Showing papers in "Pharmacy World & Science in 2002"

Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies.

Abstract: Aim: to establish the percentage hospital admission related to adverse drug reactions (ADRs) from the data available in the literature. Method: literature search in the Medline database, metaanalysis. Results: from the literature it is revealed that a considerable part of all hospital admissions are related to adverse drug reactions. However, these data are not homogenous, i.e. larger studies display a lower percentage of ADR related hospital admission, while smaller studies display a higher percentage. Subgroup analysis showed that for elderly people the odds of being hospitalised by ADR related problems is 4 times higher than for younger ones (16.6% vs. 4.1%). A considerable part of these hospitalisations can be prevented. Subgroup analysis revealed that in the elderly up to 88% of the ADR related hospitalisations are preventable; for the non-elderly this is only 24%. Comparatively more elderly people are hospitalised than younger ones. Combining these findings, twice as much elderly people are hospitalised by ADR related problems than non-elderly, while preventability of ADR related hospitalisation might yield 7 times more people in the elderly than in the non-elderly. The estimation of the costs of ADR related hospitalisations in the Health Care system in The Netherlands is discussed. Conclusion: many elderly people are hospitalised by ADR related problems; an important part of these hospitalisations can be avoided.

Community pharmacists' perspectives on pharmaceutical care implementation in New Zealand.

Abstract: Objective: There were three objectives to this study: to establish New Zealand community pharmacists' level of understanding of the pharmaceutical care process; to determine their attitudes to the concept of pharmaceutical care; and to determine the barriers to commencing pharmaceutical care practice. Comparisons were made between proprietors (pharmacy owners) and employees, males and females, and younger and older pharmacists. Method: The research tool was a questionnaire instrument, encompassing a total of 67 questions designed to determine community pharmacists' understanding, attitudes and appreciation of the opportunities and barriers inherent in the pharmaceutical care process. A total of 490 pharmacists representing 286 proprietors and 204 employees randomly selected from the Pharmaceutical Society register were sent a questionnaire. Results: The total responses numbered 377, which was a 76.9% overall response rate. Over 60% of the pharmacists surveyed had a correct understanding of pharmaceutical care. Approximately the same percentage felt the future of pharmacy would depend on the provision of services other than dispensing. Insufficient time, as a barrier to implementation, was identified by 87% of respondents, and an absence of a reimbursement system by a further 82%. Lack of: therapeutic knowledge; clinical problem solving skills; finance; appropriate space; patient demand; access to patient medical records; and data on the value of PC were identified as major barriers by over 50% of all respondents. There were significant differences in response to a number of issues recorded by males and females, proprietors and employees, and pharmacists above and below the mean sample age of 45 years.Conclusion: This study found that the community pharmacy environment in New Zealand had a high level of understanding of the pharmaceutical care process, but identified some significant barriers to implementation.

Discussing basic principles for a coding system of drug-related problems: the case of PI-Doc.

Abstract: Coding systems are important tools for the documentation of drug-related problems and following interventions. They should be suitable not only for scientific studies but for the broader implementation of Pharmaceutical Care in the pharmacy. A suitable coding system must be easy to use in daily routine. To facilitate later computer aided use, it should be preferably structured like a decision tree and consist of three parts: 1. the classification of drug-related problems 2. the intervention taken to solve to problem 3. the degree to which the problem was solved. PI-Doc considers other classification systems used by Hepler and Strand the PAS-Coding System and draws empirical experience from a study in 1995 and 1998 in Germany. The main groups comprise the following: unsuitable drug choice unsuitable use by the patient, incl. compliance unsuitable dosage drug-drug interactions adverse drug reactions other drug-related problems patient-related communication-related technical and logistic problems. The article discusses basic principles of the development of a coding system and the prerequisites for its application. In addition, it tries to give guidance for the classification process itself. It is also recommended to collect further information while documenting drug-related problems, in order to allow additional statistical evaluation.

Attitudes towards drugs--a survey in the general population.

Abstract: Background: Studies have shown that many drugs have a lower effectiveness in clinical practice than would be expected from results reported in randomised controlled clinical trials. Many factors influence the use of drugs. Personal factors such as knowledge, attitudes, motivation, expectations are considered to be of particular consequence. The aim of the study was to analyse attitudes towards drugs from an epidemiological perspective.Design: Cross-sectional surveySetting:The county of Uppsala, Sweden, 1995.Results: 5,404 completed the questionnaire (response rate=68%). A majority either considered drugs as something positive, a help (60%), or as something necessary but evil (38%). A small proportion — around 2% — considered drugs as a danger. There were differences in attitudes according to education and income, self-care orientation, medication knowledge, and state of health. We also found differences in attitudes between users and non-users of certain types of drugs. Users of hypertensive drugs more often considered drugs as necessary but evil than did non-users of these drugs, while users of psychotropic drugs more often viewed drugs as something positive than did patients who did not use psychotropic drugs.Conclusion: A better understanding of the general attitudes towards drugs is important when giving both written and oral information to patients and to the public at large. It is also important to be aware of differences in attitudes between various patient groups and that certain patients, e.g., patients prescribed hypertensive drugs, could require more attention from health care professionals.

