Oral anticancer medicine interventions: A cross-sectional study in French community pharmacies

INTRODUCTION

The increasing number of oral anticancer medicines (OAMs) dispensed in community pharmacies and the associated challenges (misuse, management of side effects) give the community pharmacist (CP) a major role in the pharmacotherapeutic management of cancer patients. In France, as a response to these challenges, cancer outpatients can schedule a meeting with their CP to ensure the safe and effective use of OAMs. The objectives of this study were to evaluate the perspectives of these interventions regarding their implementation and the opinion of French CPs.

METHODS

A declarative survey and semi-structured interviews were conducted with CPs that dispensed at least one OAM between January 2021 and March 2022. The study was conducted between April and August 2022.

RESULTS

Eighty-five CPs completed the survey. Of these pharmacists, 21% (n = 18) had already performed OAM interventions and 91% (n = 61) wanted to implement them. Lack of time, knowledge and training were the main barriers to implementation. No correlations were identified between the characteristics of community pharmacies and the likelihood of implementing OAM interventions.

CONCLUSIONS

Considering that CPs seem willing to implement them and the favourable context in France, this observational study highlights the potential of OAM interventions to improve the management of cancer patients. Though further studies are required to better evaluate the implementation and the potential effects of these interventions, OAM interventions could be relevant strategies in other healthcare systems to secure the management of cancer patients through the involvement of the CP.

Effect of Pharmaceutical Intervention in Pharmacologically Treated Hypertensive Patients-A Cluster-Randomized Clinical Trial: AFPRES-CLM Study

BACKGROUND

Evaluate the effect of a community pharmaceutical intervention on the control of blood pressure in hypertensive patients treated pharmacologically.

METHODS

A cluster-randomized clinical trial of 6 months was carried out. It was conducted in the Autonomous Community of Castilla-La Mancha (Spain). Sixty-three community pharmacies and 347 patients completed the study. Intervention patients received the community pharmaceutical intervention based on a protocol that addresses the individual needs of each patient related to the control of their blood pressure, which included Health Education, Pharmacotherapy Follow-up and 24 h Ambulatory Blood Pressure Measurement. Control patients received usual care in the community pharmacy.

RESULTS

The pharmaceutical intervention resulted in better control of blood pressure (85.8% vs. 66.3% p < 0.001), lower use of emergencies (p = 0.002) and improvement trends in the physical components of quality of life, measured by SF-36 questionnaire, after 6 months of pharmaceutical intervention. No significant changes were observed for any of these variables in the control group. There were also detected 354 negative medication-related outcomes that were satisfactorily resolved in a 74.9% of the cases and 330 healthcare education interventions and 29 Ambulatory Blood Pressure Monitorings were performed in order to increase adherence to pharmacological treatment and minimize Negative Outcomes associated with Medication and prevent medication-related problems.

CONCLUSIONS

Community pharmaceutical intervention can increase hypertensive patients with controlled blood pressure, after 6 months, compared with usual care.

Barriers and solutions to Alzheimer's disease clinical trial participation for Black Americans

Introduction

Black Americans are disproportionately burdened by Alzheimer's disease (AD) relative to other racial groups in the United States and continue to be underrepresented in AD clinical trials. This review explores the primary barriers for participation in clinical trials among Black Americans and provides literature-based recommendations to improve the inclusion of Black Americans in AD clinical trials.

Methods

We searched electronic databases and gray literature for articles published in the United States through January 1, 2023, ultimately identifying 26 key articles for inclusion.

Results

Barriers to participation in clinical trials for Black Americans are rooted in social determinants of health, including access to quality education and information, access to health care, economic stability, built environment, and community context. Best practices to improve the inclusion of Black Americans in clinical trials require pharmaceutical companies to adopt a multifaceted approach, investing in innovative strategies for site selection, development of local partnerships, outreach, and education.

Discussion

While multisectoral action must occur to effectively address the disproportionate burden of AD on Black Americans, the pharmaceutical industry has an important part to play in this space due to their central role in product development and clinical trials.

