Pharmacotherapy Follow-up Research Articles

Impacto de la labor del farmacéutico clínico en el manejo farmacoterapéutico del paciente crítico: Experiencia local en un hospital docente asistencial

Context: The complexity in critical patient management and polypharmacy, raise the need for support from a clinical pharmacist to optimize drug therapies. Aims: To evaluate the clinical pharmacist participation in an Adult Intensive Care Unit in a local context where the practice is not well established. Methods: The study was conducted in a teaching hospital. Consisted of two stages a retrospective in which were collected of pharmacotherapy follow-up during a period of two years and a prospective phase of observational and cross-sectional character, which picked up the clinical history of patients and pharmaceutical interventions. These pharmaceutical interventions were evaluated by two intensive care physicians and two external pharmacist, using a default score to each one of these, the degree of concordance was obtained using the kappa coefficient. Results: In the retrospective phase were collected 182 patients, who were performed a total of 750 interventions, of which 99.7% was accepted by physician. In the prospective phase, were analyzed 53 patients that involved 263 pharmaceutical interventions with 96.6% of acceptance on the part of the medical staff. The degree of correlation of the interventions was κ = 0.61 between two physicians of the unit, and κ = 0.71 between two external pharmacists. Conclusions: The contribution that a clinical pharmacist can provide in an adult intensive care has a positive impact on the treatment of patients with a high percentage of acceptances on the part of the medical team.

Clinical impact of an interdisciplinary patient safety program for managing drug-related problems in a long-term care hospital.

Background Medication reviews intended to identify drug-related problems (DRPs) have been researched in primary care, acute care and nursing homes rather than in long-term care hospitals (LTCHs). Objectives To assess the clinical impact of an interdisciplinary pharmacotherapy quality improvement and patient safety program in elderly patients with polypharmacy admitted to an LTCH. Setting An interventional, longitudinal, prospective study was conducted in a Spanish LTCH Method A total of 162 elderly (≥70years) patients with polypharmacy (≥5 medications) were included. Pharmacist conducted the pharmacotherapy follow-up of patients (reconciliation, pharmacotherapeutic optimization, educational interviews) from admission to discharge. Demographic, clinical and treatment-related variables were recorded. Main outcome measured Clinical impact of the program by DRP-based effectiveness and drug-related morbidity (DRM)-based safety indicators. Results 895 DRPs (median of 5 (1-23)) were identified in 153 (94.4%) patients. The most common DRPs were unnecessary drug (25.3%), dosage too high (24.9%) and a need for additional drug (24.8%). The most frequent pharmacotherapy recommendations were individualizing the dosage regimen (29.6%) and stopping (27.3%) or starting (21.9%) a drug. The mean implementation rate of pharmacotherapy recommendations was 90.9%. The effectiveness indicator revealed a 94.9% of prevented or resolved DRPs. The safety indicator showed an 89.3% of prevented or resolved DRM. Therefore, the program prevented or resolved 92.5% of adverse effects and 91.7% of suboptimal responses or therapeutic failures. Conclusion This interdisciplinary patient safety program seems to be a valuable approach to identify, prevent and resolve the high number of DRPs and potential DRM that elderly patients with polypharmacy admitted to an LTCH present.

Pharmacotherapy follow-up: Role in active malaria surveillance in a travel medicine centre outside the transmission area in Brazil.

