Farmacia Hospitalaria (English Edition)最新文献

Objective

The purpose of this study is to describe the structure of the CFyT, the Pharmacy and Therapeutics Committee, and a tertiary hospital's selection process for new drugs.

Material and methods

All annals of the PTC and the New Drug Incorporation Guides (GINF) to incorporate new drugs received at Hospital Virgen del Rocío between 2004 and 2007 were reviewed. We carried out a descriptive study which collected variables having to do with the drug (drug type, type of register, route of administration and legal category), the petitioner (responsible division, professional category and request type) and the result of the evaluation (final decision, elapsed time between the request and the decision).

Results

Of the 72 requested drugs, 45 (62.5%) were approved: six as equivalent treatments, 36 (80%) with specific recommendations, and three (4.2%) with no restrictions. Twelve drugs (81.1%) were not included due to insufficient evidence of their effectiveness compared with the current treatment. The most frequently-requested drug type was the antineoplastics, most commonly requested by Oncology and Haematology divisions. We highlight the fact that many of the petitioners included clinical trials (97.2%) and data referring to costs (84.7%).

Conclusions

There is a high level of compliance with the GINF guide in our centre, which guarantees that the P&TC's final decision is based on scientific evidence.

Objective

Lenalidomide (LDM) is an immunomodulatory and anti-angiogenic drug which has been shown to be effective in several haematological disorders (multiple myeloma [MM], myeloid metaplasia with myelofibrosis [MF] and myelodysplastic syndrome [MDS]). The objective of this study is to evaluate the effectiveness and tolerability of LDM in our patients.

Method

Retrospective observational study which included patients at our hospital who were monitored by the haematology unit, diagnosed with MM, MF and MDS and candidates for LDM treatment. Treatment effectiveness was assessed after approximately 4 cycles of treatment.

Results

Between February 2007 and March 2008, 16 patients were listed as candidates for receiving treatment with LDM (50% female/50% male, with a mean age of 69.6 years); of these candidates, 3 never initiated treatment. Five of the six patients with MM treated at our hospital obtained some sort of response (83.3%). Of the 4 patients with MF, 2 (66.6%) experienced some sort of response to treatment. Of the 6 patients diagnosed with MDS, treatment was initiated in 3, and it had to be suspended in 2 cases due to different reasons. Treatment only had to be suspended in two of the 13 patients who began it (15.4%) due to adverse effects (AE).

Conclusion

LDM is well-tolerated and produces sustained clinical benefits, especially in MM and MF. More studies are needed for in-depth examination of treatment duration, new indications and the use of treatments combined with other drugs.

Objective

To implement a coordinated strategy for the family care unit and the pharmacy division in order to enable revising treatment in polymedicated patients. To this end, we have developed a software tool permitting the patient's primary doctor to have a quick, summarised description of the patient's updated pharmacological treatments, and detect iatrogenic risks and/or dosage adjustments and pharmacotherapy advice.

Methods

In this study, polymedicated patients are defined as those taking 10 or more medications during at least one month.

Development phases:

Designing a guide form to assist the family doctor in reviewing treatments.

Developing a drug treatment report (DTR) as a complementary document to assist the doctor in reviewing treatments.

Introducing a coordinated communication system between the family doctor and the pharmacist.

Reviewing work instructions and distributing them to staff members involved.

Results

The target population of the study consists of 1897 polymedicated patients. We issued 1897 reports, containing the following: 8530 recommendations (10% alerts from regulatory authorities, 31% recommendations regarding high-risk drugs in elderly patients, 7% gave information about new treatments and 52% recommendations on proper drug use); 399 had high clinically relevant drug interactions; and 5036 dose adjustment recommendations. These pharmacotherapy reports allow treatment to be revised for nearly 100% of the selected population.

Conclusion

The development and implementation of software tools for monitoring polymedicated patients enables us to create DTRs that facilitate routine medical reviews of pharmacological treatment in a fairly wide range of patients.

Objective

To carry out a Budget Impact Analysis (BIA) of the inclusion of the administration of the fixed combination (FC) of amlodipine 5 or 10 mg and atorvastatin 10 mg for approved indications in the Spanish National Health System (SNHS).

