Background Drug prescription is a complex activity that involves many factors. Improving the quality is very important due to the large health and economic impact of the use of drugs. Purpose To assess the impact of a program that improves the quality of prescriptions in Specialised Healthcare. Materials and methods Prospective and intervention study (2009-2011) that compares the outcomes of the main quality indicators of prescriptions one year before and one year after the development of the program. The results were obtained using MicroStrategy® software, an application where all prescriptions written by specialists for patients not staying at hospitals are registered. The program was implemented throughout 2010. The phases of the program were: Selection of prescription quality indicators (PQI): Indicator-1: Percentage of prescriptions with international non-proprietari names(INN) for pharmaceuticals substances. Indicator-2: Percentage of prescriptions with omeprazole versus all Proton Pump Inhibitors(PPI) Indicator-3: Percentage of prescriptions with Ibuprofen, Naproxen, Diclofenac versus non-steroidal anti-inflammatory drugs(NSAIDs) Indicator-4: Percentage of prescriptions with simvastatin versus all HMG-CoA reductase inhibitors. Selection of the medical services with the greatest capacity for improvement. Training Sessions: The pharmacy department conducted two training sessions in selected medical services informing about the quality criteria in prescriptions(efficacy, safety, convenience and efficiency)and about which quality indicators should be improved. Design of a quarterly reporting system to inform doctors about the progression of their prescriptions. Table 1 Prescription Quality Indicators: Results Before Pharmaceutical Intervention After Pharmaceutical Intervention Improvement % of prescriptions with INN for pharmaceuticals substances 46,42% 67,15% 20,73% % of prescriptions with omeprazole versus all PPI 76,85% 80,96% 4,11% % of prescriptions with Ibuprofen, Naproxen, Diclofenac versus NSAIDs 48,07% 62,92% 14,85% % of prescriptions with simvastatin versus all HMG-CoA reductase inhibitors. 35,78% 36,62% 0,84% Results Conclusions The design and implementation of an active pharmaceutical intervention program to improve the quality of prescriptions in Specialised Healthcare has improved the outcome of PQI. However, The authors believe that it is necessary to go on following this line of work for further improvement.
PIP was identified prospectively in the CMA. The total number of recommendations and acceptance rate were recorded for the post-implementation period. Results At baseline, the median proportion of residual PIPs was 69.0% (range 50.0-83.3%) with a median number of 13.1 (range 9.5-15.8) residual PIPs per day. After the CMA intervention, the median proportion and median number decreased to 11.8% (range 0-50%) and 2.2 (range 0-9.5), respectively. Clinical rules showed an immediate relative reduction of 66% (p<0.0001) in pain related residual PIPs. A significant decreasing time trend was observed during the postimplementation period. Over 1 year in the post-implementation period, the clinical pharmacists provided 1683 recommendations for 1427 individual patients during 1478 hospital admissions. The treating physicians accepted 74.3% of the recommendations. Conclusion and relevance We proved that the CMA approach improved analgesic prescribing, as the number of pain related residual PIPs was reduced in a highly significant and sustained manner. The downward trend in the post-implementation period might indicate a learning effect on physicians, resulting in a higher acceptance rate of recommendations over time. More pharmacist involvement and the use of clinical rules during hospital stay should be further promoted to optimise appropriate prescribing of analgesics.
