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Objective: Adverse reactions are sometimes induced by contrast media used for medical imaging and can be life-threatening. Thus, appropriate management is important for patient safety. The purpose of this study was to clarify the actual management of adverse reactions induced by contrast media in hospitals, the opportunities for intervention by hospital pharmacy departments and the attitudes of hospital pharmacists regarding the risk of adverse reactions.Methods: A self-administered questionnaire survey was conducted in the pharmacy departments of 16 hospitals (approximately 200 to 1,000 beds) located in the Tokyo metropolitan area of Japan. The survey asked about the presence or absence of internal rules or manuals regarding contrast media administration at each hospital, the management status of patients with risk factors for adverse reactions, the opportunities for interventions by pharmacists, and the opportunities for discussion regarding contrast media administration among pharmacists and other professionals.Results: Of the 16 hospitals, 10 responded to the questionnaires, and 7 of them had internal rules or manuals. These rules or manuals stipulated actions such as “do not administer contrast media” to patients with risk factor(s) for adverse reactions. For inpatients, there were opportunities for pharmacist interventions, such as drug management and guidance services and initial interviews upon hospital admission. However, for outpatients the opportunities for interventions were limited. At 5 of the 10 hospitals, pharmacists discussed contrast administration with physicians, radiologists, and other healthcare professionals.Conclusion: The present study reveal that many hospitals take great care in deciding on the administration of contrast media to patients at risk of adverse drug reactions. Our results indicate that the limited opportunities for “outpatient intervention" is an issue in the hospital pharmacy department's participation for proper use of contrast media.
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Clinical pharmacy practice in Vietnam is unregulated by standard procedures, thus motivating this study, whichdeveloped and validated a tool called Vi-Med® for use in supporting medication review (MR) in Vietnamese hospitals.Six clinical pharmacists from six hospitals used the tool, which comprises three forms: Form 1 for the collectionof patient information, Form 2 for the implementation of MR, and Form 3 for the documentation of pharmacistinterventions (PIs). The tool also comes with eight pre-identified drug-related problems (DRPs) and seven PIs.The pharmacists were asked to categorize 30 PI-associated scenarios under appropriate DRPs and correspondinginterventions. Concordance among the pharmacists was assessed on the basis of agreement level (%) and Cohen’skappa (κ). We also evaluated the user-friendliness of the tool using a four-point Likert scale. Concordance in thepanel with respect to DRPs and PIs was substantial (κ = 0.76 and 80.4% agreement) and almost perfect (κ = 0.83 and87.6% agreement), respectively. All the experts were satisfied with the structure and content of Vi-Med®. Five of themevaluated the tool as very suitable, very useful, and definitely fitting for everyday use. Vi-Med® satisfactorily achievedconsistency and user-friendliness, enabling its use in daily clinical pharmacy practice.
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@#Introduction: In Malaysia, Diabetes Medication Therapy Adherence Clinic (DMTAC) in hospital settings significantly improved patients' glycaemic control and cardiovascular risk. Until now no randomised controlled trial of DMTAC has been done in a primary care setting where the access to subspecialist services (endocrinologists, expensive medication, etc.) is limited. The objective of this research is to compare the glycaemic control among diabetes mellitus (DM) patients between those received additional DMTAC service and those received normal clinic service in primary care settings. Materials and Method: This was a parallel, randomised controlled study. The selected participants were patients aged 18 to 70 years with type 2 DM on diabetic medication who were being treated in Kota Samarahan Health Clinic with HbA1c above 8% and who never attended any education of DM prior to the study. The control group received normal clinic visits with consultations by a medical officer. The intervention group received four or more DMTAC visits in addition to normal clinic visits. The primary outcomes were HbA1c while the secondary outcomes were the occurrence of severe hypoglycaemia, weight gain and medication compliance of patients. The subjects were randomised by numbered envelope opened chronologically by the investigator during the initial assessment. All health care professionals (nurse, lab staff and medical officer) except DMTAC pharmacist managing the subjects were blinded as there were no markings on the patients notes indicating that they were in this study. The demographic data was collected during screening while health data including glycated haemoglobin (HbA1c) levels were collected at baseline, sixth month and one year. Results: In all, 100 patients were randomised into control and intervention groups (n=50 per arm). The change of HbA1c in the intervention group (mean=-1.58) was significantly more than the control group (mean=-0.48) at 12 months with a mean difference of -1.10% (p=0.005, Cohen's d=0.627). Both study groups had similar significant changes of subjects from non-compliance to compliance (control group, n=11 vs. intervention group, n=10). The changes of BMI after 12 months between control group (0.24 kg/m2 ) and intervention group (0.24 kg/m2 ) was not significant (p=0.910). There were no episodes of severe hypoglycaemia detected in both groups. Conclusion: The addition of DMTAC service in primary care can improve glycaemic control among patients. The study was registered in the National Medical Research Register (Malaysia): NMRR-13-1449-18955 FUNDING: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. All blood test was done in our setting.
