Flucytosine is an antifungal agent used in combination with other medicines for the treatment of fungal infections. It was available as intravenous (IV), oral tablet, and capsule formulations up until October 2021, when the IV product, Ancotil, was discontinued with no alternative brands available.
Aim
This study aimed to formulate a suitable formulation with appropriate stability data for medium to long-term nasogastric (NG) administration use.
Method
Flucytosine 500 mg tablets (Ancotil) were crushed and suspended in (1) Ora-Plus (OP) + Ora-Sweet (OS) and (2) Ora-Blend (OB) to produce 100 mg/mL suspensions (n = 3 for each suspending base) that were stored at 2–8°C in amber glass bottles until assayed. Appearance, odour and pH, and the concentrations of flucytosine in the suspensions were determined by high-performance liquid chromatography on days 1, 8, and 15. A subjective assessment of the ease of suspension for NG administration via a size 10fr nasogastric tube (NGT) was also tested. Ethics approval was not required for this research article as it was a stability study and did not contain human participants or human data.
Results
One of the three OB suspension bottles demonstrated significant suspension clumping resulting in all OB suspensions being excluded from further analysis. There was no change in appearance, odour or pH with the OP + OS based flucytosine suspensions and they extruded easily through a size 10fr NGT with minimal force. The three OP + OS bottles of flucytosine suspension were stable (>98% at all timepoints assessed) for 15 days at 2–8°C when stored in amber glass bottles.
Conclusions
The OP + OS suspensions showed chemical stability for up to 15 days when stored under refrigerated conditions and protected from light, making this a suitable multidose enteral alternative to IV flucytosine.
背景氟尿嘧啶是一种抗真菌药物，可与其他药物联合用于治疗真菌感染。该药有静脉注射剂、口服片剂和胶囊剂，直到 2021 年 10 月，静脉注射剂产品 Ancotil 停产，没有替代品牌。 目的 本研究旨在为中长期鼻胃（NG）给药配制一种具有适当稳定性数据的合适制剂。 方法 将氟尿嘧啶 500 毫克片剂（Ancotil）碾碎并悬浮于 (1) Ora-Plus (OP) + Ora-Sweet (OS) 和 (2) Ora-Blend (OB) 中，制成 100 毫克/毫升的悬浮液（每种悬浮基质 n = 3），在 2-8°C下贮存于琥珀色玻璃瓶中，直至化验。在第 1、8 和 15 天，用高效液相色谱法测定悬浮液的外观、气味和 pH 值以及氟西多辛的浓度。此外，还测试了悬浮液是否易于通过 10fr 大小的鼻胃管（NGT）进行 NG 给药的主观评估。由于这是一项稳定性研究，不涉及人类参与或人类数据，因此本研究文章无需获得伦理批准。 结果 三瓶转瓶混悬液中有一瓶出现了明显的混悬液结块现象，因此所有转瓶混悬液都被排除在进一步分析之外。基于 OP + OS 的氟尿嘧啶混悬液在外观、气味或 pH 值方面均无变化，而且它们很容易通过 10fr 的 NGT 管挤出，挤出力很小。三瓶 OP + OS 氟尿嘧啶混悬液在 2-8°C琥珀色玻璃瓶中储存 15 天后保持稳定（在所有评估的时间点均为 98%）。 结论 OP + OS 悬浮液在冷藏避光条件下保存 15 天后显示出化学稳定性，使其成为静脉注射氟尿嘧啶的合适多剂量肠内替代品。
{"title":"Stability of flucytosine 100 mg/mL suspension as an alternative to intravenous administration","authors":"Pamela Huang BPharm, Carmela Corallo BPharm, Cherie Chiang MBBS (Hons), FRACP, FRCPA, MAACB, MD, FFSc, Yoke Chee Leong BSc, MAACB, Bianca Tong BPharm (Hons)","doi":"10.1002/jppr.1924","DOIUrl":"https://doi.org/10.1002/jppr.1924","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Flucytosine is an antifungal agent used in combination with other medicines for the treatment of fungal infections. It was available as intravenous (IV), oral tablet, and capsule formulations up until October 2021, when the IV product, Ancotil, was discontinued with no alternative brands available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to formulate a suitable formulation with appropriate stability data for medium to long-term nasogastric (NG) administration use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Flucytosine 500 mg tablets (Ancotil) were crushed and suspended in (1) Ora-Plus (OP) + Ora-Sweet (OS) and (2) Ora-Blend (OB) to produce 100 mg/mL suspensions (<i>n</i> = 3 for each suspending base) that were stored at 2–8°C in amber glass bottles until assayed. Appearance, odour and pH, and the concentrations of flucytosine in the suspensions were determined by high-performance liquid chromatography on days 1, 8, and 15. A subjective assessment of the ease of suspension for NG administration via a size 10fr nasogastric tube (NGT) was also tested. Ethics approval was not required for this research article as it was a stability study and did not contain human participants or human data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One of the three OB suspension bottles demonstrated significant suspension clumping resulting in all OB suspensions being excluded from further analysis. There was no change in appearance, odour or pH with the OP + OS based flucytosine suspensions and they extruded easily through a size 10fr NGT with minimal force. The three OP + OS bottles of flucytosine suspension were stable (>98% at all timepoints assessed) for 15 days at 2–8°C when stored in amber glass bottles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The OP + OS suspensions showed chemical stability for up to 15 days when stored under refrigerated conditions and protected from light, making this a suitable multidose enteral alternative to IV flucytosine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"323-327"},"PeriodicalIF":1.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Treatment guidelines for COVID-19 recommend basic analgesics/antipyretics such as paracetamol.<span><sup>1</sup></span> Paracetamol therapeutic errors are associated with morbidity and mortality.<span><sup>2</sup></span> The Victorian Poisons Information Centre (VPIC), the statewide poisons centre for Victoria, Australia, receives calls from members of the public for advice regarding errors made with medicines. Paracetamol therapeutic errors are usually accidental overdoses (e.g. double-dose, maximum daily dose exceeded, incorrectly measured liquid paracetamol, or use of two paracetamol-containing medicines). The aim of this research was to explore the impact of the COVID-19 pandemic on the number of paracetamol therapeutic error cases in the community (outside of hospitals) that were reported to VPIC.