Pharmacy care perspectives on problems with HIV antiretroviral therapy in Sweden

Objective This study has three main objectives (1) to identify the major problems or difficulties pharmacy staff in Sweden experience regarding pharmacy care of patients receiving antiretroviral therapy, (2) to identify the perceptions of pharmacy staff regarding what are patient-related concerns with antiretroviral therapy and (3) to compare the extent to which pharmacy staff awareness matches patient perceptions regarding what are the major problems or difficulties associated with antiretroviral therapy. Methods A problem detection study (PDS) containing two questionnaires was conducted: one to be completed by pharmacy staff and another to be completed by both pharmacy staff and patients. In the latter survey, staff were asked about what they thought that patients would have responded. Staff and patient responses were then matched and compared with one another. Results The pharmacy staff expressed their need for continuous education so as to assist the patients with their complex regimens. The staff were aware that patients were worried about therapy failure and viral resistance, medication-related problems and negative attitudes from the public. The staff however were less aware of the extent to which patients worried about not having their HIV infection under control. The staff also valued written patient information to a much higher extent than the patients. Conclusions The pharmacy staff’ awareness of the major problems HIV patients are experiencing seems incomplete and may lead to lack of concordance between the patients and pharmacy staff. This in turn may lead to non-adherence and poor therapy outcomes. Pharmacy staff should be encouraged to improve and systematically assess patient issues regarding antiretroviral therapy. Through assessing patient needs and concerns, the pharmacists can better identify patient needs and thus better tailor their educational and behavioural interventions to improve therapy outcomes.     

医院中心药房拆零药品的管理建议

目的：加强拆零药品的管理,减少药品的损耗和浪费,保障药品被拆零后在有效期内的质量,确保临床用药的安全有效。方法：将中心药房所有药品的说明书中贮藏项的内容进行统计、分类、归纳,制定管理方案。结论：医院中心药房应重视拆零药品的贮藏与养护,拆零药品应严格遵照药品说明书要求的贮藏条件进行科学合理的贮藏,为临床的安全用药提供保障。     

Common problems with antiretroviral therapy among three Swedish groups of HIV infected individuals

Objective The main objective of this study was to identify and compare the common problems and difficulties associated with combination antiretroviral therapy (CART) as experienced by three major groups of HIV infected individuals (homo- or bisexuals, former injecting drug users and origins of Sub-Saharan Africa) in Sweden. Methods Based on the results from in-depth interviews with 15 representatives from the three major groups, a questionnaire was designed for use in a problem detection study (PDS). The study was conducted with 195 HIV-positive patients residing in the major cities of Sweden. Results The overall response rate was 79%. The problems identified in all three groups were negative attitudes from the public, worries about disease progression or therapy failure, medication or drug-related problems and problems in connection to pharmacy visits. A specific problem in the homo- or bisexual group was drug-related problems such as adverse effects, drug interactions and pill burden. For former injecting drug users, the specific problem was disease-related conflicts with relatives and the problem of coping with the social and psychological burden caused by the HIV infection. The African group termed the risk of exposing their medication at the pharmacy as a specific problem, as this could reveal their HIV status. Conclusions Our findings regarding problems with CART in three patient groups in Sweden may be of use to tailor pharmacy care to HIV infected individuals. General strategies to improve adherence need to be complemented with approaches that will address the specific needs for the different patient groups affected by HIV. Further studies on group-specific interventions that promote concordance and adherence to CART will be necessary to minimize therapy failure and viral resistance.     

Measuring the impact of medicines information services on patient care: methodological considerations

Introduction: Medicines information services (MISs) aim to promote the safe, effective and economic use of medicines. Results from published studies suggest that they provide effective information, which in many cases results in improved patient outcome. However, there are several methodological issues that are important in the interpretation of such studies.Aim: To address methodological issues in the evaluation of MISsObjectives: To carry out a critical appraisal of papers assessing the impact on patient outcome of passive information given to health care professionals, to identify the key methodological issues and to make recommendations for future research in Europe. Methods: Literature search to identify relevant papers meeting the inclusion criteria, critical evaluation of the methods usedResults: Most studies have been conducted in the United States. Various methodological considerations were identified: study design, sampling, data collection, choice of outcome measures, and validity. The results of each study are interpreted in view of the methods used. In addition, the implications of the methods selected on the validity, reliability and generalisability of the results are discussed. Finally, suggestions for future studies are provided, in order to maximise validity and reliability.     