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BACKGROUND AND OBJECTIVE: Since the introduction of hospital pharmacy residency programs in 1983, hospital pharmacists in South Korea have been expected to expand their roles. However, their services and the outcomes have not been fully understood. In this study, we conducted a systematic review of Korean hospital pharmacist-provided interventions with regard to intervention type, intervention consequences, and target patient groups. METHODS: A literature search of the following databases was performed: Embase, PubMed, Medline, KoreaMed, RISS, KMbase, KISS, NDSL, and KISTI. The search words were “hospital pharmacist”, “clinical pharmacist”, and “Korea”. Articles reporting clinical or economic outcome measures that resulted from hospital pharmacist interventions were considered. Numeric measures for the acceptance rate of pharmacist recommendations were subjected to meta-analysis. RESULTS: Of the 1,683 articles searched, 44 met the inclusion selection criteria. Most articles were published after 2000 (81.8%) and focused on clinical outcomes. Economic outcomes had been published since 2011. The interventions were classified as patient education, multidisciplinary team work, medication assessment, and guideline development. The outcome measures were physicians’ prescription changes, clinical outcomes, patient adherence, economic outcomes, and quality of life. The acceptance rate was 80.5% (p < 0.005). CONCLUSION: Studies on pharmacist interventions have increased and showed increased patient health benefits and reduced medical costs at Korean hospital sites. Because pharmacists' professional competency would be recognized if the economic outcomes of their work were confirmed and justified, studies on their clinical performance should also include their economic impact.
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Humans , Insurance Benefits , Korea , Outcome Assessment, Health Care , Patient Compliance , Patient Education as Topic , Patient Selection , Pharmacists , Pharmacy Residencies , Prescriptions , Quality of LifeABSTRACT
OBJECTIVE: To evaluate the effect of pharmacists' interventions in the management of chronic kidney disease. METHODS: CENTRAL, MEDLINE OVID SP, EMBASE OVID SP, CNKI and Wanfang Data were searched for studies regarding pharmacists' interventions in CKD patients. Methodological quality of RCTs included was assessed using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS: Twenty - seven studies were included. Among them there were 13 RCTs, 8 quasi-randomized controlled trials, 5 cohort studies and 1 economic study. Only 1 of the included RCTs presented a low risk of bias, while the rest were all with unknown risk. The results showed that pharmacists' interventions significantly reduced the rates of ESRD and all-cause death, decreased the number of transplant rejections and adverse reactions, while improving the standard rate of drug concentrations. Pharmacists' interventions made patients' serum creatinine, blood pressure, lipids, glucose and phosphate level under control, at the same time they played a positive role in the management of secondary hyperparathyroidism and anemia. In addition, pharmacists' interventions significantly improved patients' quality of life, as well as their medication compliance and knowledge. They also saved much money for institutions and patients. CONCLUSION: Pharmacists' participation seems to have a positive impact on the control of diseases, the enhancement of life quality, the improvement of medication compliance and knowledge, and the alleviation of financial burden. However, high-quality clinical evidence is still needed to assess the degree of this impact.
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Hypertension is poorly managed in Egypt due to low rates of awareness about the disease. The aim of this study was to describe the role of the pharmacist as a health care provider and the implementation of a pharmaceutical care model to improve medications adherence, BP control, knowledge and quality of life (QOL) in a sample of Egyptian patients suffering from hypertension. A total of 280 hypertensive adults, whether their BP was controlled or not, were enrolled in the study and randomly classified into either control group (CG) or intervention group (IG); both received the usual hospital care and kept on their antihypertensive. Patients in the IG, beside the usual hospital care, received a pharmaceutical care program described in the methods. All patients visited the clinic monthly up to three months for check and evaluation. Significant improvements were observed in the studied parameters for the IG compared with the CG, at the end of the study, although there was no significant difference (P > 0.05) between them in demographics and characteristics at the baseline. At the end of the study, a significant lower SBP (-8.2 mmHg, P = 0.003) and DBP (-5.4 mmHg, P = 0.001) levels were observed in the IG with significantly higher BP control (P=0.018). Also, medication adherence was significantly higher (P = 0.002) in the IG (27.2%, 52.8%, 20.0% vs 48.6%, 33.6%, 17.8% for low, intermediate and high adherence, respectively). Similarly, patients’ knowledge, attitude and practice were significantly improved (P = 0.001) in IG ((20.5+1.8), (4.7+1.0), (4.7+1.0), respectively) vs ((13.7+7.2), (3.8+1.8), (2.9+2.0), respectively) for the CG. While end of study QOL for the IG, increased significantly compared with the CG (P = 0.001, 0.001, 0.020, 0.010 and 0.016 for patients’ rate of QOL, enjoy, energy, sleep and access to health system, respectively), most of QOL dimensions were decreased significantly from their baseline in the CG. Conclusion: Pharmacist intervention can significantly improve BP control, medication adherence, patients’ knowledge, attitude, practice and QOL in hypertensive Egyptian patients treated with antihypertensive agents.
