Clinical evaluation of pharmacists’ interventions on multidisciplinary lung transplant outpatients’ management: results of a 7-year observational study

Duwez, M.; Chanoine, Sébastien; Lepelley, Marion; Vo, Thi Ha; Pluchart, Hélène; Mazet, Roseline; Allenet, Benoît; Pison, Christophe; Briault, Amandine; Saint-Raymond, Christelle; Camara, B.; Claustre, Johanna; Bedouch, Pierrick

doi:10.1136/bmjopen-2020-041563

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…The independence of three dimensions helps to interpret the scoring results flexibly. Mongaret et al 21 and Duwez et al 22 used only the clinical dimension of the CLEO tool in their study to determine clinically significant PIs, while Zecchini et al 23 used only the clinical and economic dimensions. Another tool could take advantage of all three dimensions to demonstrate the whole effects of a PI.…”

Section: Original Researchmentioning

confidence: 99%

“…User satisfaction and acceptability with the tool was high. Indeed, the CLEO tool was used easily in French hospital settings [21][22][23] and received good feedback from three Swiss hospitals. 24 However, pharmacists suggested that training with sample cases and regular discussion of real scenarios in daily practice is necessary to improve its reliability.…”

Section: Appropriateness Acceptability Feasibility and Precisionmentioning

confidence: 99%

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CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists’ interventions

Charpiat

Chanoine

et al. 2021

Eur J Hosp Pharm

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Objectives Clinical pharmacists' interventions (PIs) are an important element in ensuring good pharmaceutical care. We aimed to develop and validate a comprehensive multidimensional tool for assessing the potential impact of PIs for daily practice of medication review. Methods Experts of the French Society of Clinical Pharmacy (SFPC) developed the CLinical, Economic and Organisational (CLEO) tool, consisting of three independent dimensions concerning clinical, economic and organisational impact. They were asked to analyse 30 scenarios of PIs, and re-rated 10 PIs with a washout of 1 month (internal validation). Then, seven external experts not involved in the development of the tool rated 60 scenarios collected when using the CLEO in daily practice. Inter-and intra-rater reliabilities were determined by calculation of the intra-class correlation (ICC A,1 ). Users' satisfaction and acceptability of the tool were assessed on a 7-level Likert scale with a 17-item questionnaire. Results For internal reliability, the inter-rater reliability for the CLEO tool was good for clinical dimensions (ICC A,1 =0.693), excellent for economic dimensions (ICC A,1 =0.815) and fair for organisational dimensions (ICC A,1 =0.421); and the intra-rater reliability was good for clinical dimensions (ICC A,1 =0.822), excellent for economic dimensions (ICC A,1 =0.918) and good for organisational dimensions (ICC A,1 =0.738). For external reliability, the inter-rater reliability was good for clinical dimensions (ICC A,1 =0.649), excellent for economic dimensions (ICC A,1 =0.814) and fair for organisational dimensions (ICC A,1 =0.500). CLEO was viewed as relevant (mean±SD 4.93±1.27), acceptable (4.81±1.78), practicable (5.56±1.45) and precise (5.38±1.47). Conclusions CLEO is a comprehensive tool assessing clinical, economic and organisational impacts of PIs which has been developed, validated and was reliable and feasible for use in routine clinical practice.

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Section: Original Researchmentioning

confidence: 99%

Section: Appropriateness Acceptability Feasibility and Precisionmentioning

confidence: 99%

CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists’ interventions

Charpiat

Chanoine

et al. 2021

Eur J Hosp Pharm

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“…More importantly, the study showed that, when accepted, a clinical pharmacist presented a positive clinical impact for 98.9% of patients, and none had a negative clinical impact. 83 The role of a pharmacist in patient-care teams can be an invaluable asset.…”

Section: Multidisciplinary Approachmentioning

confidence: 99%

Advances in the management of pulmonary arterial hypertension

Deshwal

Weinstein

Sulica

2021

Journal of Investigative Medicine

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The management of pulmonary arterial hypertension (PAH) has significantly evolved over the last decades in the wake of more sensitive diagnostics and specialized clinical programs that can provide focused medical care. In the current era of PAH care, 1-year survival rates have increased to 86%–90% from 65% in the 1980s, and average long-term survival has increased to 6 years from 2.8 years. The heterogeneity in the etiology and disease course has opened doors to focusing research in phenotyping the disease and understanding the pathophysiology at a cellular and genetic level. This may eventually lead to precision medicine and the development of medications that may prevent or reverse pulmonary vascular remodeling. With more insight, clinical trial designs and primary end-points may change to identify the true survival benefit of pharmacotherapy. Identifying responders from non-responders to therapy may help provide individualized patient-centered care rather than an algorithm-based approach. The purpose of this review is to highlight the latest advances in screening, diagnosis, and management of PAH.

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“…The participation of clinical pharmacist and therapeutic drug monitoring are considered helpful in managing DDIs. 54 , 55 In patients with C 0 variation, the pharmacist informed the physician with the appropriate recommendations. In most patients, the dose of immunosuppressant was preemptively modified to maintain C 0 within the therapeutic range, therefore, not all patients, with real DDIs due to C 0 alteration, suffered toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…The participation of clinical pharmacist and therapeutic drug monitoring are considered helpful in managing DDIs 54,55 . In patients with C 0 variation, the pharmacist informed the physician with the appropriate recommendations.…”

Section: Discussionmentioning

confidence: 99%

Real clinical impact of drug–drug interactions of immunosuppressants in transplant patients

GAGO

Font

Cárdenas

et al. 2021

Pharmacology Res & Perspec

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The main objective was to determine the prevalence of real drug–drug interactions (DDIs) of immunosuppressants in transplant patients. We conducted a prospective, observational 1‐year study at a tertiary hospital, including all transplanted patients. We evaluated data from monitoring blood concentrations of immunosuppressive drugs and adverse drug events (ADEs) caused by DDIs. The DDIs were classified as C, D, or X according to their Lexi‐Interact rating (C = monitor therapy, D = consider therapy modification, X = avoid combination). The clinical importance of real DDIs was expressed in terms of patient outcomes. The causality of DDIs was determined using Drug Interaction Probability Scale. The data were analyzed using Statistical Package for Social Sciences v. 25.0. A total of 309 transplant patients were included. Their mean age was 52.0 ± 14.7 years (18–79) and 69.9% were male. The prevalence of real DDIs was 21.7%. Immunosuppressive drugs administered with antifungal azoles and tacrolimus (TAC) with nifedipine have a great clinical impact. Real DDIs caused ADEs in 22 patients. The most common clinical outcome was nephrotoxicity (1.6%; n = 5), followed by hypertension (1.3%; n = 4). Suggestions for avoiding category D and X DDIs included: changing the immunosuppressant dosage, using paracetamol instead of non‐steroidal anti‐inflammatory drugs, and interrupting atorvastatin. The number of drugs prescribed and having been prescribed TAC was associated with an increased risk of real DDIs. There are many potential DDIs described in the literature but only a small percentage proved to be real DDIs, based on the patients´ outcomes.

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Clinical evaluation of pharmacists’ interventions on multidisciplinary lung transplant outpatients’ management: results of a 7-year observational study

Cited by 10 publications

References 30 publications

CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists’ interventions

CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists’ interventions

Advances in the management of pulmonary arterial hypertension

Real clinical impact of drug–drug interactions of immunosuppressants in transplant patients

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