我国临床药学建设与发展趋势(上篇)

目的:调整我国临床药学的发展方向,加速临床药师制和临床药师培训基地建设.方法:采用回顾和思考的方式,总结我国临床药学和临床药师制体系建设的现状、经验、不足与发展趋势.结果与结论:肯定临床药学和医院药学取得的成绩,明确临床药学学科和临床药师制体系建设的必要性,要坚持正确发展方向,药师应树立走出药房,面向临床,坚持以病人为中心、以合理用药为核心,服务患者的理念,转变观念与职责,走人才和科技发展的道路.     

我院实施制度干预前后外科退药情况调查

目的:分析我院外科退药情况,探讨实施制度干预后,降低退药率,确保临床用药安全的成效.方法:制定新的退药管理办法,对退药情况进行干预;调查统计外科系统干预前后退药的相关数据并进行分析.结果:施行新的退药干预制度之后,外科各病房退药频次和退药金额均大幅下降.结论:医院实施的退药干预政策在我院外科取得了显著的成效.     

Infovigilance: Reporting Errors in Official Drug Information Sources

Introduction: The French drug database Thériaque (http://www.theriaque.org) developed by the (Centre National Hospitalier d’Information sur le Médicament) (CNHIM), is responsible for the dissemination of independent information about all drugs available in France. Each month the CNHIM pharmacists report problems due to inaccuracies in these sources to the French drug agency. In daily practice we devised the term “infovigilance”: “Activity of error or inaccuracy notification in information sources which could be responsible for medication errors”. The aim of this study was to evaluate the impact of CNHIM infovigilance on the contents of the Summary of Product Characteristics (SPCs).Method: The study was a prospective study from 09/11/2001 to 31/12/2002. The problems related to the quality of information were classified into four types (inaccuracy/confusion, error/lack of information, discordance between SPC sections and discordance between generic SPCs).Main outcome measures:(1) Number of notifications and number of SPCs integrated into the database during the study period.(2) Percentage of notifications for each type: with or without potential patient impact, with or without later correction of the SPC, per section.Results: 2.7% (85/3151) of SPCs integrated into the database were concerned by a notification of a problem. Notifications according to type of problem were inaccuracy/confusion (32%), error/lack of information (13%), discordance between SPC sections (27%) and discordance between generic SPCs (28%). 55% of problems were evaluated as ‘likely to have an impact on the patient’ and 45% as ‘unlikely to have an impact on the patient’. 22 of problems which have been reported to the French drug agency were corrected and new updated SPCs were published with the corrections.Conclusions: Our efforts to improve the quality of drug information sources through a continuous “infovigilance” process need to be continued and extended to other information sources.     

The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals

Objective : To describe the frequency and types of drug-related problems (DRPs) in hospitalised patients, and to identify risk factors for DRPs and the drugs most frequently causing them.Methods From May to December 2002, 827 patients from six internal medicine and two rheumatology departments in five hospitals in Norway were included in this study. We recorded demographic data, drugs used, relevant medical history, laboratory data and clinical/pharmacological risk factors, i.e. reduced renal function, reduced liver function, heart failure, diabetes, compliance problems, drugs with a narrow therapeutic index and drug allergy. DRPs were documented after reviewing medical records and participation in multidisciplinary team discussions. An independent quality assessment team retrospectively assessed the DRPs in a randomly selected number of the study population.Results Of the patients, 81% had DRPs, and an average of 2.1 clinically relevant DRPs was recorded per patient. The DRPs most frequently recorded were dose-related problems (35.1% of the patients) followed by need for laboratory tests (21.6%), non-optimal drugs (21.4%), need for additional drugs (19.7%), unnecessary drugs (16.7%) and medical chart errors (16.3%). The patients used an average of 4.6 drugs at admission. A multivariate analysis showed that the number of drugs at admission and the number of clinical/pharmacological risk factors were both independent risk factors for the occurrence of DRPs, whereas age and gender were not. The drugs most frequently causing a DRP were warfarin, digitoxin and prednisolone, with calculated risk ratios 0.48, 0.42 and 0.26, respectively. The drug groups causing most DRPs were B01A-antithrombotic agents, M01A-non-steroidal anti-inflammatory agents, N02A-opioids and C09A-angiotensin converting enzyme inhibitors, with risk ratios of 0.22, 0.49, 0.21 and 0.35, respectively.Conclusions The majority of hospitalised patients in our study had DRPs. The number of drugs used and the number of clinical/pharmacological risk factors significantly and independently influenced the risk for DRPs. Procedures for identification of, and intervention on, actual and potential DRPs, along with awareness of drugs carrying a high risk for DRPs, are important elements of drug therapy and may contribute to diminishing drug-related morbidity and mortality.     

