The Canadian journal of hospital pharmacy最新文献

Background: The role of the clinical pharmacist in a correctional health care setting is not well described in the literature. Pharmacists have a unique opportunity to enhance access to and quality of health care for a large population of incarcerated persons with unmet health needs.

Objectives: To summarize the relevant literature and to propose future directions for the role of clinical pharmacists in the correctional health care setting.

Data sources study selection and data extraction: A literature search was conducted using MEDLINE, and 38 articles were selected and reviewed. Additional resources were found through screening of reference lists and online searches using the Google search engine. The literature was categorized thematically by medical condition or clinical practice area, and the results are formatted as a narrative review.

Data synthesis: The presence of pharmacists within correctional health care facilities improves the quality of health of incarcerated individuals and increases the efficiency of health care services provided. The studies supporting this concept, as reviewed here, focused largely on specific programs, such as pharmacist-led diabetes clinics, anticoagulation clinics, and substance use disorder collaborations. Although the day-to-day activities performed by clinical pharmacists in prisons are not well documented, the information presented here should serve as a catalyst for expanding clinical pharmacy services across correctional health care settings.

Conclusions: The literature supports expanding the role of pharmacists in correctional facilities to include direct patient care, medication management, and disease-specific clinics. Those pioneering practice in this area have an opportunity to add to the small body of evidence by bringing their practice successes into the literature.

Background: Venous thromboembolism (VTE) events occur in association with COVID-19, and the optimal duration of anticoagulant treatment is uncertain.

Objectives: The primary objectives were to determine the duration of anticoagulant prescriptions filled after COVID-19-associated VTE and the proportion of patients experiencing VTE recurrence. The secondary objective was to determine the proportion of patients who experienced bleeding events.

Methods: This retrospective cohort study analyzed data for cases of COVID-19-associated VTE across Alberta, Canada, confirmed between February 23, 2020, and June 30, 2022. Outpatient cases of VTE were identified using codes from the International Classification of Diseases, Ninth Revision plus Alberta Health Service procedure codes. Inpatient cases of VTE and bleeding events were identified using codes from the International Classification of Diseases and Related Health Problems, 10th Revision.

Results: Among the 822 patients included in the analysis, median follow-up was 359.0 days, with the majority of follow-up occurring while patients were off treatment (median 273.0 days). The median age was 59 years, 61.9% of the patients were male, 82.1% had a pulmonary embolism, 71.9% had not received COVID-19 vaccinations, and the median Charlson comorbidity index score was 1. The median duration of treatment was 100.0 (interquartile range 71.0-190.0) days, with 360 patients (43.8%) filling their prescriptions for 0-3 months, 234 (28.5%) for 4-6 months, 181 (22.0%) for 7-12 months, and 47 (5.7%) for more than 12 months. Overall, recurrent VTE occurred in 49 patients (6.0%), 24 of whom had continuously filled their anticoagulant prescriptions up to the time of the event. Bleeding occurred in 72 patients (8.8%).

Conclusions: Given the prolonged follow-up period off anticoagulant treatment for most patients, it is reasonable to consider 3-6 months of therapy for COVID-19-associated VTE.

Background: Evaluation of medication utilization highlights health needs and facilitates rational drug use in a population. Data on medication utilization in correctional facilities are limited.

Objective: To describe the types and volumes of medications used at a provincial remand centre, by drug schedule and therapeutic classification.

Methods: In this retrospective review of medications used at the Edmonton Remand Centre over a 1-year period (September 2022 to August 2023), the data were analyzed descriptively. Data were compared by sex and age using the unpaired 2-sided t test and by medication type using the χ² test.

Results: Of 8772 persons admitted to the remand centre during the study period, 6296 (71.8%) had medication orders. Of these, 5446 (86.5%) had orders for over-the-counter medications, 5591 (88.8%) for prescription medications, and 2513 (39.9%) for narcotics. Patients 40 years of age or younger had proportionally more orders for narcotic medications. The therapeutic classes with the highest proportions of patients were those for treating mental health problems, substance use disorder, pain, constipation, and infectious diseases.

Conclusions: Most patients in this corrections facility were receiving medications. Utilization trends specific to the corrections setting should be considered to support patient care.

Background: The role of acetylsalicylic acid (ASA) thromboprophylaxis following elective total hip arthroplasty (THA) remains unclear, given limited high-quality evidence and differing guideline recommendations.

Objectives: To compare thromboprophylaxis prescribing patterns for ASA and alternative anticoagulants and to determine subsequent health care utilization for patients undergoing elective THA within one Canadian health region.

Methods: This retrospective cohort study involved adult patients who underwent THA between January and June 2019, comparing those who received ASA with those who received an alternative anticoagulant. Data for drug- and patient-specific characteristics are reported as means and standard deviations for continuous variables and as percentages for categorical variables. Patient characteristics and treatments were compared using χ² and t tests. Multivariable logistic regression was conducted to identify predictors of the choice of treatment (ASA vs rivaroxaban).

Results: Of the 180 patients who underwent THA in the study period, thromboprophylaxis consisted of ASA for 153 (85.0%) and rivaroxaban for 27 (15.0%). The most common ASA regimen was 325 mg daily (152/153, 99.3%) for a mean of 43.0 (standard deviation 6.9) days. Significant patient differences between the ASA and rivaroxaban groups included history of malignancy (6.5% vs 51.9%, p < 0.001), previous venous thromboembolism (0% vs 11.1%, p = 0.001), thrombophilia (0% vs 3.7%, p = 0.018), and chemotherapy (0% vs 11.1%, p < 0.001). Patients with a history of malignancy were more likely to receive rivaroxaban than ASA (odds ratio 31.65, 95% confidence interval 18.22 to 2.4 × 10⁴, p < 0.001). No differences were observed for health care utilization.

Conclusions: ASA was used as thromboprophylaxis after THA for most patients within one Canadian health region. Significant differences in baseline characteristics were noted between patients who received ASA and those who received rivaroxaban.

Background: Closed-system drug transfer devices (CSTDs) are known to be effective in reducing hazardous drug contamination and, in turn, the risk of exposure for health care workers. In response, the Fraser Health Authority in British Columbia had plans to introduce CSTDs into practice.

Objectives: To confirm the effectiveness of CSTDs in reducing hazardous drug contamination and to understand health care workers' perspectives regarding the change management process for CSTD implementation.

Methods: Surface wipe samples were collected at 4 health care facilities within the health authority over 3 time points: T₀, 1 month before CSTDs were introduced; T₁, 1 month after CSTDs were introduced; and T₂, 5 months after implementation. Comparative analysis of drug contamination levels was conducted between 2 pairs of sampling times: T₀ vs T₁ and T₁ vs T₂. To understand the change management process, health care workers at the same departments (as those where wipe samples were collected) were surveyed.

Results: A total of 156 wipe samples were collected, consisting of 13 samples at each of the 4 sites at each of the 3 time points. There was a statistically significant reduction (p < 0.01) in the sum of the mass of drug contaminants from T₀ to T₁ (25.82 vs 4.01 ng/cm²) and from T₁ to T₂ (4.01 vs 0.068 ng/cm²). About 50 individuals responded to each question of the survey, and respondents had generally positive comments regarding the transition to CSTDs. Nevertheless, suggestions for improvement included offering various forms of training (e.g., online video, hands-on sessions) and ensuring ongoing communication.

Conclusions: CSTDs were confirmed to be effective in reducing surface contamination levels, and the change management process employed by the health authority appeared to be well received.