Malaria is a potentially severe disease, widespread in tropical and subtropical areas. Apart from parasite drug resistance, which receives the largest share of attention, several factors directly influence the response to antimalarial treatment such as incorrect doses, adverse drug events, lack of adherence to treatment, drug quality and drug-drug interactions. Pharmacotherapy follow-up can be used to monitor and improve the effectiveness of treatment, prevent drug-related problems and ensure patient safety. The aim of this study was to describe the results of the implementation of pharmacotherapy follow-up of patients with malaria seen at a reference centre for malaria diagnosis and treatment (CPD-Mal) located in the city of Rio de Janeiro, an area without malaria transmission. A descriptive study was conducted from January 2009 to September 2013 at the Instituto Nacional de Infectologia Evandro Chagas (INI) of the Fundação Oswaldo Cruz (Fiocruz). All malaria patients enrolled in the study were treated according to the Brazilian Malaria Therapy Guidelines. Data collected during pharmacotherapy follow-up were recorded in a standardized form. The variables included were age, gender, comorbidities, antimalarials and concomitant medications used, adverse drug reactions (ADR), clinical and parasitological cure times, and treatment outcomes classified as success, recurrence (recrudescence or relapse); and lost to follow-up. The ADR were classified by severity (DAIDS-NIH), organ system affected (WHO-ART) and likelihood to be caused by drugs (Naranjo scale). One hundred thirteen cases of malaria were included. Patients were aged between 13 and 66years and the majority of them (75.2%) were male. Ninety-four ADR were observed, most classified as mild (85.1%), related to disorders of the gastrointestinal system (63.8%), such as nausea and vomiting, and assessed as "possibly" caused by the antimalarial drugs (91.5%). The majority of clinical (90.9%) and parasitological (87.1%) cure occurred less than 72hours after treatment initiation. Pharmacotherapy follow-up of malaria treatment by surveillance activities is therefore important regarding information about treatment outcomes as well as patient safety, resulting in better patient care and reducing the chance of relapses. The results underscore its use as a tool for monitoring adherence and drug resistance outside an endemic area. Pharmacotherapy follow-up should be considered a useful malaria surveillance tool that can be developed by reference centres for comprehensive health care assistance and monitoring of therapeutic resistance.

Content design and validation of a Standard Operating Procedure to provide pharmacotherapy follow-up for the elderly in Cuba

Incorporating methodological tools that allow uniform and standardized development from the clinical pharmacy services to the Pharmaceutical Care practice, is nowadays a necessity. Considering the importance of pharmaceutical care provision to elderly patients, this manuscript introduces the design and content validation of a standard operating procedure to provide pharmacotherapy follow-up to the elderly in nursing homes in Cuba. The procedure was designed based on a deep analysis of documents relative to experiences focused on holistic care to elderly patients, criteria for the identification and assessment of potentially inappropriate prescriptions and the relationship between functional geriatric evaluation and the use of drugs. The content validation was conducted by a panel of experts, using the Delphi methodology, through two working sessions. In addition, we used Likert-type scale to evaluate the procedure by experts, in line with the indicators described. In general, the criteria issued by the experts were very appropriate and allowed us to modify, add or keep several elements of the instrument for the final version. The findings demonstrated that the instrument can be used at any level of health care.

Impact of pharmaceutical care on cardiovascular risk among older HIV patients on antiretroviral therapy.

Background Advances in the treatment of HIV infection have enabled better control of the disease, allowing patients to enjoy a longer life expectancy. However, the ageing of patients leads to an increased prevalence of cardiovascular disease. Various studies have found that pharmaceutical care results in better control of cardiovascular risk factors. Objective To measure the impact of pharmaceutical care on cardiovascular risk in patients older than 50years receiving combination antiretroviral therapy. Setting Outpatient pharmacy service of a tertiary hospital, Spain. Methods A pre/post-intervention quasi-experimental clinical study was conducted in which health education and pharmacist interventions to reduce cardiovascular risk factors were carried out in a single patient cohort using the Dader method of pharmacotherapy, with a 12-month follow-up period per patient. Patients included were older than 50 years, with moderate/elevated cardiovascular risk. Data were obtained from patient clinical histories, dispensing records and patient interviews, and were subjected to statistical analysis. Main outcome measure Cardiovascular risk estimated by SCORE and REGICOR equations. Results Forty-two patients completed the study. Of these, 93% were men, with an average age of 57 years and 15years since diagnosis of HIV. A reduction was observed in the mean values (baseline vs. 12months) of the following cardiovascular risk factors: systolic blood pressure (P=0.009), diastolic blood pressure (P=0.010), total cholesterol (P=0.006), low-density lipoprotein cholesterol (LDL-c; P=0.039), triglycerides (P=0.010) and total cholesterol/high-density lipoprotein cholesterol (HDL-c; P<0.001). An increase in HDL-c (P=0.037) was also observed. The average cardiovascular risk estimated by the SCORE instrument was reduced from 7.6% at the beginning of the study to 6.4% after 12months (P = 0.039). The risk estimate according to REGICOR also decreased (P=0.002). Over the 12-month period, 6.3±3.4 interventions were carried out per patient. Quantitative ineffectiveness was the most prevalent negative outcome associated with medication throughout the study, and noncompliance was the most frequent cause. Interventions on health education were the most common, followed by interventions on improving adherence. Conclusion Pharmaceutical care, delivered as a combination of health education and pharmacotherapy follow-up to outpatients at a tertiary hospital, had a positive impact on cardiovascular risk in patients older than 50years receiving combination antiretroviral therapy.

Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation: pharmaceutical care contribution.

Background:Cyclosporine and tacrolimus are limited by a narrow therapeutic window. Maintaining immunosuppressive drugs at desired levels may be difficult. Pharmaceutical care emerges as a philosophy of practice that enhances medication use and leads to a better control of serum concentration.Objective:This study aims to evaluate the impact of pharmaceutical care in the maintaining of proper serum levels of immunosuppressive medications in patients who have undergone allo-HSCT.Methods:The study had a quasi-experimental design that included a comparison group. The service model used was pharmacotherapy follow-up, according to an adaptation of the Dader method. The pharmacist consultation was carried out at a day-hospital or at the outpatient hematology clinic as needed. The intervention group consisted of 22 patients seen by a clinical pharmacist. The control group consisted of 44 patients that received standard care. This study aims to evaluate the impact of pharmaceutical care on keeping patient serum levels of cyclosporine and tacrolimus within the desired range.Results:Control group displayed 65% of the proper serum levels of immunosuppressive agents. While In intervention group, the figure was 82% (p = 0.004).Conclusion:The role of the pharmacist in the multidisciplinary team may contribute to a greater success in attaining the patients’ therapeutic targets with regard to the use of immunosuppressant.

PCN71 - Economic Impact of the Detection of Medication Errors in Oncological Patients with Afebrile Neutropenia in a Cancer Hospital

To determine the avoided cost derived from the opportune intervention of the pharmacist before to the administration of schemes of chemotherapy avoiding medication errors (EM). A transverse analysis of EM’s record was realized (classification in accordance with Otero et al., 2000) in solid tumors, that evaluate the Clinical Pharmacy Service (CPS), in a period from November 2014 to April 2015. The intention was to identify the cases of afebrile neutropenia (AN) before the application of the scheme of chemotherapy. The cost that had been generated by the handling of an uncomplicated febrile neutropenia were estimated, in accordance with the international recommendations of clinical practice, direct medical costs were considered: medicines (institutional catalog of prices), medical consultation, laboratory study and hospitalization from Official Federation Journal and groups related to the diagnosis IMSS 2015. It was identified a whole of 365 (30 %) EM of 1195 pharmacotherapy follow-up, We found 22 patients who had AN, with an age average of 52 years, of which 54 % were women, this means 8% of total medication errors; 100 % of these errors of this patients group was a category “B” the error did not get the patient. The saving by the pharmaceutical interventions was estimated in $80,228(USD), minus the cost of the prophylactic treatment after intervention ($13,624). The whole saving was $66,604, so that monthly average cost saved by CPS was of $11,101; there are 6 clinical pharmacists, that individually saved $1,850 monthly. The patients were rescheduled for their application of chemotherapy until cure the neutropenia, a prophylaxis was given for the subsequent cycles. The opportune intervention of the pharmacist in the identification and resolution of medication errors not only represents a clinical benefit in the safety of the patient, also is a monetary saving to the institution.