Survey of drug use practices and antibiotic prescribing pattern at a general hospital in Nigeria.

Abstract: Objective: To describe the current drug use practices at the institution, and gather baseline data, which can serve as a basis for designing an appropriate intervention to improve the drug use profile. Method: A retrospective audit of in- and out-patient prescriptions, generated during the period January–March 1999. Indicators of drug use pattern include: average number of drugs prescribed per encounter (ANDPE), average number of antibiotics prescribed per encounter (ANAPE), % encounter with antibiotics (PEA), percent of antibiotic prescriptions based on microbial sensitivity test results (MCST). Additionally, a “knowledge, attitude and practice” (KAP) survey of prescribers and dispensers was performed. Indicators of prescribing and dispensing quality include: sources of drug/prescribing information, availability and use of the hospital formulary, knowledge of the prescribing process and the adequacy of the drug supply management system.Results: A total of 9984 outpatient prescriptions and 127 in-patient case notes were audited. The total number of prescribers and dispensers surveyed were 88 and 13 respectively. The ANDPE was found to be 3.16 for out-patients and 9.7 for in-patients, ANAPE was 1.1and 2.4 for out-patients and inpatients respectively. The PEA was 50.3% for out-patients and 96.7% for in-patients. Only 4.2% of in-patient antibiotic prescriptions were based on MCST and percent encounter with switches in antimicrobial therapy was 52.1% while the average number of switches per encounter was 1.35. In 18.5% of the in-patient encounters there was evidence of drug incompatibilities. The KAP survey revealed that prescribers and dispensers in the hospital rely on different sources for their drug information needs (MIMS vs Martindale Extrapharmacoepia). None of the prescribers surveyed was able to correctly enumerate all the 4 steps involved in the prescribing process, about 25% got at least 2 steps correctly, and only 9.1% of the dispensers surveyed could accurately define a hospital formulary. The drug supply management system was found to be inadequate. Conclusion: The survey revealed that appreciable gaps in knowledge with respect to rational drug use, still exists among these cadre of healthcare professionals. The foregoing suggests an urgent need for review of current policies and systems in the hospital with the view of enhancing the drug use practices of the health providers. Specifically it is recommended that there should be an intervention program involving concerted continuing education (to influence the KAP of the various cadre of healthcare providers) and the establishment of a hospital formulary / standard treatment guidelines.

Purchasing restricted medicines in New Zealand pharmacies: results from a "mystery shopper" study.

Abstract: Objective: New Zealand has a class of drugs (Restricted Medicines) which are available over the counter in pharmacies, but must be sold by qualified pharmacists. Patient names must be recorded for each sale. Many restricted medicines have recently been reclassified from prescription only, with the expectation that pharmacists provide professional input into their sale. The study described here explored whether pharmacists do fulfil this expectation.Method: In late 1999, 12 mystery shoppers made 360 visits to 180 pharmacies around New Zealand. Shoppers were of different ages, genders, ethnic and socio-economic backgrounds. Two kinds of products were purchased: diclofenac 25 mg, which was requested for "back pain" and vaginal anti-fungals requested for "thrush". Main outcome measure: The main outcome measure described here is whether the shoppers received specified items of counselling. These included questions about the shopper's health status, contraindications to medicine use, advice about the use of the product and the health problem presented. Other outcome measures are whether sales of restricted medicines were carried out by pharmacists or other staff, and whether sales were recorded.Results: In spite of the requirement that pharmacists sell restricted medicines, shoppers often found it difficult to distinguish pharmacists from other pharmacy staff. Shoppers were able to confirm that a pharmacist was definitely involved in only 46% of visits. In 8.8% of the diclofenac visits, and 10.8% of the visits for vaginal anti-fungals, no counselling was provided. The vaginal anti-fungal visits tended to be more product-focussed than the diclofenac visits. When they purchased diclofenac, most pharmacists asked shoppers if they had, or had had, stomach problems (74.6%) or asthma (65.4%). A minority asked about the symptoms of the vaginal fungal infection which the female shoppers presented with. While most pharmacies recorded patient names, many did so in a way which compromised patient confidentiality.Conclusion: Pharmacies varied widely in the amount of counselling they provided to people purchasing restricted medicines.