浅谈我院药学管理的规范化建设

目的:探讨我院药学管理规范化建设的途径,为基层医院药学管理规范化建设提供参考。方法:结合《江苏省医院药事工作评价标准(试行)》和《医疗机构药事管理规定》(征求意见稿),提出适合我院较为全面的药事管理制度。结果:成立了与我院相适应的药物与治疗学委员会指导下的6个工作管理小组;将我院药学部门设为药学科,下设药房、药库、临床药学室、药品检验室、静脉药物配置中心等。结论:基层医院药学管理也应适应形势的需要,使之向科学化、标准化、规范化管理迈进。     

2013年第4季度我院住院药房退药现状与分析

目的：分析我院住院药房退药情况,并提出对策,促进合理用药。方法：对我院2013年第4季度的退药申请按退药科室、退药原因、退药种类进行统计分析。结果：共有1743次退药申请,其中心胸科、普通外科、呼吸科退药较多,占构成比的41.83%;退药原因主要是医嘱停用、患者拒用,占构成比的56.63%;退药种类主要是抗生素、口服制剂,占构成比的60.07%。结论：我院各科室均有退药现象,个别科室退药量大,应促进医务人员合理用药,加强药品管理,确保用药安全。     

Pharmacy practice research priorities during the COVID-19 pandemic: Recommendations of a panel of experts convened by FIP Pharmacy Practice Research Special Interest Group

Across the globe, pharmacists on the frontline continue to fight COVID-19 and its continuously evolving physical, mental, and economic consequences armed by their knowledge, professionalism, and dedication. Their need for credible scientific evidence to inform their practice has never been more urgent. Despite the exponentially increasing number of publications since the start of the pandemic, questions remain unanswered, and more are created, than have been resolved by the increasing number of publications.A panel of leading journal editors was convened by the International Pharmaceutical Federation (FIP) Pharmacy Practice Research Special Interest Group to discuss the current status of COVID-19 related research, provide their recommendations, and identify focal points for pharmacy practice, social pharmacy, and education research moving forward.Key priorities identified spanned a wide range of topics, reflecting the need for good quality research to inform practice and education. The panel insisted that a foundation in theory and use of rigorous methods should continue forming the basis of inquiry and its resultant papers, regardless of topic area. From assessing the clinical and cost effectiveness of COVID-19 therapies and vaccines to assessing different models of pharmaceutical services and education delivery, these priorities will ensure that our practice is informed by the best quality scientific evidence at this very challenging time.     

Prognostic prediction models and clinical tools based on consensus to support patient prioritization for clinical pharmacy services in hospitals: A scoping review

BackgroundIdentifying patients at high risk of adverse medication-related outcomes for targeted clinical pharmacy services is essential in hospital pharmacy. Models and predictive tools to prioritize patients are available to the clinical pharmacy services for hospital use.ObjectiveTo describe and assess prognostic models and predictive tools used to identify inpatients at risk of adverse medication-related outcomes.MethodsWe searched in Medline, Lilacs, Cochrane, CINAHL, Embase, Scopus and Web of Science, databases of theses and dissertations, and the references of the selected studies. The screening was carried out by two independent researchers. Cross-sectional studies, prospective or retrospective cohort studies, and case-control studies were eligible for inclusion. The studies addressed the development or validation of predictive models and clinical prioritization tools based on expert opinion to identify inpatients at risk of adverse medication-related outcomes.Results25 studies were included, 13 of which were prognostic prediction models, seven were instrument development using the consensus method, and five were validation. The outcome events were drug-related problems (9), adverse drug reactions (8), adverse drug events (6), and medication errors (2). Most studies targeted adult patients (14), eight had older adult patients, one had obstetric patients, and others had pediatric patients. External validation was performed after the development study in three studies. The predictive model with a low risk of bias was the Medicines Optimisation Assessment Tool. Limited details on the method of expert involvement and the number of experts were identified in four studies.ConclusionThe development of patient prioritization tools to optimize pharmacotherapy by clinical pharmacy services is a complex process. The predictive models and tools analyzed are limited in their development and validation process, hindering their effective use in prioritizing patients by the clinical pharmacy services. The development of additional prognostic prediction models for drug-related problems is a priority.     

