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.
BackgroundDrug shortages are becoming more common and may involve a reduction in pharmacotherapeutic efficacy and increased medication errors. Problems caused by medicines’ shortages are serious, threaten patient care in hospitals and require urgent action.PurposeTo analyse the impact of shortages and to describe the different actions carried out by the Pharmacy Department.Material and methodsA retrospective descriptive study was carried out from January 2017 to October 2017. The data collected were: affected drug, duration of the shortage and measures implemented. The data were obtained from the drug shortages’ list of the Spanish Agency for Medicines and Health Products (AEMPS). We analysed every drug included in the hospital pharmacotherapy guide.ResultsDuring the study period, there were 226 drugs affected by supply problems, 172 of them active principles included in our pharmacotherapy guide, specifically 98 pharmaceutical specialties.The strategies for the management were:To change the provider or the form of presentation (packaging) in 38 cases (38.77%).To use a therapeutic alternative in 13 cases (13.26%).The AEMPS authorised temporarily the importation of six medicines with the outer packaging and package leaflet in a language other than Spanish, but this option was not used.In eight cases (8.16%) there was controlled distribution of certain drugs just in case of clinical need.Despite the AEMPS offer to import 17 foreign medicinal products, only nine applications (9.18%) were processed. The foreign medicinal products were relabelled in Spanish before being dispensed in the hospital.No action was taken in 30 cases due to the low prescription rate in our centre or the availability of sufficient stock.ConclusionThe unpredictability of shortages and lack of information provided to healthcare professionals make it increasingly difficult to plan effective coping strategies to provide medication to patients. In fact, it implies a greater workload for hospital pharmacists due to administrative procedures, the determination of therapeutic alternatives and the need to inform all health professionals so as not to compromise the continuity of treatment, increased stress and confusion within safety-critical working environments, the frequent high costs of procuring alternative medicines and the cancellation of service improvements due to resources needing to be reallocated to deal with medicines’ shortages.No conflict of interest
BackgroundEtanercept is a biological drug that treats autoimmune diseases by inhibiting tumour necrosis factor (TNF) with a considerable economic impact on the hospital’s annual budget. Biosimilar therapies are expected to be less costly for healthcare systems.PurposeThe primary endpoint was to analyse treatment costs with etanercept biosimilar (EB) vs etanercept reference product (ERP) as initial treatment and the potential economic impact of switching to EB for maintenance therapy.Material and methodsRetrospective observacional study including all patients treated with etanercept from March to September 2017. Data on prescription details, number of prescriptions and costs, were retrieved from the Farmatools® management tool (outpatients clinical module). The Pharmacy and Therapeutics Committee included EB as a cost-effective alternative and in the light of available scientific data, prescribers agreed with the pharmacy staff to use it as initial therapy. Regarding switching maintenance therapy from ERP to EB, prescribers were responsible for individualising the decision according to patients’ medical records.ResultsDuring the study period 190 patients were treated with etanercept. Seventy-eight per cent were rheumatology patients and 22% were dermatology patients. EB was prescribed as initial treatment in 100% of cases (25 new treatments in rheumatology, nine in dermatology). No switching to EB was prescribed in maintenance therapy. A total of 256 doses of EB 50 mg were dispensed, which generated savings of €43.491, when compared to ERP’s best offer. Regarding the potential economic impact of switching maintenance therapy, we estimated that this strategy would mean savings of €339.012 to our centre. No adverse effects or low efficacy data were reported with EB treatments.ConclusionIntroducing EB as initial therapy for rheumatology and dermatology patients has resulted in a modest reduction in drug spending in our centre. Potential savings justify the urgent need to implement agreed protocols for switching to EB in maintenance therapy as well. This would mean significant cost savings and improved access for patients to these highly effective therapies. A cross-sectoral collaboration among prescribers, pharmacists and nurses facilitate pharmacovigilance activities, in order to assure the quality, safety and efficacy of EB.No conflict of interest
OBJECTIVES: Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are a major contributor to the substantial costs associated with psoriatic arthritis (PsA), a chronic inflammatory rheumatic disease associated with psoriasis. Currently there are no cost-effectiveness analyses (CEAs) comparing the interleukin-17A antagonists ixekizumab and secukinumab in Spain. A CEA was conducted from the perspective of the Spanish National Health System to compare the cost-effectiveness of ixekizumab versus secukinumab in bDMARD-naïve patients with PsA and concomitant moderate-to-severe psoriasis. METHODS: A Markov model with a lifetime horizon and monthly cycles was developed based on the widely accepted York model. The model included four health states: induction period (12 weeks), continuous treatment, best supportive care (BSC) and death. The response criterion was a combination of Psoriatic Arthritis Response Criteria and 90% improvement in Psoriasis Area Severity Index (PASI90). At the end of the bDMARD induction period, responders transitioned to continuous treatment with the induction bDMARD. Non-responders and patients who discontinued continuous treatment transitioned to BSC. Clinical efficacy data were derived from network meta-analyses. Health utilities were generated by applying a regression analysis to PASI and Health Assessment Questionnaire scores collected in the SPIRIT studies with ixekizumab in PsA for bDMARD-naïve patients with moderate-to-severe psoriasis. Only direct medical costs were included (year of costing 2017). RESULTS: Ixekizumab was associated with incremental reductions in costs of V5,333 and comparable gains in quality-adjusted life-years (QALYs) with a difference of 0.01 in favour of ixekizumab. Deterministic and probabilistic sensitivity analyses globally confirmed the base case results. CONCLUSIONS: Yielding comparable QALY gains at lower cost, ixekizumab is cost-effective versus secukinumab in biologic-naïve PsA patients with concomitant moderate-to-severe psoriasis in Spain.
OBJECTIVES: Vaccination is an effective medical intervention to reduce death and morbidity caused by infectious diseases. The aim of the study was to analyse the dispensing patterns of vaccines in South Africa from a medical insurance scheme perspective. METHODS: A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2017. The database contained 3 898 535 records for medicine, medical devices and procedures. All products in ATC subgroup J07 (vaccines) were extracted and analysed. RESULTS: A total of 7 254 vaccines at a cost of R1 982 238.86 were dispensed in 2017 to 4 596 patients. The average age of patients was 32.57 (SD¼21.67) years, with 65.62% male patients. Bacterial vaccines (J07B) accounted for 47.13% of the total number of vaccines dispensed (28.24% of cost), viral vaccines for 36.89% (44.02% of cost), and combined bacterial and viral vaccines for 15.98% (27.73% of cost). The Influenza vaccine (J07BB01) accounted for most of the vaccines dispensed (26.70%), followed by tetanus toxoid (J07AM01, 23.85%) and the diphtheria-pertussis-poliomyelitistetanus-hepatitis B vaccine (J07CA12, 15.00%). Three-quarters of the influenza vaccine prescriptions were dispensed during March and April 2017. The trade name vaccine that was the most commonly dispensed was TetavaxR (tetanus toxoid) single dose syringe 0.5 ml. Sixty percent of these vaccines were dispensed to patients between 30 and 49 years (mostly to male patients). The average cost claimed per vaccine was R273.26, with pneumococcus, purified polysaccharide antigen (J07AL01) on average the most expensive (R794.49). Most vaccines were dispensed by private hospitals (27.29%) and registered nurses (34.86%), with only 11.18% dispensed by pharmacies. CONCLUSIONS: The influenza vaccine was the most commonly dispensed, followed by tetanus toxoid. This is possibly due to medical scheme members being mostly the economically active sector of the population where workplace vaccination campaigns are often offered.
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