Non-observance of guidelines for surgical antimicrobial prophylaxis and surgical-site infections.

Abstract: Objective:a prospective multicentre study was conducted to assess major aspects of surgical prophylaxis and to determine whether inappropriate antimicrobial prophylaxis was a factor associated (risk or protective factor) with surgical site infection (SSI). Method: surgical prophylaxis practices were assessed by analysing four variables: indication, antimicrobial agent, timing and duration. Univariate and multivariate analyses were carried out to identify predictors of SSI among patient-specific, operation-specific and antimicrobial prophylaxis-specific factors.Results: The frequency of SSI was 2.7% (13 SSI in 474 observations). Total compliance of the prescription with guidelines was observed in 41.1% of cases (195 prescriptions). Of the 139 patients who received an inappropriate drug, 126 (90.6%) received a drug with a broader spectrum than the recommended drug. Prophylaxis was prolonged in 71 (87.7%) of the 81 patients who received prophylaxis for inappropriate lengths of time and 43 (61.4%) of the 70 patients who did not receive prophylaxis at the optimal moment were treated too late. Multivariate analysis clearly demonstrated that SSI was associated with multiple procedures (relative risk 8.5), short duration of prophylaxis (relative risk 12.7) and long-term therapy with antimicrobial agents during the previous year (relative risk 8.8).Conclusions: the ecological risk of the emergence of resistance associated with the frequent use of broad-spectrum antibiotics and prophylaxis for longer periods was not offset by individual benefit to the patients who received inappropriate prophylaxis.

Data collection methods for analyzing the quality of the dispensing in pharmacies.

Abstract: Objective: To review and discuss the advantages and limitations of the different data collection methods for analyzing the dispensing quality in community pharmacies Methods: A bibliographic search was carried out in MEDLINE (1980‐2000) Articles with Medical Subject Heading (Mesh) “pharmacies”written in English and Spanish that evaluated the quality of dispensing (structure, process or outcome) were selectedResults: Various data collection methods were observed To analyze the quality of the structure, questionnaires and pharmacist interviews were used To analyze the quality of the process, self‐completed records, external observers and simulated clients were used For analyzing the quality of the outcome, questionnaires, client interviews, and biologic samples were collected Conclusions: The analysis of quality of structure can be useful as a first approach, however, this method may lack sensitivity On the other hand, the analysis of outcome may be excessively complex and difficult to use, except for experimental or observational studies with large resources Therefore, an analysis of the quality of the process is the best option Methods utilizing external observers and simulated clients may best conjugate both internal and external validity

Cost-effectiveness of periconceptional supplementation of folic acid.

Abstract: Background: Supplementation of folic acid prior to and in the beginning of pregnancy may prevent neural tube defects (NTDs) in newborns – such as spina bifida – and possibly other congenital malformations.Objective: To estimate cost effectiveness of periconceptional supplementation of folic acid using pharmaco‐economic model calculation.Method: Probabilities for NTDs, risk reductions through periconceptional supplementation of folic acid and lifetime costs of care for children with spina bifida were estimated using Dutch registrations and international literature.Main outcome measure: Cost effectiveness was expressed in net costs per discounted life‐year gained. Cost effectiveness was calculated in the baseline and in sensitivity analysis.Results: Estimated cost effectiveness of periconceptional supplementation of folic acid amounts to NLG 3900(D1800) in the base case. In sensitivity analysis cost effectiveness mostly remains below NLG 10.000(D4500).Conclusion: Periconceptional supplementation of folic acid shows a favorable cost effectiveness. From pharmaco‐economic point of view this justifies further stimulation of folic‐acid supplementation prior to pregnancy. This can be done through targeted education by health‐care workers, such as pharmacists.

A systematic review of the clinical and economic impact of drug information services on patient outcome.

Abstract: Aim: to establish what is known about the clinical and economic impact of drug information (DI) services on patient outcome. Method: a systematic review and critical appraisal of world literature on work conducted by Drug Information Centres and UK Schools of Pharmacy.Results: six relevant published articles were recovered – three from the UK, two from the US and one from Canada; just one was prospective in design. Four were single-centre and two were multi-centre studies. Four studies relied heavily on questionnaire surveys of the enquirer to establish an effect; only one monitored patient outcome independently and used peer review to assess impact.Conclusion: the clinical and economic impact of drug information consultation and provision on patient care has not been investigated rigorously. A research methodology for such an investigation is suggested.