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<b>Purpose:</b> This study aimed to evaluate the effect of continuous patient education on pain control in outpatients based on changes in pain intensity scores and occurrence of opioid-related adverse effects. <b>Methods:</b> The education intervention was conducted in the following phases; 1) interview at the first visit for opioid introduction, 2) telephone follow-up at home 3 to 7 days after introducing opioid analgesics, and 3) interview at the next visit. Pain intensity scores; frequency of rescue dose; and occurrence of adverse opioid-related effects such as constipation, nausea, and drowsiness were compared among the three intervention phases. <b>Results:</b> When comparing data at phase 2 and 3 with those at phase 1, daily maximum pain score decreased significantly, frequency of rescue dose and opioid dosage increased significantly, and occurrence rates of constipation decreased. <b>Conclusion:</b> Continuous patient education by pharmacist intervention based on not only patient visit interviews but also telephone communication on non-visiting days can improve the pain intensity scores and reduce the rate of opioid-related adverse effects for cancer outpatients.
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The purpose of the work was to evaluate the extent of interception of prescriptions requiring review for drug order that could have led to adverse drug events or irrational drug use in the community and public hospital pharmacy unit. Three government hospitals and community pharmacy outlets in Ikot Ekpene senatorial district in Akwa Ibom state, Nigeria were selected for the study which lasted 4 months. The pharmacists in the various units were inducted into the purpose of the work and the associated documentation processes. The data collected were patient’s details, reasons for the intervention, doctor’s contact details. The years of experience of the pharmacists in the community was significantly higher than those in the hospital setting in the study (P<0.05). Within the study period, 698 and 1280 interventions were noted in the community and hospital units respectively. The prevalence of pharmacists intervention in terms of ratio of prescriptions generated and interventions made in the hospital was not significantly higher than in the community setting (P<0.05). There was no significant difference in the ratio of therapy/information to safety intervention for the two units of practice but there was significant difference in the frequency of safety to therapy/information intervention within the individual units (P<0.05).The percentage frequency of the safety interventions recorded in the hospital and community pharmacy units were thirty two percent (32) and thirty eight percent (38%) respectively. Active screening of prescriptions that leads to effective pharmaceutical interventions during dispensing process can provide useful contribution to healthcare delivery.
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O objetivo deste trabalho foi fornecer o serviço de Atenção Farmacêutica e acompanhamento farmacoterapêutico a hipertensos usuários da Farmácia Popular de Alfenas-MG, avaliando seu impacto no controle da pressão arterial. Este trabalho foi desenvolvido com pacientes de ambos os sexos com faixa etária entre 40 ? 70 anos ou mais, usuários da Farmácia Popular de Alfenas-MG. Foram selecionados a esmo 27 pacientes que foram alocados em grupo controle (GC) (n= 12) e teste (GT) (n=15). O método de Acompanhamento Farmacoterapêutico utilizado foi o Programa Dáder. Os pacientes do grupo controle tiveram sua pressão arterial aferida periodicamente, mas sem receber as intervenções farmacêuticas. O grupo teste recebeu o acompanhamento farmacoterapêutico por 12 meses. Os dados foram analisados quanto à distribuição normal (Shapiro Wilk) e uma vez confirmada a normalidade, foi realizado o teste ?t? de Student para avaliar a significância dos dados obtidos. No início a média das pressões do grupo controle era 143,3 mmHg (sistólica) e 75,83 mmHg (diastólica) reduzindo para 137,5 mmHg (p=0,0945) e 75,83 mmHg (p=0,5) ao final do estudo. A média das pressões do GT ao final do acompanhamento teve uma redução de 19 mmHg (sistólica) (p<0,0001) e 12,67 mmHg (diastólica) (p<0,0001). A redução da pressão sistólica do GT foi maior que a do GC (p=0,0244).
The purpose of this study was to provide the service of Pharmaceutical Care and pharmacotherapeutic follow-up to hypertensive patients who attend the Popular Pharmacy of the city of Alfenas, in Minas Gerais- Brazil, through the assessment of its impact on arterial pressure control. The present study was conducted with patients of both sexes aged between 40 and 70 years and above, who attend at the Popular Pharmacy of Alfenas, Minas Gerais. So it was selected 27 patients and they were allocated to control groups (CG) (n= 12) and test groups (TG) (n=15). The pharmacotherapeutic follow-up used was the Dáder Program. The patients in the control group had their arterial pressure periodically measured but they did not receive pharmaceutical care. The test group received pharmacotherapeutic follow-up for 12 months. The data were analyzed as to normal distribution (Shapiro Wilk) and when its normality was confirmed, it was performed the test ?t? of Student to assess the significance of the obtained data. In the beginning, the average arterial pressure of patients in the control group was 143.3 mmHg (systolic) and 75.83 mmHg, which was reduced to 137.5 mmHg (p=0.0945) and 75.83 mmHg (p=0.5) at the end of the study. The average arterial pressure of patients in the test group (TG) at the end of follow-up was reduced in 19 mmHg (systolic) (p<0.0001) and 12.67 mmHg (diastolic) (p<0.0001). The reduction in the systolic pressure of the TG was higher than that of the CG (p=0.0244).