</p><p>Call records were extracted from the VPIC database from 1 July 2017 to 30 June 2022 (approximately 2.5 years before and after the first cases of COVID-19 in Victoria). Retrospectively, records were reviewed where callers reported a therapeutic error with any form of paracetamol that occurred in an adult or child in the home or community.</p><p>In the 2.5 years prior to the pandemic there was an average of 120 (standard deviation [SD] 21) paracetamol therapeutic error cases per month. In the 2.5 years from January 2020 there was an average of 116 (SD 33) cases per month, but case numbers varied as the Victorian population went into and out of lockdown (lockdowns were a stay-at-home order to reduce the spread of COVID-19). During the first two Melbourne lockdowns, which occurred between 31 March 2020–12 May 2020 and 9 July 2020–27 October 2020,<span><sup>3</sup></span> the average number of paracetamol therapeutic error cases per month fell to 60 (SD 19) and 80 (SD 5) per month, respectively. During this time, COVID-19 cases remained low (Figure 1).<span><sup>4</sup></span> When the number of COVID-19 cases rose in the second half of 2021, the average number of paracetamol therapeutic error cases per month increased.<span><sup>4</sup></span> The mean number of cases after lockdowns ended (22 October 2021–30 June 2022) was 145 per month compared to 120 per month pre-pandemic (p < 0.001).</p><p>In reviewing cases related to paediatrics and adolescents (defined in the database as people ≤19 years of age) prior to COVID-19, the average number of therapeutic error cases was 62.66 (SD 13) per month. After the COVID-19 lockdown periods, the average number of therapeutic error cases per month increased to 80 (SD 26, p < 0.001).</p><p>The lower number of paracetamol therapeutic error cases reported to VPIC during the first two lockdowns could be explained by an overall reduction in viral illness due to prolonged lockdowns and improved infection control (e.g. social distancing, face masks, improved hand hygiene).<span><sup>5</sup></span> The statistically significant increase in paracetamol therapeutic errors in the post-lockdown period, compare
{"title":"Rise in paracetamol therapeutic errors in the community during the COVID-19 pandemic","authors":"Nicole O'Shea BPharm, MClinPharm, MSHP, GradCertPharmPrac, GradCertHlthMgmt, FANZCAP (Tox, MedSafety), Rohan A. Elliott BPharm, BpharmSc(Hons), MClinPharm, PhD, FSHP, FANZCAP (GeriMed, Research), Anselm Wong MBBS, DipTox, PhD, FACEM, FACMT, FAACT, FEAPCCT","doi":"10.1002/jppr.1936","DOIUrl":"10.1002/jppr.1936","url":null,"abstract":"<p>Treatment guidelines for COVID-19 recommend basic analgesics/antipyretics such as paracetamol.<span><sup>1</sup></span> Paracetamol therapeutic errors are associated with morbidity and mortality.<span><sup>2</sup></span> The Victorian Poisons Information Centre (VPIC), the statewide poisons centre for Victoria, Australia, receives calls from members of the public for advice regarding errors made with medicines. Paracetamol therapeutic errors are usually accidental overdoses (e.g. double-dose, maximum daily dose exceeded, incorrectly measured liquid paracetamol, or use of two paracetamol-containing medicines). The aim of this research was to explore the impact of the COVID-19 pandemic on the number of paracetamol therapeutic error cases in the community (outside of hospitals) that were reported to VPIC.</p><p>Call records were extracted from the VPIC database from 1 July 2017 to 30 June 2022 (approximately 2.5 years before and after the first cases of COVID-19 in Victoria). Retrospectively, records were reviewed where callers reported a therapeutic error with any form of paracetamol that occurred in an adult or child in the home or community.</p><p>In the 2.5 years prior to the pandemic there was an average of 120 (standard deviation [SD] 21) paracetamol therapeutic error cases per month. In the 2.5 years from January 2020 there was an average of 116 (SD 33) cases per month, but case numbers varied as the Victorian population went into and out of lockdown (lockdowns were a stay-at-home order to reduce the spread of COVID-19). During the first two Melbourne lockdowns, which occurred between 31 March 2020–12 May 2020 and 9 July 2020–27 October 2020,<span><sup>3</sup></span> the average number of paracetamol therapeutic error cases per month fell to 60 (SD 19) and 80 (SD 5) per month, respectively. During this time, COVID-19 cases remained low (Figure 1).<span><sup>4</sup></span> When the number of COVID-19 cases rose in the second half of 2021, the average number of paracetamol therapeutic error cases per month increased.<span><sup>4</sup></span> The mean number of cases after lockdowns ended (22 October 2021–30 June 2022) was 145 per month compared to 120 per month pre-pandemic (p < 0.001).</p><p>In reviewing cases related to paediatrics and adolescents (defined in the database as people ≤19 years of age) prior to COVID-19, the average number of therapeutic error cases was 62.66 (SD 13) per month. After the COVID-19 lockdown periods, the average number of therapeutic error cases per month increased to 80 (SD 26, p < 0.001).</p><p>The lower number of paracetamol therapeutic error cases reported to VPIC during the first two lockdowns could be explained by an overall reduction in viral illness due to prolonged lockdowns and improved infection control (e.g. social distancing, face masks, improved hand hygiene).<span><sup>5</sup></span> The statistically significant increase in paracetamol therapeutic errors in the post-lockdown period, compare","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"436-438"},"PeriodicalIF":1.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1936","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141797046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andre Wang BPharm, Jonathan Yong Jie Lam BPharm, Nazanin Falconer BPharm, PhD, Michael Barras BPharm, GradDipClinPharm, PhD