Patient oriented activities in Dutch community pharmacy: Diffusion of innovations

Abstract: Objectives: To explore the implementation of patient oriented activities, the perception of an innovation aimed at implementation of patient education and the preconditions for implementation of this innovation among Dutch pharmacists.Method: A survey, based on Rogers' theory of diffusion of innovations, was carried out among a random sample (n = 300) of Dutch managing pharmacists.Main outcome measures: Reported activities regarding patient education, medication surveillance and drug therapy meetings, as well as perception of the innovation and its perceived compatibility with pharmacy practice.Results: The response rate was 49.3%. Hundred (84.7%) respondents reported to provide extra written and verbal information with first prescription medication. Medication surveillance (100% check by computer, and check of the lists by the pharmacist) was reported by 43 (36.4%), and complete participation in drug therapy meetings was reported by 57 (48.3%) respondents. Observability (of results to others) of the new strategy was perceived as important by 90 (77.6%), compatibility (perceived consistency with existing values, past experiences and needs of potential adopters) by 87 (76.4%) and trialability (degree to which an innovation may be experimented with) by 81 (69.8%) respondents. Relative advantages (perception of the innovation as being better) and complexity (relatively difficult to understand and use) of the innovation were perceived as important by less respondents. The preconditions that were met by most pharmacists were 'financial resources' (n = 70; 59.8%), 'enough workspace' (n = 61; 53.1%) and 'enough time' (n = 58; 50%). Fifty-eight (49.2%) respondents intend to adopt the innovation, but this intention would be higher when more time and money and technicians are available, as well as less situations that are experienced as barriers (rush hours, lack of support, illness of employees).Conclusion: Based on the definitions used, we conclude that the implementation of medication surveillance and drug therapy meetings is relatively low compared to patient education. The development of an implementation tool is justified, but should deal with the experienced preconditions, barriers and needs of pharmacists. Combined, comprehensive pharmacy interventions promise to be a good way to change pharmacy practice.

Prescribing of gastroprotective drugs among elderly NSAID users in the Netherlands

Abstract: Background: Use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of gastrointestinal toxicity, in particular when risk factors are present. Methods: A study was performed to investigate concomitant prescribing of gastroprotective agents (H2-receptor antagonists, proton pump inhibitors, or misoprostol) in an ambulatory cohort of NSAID users aged 65 years and over. The prevalence of concomitant prescribing was studied, as well as the prophylactic prescribing of gastroprotective drugs. A stepwise logistic regression was performed to determine predictive variables of prophylactic and concomitant gastroprotective drug prescribing.Results: Co-prescribing of gastroprotective drugs occurred in 1522 (23%) (of which 944 concerned prophylactic prescribing) of the NSAID users (n=6557), with an average duration of 67 days per 100 days of NSAID use.Co-prescribing of gastroprotective drugs varied among individual NSAIDs. Concomitant use of oral corticosteroids (ORadj 2.4; CI95 2.0-2.9), coumarins (ORadj 1.6; CI95 1.3-2.0), and low dose aspirin (ORadj 1.6; CI95 1.4-1.9) were significantly associated with both prophylactic and concomitant prescribing of gastroprotective agents during NSAID therapy. Discussion: Despite current guidelines recommending gastroprotective drug prescribing among high risk groups, the rate of concomitant prescribing of gastroprotective agents in NSAID users aged 65 years and over is low. Feedback to prescribers should be given to improve prescribing practices in this high risk group.

Pharmacoeconomic evaluation of a patient education letter aimed at reducing long-term prescribing of benzodiazepines.

Abstract: Objective: To determine the economic implications of sending an educational letter to patients, aimed at reducing long‐term BDZ prescribing.Method: Letters were sent to 242 patients from 2 general medical practices. BDZ usage and costs were compared in the years before and after intervention using numbers of defined daily dosages (DDDs) prescribed. The cost of intervention implementation was estimated using pharmacist, GP and administrative staff time, plus postage costs.Main outcome measures:Number of BDZ DDDs prescribed during the 12‐month periods before and after intervention. The cost implications of intervention.Results: Mean patient age was 67 years, 75% were female and the mean duration of BDZ usage was 19 years. A mean of 337 benzodiazepine DDDs per patient were prescribed during the baseline year. Overall BDZ usage at baseline was increasing by 13%. After receiving the letter, 31% of patients discussed BDZ usage with their GP and 10% had their drug or strength changed. During the year after intervention, a significant reduction of 17% in benzodiazepine usage was observed compared to baseline; 5% of patients ordered no more benzodiazepine prescriptions after receiving the letter.Mean BDZ costs reduced by £1.20 per patient after intervention. The cost of intervention implementation was £5.54 per patient, giving a net cost of £4.34 per patient, or £86.80 to obtain one BDZ discontinuation.Conclusion: This intervention is effective, simple, and inexpensive. Its minimal cost could be justified given the morbidity associated with the long‐term prescribing of benzodiazepines, particularly in the elderly.