Active Pharmacovigilance Study: A Follow-Up Model of Oral Anti-Cancer Drugs under Additional Monitoring

Adverse drug reactions (ADRs) are responsible for almost 5% of hospital admissions, making it necessary to implement different pharmacovigilance strategies. The additional monitoring (AM) concept has been highlighted and intended to increase the number of suspected ADRs reported, namely in medicines with limited safety data. A prospective, descriptive study of active pharmacovigilance (AP) was conducted between 2019 and 2021 in the Local Health Unit of Matosinhos (LHUM) (Porto, Portugal). A model of AP for medicines under AM, namely oral antineoplastic agents, was designed. Follow-up consultations were performed, and adverse events (AEs) data were collected. The overall response to the treatment was evaluated through the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. A total of 52 patients were included in the study, and 14 antineoplastic drugs under AM were analyzed. Of the total number of patients included, only 29 developed at least one type of toxicity. Hematological disorders were the most reported suspected ADR. However, only four patients interrupted their treatment due to toxicity. After 12 months of treatment, most patients had disease progression, which was the main reason for therapy discontinuation. This AP model played an important role in the early detection of AEs and, consequently, contributed to better management of them. Increasing the number of suspected ADR reports is crucial for drugs with limited safety data.

Pharmaceutical intervention in the pharmacological therapy of elderly patients in San Luis-ECUADOR

Population's aging leads to a frequent usage of pharmaceutical medications to treat or control various ailments because of aging, increasing the probability of occurrence of problems related to its usage. The primary objective of this study was to conduct pharmaceutical interventions in elderly patients from San Luis - Riobamba, using surveys to identify the sociodemographic characteristics, diseases, and medicines usage. Once the problems related to pharmacological therapy were identified, pharmaceutical interventions were carried our prior the acceptance of each patient. The study had the participation of 422 elderly patients, with the prevalence of females (59.7%), aged between 60 and 70 years (45.5%); we identified that 82.5% of the elderly patients have diseases, finding that joint pain such as Arthritis/Osteoarthritis has the higher incidence (38.8%), and 50% of the surveyed people consume medication to treat the disease. 40.28% (n=170) of the participants conciliate the treatment review to identify any medication-related problem (MRP), finding interactions (21.2%) and adverse effects probability (21.2%), starting from the PRM identified, 170 pharmaceutical interventions were conducted, considering as priority (67.6%) the education on non-pharmacological measures. The pharmaceutical interventions done through the study benefited the elderly patients and will contribute to reduce the appearance of PRM.

Medical Economic Benefit Derived from the Use of Tracing Reports by Pharmacy-Based Pharmacists for Pharmaceutical Intervention and Reduction of Leftover Medicines

This study aimed to evaluate the effects on the medical economy of the use of tracing reports by pharmacy-based pharmacists for pharmaceutical interventions, including to reduce leftover medicines. These effects were estimated by analyzing 267 tracing reports issued by pharmacy pharmacists over a period of 1 year, 2020-2021. We estimate that these interventions created cost savings of USD108170.02/year (USD104800 via pharmaceutical interventions, USD3370.02 via interventions to reduce leftover medicines). The cost savings from pharmaceutical interventions prompted by patient follow-up was estimated to be USD47650. The medical economic effect per tracing report was estimated to be USD392.51 from pharmaceutical interventions, USD12.62 from reducing leftover medicines, and USD445.33 from pharmaceutical intervention prompted by patient follow-up. Overall, therefore, pharmaceutical interventions by pharmacy pharmacists using tracing reports, including those designed to reduce leftover medicines, may benefit the medical economy.

Context-Sensitive Implementation of Clinical Pharmacy Missions Within an Academic Hospital

Clinical pharmacy activities contribute to improve patient safety. Yet, the work system's characteristics influence how clinical pharmacy activities are performed and conversely clinical pharmacy causes that work system to evolve. This exploratory study aims to identify the different ways in which clinical pharmacy activities are performed in different units of a large academic hospital. Interviews and observations have been performed to identify in each ward the clinical pharmacy activities implemented and how they are carried out.

Intervention study for the reduction of medication errors in elderly trauma patients

OBJECTIVE

To analyse the impact of a set of measures designed by a working group to reduce medication errors (MEs) during the care transition of elderly trauma patients. The secondary objectives were to classify MEs and determine their location.

METHODS

A 43-month pre-post prospective intervention study in a university hospital. A working group was set up in the Trauma Service. A pharmacist analysed the pharmacotherapeutic processes of all patients admitted to the Trauma Service in different healthcare locations from Monday to Friday. To detect MEs, the pharmacist reviewed this process at the following points: reconciliation, prescription, validation, dispensing, and administration records. Errors were classified according to the Ruiz Jarabo classification. Subsequently, the working group designed a set of measures that were implemented with the incorporation into the Acute Care Team and the intervention of a pharmacist. Data on MEs were again collected in a post-implementation phase.

RESULTS

There was a statistically significant reduction in MEs between phases. A total of 132 (31.3%) patients experienced MEs during the pre-implementation phase and 75 (16.2%) during the post-implementation phase. Among the measures implemented, the incorporation of the pharmacist to the team, as well as training sessions and design of medication protocols. During the pre-implementation and post-implementation phases, the ME rates were respectively as follows: reconciliation 31.6% (172) vs 14.8% (91); prescription 7.7% (79) vs 1.9% (23); dispensing 1% (10) vs 0.3% (3); administration record 0.4% (4) vs 0.0% (0); and validation 0.3% (3) vs 0.1% (1). There were significant reductions in reconciliation, prescription, and dispensing errors. The majority of the MEs occurred in the Trauma Service.

CONCLUSIONS

The implementation of specific measures by a Multidisciplinary Safety Group reduced MEs in the care transition of elderly trauma patients, particularly those MEs that occurred during reconciliation. The greatest reduction in MEs occurred in the Trauma Service.

Evaluation of process indicators of a medication review service between pharmacists and physicians

RATIONALE, AIMS AND OBJECTIVES

Literature have showed inconclusive or contradictory results regarding medication review services effectiveness in optimizing process indicators. Thus, this study aimed to evaluate the process indicators of a medication review service between pharmacists and physicians.

METHOD

This quasi-experimental study was conducted between March 2013 and February 2014 with patients who were receiving care in a medication review service in a teaching hospital in northeastern Brazil. The main process indicators were number of pharmaceutical consultations; identification and resolution of drug-related problems (DRP) and pharmaceutical interventions that were classified according to type and degree of acceptance. Descriptive statistics were used to report data. The statistical significance of the association between variables was evaluated using the Mantel-Haenszel chi-square test. The 95% confidence interval was considered, and differences were deemed statistically significant if P ≤ .05.

RESULTS

A total of 146 patients attended the medication review service. The number of consultations per patient ranged from one to five (2.1 ± 1.1). The service identified 366 DRP, most of which were indication (67.5%). Patients who had four to five pharmaceutical consultations were 1.14 times more likely to have their DRP identified (χ² = 33.83, P < .0001). Of the DRP identified, 183 (42.33%) were resolved. Patients who had between one and two pharmaceutical consultations were 1.22 times more likely not to have their DRP resolved compared with the group with more than three consultations (χ² = 3.44, P < .05). Of the 173 pharmaceutical interventions made to the medical students and physicians, the majority (98.7%) was accepted.

CONCLUSION

The collaborative medication review service optimized the process indicators. Drug-related problems identification and resolution required more than three pharmaceutical consultations. Most of the pharmaceutical interventions were accepted by prescribers. Thus, collaborative medication review services may be fundamental to the construction of more effective and safe health systems.

