahl, MEDLINE (Ovid), Scopus, International Pharmaceutical Abstracts, and Cochrane Library were searched for articles published between January 2000 and February 2016. Articles involving community pharmacists in medication reviews for outpatients aged 65 and older were included. Evidence of economic, clinical, and humanistic outcomes of interventions was summarized. RESULTS: Sixteen articles were found that described 12 medication review interventions, of which 6 were compliance and concordance reviews, 4 were clinical medication reviews, and 2 were prescription reviews according to a previously developed typology. Community pharmacists' contributions to reviewing medications varied from sending the dispensing history to other healthcare providers to comprehensive involvement in medication management. The most commonly assessed outcomes of the interventions were medication changes leading to reduction in actual or potential drug-related problems (n=12) and improved adherence (n=5). CONCLUSION: Regardless of community pharmacists' contributions to interventions, medication review interventions seem to reduce drug-related problems and increase medication adherence. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacists' contributions to reviewing medications and improving the health of older adults.


Assuntos
Serviços Comunitários de Farmácia/estatística & dados numéricos , Revisão de Uso de Medicamentos/métodos , Farmacêuticos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Papel Profissional
19.
Int J Clin Pharm ; 40(5): 1180-1188, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29909563

RESUMO

Background In December 2014 Slovene Chamber of Pharmacies defined procedures for Medicines Use Review (MUR) in Slovenia, together with an educational program and certification to ensure pharmacists' competency to perform MUR. The first 15 pharmacists were certified in June 2015 and implemented the service in their practices. Objective This study aimed to understand the implementation of MUR from the perspectives of the first community pharmacists providing the service in practice. Methods A focus group with first MUR providers took place in February 2016, 6 months after the first pharmacists were certified to provide MUR service. Based on regional and institutional criteria ten pharmacists from the first certified group were chosen and invited to participate in guided discussion, where the development and assurance of competencies, the provision of the service in practice and the future of the service were addressed. The discussion was voice recorded with written consent obtained from all participants. Analysis was performed in NVivo 11 software with the use of inductive qualitative content analysis approach. Main outcome measure Views, challenges and opportunities for the Medicines Use Review service in Slovenia. Results Seven pharmacists attended the focus group, 5 from public pharmaceutical institution and 2 from concessionary pharmacies. Three main thematical categories were identified: quality assurance of MUR, different stakeholders' perceptions of MUR and MURs' management. Pharmacists' broad knowledge in pharmacotherapy was emphasized as the basis of quality provision and main advantage in performing MUR in comparison with other healthcare professions. Recognisability of MUR among different stakeholders should be improved with comprehensive approach in marketing of the service. Positive patient feedback was reported, however persuading them to attend MUR presented a challenge. Better management of the service, especially in terms of work organization, would facilitate MUR provision. Conclusion Overall, positive experiences with implementation and provision were reported. To ensure MUR sustainability, the service needs to become more widely known and opportunities must be provided for continuing professional development of providing pharmacists.


Assuntos
Atitude do Pessoal de Saúde , Serviços Comunitários de Farmácia , Revisão de Uso de Medicamentos/métodos , Farmacêuticos/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Papel Profissional , Pesquisa Qualitativa , Eslovênia
20.
Int J Clin Pharm ; 40(5): 1086-1095, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29796962

RESUMO

Background The Medicines use review (MUR) service, provided by community pharmacists, seeks to optimise patients' use of medicines. There is limited evidence on the clinical effectiveness of this service. Structuring MURs to include an assessment of prescribing appropriateness, facilitated by a validated prescribing screening tool, has the capacity to enhance this service. Objective To explore community pharmacists' views on the facilitators and barriers towards the utilisation of a screening tool as a guide to conducting structured MURs. Setting Community Pharmacy, Northern Ireland. Method Using the 14 domain Theoretical Domains Framework (TDF), semi-structured interviews were conducted with community pharmacists. Interviews were digitally recorded, transcribed verbatim and analysed using the Framework method. Main Outcome Measure Pharmacists' views towards utilisation of a screening tool as a guide to conducting structured MURs. Results Based on the analysis of 15 interviews, 11 TDF domains ('Knowledge', 'Skills', 'Social and professional role and identity', 'Beliefs about capabilities', 'Beliefs about consequences', 'Reinforcement', 'Goals', 'Memory, attention and decision process', 'Environmental context and resources', 'Social influences', 'Behavioural regulation') were deemed relevant. Facilitators included: knowledge of patients, clinical knowledge, perceived professional role, patients' clinical outcomes, influence of peers. Barriers included: prioritisation of other clinical activities, inability to access patients' clinical information, perceived alienation from the primary healthcare team and staffing issues. Conclusions Using the TDF, key facilitators and barriers were identified in the use of a screening tool as a guide to conducting MURs. These findings may assist in further development of MURs as a means to optimise patients' medicines use.


Assuntos
Atitude do Pessoal de Saúde , Serviços Comunitários de Farmácia , Revisão de Uso de Medicamentos/métodos , Conhecimentos, Atitudes e Prática em Saúde , Farmacêuticos/psicologia , Pesquisa Qualitativa , Idoso , Serviços Comunitários de Farmácia/normas , Revisão de Uso de Medicamentos/normas , Feminino , Humanos , Masculino , Farmacêuticos/normas
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