Background
Medication harm (MH) causes patient morbidity and is a major healthcare burden. Research into MH is growing, but effective methods to identify MH are debated. The prevalence of MH is often based on an incomplete, retrospective chart review or spontaneous reporting, reliant on busy clinicians. A practical and clinically relevant method to detect MH is required. A trigger tool (TT) offers a solution.
Aim
To evaluate a modified TT to prospectively detect MH and determine the prevalence and severity of MH in a geriatric population.
Method
An international TT was peer evaluated and modified for use in a geriatric ward of a quaternary hospital. Patients were recruited over a 6-month period. The TT was applied to prospectively help identify MH, which was assessed for causality and severity. Positive predictive values (PPV) were estimated for each trigger to determine its sensitivity in identifying MH. Ethics approval was granted by the Metro South Human Research Ethics Committee (Reference no: HREC/2022/QMS/80654) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants through completion of a written consent form, after a full explanation of the protocol design.
Results
Fifty patients consented, of which 16 (32%) patients experienced one or more MH events. A total of 257 triggers were activated (mean of 5.14 per patient) and 31 (12%) predicted an event. Of the 31 events, 19 (61.3%) events were rated as mild and 12 (38.7%) events were rated as moderate to severe. The most common events were bleeding/large bruising, major constipation, diarrhoea, and vomiting. The triggers with the highest PPV included triggers T5 (bleeding/bruising), T9 (gastrointestinal disorders), and T11 (major constipation) with PPVs of 0.455, 0.238, and 0.286, respectively.
Conclusion
A modified TT helped to detect MH in a geriatric population and will aid in identifying events in future studies.
{"title":"Prospective identification of medication harm in geriatric inpatients using a modified trigger tool","authors":"Andre Wang BPharm, Jonathan Yong Jie Lam BPharm, Nazanin Falconer BPharm, PhD, Michael Barras BPharm, GradDipClinPharm, PhD","doi":"10.1002/jppr.1929","DOIUrl":"10.1002/jppr.1929","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medication harm (MH) causes patient morbidity and is a major healthcare burden. Research into MH is growing, but effective methods to identify MH are debated. The prevalence of MH is often based on an incomplete, retrospective chart review or spontaneous reporting, reliant on busy clinicians. A practical and clinically relevant method to detect MH is required. A trigger tool (TT) offers a solution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate a modified TT to prospectively detect MH and determine the prevalence and severity of MH in a geriatric population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>An international TT was peer evaluated and modified for use in a geriatric ward of a quaternary hospital. Patients were recruited over a 6-month period. The TT was applied to prospectively help identify MH, which was assessed for causality and severity. Positive predictive values (PPV) were estimated for each trigger to determine its sensitivity in identifying MH. Ethics approval was granted by the Metro South Human Research Ethics Committee (Reference no: HREC/2022/QMS/80654) and the study conforms to the <i>Australian National Statement on Ethical Conduct in Human Research</i>. Informed consent was obtained from all participants through completion of a written consent form, after a full explanation of the protocol design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty patients consented, of which 16 (32%) patients experienced one or more MH events. A total of 257 triggers were activated (mean of 5.14 per patient) and 31 (12%) predicted an event. Of the 31 events, 19 (61.3%) events were rated as mild and 12 (38.7%) events were rated as moderate to severe. The most common events were bleeding/large bruising, major constipation, diarrhoea, and vomiting. The triggers with the highest PPV included triggers T5 (bleeding/bruising), T9 (gastrointestinal disorders), and T11 (major constipation) with PPVs of 0.455, 0.238, and 0.286, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A modified TT helped to detect MH in a geriatric population and will aid in identifying events in future studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"376-383"},"PeriodicalIF":1.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1929","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iouri Banakh BPharm, MClinPharm, Stephen Louey BPharm, MClinPharm, Graham Rivers BSc, PgD Pharm Practice, Tavan Hem BPharm, Lili Israelian BPharm, Junwon Kang BPharm, Vivienne Luu BPharm, Firuz Tanyeri MBChB, Rachel Rosler MBChB, FACEM
Background
Sepsis and septic shock are common emergency department (ED) presentations, with current guidelines recommending early administration of antibiotics to reduce mortality.