Measuring the impact of medicines information services on patient care: methodological considerations

Abstract: INTRODUCTION: Medicines information services (MISs) aim to promote the safe, effective and economic use of medicines. Results from published studies suggest that they provide effective information, which in many cases results in improved patient outcome. However, there are several methodological issues that are important in the interpretation of such studies. AIM: To address methodological issues in the evaluation of MISs. OBJECTIVES: To carry out a critical appraisal of papers assessing the impact on patient outcome of passive information given to health care professionals, to identify the key methodological issues and to make recommendations for future research in Europe. METHODS: Literature search to identify relevant papers meeting the inclusion criteria, critical evaluation of the methods used. RESULTS: Most studies have been conducted in the United States. Various methodological considerations were identified: study design, sampling, data collection, choice of outcome measures, and validity. The results of each study are interpreted in view of the methods used. In addition, the implications of the methods selected on the validity, reliability and generalisability of the results are discussed. Finally, suggestions for future studies are provided, in order to maximise validity and reliability.

Patients' drug-information needs: a brief view on questions asked by telephone and on the internet

Abstract: Objective: To compare patient characteristics and types of questions from individuals who consulted a toll-free telephone number with individuals who consulted a free information site on the InternetMethod:Characteristics of all individuals and the questions they asked on both services in the month of February 2000 were analysed.Results:There were several differences between individuals who consulted both services. Individuals who asked questions through the Internet were younger and consisted of a relatively higher percentage of men than individuals who used the telephone. Conclusion: Different services can meet the needs of different patient groups.

Basing pharmacy counselling on the perspective of the angina pectoris patient

Abstract: Aim of the study: A participatory action research study design was developed and tested in 40 Danish internship pharmacies as part of a 3-year study supported by the Research Centre for Quality in Medicine Use. The aim of the study was to create a foundation for improving the quality of counselling practice in pharmacies by comparing the pharmacy staff's views on, knowledge of and behaviour towards a specific patient group with the knowledge, perceptions and medication use of the same patients. Method: Pharmacy students in their fourth year collected data for the study. In 1999, the students carried out 123 qualitative interviews with angina pectoris patients and collected 569 questionnaires from pharmacy staff in 40 internship pharmacies. Results: The results indicate that discrepancies exist between the patients' and pharmacy staff's perspectives on important issues such as knowledge about medicines (patients)/provision of information about medicines (pharmacy staff), experienced side effects (patients)/information about side effects (pharmacy staff), knowledge on prevention and lifestyle (patients)/information on lifestyle and prevention (pharmacy staff) and expectations of pharmacies (patients)/initiatives started in pharmacies (pharmacy staff). Conclusion: The study gives reason to believe that angina pectoris patients might benefit if pharmacies provided more information on the relationship between lifestyle factors and angina pectoris, the possible side effects of medicines and the function of medicines.

Desire for information about drugs: relationships with patients' characteristics and adverse effects.

Abstract: Introduction: Adverse effects of drugs are known to cause problems both in hospital and general practice settings, contributing to longer stays in a hospital, and increased costs of hospitalisation. By developing both a greater understanding of adverse drug reactions and effects and developing ways to reduce them will assist pharmacists in managing medicines more effectively. The aim of this study was to explore the relationships between patient characteristics, information requirements and perceptions about adverse drug effects to assist pharmacists in identifying patients most at risk of ADRs. Methods: The study took place on medical wards at a London teaching hospital during an eight week period in Autumn 2000. Patients were recruited using convenience sampling during the recruitment period. Once eligible patients consented to take part, standardised interviews were conducted at their bedside. The interviews included the use of the previously validated scale which measures the extent of information desired (EID), patient characteristics including age, gender, socio‐economic status etc and the presence of an adverse drug effect was assessed using the Naranjo algorithm. Patients were also asked semi‐structured questions to explore past and present experiences of adverse drug effects.Results: 82 patients were recruited, 80 were eligible for adverse effects of drugs assessment. Fifteen percent (12/80) of patients were assessed as having "definite" and "probable" adverse drug effects, based on the Naranjo algorithm. The previously validated EID scale was found to be both valid and reliable in this patient sample. There was an association between high scores on the EID scale and the presence of an adverse drug effect (chi‐squared = 4.97, p = 0.02). Conclusion: The results show an association between the occurrence of an adverse drug effect on admission (identified by the Naranjo scale), the experience of an adverse drug effect in the past and a patient's desire for information. The EID‐scale could be developed into a useful tool for assessing and addressing patients' drug information needs for pharmacists to use when assessing adverse drug effects in everyday practice.