Material and methods

A BIA was carried out from the SNHS perspective for a 3-year period (2009–2011). A tree-type decision model was designed (patient tree), based on epidemiological data and scientific literature, in order to estimate the hypertensive population that could be treated with the FC. The total per annum BIA was calculated by attributing the retail price+VAT of the FC to the number of patients to be treated, and deducting the cost of the treatment for hypertension that was replaced and the updated average cost per patient of cardiovascular events (CVEs) prevented by the use of the FC by the SNHS during the period of study.

Results

The patient population likely to be treated with the FC was 51,104 patients (1st year), with a growth rate of 1%–2% over the following years, which means an annual cost (€) of 15.9 M (2009), 19.9 M (2010) and 24.1 M (2011), with a total of 60.0 M. The BIA was compensated showing negative impact values for the SNHS when the cost of replaced antihypertensive treatment and prevented CVEs was deducted, with savings of 69.9 M € over 3 years.

Conclusion

The BIA of a FC of atorvastatin and amlodipine shows that the use of this medication for approved indications could generate net savings for the SNHS of 9.9 M € for the period 2009–2011.

Objective

Calculate error prevalence occurred in different medication-dispensing systems, the stages of occurrence, and contributing factors.

Methodology

Prospective observational study. The staging of the dispensing process were reviewed in five dispensing systems: Stock, Unitary-Dose dispensing systems (UDDS) without Computerised Prescription Order Entry (CPOE), CPOE-UDDS, Automated Dispensing Systems (ADS) without CPOE and CPOE-ADS. Dispensing errors were identified, together with the stages of occurrence of such errors and their contributing factors.

Results

Two thousand one hundred eighty one errors were detected among 54,169 opportunities of error. Error-rate: Stock, 10.7%; no-CPOE-UDDS, 3.7%, CPOE-UDDS, 2.2%, no-CPOE-ADS, 20.7%; CPOE-ADS, 2.9%. Most frequent stage when error occurs: Stock, preparation of order; no-CPOEUDDS and CPOE-UDDS, filling of the unit dose cart; no-CPOE-ADS and CPOE-ADS, filling of the ADS. Most frequent error: Stock, no-CPOE-ADS and CPOE-ADS, omission; CPOE-UDDS, different amount of drug and no-CPOE-UDDS, extra medication. Contributing factor: Stock, CPOE-ADS and no-CPOE-ADS, stock out/supply problems; CPOE-UDDS, inexperienced personnel and deficient communication system between professionals; no-CPOE-UDDS, deficient communication system between professionals.

Conclusions

Applying new technologies to the dispensing process has increased its safety, particularly, implementation of CPOE has enabled to reduce dispensing errors.

Objective

Description and analysis of pharmaceutical interventions for patients with parenteral nutrition and an assessment of the degree of acceptance.

Method

Prospective six-month study. Design of a data collection sheet (with personal data, the indication for parenteral nutrition, hospital area, nutrition type, time and type of intervention, type of notification, acceptance) for recording interventions carried out based on normal activities: complete review of pharmacotherapy and clinical history.

Results

A total of 265 interventions were carried out during the study period (1.5 interventions/day) with a mean of 2.1 interventions/patient. The overall degree of acceptance was 83.77%; significant differences were found between type of communication for the intervention (oral and/or written) and the degree of acceptance.

Conclusions

Adding a pharmacist to the care team permits direct intervention in partnership with the doctor, and it is an effective method for preventing and resolving the complications, generally metabolic, that are associated with parenteral nutrition. Using this process for resolving medication-related problems in hospitalised patients, principally in surgical areas, is an addition to the pharmacist's activities in the area of nutritional support.

Objectives

The purpose of this study is to review the prevalence of aspirin resistance in patients with a high risk of cardiovascular events, and secondly, to investigate its epidemiology and mechanism of action, and the clinical consequences it can provoke.

Material and methods

A search was run on PubMed, EMBASE and Reviews Database for English or Spanish articles on aspirin resistance published up to November 2008. Additional studies were obtained by searching the reference lists in the selected articles for articles relevant to our secondary objectives.