Aim
Sepsis calls with pharmacist attendance have been introduced at two EDs, and the aim of this study was to evaluate the impact of this service on outcomes of all septic patients.
Method
At a multisite, single healthcare network, located in Victoria, Australia, emergency medicine pharmacists were trained in assisting medical staff in antibiotic selection, dosing, and delivering antibiotics directly to nursing staff. The sepsis call service was introduced in May 2022 at one site and in March 2023 at another site, with time to first antibiotic administration, morbidity, and mortality being compared to the outcomes of patients from the same EDs from January–April 2022 (group 1). Post the sepsis call introduction, two cohorts were compared: sepsis call attended patients without a pharmacist (group 2) and with a pharmacist (group 3). This project was exempt due to the local policy requirements that constitute research by the Monash Health Human Research Ethics Committee (Reference no: RES-23-0000-237Q). The justification for this ethics exemption was as follows: the study was retrospective, included privacy protections for patients' data, and presented no increased risk to patient care.
Results
The study included 201 patients, with time to first antibiotic administration on average 302.0 min in group 1, 201.3 min (p = 0.007) in group 2, and 89.8 min (p < 0.001) in group 3. Mortality (p = 0.306), rates of acute kidney injury (p = 0.111), intensive care unit (ICU) admission (p = 0.002), and need for dialysis (p = 0.497) were all reduced in group 3. Adherence to antibiotic guidelines was increased in group 3 (p < 0.001).
Conclusion
Emergency medicine pharmacist contribution led to reduced time to first antibiotic, an improved adherence to antibiotic guidelines, and positive trends in secondary clinical outcomes. Further research is required to determine the significance of improvements in mortality, intensive care unit admissions, and renal impairment.
{"title":"Sepsis call emergency department pharmacist service: a single healthcare network cohort study","authors":"Iouri Banakh BPharm, MClinPharm, Stephen Louey BPharm, MClinPharm, Graham Rivers BSc, PgD Pharm Practice, Tavan Hem BPharm, Lili Israelian BPharm, Junwon Kang BPharm, Vivienne Luu BPharm, Firuz Tanyeri MBChB, Rachel Rosler MBChB, FACEM","doi":"10.1002/jppr.1931","DOIUrl":"10.1002/jppr.1931","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sepsis and septic shock are common emergency department (ED) presentations, with current guidelines recommending early administration of antibiotics to reduce mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Sepsis calls with pharmacist attendance have been introduced at two EDs, and the aim of this study was to evaluate the impact of this service on outcomes of all septic patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>At a multisite, single healthcare network, located in Victoria, Australia, emergency medicine pharmacists were trained in assisting medical staff in antibiotic selection, dosing, and delivering antibiotics directly to nursing staff. The sepsis call service was introduced in May 2022 at one site and in March 2023 at another site, with time to first antibiotic administration, morbidity, and mortality being compared to the outcomes of patients from the same EDs from January–April 2022 (group 1). Post the sepsis call introduction, two cohorts were compared: sepsis call attended patients without a pharmacist (group 2) and with a pharmacist (group 3). This project was exempt due to the local policy requirements that constitute research by the Monash Health Human Research Ethics Committee (Reference no: RES-23-0000-237Q). The justification for this ethics exemption was as follows: the study was retrospective, included privacy protections for patients' data, and presented no increased risk to patient care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 201 patients, with time to first antibiotic administration on average 302.0 min in group 1, 201.3 min (p = 0.007) in group 2, and 89.8 min (p < 0.001) in group 3. Mortality (p = 0.306), rates of acute kidney injury (p = 0.111), intensive care unit (ICU) admission (p = 0.002), and need for dialysis (p = 0.497) were all reduced in group 3. Adherence to antibiotic guidelines was increased in group 3 (p < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Emergency medicine pharmacist contribution led to reduced time to first antibiotic, an improved adherence to antibiotic guidelines, and positive trends in secondary clinical outcomes. Further research is required to determine the significance of improvements in mortality, intensive care unit admissions, and renal impairment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"368-375"},"PeriodicalIF":1.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141650207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Community pharmacists have become flu vaccine immunisers in several countries to increase vaccine uptake.
Aim
This study aimed to perform a scoping review to evaluate the pharmacist's role and contribution to flu immunisation coverage, satisfaction and promotion as vaccine providers.
Design
The framework proposed by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) were considered for this analysis. Two electronic databases (PubMed and Cochrane Library) were used to search for relevant peer-reviewed quantitative, qualitative and mixed-method studies published between 1990 and 2022.
Results
A total of 37 studies were included. These studies suggested that, over time, there was an increase in the rate of vaccine administration within community pharmacies across the various countries examined. Moreover, patients have consistently expressed their satisfaction with the convenience and accessibility of pharmacy-based vaccine services, with some expressing a preference for pharmacies over traditional visits to their general practitioner′s office.
Conclusion
Several initiatives aimed at promoting flu vaccination have been rolled out in pharmacy settings, and a number of these initiatives have demonstrated positive outcomes. The flu vaccination service provided by pharmacists has proven to be an asset in public health by improving accessibility to immunisation services. Pharmacists should continue to take part in yearly flu vaccination programs as flu vaccine providers as they contribute to an increased uptake of immunisations by the population. Extending these services to other vaccines should be further considered.
{"title":"Pharmacist's role in influenza immunisation: a scoping review","authors":"Edna Ribeiro Parracha PharmD, António Teixeira Rodrigues PharmD, PhD, Sofia Oliveira-Martins PharmD, MPH, PhD, Sónia Romano PharmD, Diogo Almeida PharmD, Bruno Sepodes PharmD, MSc, PhD, MPH, Carla Torre PharmD, MSc, PhD","doi":"10.1002/jppr.1932","DOIUrl":"10.1002/jppr.1932","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Community pharmacists have become flu vaccine immunisers in several countries to increase vaccine uptake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to perform a scoping review to evaluate the pharmacist's role and contribution to flu immunisation coverage, satisfaction and promotion as vaccine providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The framework proposed by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) were considered for this analysis. Two electronic databases (PubMed and Cochrane Library) were used to search for relevant peer-reviewed quantitative, qualitative and mixed-method studies published between 1990 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 37 studies were included. These studies suggested that, over time, there was an increase in the rate of vaccine administration within community pharmacies across the various countries examined. Moreover, patients have consistently expressed their satisfaction with the convenience and accessibility of pharmacy-based vaccine services, with some expressing a preference for pharmacies over traditional visits to their general practitioner′s office.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Several initiatives aimed at promoting flu vaccination have been rolled out in pharmacy settings, and a number of these initiatives have demonstrated positive outcomes. The flu vaccination service provided by pharmacists has proven to be an asset in public health by improving accessibility to immunisation services. Pharmacists should continue to take part in yearly flu vaccination programs as flu vaccine providers as they contribute to an increased uptake of immunisations by the population. Extending these services to other vaccines should be further considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"273-286"},"PeriodicalIF":1.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1932","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141650251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul Wembridge BPharm (Hons), M Clin Pharm, FANZCAP, Saly Rashed BPharm (Hons), Grad Cert Pharm Practice, M Clin Pharm, FANZCAP, Nick Monypenny BNursing, Grad Cert of Information Systems, RN, Hamish Rodda MBBS, BMedSci, FACEM
Patients discharged from Australian hospitals require a list of current medications at the point of discharge, which is commonly in the form of a Patient Friendly Medication List (PFML). Furthermore, the provision of an Interim Medication Administration Chart (IMAC) reduces the number of medication administration delays and omissions for patients discharged to residential aged-care facilities. To increase the adoption of PFMLs and IMACs, a new process was developed for creating PFMLs and IMACs directly from the discharge prescription in the Electronic Medical Record (EMR). This retrospective pre- and post-intervention audit aimed to evaluate 1 year of PFML and IMAC generation from three acute metropolitan hospitals, prior to and after transitioning from pharmacy dispensing software to EMR-generated documents. Despite similar hospital activity, the transition to EMR-generated PFMLs and IMACs was associated with a 157% increase in PFML provision (7930 vs 20 373), a 220% increase in IMAC provision (1569 vs 5022) and a 99% reduction in the number of items typed into the pharmacy dispensing software that did not require supply (−59 171/year). Discharge dispensary turnaround times were lower in the post-intervention period (36 min vs 30 min, p < 0.01). In conclusion, the transition to EMR-generated PFMLs and IMACs was associated with increased provision of these documents, reduced data entry for items not required to be supplied, decreased risk of transcription errors and shortened time taken for the hospital pharmacy to process discharge items. This project was exempt due to the local policy requirements that constitute research by the Eastern Health Office of Research and Ethics (Reference no: QA21-094). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's Ethical considerations in quality assurance and evaluation activities and met local requirements for an audit or quality assurance activity.
{"title":"Implementation of hospital electronic medical record Patient Friendly Medication Lists and Interim Medication Administration Charts","authors":"Paul Wembridge BPharm (Hons), M Clin Pharm, FANZCAP, Saly Rashed BPharm (Hons), Grad Cert Pharm Practice, M Clin Pharm, FANZCAP, Nick Monypenny BNursing, Grad Cert of Information Systems, RN, Hamish Rodda MBBS, BMedSci, FACEM","doi":"10.1002/jppr.1927","DOIUrl":"10.1002/jppr.1927","url":null,"abstract":"<p>Patients discharged from Australian hospitals require a list of current medications at the point of discharge, which is commonly in the form of a Patient Friendly Medication List (PFML). Furthermore, the provision of an Interim Medication Administration Chart (IMAC) reduces the number of medication administration delays and omissions for patients discharged to residential aged-care facilities. To increase the adoption of PFMLs and IMACs, a new process was developed for creating PFMLs and IMACs directly from the discharge prescription in the Electronic Medical Record (EMR). This retrospective pre- and post-intervention audit aimed to evaluate 1 year of PFML and IMAC generation from three acute metropolitan hospitals, prior to and after transitioning from pharmacy dispensing software to EMR-generated documents. Despite similar hospital activity, the transition to EMR-generated PFMLs and IMACs was associated with a 157% increase in PFML provision (7930 vs 20 373), a 220% increase in IMAC provision (1569 vs 5022) and a 99% reduction in the number of items typed into the pharmacy dispensing software that did not require supply (−59 171/year). Discharge dispensary turnaround times were lower in the post-intervention period (36 min vs 30 min, p < 0.01). In conclusion, the transition to EMR-generated PFMLs and IMACs was associated with increased provision of these documents, reduced data entry for items not required to be supplied, decreased risk of transcription errors and shortened time taken for the hospital pharmacy to process discharge items. This project was exempt due to the local policy requirements that constitute research by the Eastern Health Office of Research and Ethics (Reference no: QA21-094). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's <i>Ethical considerations in quality assurance and evaluation activities</i> and met local requirements for an audit or quality assurance activity.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"412-416"},"PeriodicalIF":1.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141652644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandros Chronas BBioMed, MD, Karin Thursky MBBS, BSc, MD, FRACP, FAHMS, FAIDH, Simone Mo BBioMed, MD, Lisa Hall BTech(BiomedSci) (Hons), PhD, Rodney James BMedSci, BMed, MPHTM, FRCPA, Courtney Ierano BPharm(Hons), GradCertPharmPrac, PhD
Background
Oral amoxicillin-clavulanic acid, a broad-spectrum antimicrobial and one of the most commonly prescribed antimicrobials in Australia, has demonstrated poor prescribing guideline compliance and appropriateness. This may have inadvertent impacts on patient care and safety, from adverse drug reactions to antimicrobial resistance. Intravenous (IV) amoxicillin-clavulanic acid was first registered in Australia in 2017, reflecting a subsequent and immediate increase in use. There is a need to assess the quality of such prescribing.
Aim
To describe the quality of IV amoxicillin-clavulanic acid prescriptions through assessing guideline compliance and appropriateness of use in Australian hospitals.
Method
A retrospective data analysis of IV amoxicillin-clavulanic acid prescriptions from the Hospital National Antimicrobial Prescribing Survey database between 2013 and 2021. The main outcomes measured were guideline compliance and appropriateness. Ethical approval was granted by the Melbourne Health Human Research Ethics Committee (HREC/74195/MH-2022).
Results
The proportion of prescriptions for IV amoxicillin-clavulanic acid, compared to all other antimicrobials, increased from 0.02% (2013) to 2.3% (2021). Guideline compliance and appropriateness have overall decreased (by 18.9% and 16.7%, respectively). Over time, national guidelines predominantly replaced local guidelines as the primary guideline source for prescribing. The most common reason for inappropriateness was unnecessarily broad spectrum of activity (39.5%).
Conclusion
Intravenous amoxicillin-clavulanic acid prescribing continues to increase throughout Australian hospitals, with notable reductions in guideline compliance and appropriateness. Since 2019, the increase in these outcomes coincided with updated national prescribing guidelines, evident by prescribers utilising national over local guidelines. These findings reinforce the concept that antimicrobial stewardship initiatives, including auditing, robust national guidelines and education, are crucial to optimise IV amoxicillin-clavulanic acid prescribing.