Exploring the domains of appropriateness of drug therapy, using the nominal group technique

Abstract: Objective: To explore the domains encompassed within the assessment of the appropriateness of prescribing for an individual patient.Method: The Nominal Group Technique was used to address the question "How can we assess inappropriate drug therapy of individual patients that is responsive to pharmaceutical care?" The group participants were a self-selected group of nine pharmacists and one pharmacologist attending an international working conference on the Outcomes of Pharmaceutical Care. Item generation was followed by discussion for clarification and operationalisation. Voting achieved a consensus, defined as ≥70%, agreement on the importance of items for inclusion in an instrument to assess appropriateness.Results: Sixty-seven items were initially generated. During discussion, similar items were combined and items were grouped into domains. Items that considered the patient's perspective were commonly suggested, but many were discarded after discussing their operationalisation. Consensus was obtained that eighteen items, in seven domains, should be included in the instrument. The domains were indication and drug choice (5 items), effectiveness (2), risks and safety (2), dosage (3), interactions (1), practical use (4), and monitoring (1).Conclusion: It is hoped that, with adequate testing, these indicators of appropriateness of prescribing can be used by pharmacists to begin to routinely assess the impact of pharmaceutical care on the quality of prescribing for patients under their care.

Evaluation of human albumin use in a university hospital in Belgium

Abstract: In 1996 — 1997, a drug use evaluation )DUE) of human albumin was conducted in the Ghent University Hospital )Belgium) to determine the pattern and appropriateness of the albumin use. The DUE was followed by permanent review of the albumin consumption. This paper describes how the DUE was carried out and how the albumin use in our hospital changed over time.Method: The study was based on criteria for indications and end of treatment, accepted by consensus of the physicians prescribing albumin. Albumin treatment episodes were classified as appropriate or inappropriate according to these criteria.Results: For 115 treatment episodes in 90 patients, the researchers found 21 )18.3%) deviations from the developed criteria. After analysis, half out of them were considered as minor. Most deviations involved starting treatment too early )n = 17). Follow-up results indicated that the overall consumption of albumin dropped by 50.1% from 1994 to 1999, while the consumption of colloid solutions during the same period remained stable.Conclusion: A good compliance with internally developed criteria for indications and end of treatment with human albumin was observed. Discussion with the clinicians involved led to the development of stricter criteria and a continuous decrease in albumin consumption.

Analysis and quantification of prescribing and transcription errors in a paediatric oncology service

Abstract: Objective:To analyse and quantify the omission errors linked to physicians' prescribing and errors linked to nurses' transcription and to identify the type and frequency of factors associated. No pharmacological factors are taken into account.Design: Analysis of physicians' prescriptions and nurses' transcriptions in chemotherapeutic treatments (20 patient files) and non‐chemotherapeutic treatments (20 patient files) retrospective study.Setting:Paediatric onco‐haematology unit.Main outcome measures :categorisation of physicians' prescriptions as complete or incomplete, categorisation of the various nurses' transcriptions as correct or incorrect. Results: Physicians' prescriptions were complete for 61.6% of non‐chemotherapy treatments. As each prescription is transcribed twice, two nurses' transcription sheets are filled in by the nurses. At the first transcription 79.3% of non‐chemotherapy prescriptions and 88.2% of chemotherapy prescriptions were transcribed correctly, while in the second sheet these percentages were respectively 96.2% and 93.7%. Conclusions: Too many sheets of paper generate confusion and increase the risk of errors. The several transcriptions are, in both types of treatment, sources of errors. The problems identified in this study allowed us to open a discussion as how to improve the physicians prescriptions and the nurses' transcription sheets.

The lay user perspective on the quality of pharmaceuticals, drug therapy and pharmacy services--results of focus group discussions.

Abstract: Background: This article presents the results of a study on quality of pharmacy services and perceived risk of pharmaceuticals The results presented here are part of a multi-study evaluation of major changes in drug distribution in Iceland Objectives: This sub-study addressed the question: what is the lay user perspective on pharmaceuticals and pharmacy services, including their perception of risk? Methods: To answer this question, seven focus group discussions were conducted with pharmacy customers in different locations in Iceland following new drug distribution legislation in 1996Results: The lay perspective emphasizes a definite split between lay and expert views on the value and quality of pharmaceuticals, drug therapy and pharmacy services, as well as in their assessment of risk Participants voiced spontaneous criticism of the roles of both physicians and pharmacists in drug therapy; and expressed concern about the quality and safety of pharmaceuticals Some scope for shared values was noted between the legislative goals and the lay user perspective, despite the fact that the public was in no way involved in the drafting of the new legislation Conclusion: The results of this study raise questions about the nature and extent of the perceived gap between the medical and pharmacy professions on the one side and the lay public and health policy decision-makers on the other side in their views on the quality and safety of pharmaceuticals and pharmacy services

The validation of an existing method of scoring the severity of medication administration errors for use in Germany.

