Clinical Pharmacology in Denmark in 2016 - 40 Years with the Danish Society of Clinical Pharmacology and 20 Years as a Medical Speciality

Rational Pharmacotherapy in Type 2 Diabetes: Danish Data From 2002 to 2020 on Mortality, Diabetes- Related Outcomes, Adverse Events, and Medication Expenses

OBJECTIVE

Developments in pharmacotherapy and management of type 2 diabetes may have shifted the balance of treatment benefits versus harms and costs over the past decades. This study aimed to describe the trends in this balance.

RESEARCH DESIGN AND METHODS

We followed the Danish population with type 2 diabetes between 2002 and 2020, analyzing their medication use in relation to treatment benefits (such as mortality and diabetes-related outcomes), adverse events, and medication costs. Using multivariate analyses, we adjusted for potential confounders, including age, sex, and socioeconomic status.

RESULTS

The study included 461,805 individuals. From 2002 to 2020, the median age increased from 66 to 68 years, and the mean number of comorbidities increased from 5.2 to 8.8. The overall incidence of cardiovascular, renal, and other important adverse clinical outcomes decreased. Similarly, the rate of some adverse events, such as gastric bleeding, hypoglycemia, and falls declined, whereas the incidence of electrolyte imbalances and ketoacidosis increased. The average per-patient cost was reduced by 8%, but total medication expenses increased by 148% due to an expanding population size, lowered costs of most cardiovascular medications, and increasing costs for glucose-lowering drugs.

CONCLUSIONS

Advancements in type 2 diabetes management have led to reduced risk of both diabetes-related outcomes and treatment harms, while maintaining relatively stable per-patient medication expenses. Although these trends are multifactorial, they suggest more rational pharmacotherapy. Still, increased risk of certain adverse events, along with increasing costs for glucose-lowering medications, underscores the need for ongoing vigilance and risk-benefit analysis.

The expert clinical pharmacological advice program for tailoring on real-time antimicrobial therapies with emerging TDM candidates in special populations: how the ugly duckling turned into a swan

INTRODUCTION

The growing spread of infections caused by multidrug-resistant pathogens makes the need of tailoring antimicrobial therapies by means of a 'patient-centered' approach fundamental. In this scenario, therapeutic drug monitoring (TDM) of emerging antimicrobial candidates may be a valuable approach, but expert interpretation of TDM results should be granted for making them more clinically useful. The MD Clinical Pharmacologist may take over this task since this specialist may couple PK/PD expertise on drugs with a medical background and may provide expert interpretation of TDM results of antimicrobials for tailoring therapy on real-time in each single patient based on specific both drug/pathogen issues and patient issues.

AREAS COVERED

This article aims to highlight the main key-points and organizational aspects for implementing a successful TDM-based expert clinical pharmacological advice (ECPA) program for tailoring antimicrobial therapies on real-time in different hospitalized patient special populations.

EXPERT OPINION

TDM-based ECPA programs lead by the MD Clinical Pharmacologist may represent a way forward for maximizing clinical efficacy and for minimizing the risk of resistance developments and/or toxicity of antimicrobials. Stakeholders should be aware of the fact that this innovative approach may be cost-effective.

The perceived development needs for medicines information services in university hospital pharmacies: A mixed methods study

Background

Reliable and evidence-based medicines information (MI) is critical for patient care. To guarantee this, in many countries, there are medicines information centers (MICs) which offer medicines information services (MISs). While there are no MICs in Finland, pharmacists in all five university hospital pharmacies provide MISs. A proposal for establishing five MICs has been made by the National Medicines Information Network.

Objectives

The aim was to explore the current MISs and the perceptions of current and potential MI service providers of the need for the proposed national MICs. Barriers and facilitators for potential transition from the current MISs provided by the university hospital pharmacies to establishing national MICs, were examined.

Methods

This sequential explanatory mixed methods study was conducted nationally during September 2019-April 2020 as an online survey and semi-structured individual, pair and group theme interviews with hospital representatives. The survey questionnaire was sent to chief pharmacists and MI pharmacists in all five Finnish university hospital pharmacies (n = 5, census). The interviews (n = 13) were carried out with chief pharmacists, MI pharmacists, medication safety officers (pharmacists), chairs of the Medicines Advisory Board (physicians) and clinical pharmacologists (physicians) (participants n = 19). The data was analyzed using descriptive quantitative analysis and qualitative content analysis.

Results

All invited representatives participated in the study. Offered MISs are quite similar but the human resources vary among the organizations. Answering MI questions was one of the core MISs. Most representatives considered a proposal of establishing five MICs to Finland positively. The expected benefits were related to achieving an official status to enhance MI, establishing the MICs within the university hospitals and close to where the MISs are needed, and fostering multiprofessional collaboration and collaboration between the MICs. Limited financial and human resources were seen the most critical challenges.

Conclusion

The existing expertise of the pharmacists and the similarities in MISs provided by the university hospital pharmacies seem to provide a good basis and preconditions for expanding MI operations and forming MICs at the national level. By pooling current limited resources, synergies could be achieved and MISs, and potentially MICs developed. The establishment of MICs may enhance utilization of networking and multiprofessional collaboration in producing MISs at the national level.