根据三级医院评审要求谈药房药品有效期管理中存在的问题与对策

目的：总结医疗机构药剂科药品有效期管理中存在的问题并对其进行规范管理。方法根据三级医院评审的要求以及工作实践,针对药剂科药品有效期管理存在的问题如采购计划不合理,贮存条件及硬件设施不完善、药品摆放不科学等几个方面的问题进行分析并提出对策。结果与结论提出规范的药品采购计划、完善药品贮存硬件设施、科学的药品摆放方法、药品有效期管理的制度等方法和对策,实施制度化、规范化、系统化的管理,以保障药品质量和临床用药安全,使药剂科能够更好地为临床用药服务。     

Student-Led discharge counseling program for High-Risk medications in a teaching hospital in Saudi Arabia: A pilot study

Discharge counseling by pharmacists reduces adverse medication events, emergency department visits, and readmissions. Studies indicate that pharmacy students in advanced pharmacy practice experiences (APPE) can deliver effective medication-related activities. An open label randomized controlled trial was conducted in adults discharged on warfarin, insulin, or both. Pharmacy students performed medication reconciliation, structured medication counseling, and follow-up calls 72-hours post-discharge. The usual care arm received traditional education. The primary outcome was the 30-day readmission rate post-discharge. Ninety-eight patients on high-risk medications were randomized to intervention (n = 51) or usual care (n = 47). The 30-day hospital readmission rate was lower in the intervention group (8/51, 15% vs. 11/47, 23%); (p = 0.48). There was no statistical difference in the time to first unplanned health care use (hazard ratio = 0.49 (95 %CI, 0.19–1.24), or the time-to-first clinic visit post-discharge (p = 0.94) between the two arms. Students identified 26 drug-related problems during reconciliation. Patients in the intervention arm reported high satisfaction with the service (mean 3.94; SD 0.11). Involving APPE students in the transition of care activities presents an excellent opportunity to minimize pharmacists' workload while maintaining patient care services.     

从药店服务理念看药品零售市场价格竞争

目的:为零售药店参与市场竞争提供参考。方法:分析顾客满意理念和顾客让渡价值理论,探讨提高顾客让渡价值的途径。结果与结论:降低货币价格只是药店提高顾客满意度的多种方法中的一种,药店应综合分析影响顾客让渡价值的因素,作出正确的营销决策。     

The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines

Objective This “proof of concept” study aimed to assess the cost effectiveness of pharmacists giving advice via telephone, to patients receiving a new medicine for a chronic condition, in England. Methods The self-regulatory model (SRM) theory was used to guide development of our intervention and used in training pharmacists to adopt a patient-centred approach. Non-adherence to new medicines for chronic conditions develops rapidly so we developed a study intervention in which a pharmacist telephoned patients two weeks after they had started a new medicine for a chronic condition. Patients were included if they were 75 or older, or were suffering from stroke, cardiovascular disease, asthma, diabetes or rheumatoid arthritis, and were randomized into treatment or control arms. Main outcome measures were non-adherence and cost to the UK NHS, obtained via a questionnaire sent two months after starting therapy. Cost of the intervention was also included. Incremental cost effectiveness ratios (ICERs) were generated. Results Five hundred patients were recruited. At 4-week follow-up, non-adherence was significantly lower in the intervention group (9% vs 16%, p = 0.032). The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control, (23% vs 34% p = 0.021). Mean total patient costs at 2-month follow-up (median, range) were intervention: ￡187.7 (40.6, 4.2–2484.3); control: ￡282.8 (42, 0–3804) (p < 0.0001). The intervention was dominant (less costly and more effective). If the decision maker is not willing to pay anything for one extra adherent patient, there is still a 90% probability that the intervention is cost effective. Conclusions These findings suggest that pharmacists can meet patients’ needs for information and advice on medicines, soon after starting treatment. While a larger trial is needed to confirm that the effect is real and sustained, these initial findings suggest the study intervention may be effective, at least in the short term, with a reduced overall cost to the health provider.