Abstract: Objective: The aim of this study was to assess the validity and reliability of an existing method of scoring the severity of medication administration errors, developed in the United Kingdom (UK), for use in Germany. Method: 10 doctors, 10 nurses, and 10 pharmacists from German hospitals were asked to score the potential clinical significance of 49 cases of medication administration errors on a visual analogue scale. Main outcome measure: Generalisability theory was used to determine the minimum number of judges required to obtain a reliable mean score. Validity was assessed by comparing the mean scores given by the judges to the known outcome of the errors for a subset of the cases. German results were compared to original UK data. Results: The scores of 27 judges could be used (nine from each profession). At least three health professionals, one from each profession, were required to achieve a generalisability coefficient of 0.86, indicating acceptable reliability. The mean scores were found to be valid indicators of the potential severity of the errors. German scores were significantly below UK scores for the same cases. Conclusion: The mean score calculated from scores given by one doctor, one nurse and one pharmacist from the population of German health professionals was a valid and reliable measure of the potential clinical significance of medication administration errors. That German health professionals see cases as less dangerous than their UK counterparts is worthy of further investigation.

Drug misuse and community pharmacy

Abstract: Part 1: Background. Opiate Addiction and the "British System:" Looking Back on the Twentieth Century and Trying to see its Shape in the Future. Drug Misuse and the Community Pharmacist: a Historical Overview. Part 2: Surveying the Situation. Reviewing the Situation - Pharmacists and Drug Misuse Services in England and Wales. Drug Misuse and Community Pharmacy in Scotland. Drug Misuse in Northern Ireland: the Role of the Community Pharmacist. Drug Users and Pharmacists: the Client Perspective. Part 3: Working with Drug Users. The History and Operation of Pharmacy Needle Exchanges. New Approaches to Dispensing Controlled Drugs: Supervised Consumption. Providing Health Care for Drug Users. Misuse "Over-the-Counter" Products. Part 4: Practical Matters - Training, Support and Shared Care. Legal and Ethical Considerations for Community Pharmacists. Training and Support for Pharmacists. Professional Conflicts for the Front-Line Community Pharmacist. Shared Care at the Primary and Secondary Interface: The Role of GPs and Specialist Drug Services. Part 5: The Way Forward. The Way Forward - Greater Specialism or More Generalism?

A qualitative study of the difficulties of smoking cessation; health care professionals' and smokers' points of view.

Abstract: Objective: To obtain a deeper understanding of smokers' feelings and to establish co-operative networking groups,the opinions about smoking cessation of health careprofessionals and smokers were studied.Design: Focus group discussions were held in order to gainideas and tools to be used in smoking cessation work, inparticular in network groups. Two focus group discussions forhealth care professionals (n = 7) and one focus groupdiscussion for ex-smokers/smokers (n = 3) were held.Results: The study suggests that problems exist in smokingcessation work among health care professionals. The mainissues among the health care professionals were lack ofmotivation and consistency of approach. Informationconcerning the health risk related to smoking no longerreaches people. New ways of health promotion are desired.Smokers feel that lack of positive support and nicotinedependence are the main problems in their attempts to quit.Conclusions: Society and smokers have the same goal:smoking cessation. However, both parties do not seem toagree on ways of achieving this goal. A local network amonghealth care professionals could motivate and give rise to newmethods of smoking cessation counselling. Positive supportand nicotine replacement therapy could significantlyimprove smokers' success rates. Trained personnel havebetter opportunities for meeting smokers and that is whycessation should be part of the core curriculum and basictraining for health care professionals.

Saquinavir soft-gel capsules (Fortovase) give lower exposure than expected, even after a high-fat breakfast.

Abstract: Background: The soft-gel capsule (sgc) of saquinavir has been developed in order to improve the poor oral bioavailability of the original hard-gel capsules. However, in a Dutch study population using saquinavir-sgc plasma levels were lower than expected. We hypothesised that this was caused by differences in the amount of fat in the meals of the study populations. Methods: 8-h steady-state plasma curves after observed ingestion of 1200 mg saquinavir-sgc were recorded, concomitantly with a normal breakfast (600 kcal, 33% fat) on the first day, and a high-fat breakfast (1040 kcal, 54% fat) on the second day. Additionally, a comparison was made between saquinavir hard-gel capsules and saquinavir-sgc with or without grapefruit juice (n=1). Furthermore, a comparison between saquinavir-sgc and ritonavir+saquinavir-sgc 400/400 mg bid was made (n=1). Results: Although saquinavir exposure was improved by fat, grapefruit juice or ritonavir, exposure to saquinavir for all recorded curves was lower than expected. A large proportion of trough concentrations was below the efficacy threshold.Conclusion: Intake of saquinavir-sgc with high-fat meals or grapefruit juice may improve the pharmacokinetic profile. However, plasma concentrations may then still be lower than expected and insufficient for good antiviral efficacy. Probably the only way to reach adequate saquinavir concentrations is by combining saquinavir with ritonavir.

