RESUMO
Despite the scientific evidence of reducing cardiac events with HMG Co-A reductase inhibitors [statins] therapy in both primary and secondary preventions, these therapies continue to be underutilized in patients receiving convictional care. Simvastatin, a HMG Co-A inhibitor agent, is the most commonly used statin in Sultan Qaboos University Hospital. The aim of this study is to review the safety and the effectiveness of achieving LDL-C targets with Simvastatin according to the NCEP-ATP3 guidelines in patients with different cardiovascular risk categories at Sultan Qaboos University Hospital. A retrospective chart review was conducted for 160 patients. Patients were identified by outpatient prescriptions provided by pharmacy department from April 2008 to May 2008. 98% of the patients were prescribed simvastatin 20 mg and only 2% received 40 mg. The mean age of patients was 57 years +/- 12. While 49% of the patients were male and 45% had diabetes mellitus, 50% had cardiovascular disease, 2.5% were smokers, 67% were hypertensive, and 3% had positive family history of coronary artery disease. 75% of patients were classified as high risk, 7% moderate risk and 18% low risk for coronary artery disease. Among all lipid profiles, only LDL-C was changed from baseline with simvastatin treatment in all patients [3.60 +/- 1.03 to 3.25 +/- 1.34 mmol/L]. LDL-C level at baseline was higher in the high risk group [4.11 +/- 1.06 mmol/L] compared to low and moderate risk groups [3.68 +/- 0.89, 3.42 +/- 1.15] respectively. Achievement of LDL-C goals was achieved in only 43% for high risk, 50% in moderate risk, and 90% in low risk patients. There was no significant increase in liver enzymes and creatinine kinase. This study identified that more than half of the high risk patients were not at the target LDL-C goals which place them at a continuous risk of coronary heart disease. More appropriate lipid lowering therapy using more potent statins or combination therapy should be optimized to improve achievement of LDL-C goals according to ATP-III guidelines
RESUMO
Frequent physician visits, improper therapeutic adherence and treatment modification after hospitalisation could result in unused medicine accumulating at home. This study aims to examine the value and types of medicines returned by patients at a tertiary care unit in Oman. All medicines voluntarily returned to Sultan Qaboos University Hospital main pharmacy between February and June 2003 were reviewed. The cost of these medicines and potential cost saving, if some were returned to the hospital distribution cycle, were computed. A method of determining by physical observation whether they can be recycled was developed based on institutional-based guidelines and criteria. Three hundred and eighty one patients returned their medicines [69% female]. The patients returned a total of 1071 drugs [mean per patient 3.1 per month] corresponding to a total cost of Omani Rials [OR] 20, 140 [mean per patient OR 10.6] [1 OR = 2.58 US dollar]. Potential cost saving was OR 5, 550 [mean per patient OR 2.9]. Medicines of the cardiovascular group were returned in greatest number [24%] while anti-infective drugs had the highest share of the total cost [61%]. The study identified values and types of medicines returned by patients at tertiary care unit in Oman. Medications used for cardiovascular and infectious diseases appeared as the most frequent and the most expensive returned medicines. It suggests that health care providers in Oman should devise health education programmes to improve proper utilization of medicine