Clinical Pharmacy Activities Documented (ClinPhADoc): Development, Reliability and Acceptability of a Documentation Tool for Community Pharmacists

Documentation of community pharmacists’ clinical activities, such as the identification and management of drug-related problems (DRPs), is recommended. However, documentation is not systematic in Swiss community pharmacies, and relevant information about DRPs, such as consequences or involved partners, is frequently missing. This study aims to evaluate the interrater and test-retest reliability, appropriateness and acceptability of the Clinical Pharmacy Activities Documented (ClinPhADoc) tool. Ten community pharmacists participated in the study. Interrater reliability coefficients were computed using 24 standardized cases. One month later, test-retest reliability was assessed using 10 standardized cases. To assess the appropriateness, pharmacists were asked to document clinical activities in their own practice using ClinPhADoc. Acceptability was assessed by an online satisfaction survey. Kappa coefficients showing a moderate level of agreement (>0.40) were observed for interrater and test-retest reliability. Pharmacists were able to document 131 clinical activities. The good level of acceptability and brief documentation time (fewer than seven minutes) indicate that ClinPhADoc is well-suited to the community pharmacy setting. To optimize the tool, pharmacists proposed developing an electronic version. These results support the reliability and acceptance of the ClinPhADoc tool.

Influence of pharmacist intervention on drug safety of geriatric inpatients: a prospective, controlled trial

BACKGROUND

Demographic shift leads to an increasing number of geriatric patients suffering from multimorbidity and resulting polypharmacy. Polypharmacy is shown to be associated with drug-related problems (DRPs) and increased morbidity. For Germany, a hospital-based intervention may be successful optimizing of polypharmacy. The aim of this study was to reduce DRPs in geriatric inpatients by a structured pharmacist's intervention and to measure the acceptance rate of pharmaceutical recommendations.

METHODS

This study followed an open, prospective, quasi-randomized, controlled design and was conducted in a geriatric department in a teaching hospital in Germany. Patients of all sexes were included, with a minimum age of 70 years, a written informed consent and a regular intake of at least five drugs daily. Primary outcome was the percentage of patients having a DRP at admission and discharge. A DRP was defined as a prescription without indication or a relevant drug-drug interaction or prescription of a potentially inappropriate medication or presence of an adverse drug reaction. Recommendations were classified and discussed face to face. Statistical analyses were performed using a full-set analysis and a matched-pairs design.

RESULTS

Within 12 months, 411 patients were recruited with median age of 82 years (intervention: n = 209; control: n = 202). Median number of drugs at admission was 10 (range 5-24), at discharge 9 (range 3-21). In the intervention group, the percentage of patients with a DRP was reduced from 86.6% to 56.0%; in the control group, from 76.7% to 76.2% (p value < 0.001). Medication appropriateness index score was reduced by 56% in the intervention group and by 0.2% in the control group (p value < 0.001). Implementation rate of the pharmaceutical recommendation was 80%.

CONCLUSION

This prospective controlled trial showed that a pharmacist's intervention was successful in optimizing polypharmacy in geriatric inpatients.

Dispensing of Prescribed Medicines in Swiss Community Pharmacies-Observed Counselling Activities

BACKGROUND

Patient counselling and addressing drug-related problems are the pharmacist's key activities to ensure the safe and effective use of medicines. This study aimed to describe the dispensing practice of prescribed medicines in daily community pharmacy practice and to identify factors influencing counselling provision; Methods: An observational study was conducted in community pharmacies in Basel, Switzerland. One master student in pharmacy performed non-participatory observations for one day at each of the participating community pharmacies. Patient characteristics, counselling content, additional activities, and pharmaceutical interventions were documented on a structured checklist; Results: 556 prescription encounters (PE) in 18 participating community pharmacies were observed (269 first prescriptions; 287 refill prescriptions). Patients were regular customers (n = 523, 94.1%) and 53.8 ± 23.4 years old. Counselling was provided to 367 (66.0%) customers on 2.9 ± 3.1 themes per PE. Factors influencing counselling were dispensing by the pharmacist, new customer, customer who did not refuse counselling, customer with a first prescription, with a prescription resulting in a pharmaceutical intervention, and a prescription filled by carers. During 144 PEs, 203 interventions were documented. Pharmacists proposed few additional activities and performed no cognitive pharmaceutical service; Conclusions: Our study quantified counselling and additional services at the dispensing of prescribed medicines and identified influencing factors on counselling provision at the patient, prescription, and pharmacy level.