Results

Aspirin resistance is described as affecting 0% to 57% of the population, and is related to a decreased protective effect against strokes and cardiovascular events. Many modifiable and unmodifiable factors can affect the efficacy of antiplatelet drugs. Possible strategies for overcoming this decreased antiaggregant effect include increasing the aspirin dosage or dual therapy with another antiplatelet agent.

Conclusions

Lack of response to aspirin decreases its protective effects. However, lack of a standard definition for aspirin resistance, the absence of diagnostic reference methods to identify resistant patients, and the different mechanisms of action involved in platelet aggregation call the clinical importance of this fact into question. Additional well-designed studies are needed to detect patients with real resistance in order to have more effective prevention of cardiovascular morbidity and mortality.

Objective

Measure the degree of compliance of prescriptions given to chronic obstructive pulmonary disorder (COPD) patients upon hospital discharge by comparing them to international recommendations. Identify factors that influence the degree of compliance. Evaluate the effect of that degree of compliance on the number of COPD exacerbations.

Method

Retrospective observational study. We selected all episodes identified as COPD in a tertiary hospital during 2006. By consulting the clinical history database, we accessed the hospital discharge report and calculated the treatment's degree of proximity to the recommendations issued in the Global Initiative for Chronic Obstructive Lung Disease (GOLD). For each episode, we calculated the number of exacerbations in the six following months. Descriptive, bivariate statistical analysis.

Results

We obtained 365 episodes. The mean degree of compliance was 82% (SD = 15.9). The patient's age and the severity of the disease did not influence the degree of compliance. We observed an inverse correlation between the hospital stay and the degree of compliance (P = .026). Discharge reports issued by the Pneumonology Department had a significantly higher degree of compliance (P < .001). No statistically significant relationship was found between the degree of compliance and the number of exacerbations.

Conclusions

The degree of compliance is high according to the GOLD recommendations. The Pneumology Department had the highest degree of compliance, and a higher degree of compliance was related to a shorter hospital stay. The treatment compliance had no effect on the number of exacerbations of the disease.

Introduction

The objective of this study is to analyse the available evidence regarding the effectiveness of the strategy of induction maintenance with boosted protease inhibitors with ritonavir in adult HIV patients as compared to conventional treatment.

Methods

We performed a meta-analysis of randomised controlled trials in HIV patients to compare the efficacy of a monotherapy strategy of boosted protease inhibitors as compared with conventional antiretroviral therapy. The literature search was conducted in PubMed, EMBASE (September 1999-September 2009) and in conference abstracts of the last 5 years. The Odds Ratio of treatment failure and their 95% confidence intervals were calculated. To combine the results of individual studies selected, a fixed effects model based on the Mantel-Haenszel method or random effects was used, depending on whether or not the results were heterogeneous.

Results

Initially a total of 1510 publications were found, of which just 8 studies met the criteria for inclusion in the meta-analysis. The combined Odds Ratio of the 8 studies is 1.39 (95% CI 1.02–1.90) for the treatment group with conventional antiretroviral treatment, but with a confidence interval close to the limits of statistical non-significance.

Conclusion

The results of the combined effectiveness analysis in the meta-analysis found no significant differences between the conventional strategy and monotherapy. This strategy is considered recommended (level A evidence) in patients with no history of previous failure of protease inhibitor, with undetectable plasma viral load and signs or symptoms of nucleoside/nucleotide toxicity.

Introduction

The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage.

Methods

Multi-centre, prospective observational study lasting 4 months, performed in 5 hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identified by direct observation and the use of previously defined alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classified according to the taxonomy that the Ruiz-Jarabo 2000 group defined, and coordinated by ISMP-Spain.

Results

We included 1550 patients, 159 of whom experienced at least one ADE (10.3%). The preventability percentage was 51.6%, which represented 5.3% of the total sample. The endocrine system (34.8%) and the cardiovascular system (20.7%) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5% of all ADEs. Nine point three percent of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3%) resulted from omitting a necessary medication. Only 4.4% of preventable ADEs are considered to be serious.

Conclusions

There is a high incidence rate of ADEs during patients’ hospital stay (10.3%), and half of them (51.6%) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs.