CANADIAN JOURNAL OF HOSPITAL PHARMACY最新文献

Background: Oral antineoplastic drugs (OADs) play an increasing role in the treatment of cancer. Patients must have a high degree of understanding and autonomy to manage the numerous adverse effects at home. In Quebec, recommendations have been made for oncology pharmacists to systematically counsel all patients who are starting an OAD.

Objective: To measure the impact of education provided by oncology pharmacists on patient activation.

Methods: In this prospective, single-centre, observational cohort study, patients starting an OAD received education from oncology pharmacists, who used the 2020 updated version of information sheets from the Groupe d'étude en oncologie du Québec (GEOQ, www.geoq.info). The Patient Activation Measure (PAM-13) questionnaire was used to measure patients' activation before and after the intervention.

Results: Of the 43 patients recruited in the intention-to-treat analysis, 41 were included in the modified intention-to-treat analysis. The mean difference between PAM-13 scores before and after the intervention was 2.30 (standard deviation [SD] 11.85) (p = 0.22) in the intention-to-treat analysis and 3.63 (SD 10.33) (p = 0.032) in the modified intention-to-treat analysis; these differences were less than the 5 points required for a result to be considered clinically meaningful. None of the effect-modifying variables for which data were collected had a significant impact on the degree of activation; however, a weak negative correlation was observed between the level of health literacy and the change in PAM-13 score.

Conclusions: The study did not show a clinically meaningful change in patient activation following pharmacist-provided education, according to the updated GEOQ information sheets. Further studies are needed to evaluate these data in a larger population and to determine whether the impact of education persists beyond the first treatment cycle.

Background: Older adults face challenges with managing their medications, obtaining health education, and accessing health services. Mobile health (mHealth), defined as any medical or public health practice facilitated through mobile devices, could help to overcome these difficulties.

Objectives: To determine what technologies and apps are in current use by older adults, to explore the types of technologies and apps that may be of interest to people in this age group, to explore concerns about technologies, and to examine any age-related differences.

Methods: Adults 60 years of age or older were invited to complete a 35-item electronic survey, in either French or English, which was distributed through social media and by email from organizations working with older adults. The survey was conducted in mid-2020.

Results: A total of 266 respondents completed some or all of the survey. Most participants had a mobile phone (229/243, 94.2%), and approximately one-third (78/222, 35.1%) had used a health-related app in the previous 12 months; this level of usage was consistent across age groups. Most respondents were interested in using an app to improve their health (171/225, 76.0%), with variation by age: highest among those 60-64 years of age (82/95, 86.3%), lower among those 80 years or older (40/52, 76.9%), and lowest among those 65-69 years of age (6/14, 42.9%). Most older adults were interested in using an app to ask questions of pharmacists (161/219, 73.5%) and to review their medications (154/218, 70.6%). Participants' mHealth concerns focused on costs, disclosure of personal information, effectiveness, usability, and endorsement by health care providers. The study limitations included challenges related to electronic recruitment and survey distribution, as well as a high representation of participants with postsecondary education.

Conclusions: These findings suggest that a substantial proportion of older adults are already using and are interested in using mHealth for health information, to ask questions, and/or to review their medications with a health care team member.

Background: Smart pump technology is relatively new, and uncertainty exists regarding best practices for development and management of the drug libraries in these devices. In Canadian hospitals, IV smart pumps and their drug libraries are created and maintained according to recommendations from Accreditation Canada and guidelines from the US Institute for Safe Medication Practices (ISMP). Current compliance with these standards in Canada is unknown. However, neither organization provides specific operational steps detailing how to effectively create and manage a drug library, which leaves significant room for interpretation. Furthermore, the human resources dedicated to creation and management of these libraries in accordance with guidelines and standards are unknown.

Objectives: To describe current compliance with standards and guidelines for smart pump drug libraries; the processes used for drug library set-up, management, training, and support; and the resources currently used for these activities in Canadian hospitals.

Methods: A 43-question online survey was made available in spring 2021 to multidisciplinary team members involved in implementation of IV smart pumps and/or management of drug libraries in Canadian hospitals.

Results: A total of 55 complete or partial responses were received. Most responses indicated that standards set by Accreditation Canada and ISMP were not being met, with only 30% (14/47) updating their libraries at least quarterly and 47% (20/43) performing quality reviews at least every 6 months. Although the majority of respondents reported regular monitoring of compliance, 30% (11/37) did not perform such monitoring. Results further indicated variation across Canadian hospitals in set-up, management, training, and support related to drug libraries, as well as variation in the human resources available for these activities.

Conclusions: Canadian health authorities and organizations are not meeting current ISMP and Accreditation Canada standards for smart pumps. Variation exists in terms of strategies for creating and managing drug libraries, as well as in the training and resources needed to support these initiatives. Canadian health authorities and organizations should prioritize meeting these standards and should closely review the resources required to do so.

Background: Peer review to assess the quality of documentation is essential, as it provides a framework for constructive feedback, using evaluators with similar qualifications to increase acceptability.

