First drive-through pharmacy services in Taiwan.

BACKGROUND: Taiwan has separated drug prescribing and drug dispensing services since 1997. Because of this, patients with chronic illness as well as those with diseases that have a relatively stable status may have their prescriptions refilled in nearby clinic pharmacies without having to go to hospitals. METHODS: Shuang-Ho Hospital in Taipei, Taiwan, implemented a drive-through pharmacy service as a more convenient refilling system to provide patients in need with a more effective way to refill their prescriptions. To assess the efficacy of this new refilling system, changes in patient drug prescription behavior were compared 6 months before and 6 months after the system was deployed. RESULTS: We found an increase in the overall refilling prescription rate, with an increased use of online reservations (7.9% vs. 4.9%, p < 0.001), an increased proportion of medications picked up (93.0% vs. 88.1%, p < 0.001) after the implementation period, and an elevation in the percentage of patients using drive-through pharmacy services (45.4% vs. 28.9%, p < 0.001; second vs. first quarter, respectively) during the 6 months after the implementation period. Generally, the prescription refilling rate for all population categories at Shuang-Ho Hospital increased significantly after the drive-through service was provided (51.1% vs. 50.2%, p < 0.01). The middle-aged population group (40-65 years of age) was found to utilize the drive-through prescription service more than other age groups. CONCLUSION: The drive-through pharmacy provides patients with convenient access to pick up refilling prescriptions in a shorter time than ordinary pharmacy service. During a short-term follow-up, an overall increase in the prescription refilling rate was noted after the drive-through service was put into place. Our survey revealed that an upward of 90% of the patients were satisfied with the drive-through service. Future promotion of the service may help patients effectively utilize drive-through pharmacy prescription refilling and enhance disease control.

Evaluation of a vancomycin dosing nomogram in achieving high target trough concentrations in Taiwanese patients.

BACKGROUND: The use of a vancomycin dosing nomogram is an alternative and more cost-effective method to conventional dosing; it reliably allows the achievement of trough vancomycin serum concentrations of 5-15 mg/l, with a successful clinical response. Recent guidelines have further recommended that the trough concentration be maintained at 15-20mg/l for complicated infections. However, to date no published nomogram has been constructed to achieve the optimal trough of 15-20mg/l in an Asian population. This study aimed to develop two vancomycin nomograms for the achievement of trough concentrations of 5-15 mg/l and 15-20mg/l in the Taiwanese population, and to ensure the clinical efficacy and safety of such nomograms. METHODS: The estimated concentrations and the real concentrations in our patient population were compared between six pharmacokinetic models to see which was the most precise. As the Ambrose method was the best at predicting the trough, this was used to create two nomograms, one for a target trough at 5-15 mg/l and the other for a target trough at 15-20mg/l. We then evaluated the nomograms by analyzing the number of patients with the target vancomycin trough concentration, clinical and microbiological outcomes, and safety. RESULTS: More patients who had dosing according to the nomogram had a vancomycin trough concentration within the desired target range than patients who had conventional dosing (65.1% vs. 32.1%, p = 0.001). These patients also had a higher rate of 'cure' as the clinical response (35.7% vs. 27.1%) and 'eradication' as the microbiological response (46.4% vs. 29.2%), and a lower rate of nephrotoxicity (14.3% vs. 22.9%). For the patients with a complicated infection, more had a trough between 15 and 20mg/l when vancomycin was dosed with the nomogram than when dosed conventionally (41.2% vs. 12.1%, p = 0.019). CONCLUSIONS: We found that when dosing vancomycin with these nomograms, patients tended to have vancomycin trough concentrations within the target range and also to have a better outcome with regard to clinical efficacy and the safety profile.