A European cross-sectional survey to investigate how involved doctors training in clinical pharmacology are in drug concentration monitoring

Purpose

Therapeutic drug monitoring (TDM) is widely recognised as a key attribute of clinical pharmacologists; yet, the extent to which physicians undertaking postgraduate training in clinical pharmacology (hereafter trainees) are involved in TDM is poorly characterised. Our own experience suggests wide variation in trainee exposure to TDM.

Method

We performed a Europe-wide cross-sectional internet-based survey of trainees to determine the nature and extent of trainee involvement in TDM.

Results

There were 43 responses from eight countries analysed. Of the 21 respondents from the UK, all were also training in general internal medicine (GIM), while all of the respondents who were solely training in clinical pharmacology were from outside the UK. Overall, 86.0% of respondents reported access to drug monitoring for clinical care at their affiliated institution, of which 81.0% were personally involved in TDM in some capacity. On average, trainees reported that drug monitoring was available for 16 of the 33 (48%) of the drug/drug classes surveyed. UK-based respondents were involved in requesting drug-level investigations and interpreting the results for patients under their care in 76.2% and 85.7% of cases, respectively, while non-UK respondents supported other healthcare professionals to interpret results in 45.4% of cases. Trainees felt TDM training was generally either insufficient or very inadequate.

Conclusion

While access to TDM is relatively available at institutions where trainees are based, the role of trainees is variable and affected by a variety of factors including country and training programme. Universally, trainees feel they need more education in TDM.

Medication errors in hematology-oncology ward by consultation: The role of the clinical pharmacologist

Background

The aim was to describe, evaluate and document the prevention of medication errors by clinical pharmacologist consultations in patients with cancer.

Methods

We assessed the effect of clinical pharmacologist consultation by the acceptance of interventions recommended due to dosage, frequency, duration of therapy errors and drug-drug interactions (DDIs). All medication errors detected by clinical pharmacologist were reported in the format of medical consultation. A documentation template was designed to collect the patient's data (sex, age, and diagnosis), prescriptions written, and drug-specific recommendations. For the descriptive analysis of medication errors, the unit of analysis was the number and percentage of errors.

Results

A total of 296 patients included in this study with a median age of 48.67±19.76 years of which 47.30% were females. 936 prescribing errors were detected and recommended for their correction. The specialist physicians accepted 897 of prescribed errors. DDIs that were detected in 66.22% of patients, were the most errors in this group of errors (47%). Improper dose (17.41%) wrong frequency (16.67%) and drug-food interaction (10.26%) were after that.

Conclusion

Pharmacological consultation in the hematology-oncology ward revealed many medication errors. The trust of physicians in the views of the clinical pharmacologist led to a large part of these errors being accepted and resolved.

Footprints of Clinical Pharmacology in Turkey: Past, Present, and Future

Clinical pharmacology is an interdisciplinary field that encompasses all components of the relationship between drugs and humans. All clinical pharmacology professionals aim to support an improved quality of drug-oriented health services by providing teaching, research, and routine health care services that ensure more tolerable and more effective, suitable, and cost-effective use of drugs. Subsections of clinical pharmacology include clinical trials, pharmacoepidemiology and drug use, pharmacovigilance, pharmacoeconomics, the rational use of medicines, pharmacotherapy consultation, drug monitoring, counseling to authorities and industry, pharmacogenetics, and other practices. By approaching these subsections as part of 3 main aspects of clinical pharmacology-education, research, and health care-this review aims to provide local and international practitioners with detailed information about clinical pharmacology practices in Turkey and to contribute to building the network of communication and collaboration. This review also aims to play an encouraging and pioneering role for Turkey's national community and other countries that have not yet made clinical pharmacology functional in improving the quality of health services, promoting the dissemination of rational use of medicines, helping the set-up of clinical pharmacology organizations, enhancing quantity and quality of the clinical pharmacology workforce, and increasing the infrastructural facilities.

Naturalistic Evaluation of Pharmacotherapy Consultations Provided to Hospital Clinicians: A Developing Country's Perspective

Background: Critical appraisal of published literature for hospital clinicians has never been taken as an initiative in developing countries. Objective: This study was aimed at evaluating the nature of pharmacotherapy consultations from the drug information center (DIC) of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. Methods: The DIC received pharmacotherapy consultation requests from January 2016 to December 2017. Various aspects such as clinical queries, patient-related factors, and disease-related information in these requests were recorded and analyzed. Descriptive statistics and χ2 test were used for the analysis of the data and feedback evaluation, respectively. Results: During the study, a total of 179 consultation requests were documented. On 19 (10.61%) encounters, pharmacotherapy consultations occurred for emergency patient care. Of the 179 queries, 31 (17.3%) were answered immediately while 148 (82.68%) were answered within an average time of 1.6 hours. The most common type of query was the pharmacotherapy of disease, followed by dose calculation and dose modification. Communications with DIC staff took place for timely critical appraisal of the medical literature, followed by a judicious selection of higher antimicrobials and other drugs. The time taken for answering a query was found to be a statistically significant determinant of user satisfaction (P < .05). Conclusion: The evidence level-specific drug information service was established and catered to hospital clinicians through critical evaluation of offline and online resources. DIC services have the potential to revolutionize the pharmacy and pharmacology curriculum in developing countries.