Pharmacological Intervention to Modulate HDL: What Do We Target?

The cholesterol concentrations of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) have traditionally served as risk factors for cardiovascular disease. As such, novel therapeutic interventions aiming to raise HDL cholesterol have been tested in the clinical setting. However, most trials led to a significant increase in HDL cholesterol with no improvement in cardiovascular events. The complexity of the HDL particle, which exerts multiple physiological functions and is comprised of a number of subclasses, has raised the question as to whether there should be more focus on HDL subclass and function rather than cholesterol quantity. We review current data regarding HDL subclasses and subclass-specific functionality and highlight how current lipid modifying drugs such as statins, cholesteryl ester transfer protein inhibitors, fibrates and niacin often increase cholesterol concentrations of specific HDL subclasses. In addition this review sets out arguments suggesting that the HDL3 subclass may provide better protective effects than HDL2.

Documentation of pharmaceutical care: Validation of an intervention oriented classification system

RATIONALE, AIMS, AND OBJECTIVES

During the dispensing process, pharmacists may come across technical and clinical issues requiring a pharmaceutical intervention (PI). An intervention-oriented classification system is a helpful tool to document these PIs in a structured manner. Therefore, we developed the PharmDISC classification system (Pharmacists' Documentation of Interventions in Seamless Care). The aim of this study was to evaluate the PharmDISC system in the daily practice environment (in terms of interrater reliability, appropriateness, interpretability, acceptability, feasibility, and validity); to assess its user satisfaction, the descriptive manual, and the online training; and to explore first implementation aspects.

METHOD

Twenty-one pharmacists from different community pharmacies each classified 30 prescriptions requiring a PI with the PharmDISC system on 5 selected days within 5 weeks. Interrater reliability was determined using model PIs and Fleiss's kappa coefficients (κ) were calculated. User satisfaction was assessed by questionnaire with a 4-point Likert scale. The main outcome measures were interrater reliability (κ); appropriateness, interpretability, validity (ratio of completely classified PIs/all PIs); feasibility, and acceptability (user satisfaction and suggestions).

RESULTS

The PharmDISC system reached an average substantial agreement (κ = 0.66). Of documented 519 PIs, 430 (82.9%) were completely classified. Most users found the system comprehensive (median user agreement 3 [2/3.25 quartiles]) and practical (3[2.75/3]). The PharmDISC system raised the awareness regarding drug-related problems for most users (n = 16). To facilitate its implementation, an electronic version that automatically connects to the prescription together with a task manager for PIs needing follow-up was suggested. Barriers could be time expenditure and lack of understanding the benefits.

CONCLUSION

Substantial interrater reliability and acceptable user satisfaction indicate that the PharmDISC system is a valid system to document PIs in daily community pharmacy practice.

Assessment of a Clinical Pharmacy Activity in a Pediatric Inpatient Department in Cote D'ivoire

BACKGROUND

Clinical pharmacy activities in a pediatric inpatient department help to improve the management of patients clinically and economically.

OBJECTIVE

To assess the relevance of pharmaceutical interventions (PIs) in a pediatric inpatient department in Abidjan (Cote d'Ivoire).

MATERIALS AND METHODS

We carried out a cross-sectional, descriptive study from February to September 2014. The information collected was classified according to the classification of drug-related problems (DRPs) and PIs of the French Society of Clinical Pharmacy. The score assigned to each PI varied from PI₀ (without direct clinical impact) to PI₃ (vital clinical impact) as the importance of the potential clinical impact of the DRP was correlated to the severity of clinical consequences avoided by the PI. The relevance of PIs was assessed by their rate of acceptance by physicians and by the analysis of their clinical impact.

