Ticagrelor is likely to be cost-effective even for individuals not carrying a CYP2C19 LoF allele.

Background There is a relative paucity of information to characterise potential changes in medication regimen complexity and prevalence of prescribing of potentially inappropriate medications after hospitalisation, both in Australia and elsewhere. Objective To evaluate medication regimen complexity and the prevalence of potentially inappropriate medications before and after admission to hospital. Setting General medical units of a tertiary care hospital in Australia. Methods Retrospective cohort study of patients aged 65 years and above. Medication complexity was measured by using the Medication Regimen Complexity Index (MRCI). Main outcome measure The primary outcome was the change in the Medication Regimen Complexity Index for all prescribed medications after hospitalization. Results A convenience sample of 100 patients was included in the study. There was a significant change in the mean medication complexity score (as measured using the MRCI), increasing from 29 at the time of admission to 32 at the time of discharge (p < 0.05). Factors such as baseline medication regimen complexity (pre-admission MRCI) and length of stay in the hospitals appear to influence the change in medication complexity. However, the proportion of patients prescribed at least one potentially inappropriate medicine (PIM) decreased significantly, from 52% pre-hospitalization to 42% at discharge (p = 0.04). Conclusions Relative to the time of admission, overall medication complexity increased and the proportion of patients who were prescribed PIMs decreased after hospitalisation.

Background Patient education delivered through pharmacist counselling is important in promoting the safe and effective use of anticoagulants. Aim To evaluate the extent to which patients retain information after counselling from a clinical pharmacist about the anticoagulant warfarin; to perform a brief analysis of the cost‐analysis of warfarin counselling; and to investigate relationships between case‐specific characteristics and patient outcomes. Method A total of 22 patients was recruited. Eligibility criteria included age ≥18 years, new initiation of warfarin in hospital, intact cognition and an expectation of self‐administration of warfarin after discharge. Key elements of knowledge were assessed immediately after counselling and 6 weeks after counselling. The duration of each counselling session was recorded as a surrogate for costs involved, and case‐specific characteristics were documented. Results Participants demonstrated an ability to recall an average (mean ± standard deviation) of 79.9 ± 14.6% of key information elements immediately after counselling, significantly higher than was observed 6 weeks after counselling (71.0 ± 11.7%; p = 0.02). The percentage of participants achieving an ‘acceptable’ score for knowledge was 68.2%, both immediately after counselling and 6 weeks later. No significant relationships between specific case characteristics and patient outcomes, duration of counselling or overall warfarin knowledge retention scores 6 weeks after counselling were demonstrable. Conclusion These findings imply that more emphasis should be placed on educating patients on the critical information elements for warfarin counselling. Further research is required to explore potential relationships between case‐specific characteristics and patient outcomes, as well as the costs associated with the counselling process.

Aim:To determine the prevalence of vitamin B 12 deficiency in elderly patients using metformin long term and to assess putative risk factors for reduced vitamin B 12 concentrations. Method: Patients using metformin for more than 2 years admitted to or reviewed in the Repatriation General Hospital from June to December 2006 were enrolled in this cross-sectional study. The prevalence of vitamin B 12 deficiency and the association between vitamin B 12 deficiency and putative risk factors were determined. Results: 60 patients were recruited. Of the 53 patients not taking vitamin B 12 supplements, 8 (15%;