English

The aging process is followed by an increase in the number of chronic diseases and, thus, the use of multiple medicines and prevalence of drug-related problems (DRP). This paper aims to identify the impacts of Pharmacotherapy follow-up (PF) in elderly with chronic non-communicable diseases while in polypharmacy using, in the public health service of Brazil. A prospective cohort study with 45 elderly of both sexes was done. Socioeconomic and pharmacotherapy data was collected at the first pharmaceutical appointment. According to the pharmacotherapeutic needs of each case were applied interventions for four appointments as blood pressure and blood glucose monitoring, schedule control medicine use and prescription changes by the letter to prescriber. Some variables as blood pressure, blood glucose, body weight, adverse drug reactions, negative outcomes associated with medication, drug-drug interactions and adherence were compared after 3, 6 and 12 months of follow-up during baseline in order to evaluate the impact of the study. Sample included elderly with a mean age of 71 years old, mainly low income and low education women. After 12 months of PF, pharmacotherapy adherence has shown an improvement (21.3 vs 52.4%), as well as a decrease in the number of adverse drug reactions (-1.61), drug-drug interactions (-1.17) and negative outcomes associated with medication (-2.49). &nbsp;Besides, there was better control of systolic blood pressure (-5.89 mmHg), body mass index (-2.01) and blood glucose (-12.51 mg/dl) besides plasmatic levels of lipoproteins, vitamin D and thyroid hormones. Results show evidence of PF importance as a strategy to improve adherence to pharmacological treatment, reduce drug-drug related problems and promote better quality of pharmacotherapy. Hence, better health for medication users. Key words: Pharmaceutical care, pharmaceutical service, patient adherence, pharmacist, drug therapy, aged, medication therapy management.

El coste del seguimiento farmacoterapéutico en una farmacia comunitaria (II): costes de funcionamiento del servicio

Introduction: Pharmacotherapy follow-up is a service that meets the needs of polymedicated patients but invests a lot of resources. The aim of this study was to determine the changes in drug dispensation due to pharmacotherapy follow-up and the resources invested in the service and its associated costs. Methods: Twenty patients in risk of drug related problems entered a pharmacotherapy

Economic evaluation of a hospital-initiated intervention for smokers with chronic disease, in Ontario, Canada

IntroductionCigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness...

Cost-utility analysis of a pharmacotherapy follow-up for elderly nursing home residents in Spain.

To compare the cost-effectiveness of a pharmacotherapy follow-up for elderly nursing home (NH) residents with that of usual care. Prospective observational study with a concurrent control group conducted over 12 months. Fifteen NHs in Andalusia assigned to control (n = 6) or intervention (n = 9). Residents aged 65 and older. Pharmacotherapy follow-up. Negative outcomes associated with medication, health-related quality of life, cost, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER). ICERs were estimated for three scenarios: unadjusted cost per QALY (first scenario), costs adjusted for baseline prescribed medication and QALYs adjusted for baseline utility score (second scenario), and costs and QALYs adjusted for a fuller set of baseline characteristics (third scenario). Three hundred thirty-two elderly residents were enrolled: 122 in the control group and 210 in the intervention group. The general practitioner accepted 88.7% (274/309) of pharmacist recommendations. Pharmacist interventions reduced the average number of prescribed medication by 0.47 drugs (P < .001), whereas the average prescribed medication increased by 0.94 drugs in the control group (P < .001). Both groups reported a lower average EuroQol-5D utility score after 12 months (intervention, -0.0576, P = .002; control, -0.0999, P = .003). For the first scenario, usual care dominated pharmacotherapy follow-up (was less effective and more expensive). Adjusted ICERs were € 3,899/QALY ($5,002/QALY) for the second scenario and € 6,574/QALY ($8,433/QALY) for the third scenario. For a willingness to pay of € 30,000/QALY ($38,487/QALY), the probabilities of the pharmacotherapy follow-up being cost-effective were 35% for the first scenario, 78% for the second, and 76% for the third. Pharmacotherapy follow-up is considered cost-effective for elderly NH residents in Spain.