The potential interaction between oral anticoagulants and acetaminophen in everyday practice

Abstract: Objective: The drug–drug interaction between oral anticoagulants (especially warfarin) and acetaminophen has been described, but evidence is conflicting and evidence for a similar interaction between acenocoumarol or phenprocoumon and acetaminophen is limited. Therefore, a study was performed to determine the influence of acetaminophen on oral anticoagulation with acenocoumarol or phenprocoumon in everyday practice.Method: Included were patients from two Dutch anticoagulant clinics who had used oral anticoagulants for at least three months and who started with acetaminophen (case group) or benzodiazepines (control group). Results: Fifty-four patients were included who had a first prescription of acetaminophen in their pharmacy record (during oral anticoagulant use) and twenty patients with a first prescription of a benzodiazepine (during oral anticoagulant use). The INR (International Normalized Ratio) difference before and after acetaminophen use was not statistically significant between the two groups and showed no dose dependency.Conclusion: These data do not demonstrate that acetaminophen, in the dosages used in everyday practice, has a clinically relevant influence on the INR in patients using acenocoumarol or phenprocoumon

Using the Internet to develop an international learning community of pharmacists.

Abstract: Until recent years, the level of interaction across a profession, necessary to provide for an optimum learning environment which supports professional development, has only been significantly possible in face-to-face interaction and has therefore been place and time dependent. With the explosive development of the internet, communication barriers are breaking down and international interaction, networking and collaboration is becoming increasingly possible. This short report describes the manner in which an Internet-based postgraduate study programme, entitled "Enhancing Pharmacy Practice" has made use of these communication opportunities to develop an international learning community of pharmacists. Programme evaluation data collected from surveys completed online by participants and content analysis of online discussion groups during the first four modules of the programme, demonstrates that there is a high level of interaction amongst participants. It also suggests that this interaction has contributed to the learning experience and professional growth of the participants and impacted positively upon their practice.

Pharmaceutical care research: hard or soft?--Part II.

Abstract: In pharmaceutical care research (PCR) quantitative research methodologies are strongly represented. However, in PCR also other qualities should be included in the tool kit of the researcher. For that purpose, it is argued that social science provides rich frameworks applicable for PCR. It offers both quantitative and qualitative methodological frameworks. In the most challenging and powerful field work the two approaches are combined. The case study design is a framework to synthesise quantitative and qualitative research approaches. For the development of PCR the case study design may be an important addition to the tool kit of its researchers.

Anti-asthmatic drugs dosage forms in children: a cross-sectional study

Abstract: Objective: To describe the choice of drugs as well as the dosage forms of anti-asthmatic drugs in children with regard to different age groups. Methods: Cross-sectional study based on computerized pharmacy dispensing records of 1999 for children aged 0-16 years in the north of the Netherlands. All children were selected and divided in the following age groups: 0-1, 2-5, 6-11 and 12-16-year-olds. Results: Inhaled beta2-agonists and inhaled corticosteroids were the most widely used anti-asthmatic drugs in all age groups (respectively 59 and 58 users per 100 anti-asthmatic using 0-16 year-olds). Cromones were rarely used. Up to four years of age the use of treatment with aerosol inhalers increased simultaneously with a decrease of oral dosage forms. The use of dry powder inhalers started at the age of approximately 4 years old and increased to about 85% of the users at the age of 11, with the strongest increase around the age of 6 and 7. Conclusion: The choice of drugs and dosage forms corresponds with what might be expected based on guidelines for the treatment of asthma in children, except for the high use of deptropine in the youngest age group. Anti-asthmatic drugs for preventive treatment are used so frequently without beta2-agonists that questions about possible overtreatment need to be raised.

Recommended structure for reporting economic evaluation on pharmaceuticals in Belgium

Abstract: Pharmaco‐economic evaluations become more important for the reimbursement of pharmaceuticals, and will be obligatory for new pharmaceutical drugs for which an added therapeutic value is claimed and a price premium is proposed by the manufacturer Therefore, it is important to guide purchasers and providers of pharmaceutical care in their efforts related to the evaluation process Standard Report Format can support the quality, transparency and exhaustiveness of the data submitted A multidisciplinary task force developed a Standard Report Format for pharmaco‐economic evaluations in Belgium