{"title":"Intravenous amoxicillin-clavulanic acid: prescribing practices in Australian hospitals","authors":"Alexandros Chronas BBioMed, MD, Karin Thursky MBBS, BSc, MD, FRACP, FAHMS, FAIDH, Simone Mo BBioMed, MD, Lisa Hall BTech(BiomedSci) (Hons), PhD, Rodney James BMedSci, BMed, MPHTM, FRCPA, Courtney Ierano BPharm(Hons), GradCertPharmPrac, PhD","doi":"10.1002/jppr.1930","DOIUrl":"10.1002/jppr.1930","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oral amoxicillin-clavulanic acid, a broad-spectrum antimicrobial and one of the most commonly prescribed antimicrobials in Australia, has demonstrated poor prescribing guideline compliance and appropriateness. This may have inadvertent impacts on patient care and safety, from adverse drug reactions to antimicrobial resistance. Intravenous (IV) amoxicillin-clavulanic acid was first registered in Australia in 2017, reflecting a subsequent and immediate increase in use. There is a need to assess the quality of such prescribing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe the quality of IV amoxicillin-clavulanic acid prescriptions through assessing guideline compliance and appropriateness of use in Australian hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective data analysis of IV amoxicillin-clavulanic acid prescriptions from the Hospital National Antimicrobial Prescribing Survey database between 2013 and 2021. The main outcomes measured were guideline compliance and appropriateness. Ethical approval was granted by the Melbourne Health Human Research Ethics Committee (HREC/74195/MH-2022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of prescriptions for IV amoxicillin-clavulanic acid, compared to all other antimicrobials, increased from 0.02% (2013) to 2.3% (2021). Guideline compliance and appropriateness have overall decreased (by 18.9% and 16.7%, respectively). Over time, national guidelines predominantly replaced local guidelines as the primary guideline source for prescribing. The most common reason for inappropriateness was unnecessarily broad spectrum of activity (39.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Intravenous amoxicillin-clavulanic acid prescribing continues to increase throughout Australian hospitals, with notable reductions in guideline compliance and appropriateness. Since 2019, the increase in these outcomes coincided with updated national prescribing guidelines, evident by prescribers utilising national over local guidelines. These findings reinforce the concept that antimicrobial stewardship initiatives, including auditing, robust national guidelines and education, are crucial to optimise IV amoxicillin-clavulanic acid prescribing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"384-392"},"PeriodicalIF":1.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1930","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141680309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osimertinib is an irreversible epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor (TKI) and an available therapy for patients with non-small cell lung cancer (NSCLC) that have an EGFR or T790M mutation. It has become the preferred TKI in this patient group as it is superior to first-generation TKIs; however, osimertinib may be discontinued due to various toxicities or reactions.
Aim
We report two instances of successful osimertinib desensitisation in a 70-year-old woman requiring treatment for NSCLC following two hypersensitivity reactions presenting as angioedema and urticaria.
Clinical details
Osimertinib desensitisation started at 5 mg/day and was gradually increased to 80 mg/day over a period of 30 days.
Outcomes
The patient continued osimertinib 80 mg daily for over a year until treatment was withheld for 4 weeks due to thrombocytopenia and diverticulitis. She restarted osimertinib, completing a second desensitisation to a reduced dose of 40 mg daily without serious adverse effect. The patient continues reduced-dose osimertinib with stable disease.
Conclusion
This case report proposes an osimertinib desensitisation strategy useful for select patients experiencing osimertinib-induced hypersensitivity reactions. It also demonstrates that if there is prolonged disruption to treatment, a second desensitisation can be completed successfully in the same patient so effective treatment in NSCLC may be continued.
{"title":"Two instances of successful oral desensitisation following hypersensitivity reaction in a patient receiving osimertinib: a case report","authors":"Georgia D. Bennett BPharm, Krysti Rosmalen-Brinkley MBBS, Kristoffer Johnstone BPharm, Genevieve Messina BPharm","doi":"10.1002/jppr.1928","DOIUrl":"https://doi.org/10.1002/jppr.1928","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Osimertinib is an irreversible epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor (TKI) and an available therapy for patients with non-small cell lung cancer (NSCLC) that have an EGFR or T790M mutation. It has become the preferred TKI in this patient group as it is superior to first-generation TKIs; however, osimertinib may be discontinued due to various toxicities or reactions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We report two instances of successful osimertinib desensitisation in a 70-year-old woman requiring treatment for NSCLC following two hypersensitivity reactions presenting as angioedema and urticaria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical details</h3>\u0000 \u0000 <p>Osimertinib desensitisation started at 5 mg/day and was gradually increased to 80 mg/day over a period of 30 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcomes</h3>\u0000 \u0000 <p>The patient continued osimertinib 80 mg daily for over a year until treatment was withheld for 4 weeks due to thrombocytopenia and diverticulitis. She restarted osimertinib, completing a second desensitisation to a reduced dose of 40 mg daily without serious adverse effect. The patient continues reduced-dose osimertinib with stable disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case report proposes an osimertinib desensitisation strategy useful for select patients experiencing osimertinib-induced hypersensitivity reactions. It also demonstrates that if there is prolonged disruption to treatment, a second desensitisation can be completed successfully in the same patient so effective treatment in NSCLC may be continued.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"328-332"},"PeriodicalIF":1.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1928","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lemlem G. Gebremichael PhD, Alline Beleigoli PhD, Jonathon W. Foote RN, ICU Cert, ACE, Norma B. Bulamu PhD, Joyce S. Ramos PhD, Orathai Suebkinorn RN, MSN, Julie Redfern PhD, Robyn A. Clark PhD, the National Health and Medical Research Council (NHMRC) Country Heart Attack Prevention Project Team