Pharmaceutical care as a strategy to improve the safety and effectiveness of patients? pharmacotherapy at a pharmacy school: a practical proposal

Several patients experience at least one drug-related problem and Pharmaceutical Care can change this reality. This work describes a model for structuring the pharmaceutical care service at a pharmacy training unit of the Brazilian Public Health System based on pharmacotherapy follow-up program of Parkinson’s disease patients’ results. From the follow-up results (phase 1), a Therapy Management Scheme was designed (phase 2). Of the 57 patients followed-up, 30 presented at least one drug-related problem and 42% were non-adherent to treatment, which supported the need of pharmacotherapy management. The Pharmacotherapy Management Scheme was proposed as a pharmaceutical care service model, which presents 6 steps: first, the pharmacist fills out the dispensing form and assesses patient´s pharmacotherapy, if there is a suspect problem, he is invited to the follow-up (steps 1 and 2) and they agree the first appointment. After that, pharmacist studies the patient’s case (study phase, steps 3 and 4). At the second meeting, the pharmacist proposes the intervention needed, and at the third, assesses the intervention results and new problems (steps 5 and 6, respectively). The process ends when all therapeutics outcomes are reached. This practical model can significantly contributed to the development and organization of pharmaceutical care services.

Drug-refractory aggression, self-injurious behavior, and severe tantrums in autism spectrum disorders: A chart review study

Aggression, self-injurious behavior, and severe tantrums are impairing symptoms frequently experienced by individuals with autism spectrum disorders. Despite US Food and Drug Administration approval of two atypical antipsychotics targeting these symptoms in youth with autistic disorder, they remain frequently drug refractory. We define drug-refractory aggression, self-injurious behavior, and severe tantrums in people with autism spectrum disorders as behavioral symptoms requiring medication adjustment despite previous trials of risperidone and aripiprazole or previous trials of three psychotropic drugs targeting the symptom cluster, one of which was risperidone or aripiprazole. We reviewed the medical records of individuals of all ages referred to our clinic for autism spectrum disorder diagnostic evaluation, as well as pharmacotherapy follow-up notes for all people meeting autism spectrum disorder criteria, for drug-refractory symptoms. Among 250 consecutively referred individuals, 135 met autism spectrum disorder and enrollment criteria, and 53 of these individuals met drug-refractory symptom criteria. Factors associated with drug-refractory symptoms included age 12 years or older (p < 0.0001), diagnosis of autistic disorder (p = 0.0139), and presence of intellectual disability (p = 0.0273). This pilot report underscores the significance of drug-refractory aggression, self-injurious behavior, and severe tantrums; suggests the need for future study clarifying factors related to symptom development; and identifies the need for focused treatment study of this impairing symptom domain.

DI-028 Pharmacotherapy profile of HIV-patients older than 50 years in use of antiretroviral therapy

BackgroundThe introduction of highly-active antiretroviral treatment (HAART) has decreased mortality related to HIV infection. The number of patients over the age of 50 is increasing. This population suffers multiple comorbidities...

CP-019 Hospital pharmacists’ interventions in a central hospital

BackgroundSeveral studies have demonstrated the positive impact of clinical pharmacy services in the hospital setting. Interventions by clinical pharmacists have been shown to reduce the frequency of drug-related problems.Pharmacist interventions...

Clinical and serological evolution in chronic Chagas disease patients in a 4-year pharmacotherapy follow-up: a preliminary study

The role of trypanocidal therapy in the chronic phase of Chagas disease remains controversial. A total of 13 patients with chronic Chagas disease were treated with benznidazole (5mg/kg/day/60 days) and surveyed via antibody measurement and conventional electrocardiogram over the course of 4 years. The antibody titers were significantly reduced after 4 years (p<0.05). Most of the patients showed maintenance of the initial clinical picture (electrocardiographic), with the exception of 4 cases. Although trypanocidal therapy in the chronic phase of Chagas disease was of limited effectiveness, we believe that it is beneficial in treating these patients.