Objective: To determine the feasibility of implementing a peer review continuous quality improvement program for pharmacists' documentation at the Montreal Children's Hospital.

Methods: A prospective, single-centre mixed-methods feasibility study was conducted (from January to June 2021) to evaluate the practicality and acceptability of a peer review program (PRP) for assessing the quality of pharmacists' documentation. A peer review committee of 5 pharmacists evaluated their peers' clinical notes using a standardized assessment tool. Practicality was determined through the time required for administrative and evaluative tasks and the resources needed for each evaluation cycle. Acceptability was determined through pooled quantitative data related to pharmacists' perceived relevance of the PRP, confidence in their peers, and satisfaction with the evaluation process. Qualitative data collected through surveys, a focus group, and semistructured individual interviews helped to further explain the results.

Results: A total of 37.4 hours was required to complete both administrative and evaluative tasks in one peer review cycle, which respected the budgeted cut-off for practicality. Acceptability was also achieved, given that more than 80% of survey respondents found the PRP relevant to their practice, were confident in their peers, and were satisfied with the PRP. Qualitative results showed that participants found the PRP to be instructive and that qualitative feedback was preferred over a grade issued as a percentage.

Conclusion: This study showed that it is feasible to implement a PRP to assess the quality of pharmacists' documentation. To ensure success, it is key that documentation objectives and department resources be predefined.

Background: Little is known about the current landscape of vancomycin therapeutic drug monitoring (TDM) in Canadian hospitals, which operate within publicly funded health care systems.

Objectives: To determine current TDM practices for vancomycin and associated challenges and to gather perceptions about TDM based on area under the concentration-time curve (AUC) in Canadian hospitals.

Methods: An electronic survey was distributed to hospital pharmacists in spring 2021 through multiple national and provincial antimicrobial stewardship, public health, and pharmacy organizations. The survey gathered data about hospital characteristics, TDM methods, inclusion criteria for patient selection, pharmacokinetic and pharmacodynamic targets, vancomycin susceptibility testing and reporting, and perceived barriers and challenges.

Results: In total, 120 pharmacists from 10 of the 13 provincial and territorial jurisdictions in Canada, representing 12.5% of Canadian acute care hospitals (n = 962), completed at least 90% of survey questions. The predominant TDM method was trough-based (107/119, 89.9%); another 10.1% of respondents (12/119) reported performing AUC-based TDM (with or without trough-based TDM), and 17.9% (19/106) of those not already using AUC-based TDM were considering implementing it within 1 to 2 years. Among hospitals performing trough-based TDM, 60.5% (66/109) targeted trough levels between 15 and 20 mg/L for serious infections with methicillin-resistant Staphylococcus aureus. One-quarter of the respondents using this method (27/109, 24.8%) agreed that trough-based TDM was of uncertain benefit, and about one-third (33/109, 30.3%) were neutral on this question. Multiple challenges were identified for trough-based TDM, including sub- or supra-therapeutic concentrations and collection of specimens at inappropriate times. Overall, 40.5% (47/116) of respondents agreed that AUC-based TDM was likely safer than trough-based TDM, whereas 23.3% (27/116) agreed that AUC-based TDM was likely more effective.

Conclusions: This survey represents a first step in developing evidence-based, standardized best practices for vancomycin TDM that are uniquely suited to the Canadian health care system.

Background: Biological sex-related factors influence pharmacokinetic, pharmacodynamic, and disease processes that may affect the predictability of drug dosing and adverse effects, which may in turn have clinical consequences for patients' lives. Nonetheless, sex-related factors are not always taken into account in clinical trial design or clinical decision-making, for multiple reasons, including a paucity of studies that clearly and objectively study and measure sex-disaggregated and sex-related outcomes, as well as gaps in regulatory and policy structures for integrating these considerations.

Objectives: To complete a narrative review and use a case study to understand available evidence, inform future research, and provide policy considerations that incorporate information on sex- and gender-related factors into clinician-facing resources.

Methods: A comprehensive review of available literature was conducted using a sex- and gender-based analysis plus (SGBA Plus) approach to identify sex- and/or gender-disaggregated information for gilteritinib, a chemotherapeutic agent. Systematic searches were performed in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Wiley), International Pharmaceutical Abstracts (Ovid), Scopus, and ClinicalTrials.gov, from inception to March 18, 2021. The information was then summarized and compared with the Canadian product monograph for this drug.

Results: Of 311 records screened, 3 provided SGBA Plus information as a component of outcomes, rather than just as categories or demographic characteristics. Of these, 2 were case studies, and 1 was a clinical trial. No studies from the ClinicalTrials.gov database that were in progress at the time of this review provided details about sex-disaggregated outcomes. The Canadian product monograph did not include sex-disaggregated outcome data.

Conclusions: The available evidence from clinical trials, other published literature, and guidance documents does not provide details about sex-disaggregated outcomes for gilteritinib. This paucity of available evidence may create a challenge for clinicians who are making decisions about the efficacy and safety of prescribed therapies in sex-specific populations that have not been well studied.