<div> <section> <h3> Background</h3> <p>Although guidelines recommend guideline-directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice.</p> </section> <section> <h3> Aim</h3> <p>To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes.</p> </section> <section> <h3> Method</h3> <p>A cross-sectional study was conducted in 13 rural and 10 metropolitan CR programs via all modes of delivery (face-to-face, telephone, or general practice-hybrid) operating in South Australia, Australia. ACS patients were included if they were ≥18 years of age and were referred and attended CR programs with medication details recorded in their hospital discharge summary. GDMT was assessed according to the Australian clinical guidelines for the management of acute coronary syndromes 2016. Prescription of all the four recommended medication classes was considered optimal. Logistic regression and <i>χ</i><sup>2</sup> test were used for association. Ethical approval was granted by the South Australian Department for Health and Wellbeing Human Research Ethics Committee (Reference No. HREC/15/SAH/63) and the Northern Territory Department of Health Human Research Ethics Committee (Reference No. HREC 2015-2484) which included a waiver of consent per the <i>National Statement on Ethical Conduct in Human Research</i> and the study conforms with the <i>Good Clinical Practice Guidelines</i>.</p> </section> <section> <h3> Results</h3> <p>Of the 1229 patients included, 74.6% were male and 41.1% had acute myocardial infarction. Only 39.7% of patients received optimal prescription. Prescription of any three or two medication class combinations occurred for 78.3% and 94.1% of patients, respectively. Optimal GDMT was associated with fewer hospital admissions (odds ratio = 0.647, 95% confidence interval 0.424–0.987, p = 0.043) with no significant gender association. Women were less likely to be prescribed angiotensin converting enzyme inhibitors (p = 0.003), angiotensin receptor blockers (p = 0.007), statins (p = 0.005), and any two (p < 0.001) and three combinations (p = 0.023) of medication classes.</p> </section> <section> <h3> Conclusion</h3> <p>GDMT prescription was suboptimal in patients with ACS before attendance at CR. Primary care and CR clinicians have missed an opportunity to implement best practice guideline recomme
{"title":"Missed opportunity: a clinical data linkage study of guideline-directed medical therapy and clinical outcomes of patients discharged with acute coronary syndrome who attended cardiac rehabilitation programs","authors":"Lemlem G. Gebremichael PhD, Alline Beleigoli PhD, Jonathon W. Foote RN, ICU Cert, ACE, Norma B. Bulamu PhD, Joyce S. Ramos PhD, Orathai Suebkinorn RN, MSN, Julie Redfern PhD, Robyn A. Clark PhD, the National Health and Medical Research Council (NHMRC) Country Heart Attack Prevention Project Team","doi":"10.1002/jppr.1923","DOIUrl":"https://doi.org/10.1002/jppr.1923","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although guidelines recommend guideline-directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A cross-sectional study was conducted in 13 rural and 10 metropolitan CR programs via all modes of delivery (face-to-face, telephone, or general practice-hybrid) operating in South Australia, Australia. ACS patients were included if they were ≥18 years of age and were referred and attended CR programs with medication details recorded in their hospital discharge summary. GDMT was assessed according to the Australian clinical guidelines for the management of acute coronary syndromes 2016. Prescription of all the four recommended medication classes was considered optimal. Logistic regression and <i>χ</i><sup>2</sup> test were used for association. Ethical approval was granted by the South Australian Department for Health and Wellbeing Human Research Ethics Committee (Reference No. HREC/15/SAH/63) and the Northern Territory Department of Health Human Research Ethics Committee (Reference No. HREC 2015-2484) which included a waiver of consent per the <i>National Statement on Ethical Conduct in Human Research</i> and the study conforms with the <i>Good Clinical Practice Guidelines</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1229 patients included, 74.6% were male and 41.1% had acute myocardial infarction. Only 39.7% of patients received optimal prescription. Prescription of any three or two medication class combinations occurred for 78.3% and 94.1% of patients, respectively. Optimal GDMT was associated with fewer hospital admissions (odds ratio = 0.647, 95% confidence interval 0.424–0.987, p = 0.043) with no significant gender association. Women were less likely to be prescribed angiotensin converting enzyme inhibitors (p = 0.003), angiotensin receptor blockers (p = 0.007), statins (p = 0.005), and any two (p < 0.001) and three combinations (p = 0.023) of medication classes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>GDMT prescription was suboptimal in patients with ACS before attendance at CR. Primary care and CR clinicians have missed an opportunity to implement best practice guideline recomme","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"314-322"},"PeriodicalIF":1.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1923","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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