Assessment of the effectiveness of pharmacotherapy follow-up in patients treated for depression.

Several studies have established the effectiveness of pharmaceutical care (PC) in patients with heart failure, diabetes, hypertension, and dyslipidemia. However, there are few studies using standardized methods, e.g., randomized controlled trials, to assess the effectiveness of pharmacotherapy follow-up (PF) in patients with depression. To assess the effectiveness of PC via PF according to the Dáder Method in female patients diagnosed with depression. Sixty-eight patients were selected and randomly allocated to groups, stratified by age, type of medication, severity of depression, and presence of recurrence and/or relapse. Patients in the intervention group (IG) received clinical pharmacy intervention at monthly visits over a 3-month follow-up period. The control group (CG) also received monthly visits from the pharmacist, but PF intervention was not performed. A comparison of the effects of usual treatment (CG) and PC (IG) on depressive symptoms showed a statistically significant difference between groups, with a median reduction in Beck Depression Inventory score (Δ) of 2.5 points in the CG and 13.5 points in the IG. Similarly, statistically significant results were observed for anxiety symptoms, with a median reduction in Beck Anxiety Inventory score (Δ) of 3.5 points in the CG and 13.0 points in the IG. The patients who underwent PF showed a high level of satisfaction with the service. The PF is well accepted and effective in treating depressed patients, as indicated by the reduction of the depressive and anxious symptoms.

GRP-141 Pharmacotherapy Follow-Up and Analysis of Changes in Antiretroviral Therapy

BackgroundAntiretroviral therapy (ART) has markedly decreased the morbidity and mortality due to HIV. However, toxicity, comorbidity and treatment failure, among others, may result in frequent initial ART regimen change.PurposeTo identify...

TCH-048 The Security of Pharmacokinetic Information in Electronic Health Records

BackgroundAccurate and complete electronic health record (EHR) information is essential for patient safety, especially when drugs with a narrow therapeutic range are involved.Purpose To evaluate the quality and quantity of...

VALIDATION OF A METHODOLOGY FOR INPATIENT PHARMACOTHERAPY FOLLOW-UP

Background: Pharmacotherapy follow-up is a practice in which the pharmacist assumes responsibility for the patient’s drug-related Problems. Its goal is to achieve positive clinical outcomes. Methods to perform pharmacotherapy follow-up have centered principally on ambulatory patients. Objective: The purpose of this study is to propose and validate a methodology for inpatient pharmacotherapy follow-up. Methods: A systematic review was performed. This consisted in a comprehensive search of databases containing studies published in English or Spanish during 1998 - 2008, and that sought to improve the transfer of accurate information about Pharmacotherapy follow-up in inpatients. The key terms used to conduct the search were identified in consultation with clinical experts and included: Pharmacotherapy follow-up methods, pharmacotherapy follow-up, drug therapy problems, and validation. A comparative table was elaborated to differentiate and evaluate the advantages of each of the proposed methodologies. The information gathered allowed to propose a sequence of general steps for inpatient Pharmacotherapy follow-up. To validate the methodology, a descriptive study was carried out with 32 randomly selected patients and was independently followed up by two pharmacists to assess the reproducibility of the process. Results: Pharmaceutical Care Practice: The Clinician’s Guide, proposed by Cipolle &amp; Strand. Applied Therapeutics: The Clinical Use of Drugs, the DÁDER method, and the IASER program, were selected. 79 drug therapy problems (DTPs) were identified and resolved, where errors in necessity of medication had the highest incidence (46.6%), followed by effectiveness (24.5%) and safety (28.9%). The degree of agreement among researchers in the identification and resolution of DTPs was quantified using the kappa coefficient, showing a high concordance (90% CI). The Fisher’s exact test determined that DTPs are related to the duration of the follow up, number of medications, length of the stay and previous hospitalizations. Conclusions: The methodology allows identifying, preventing and resolving DTPs. It proved to be reproducible and have a high degree of concordance between applications.