Background Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal haematopoietic neoplasms, characterised by the presence of morphological and functional alterations in different haematopoietic cell lines and anaemia, leucopenia and thrombocytopenia. 5-Azacitidine (AZA) is a hipomethylating agent indicated for the treatment of adult patients, who are not eligible for haematopoietic stem cell transplantation with intermediate-2 and high-risk MDS, according to the International Prognostic Scoring System (IPSS).Its effectiveness was evaluated in 3 studies conducted by the Cancer and Leukaemia Group B. Purpose This study aims to evaluate the effectiveness of AZA in patients diagnosed with MDS, outside the scope of CT. Materials and methods Results are taken from a retrospective observational study, including all patients with MDS treated with AZA 75 mg/m2 subcutaneously in our Hospital, during the period November 2007-April 2011. The World Health Organisation (WHO) criteria for diagnosis (bone marrow examination and cytogenetics studies) and classification of MDS were used. Response to treatment was assessed using the International Working Group (IWG 2006) criteria: overall response (complete and partial remission), stable disease, time of transformation to acute myeloid leukaemia (AML), overall survival, cytogenetic response and hematologic improvement. Results Data collection comprised results from 16 male and 9 female with a median age of 68,72 (±12,52) years. The average time to diagnosis of MDS was 22.56 (± 22.11) days. The number of blasts in bone marrow of patients at the time of diagnosis was on average 11%. An intermediate-2/high IPSS risk was documented in 76% of the patients, an intermediate-1 IPSS risk in 24%. The most frequently used dose was 75 mg/m2 subcutaneously, 12% of the patients required dose adjustment. The mean number of administered cycles was 9 (±6,08). 68% of patients had high transfusion requirement. Overall response was achieved in 29,16% of patients, stable disease in 33,34%, cytogenetic response in 48% and transfusion independence in 25%. The rate and the time of transformation to Acute myeloid leukaemia (AML) was 20,83%. The median overall survival was 32 months (95% CI 10.72-53.29) and the median time to AML transformation in 23 months (95% CI 21.54-24.4). Conclusions Results demonstrate that 5-azacitidine is an effective drug in the treatment of MDS, outside the scope of CT, which improves overall survival, quality of life and delays AML transformation.
Background In the pharmacy there is a unit where certain drugs are dispensed to outpatients. Pharmacists provide pharmaceutical care to all patients starting new treatment. Purpose 1) To identify and classify drug interactions (DIs) in all patients starting any treatment in the outpatient unit of our hospital pharmacy. 2) To carry out pharmaceutical interventions. 3) To identify patients who suffer more frequently from DIs. Materials and methods Prospective intervention study (January–May 2011) that included patients who started treatment at the outpatient unit of the hospital pharmacy. Data were obtained from the medical prescription and an interview with the patient. To detect and classify DIs the authors used the software ‘Lexi-Interact-Online’ and the book ‘Stockley, Drug Interactions. Third Edition (2009). Data were analysed with SPSS-15.0. Results Data collection comprised results from 104 patients (39 women, 65 men). Median age 53. SD 20 years (18–92). 187 DIs were detected (incidence 50.96%). 10.16% of the interactions occurred between drugs dispensed in hospital and concomitant home medicines (CHMs). 89.83% of the interactions detected were CHM-CHM. The risk of DI was rated as ‘major’ (14.43%), ‘moderate’ (79.14%) and ‘minor’ (6.43%). The reliability of the DI was ‘excellent’ (6.95%), ‘good’ (32.08%), ‘reasonable’ (57.75%) and ‘poor’ (3.22%). The mechanisms by which the DI developed were ‘pharmacokinetic’ (50.26%), ‘pharmacodynamic’ (35.82%), ‘unknown’ (12.3%), ‘other’ (1.09%) and ‘mixed pharmacokinetic/pharmacodynamic’ (0.53%). 38.46% of patients were polymedicated (≥6 drug). In these patients DI incidence was 87.70% versus a single drug in which DI was 12.3%. Pharmaceutical interventions were: monitoring DI from the outpatient unit in the pharmacy (10.6%), informing doctors (45.45%), advising on administration (31.81%), informing/educating patients (11.36%). Causes of non-intervention: habitual association/DI clinically irrelevant (51.93%), DI beneficial (25.12%), literature reports that there is no action required (12.59%), others (10.38%). Conclusions 1) The appearance of DIs in patients starting treatment in the outpatient units is common. CHMs should also be reviewed to detect DIs. 2) Every DI must be assessed individually and appropriate pharmaceutical interventions made. Not all DIs are harmful or clinically relevant. 3) Polymedicated patients are a group of special interest because most of the interactions occur in them.
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