RESULTS

A total of 116 PIs were performed with 31% performed during medical rounds, 68.1% during patients' records analysis, and 0.1% on patient's admission. The main DRPs were related to noncompliance with recommendations (24.1%), overdose (21.1%), and underdosing (13.8%). The most important PIs were dose adjustment (31.8%), accuracy of drugs administration modalities (29.3%), and proposals of therapeutic choice (27.6%). The acceptance rate of PIs was highly significant (94.8%). The majority of PIs (67.3%) was assessed as having a significant clinical impact (PI₁) and 16.4% of PIs as very significant clinical impact (PI₂). A single PI (0.9%) was found with vital clinical impact.

CONCLUSION

PIs performed were relevant and contributed to the therapeutic optimization and the prevention of iatrogenic events in pediatric inpatients.

Pharmaceutical interventions in the management of tuberculosis in a pneumophtisiology department, Ivory Coast

Objectives

This study aims to analyze the profile and relevance of pharmaceutical interventions (PIs) in the management of tuberculosis (TB) at inpatient settings.

Patients and methods

Cross-sectional descriptive study conducted from March to December 2014 within the inpatient unit of pneumophtisiology department, Ivory Coast. Information collected was based on the classification of drug-related problems (DRPs) and PIs outlined by the French Society of Clinical Pharmacy. A score was assigned to each PI according to the importance of the potential clinical impact. This score was correlated with the severity of clinical consequences avoided by the intervention. The listing of interventions was made by pneumophtisiology specialists. The score assigned to each intervention ranged from 0 (without clinical impact) to 3 (vital clinical impact). The acceptance rate of interventions by physicians was evaluated.

Results

Of 130 patients, 28.5% received PIs. The main reasons for interventions were drug–drug interactions (26.4%), noncompliance with recommendations (24.5%), and adverse effects (24.5%). Antituberculosis drugs were involved in 40.3% of DRPs. Interventions were predominantly proposals for monitoring treatment effectiveness and safety parameters (52.7%) followed by proposals of therapeutic choice (28.1%). All interventions were accepted by the physicians. Most interventions (59.6%) were listed as interventions with significant clinical impact.

Conclusion

The presence of a pharmacist at inpatient setting has contributed to the prevention and resolution of problems related to the pharmacotherapeutic management of TB. Pharmacists can position themselves as major players in the therapeutic management of TB inpatient in resource-limited setting.

Dose-dependent effects of mTOR inhibition on weight and mitochondrial disease in mice

Rapamycin extends lifespan and attenuates age-related pathologies in mice when administered through diet at 14 parts per million (PPM). Recently, we reported that daily intraperitoneal injection of rapamycin at 8 mg/kg attenuates mitochondrial disease symptoms and progression in the Ndufs4 knockout mouse model of Leigh Syndrome. Although rapamycin is a widely used pharmaceutical agent dosage has not been rigorously examined and no dose-response profile has been established. Given these observations we sought to determine if increased doses of oral rapamycin would result in more robust impact on mTOR driven parameters. To test this hypothesis, we compared the effects of dietary rapamycin at doses ranging from 14 to 378 PPM on developmental weight in control and Ndufs4 knockout mice and on health and survival in the Ndufs4 knockout model. High dose rapamycin was well tolerated, dramatically reduced weight gain during development, and overcame gender differences. The highest oral dose, approximately 27-times the dose shown to extend murine lifespan, increased survival in Ndufs4 knockout mice similarly to daily rapamycin injection without observable adverse effects. These findings have broad implications for the effective use of rapamycin in murine studies and for the translational potential of rapamycin in the treatment of mitochondrial disease. This data, further supported by a comparison of available literature, suggests that 14 PPM dietary rapamycin is a sub-optimal dose for targeting mTOR systemically in mice. Our findings suggest that the role of mTOR in mammalian biology may be broadly underestimated when determined through treatment with rapamycin at commonly used doses.