Long-Term Care medicines formularies: any reasons for pharmacists' concern?

Abstract This study aimed to characterize and compare medicines formularies (MFs) used in Long-Term Care (LTC) facilities in Portugal, and to identify the prevalence of Potentially Inappropriate Medicines (PIMs). A systematic contact with LTC facilities was undertaken in December 2021. MFs were systematized according to the Anatomical Therapeutical Chemical classification system (ATC), followed by descriptive content analysis. A structured comparison between MFs developed by public organizations and private LTC facilities was performed. After duplicate removal and exclusion of medicines not for systemic use, two explicit criteria - the Algorithm of medication review in frail older people and the EU(7)-PIM list - were employed for PIMs identification. Five MFs were obtained and assessed. The three MFs developed by private institutions covered 23% of the national LTC facilities and approximately 34% of the national total of beds. Heterogeneity was particularly high for the Alimentary tract and metabolism, Blood and blood-forming organs, Musculoskeletal system, and Respiratory system ATC groups. A PIM prevalence of 29,4% was identified. Medicines distribution between the MFs suggests the need to develop national guidelines towards harmonizing medicines usage in LTC. The prevalence of PIMs found highlights the importance of a particular optimized use of this health technology in aged sub-populations

Development of the modified medication regimen complexity index of Chinese version(mMRCI-C)and its validation in elderly diabetic patients / 中华全科医师杂志

Objective:To develop the modified medication regimen complexity index of Chinese version (mMRCI-C)and test its reliability and validity.Method:The Chinese version of MRCI was developed by modification,translation and back translation. The MRCI was interculturally adapted by 2-rounds of expert consultation and pilot study to ensure the semantics, content and conceptual equivalence. The validation of the mMRCI-C scale was tested among 420 community-dwelling elderly patients with type 2 diabetes mellitus(T2DM) in Shanghai Changfeng Community Health Service Center from October to December 2020. SPSS 23.0 was used to analyze the reliability and validity of the scale.Results:The mMRCI-C scale included 3 dimensions, namely drug dosage form (14 entries), medication frequency (5 entries), and additional instructions (6 entries), with a total of 25 entries. Among 420 valid questionnaires collected,the respondents were 212 males (50.4%) and 208 females (49.6%) with a mean age of (71.4±8.1) years. The test-retest reliability was 0.999 and internal consistency reliability was 0.849. The content validity exceeded 0.80,the convergent validity was 0.932; and discriminant validity P<0.001. Conclusion:The preliminary testing results show that the reliability and validity of the mMRCI-C scale are satisfactory.

Research on Development of Preparations in Traditional Chinese Medicine Classics During the Han,Tang and Song Dynasties / 中国实验方剂学杂志

This paper compared and analyzed the relevant records of Chinese medicine pharmacy in the Han,Tang and Song dynasties,and summarized the changes of the dosage forms,preparation techniques and administration methods of Chinese medicine with the development of history.In this study,three classic medical works in the Han,Tang and Song dynasties,including Treatise on Febrile Diseases Caused by Cold,Valuable Prescriptions for Emergency and Formularies of the Bureau of People's Welfare Pharmacies,were taken as the research objects,and the development of the dosage forms,auxiliary materials,preparation technology and medication theory were summarized and explored by the ways of content analysis,comparative analysis and case analysis.The comparison showed that in the development process,the dosage forms gradually increased,but the liquid dosage forms gradually decreased,the solid dosage forms gradually increased.Not only the dosage forms varied in the number,types of excipients used more and more,but the level of preparation had been constantly improved while the methods of taking became more detailed.This evolution of dosage forms and pharmaceutical technologies in Chinese history is worth learning and thinking about it.Through exploring the traditional Chinese medicine(TCM) technologies and theories in the Han,Tang and Song dynasties,we can contribute to the inheritance of traditional preparations and it can provide the basis for the development of modern preparations with TCM characteristics.

Drugs dispensed at the Division of Neonatology at University Hospital in Río Cuarto, Córdoba, Argentina / Medicamentos dispensados al Servicio de Neonatología de un hospital de Río Cuarto, Córdoba

Introduction. The objective was to analyze the number of drugs dispensed by the Pharmacy Department to the Neonatology Division, to find out if the use of these drugs is described on the package insert approved by the Administración Nacional de Medicamentos, Alimentos y Tecnología, ANMAT (Drug, Food and Technology Administration of Argentina) and to compare such information with that provided by Medical Associations and Commissions. Population and methods. Analytical, observational and retrospective study in which drugs were analyzed based on dosage units, costs and relevance in the 2011 annual budget. We analyzed the information found in ANMAT-approved label inserts, in the Neonatal Pharmacopeia of the Sociedad Argentina de Pediatría and in the Formularies of the Confederación Médica Argentina and the Comisión Nacional del Medicamento (National Medication Commission). Results. A total of 102 drugs (91 drug substances) were dispensed throughout 2011. Drugs most commonly supplied were: antiinfective agents for systemic use (24.51%), agents for the blood and blood forming organs, cardiovascular system, and nervous system (12.72% each). The total expenditure was ARS 263,285.52. Only 21 drugs accounted for 90.73% of the cost. Out of the 14 drugs in this group, only 1 had information related to its use in neonatology in all its labels (package inserts), only 4 in some of their product information and there was no information at all in any of the remaining 9 drugs. The Neonatal Pharmacopeia reported on 12 of the 14 drugs, while the Formularies made a reference to 9 of the 14 drugs. Conclusions. The most widely used drugs were antiinfectives for systemic use. A total of 21 drugs accounted for 90.73% of the annual cost in drugs. Out of 14, only 1 had information of its use in neonatology in all its labels and 9 corresponded to off-label use.

Introducción. El objetivo de este trabajo fue analizar la cantidad de medicamentos dispensados por el Servicio de Farmacia al Servicio de Neonatología, indagar si el uso de estos medicamentos en neonatología está descrito en los prospectos autorizados por la Administración Nacional de Medicamentos, Alimentos, y Tecnología Médica (ANMAT) y comparar esa información con la brindada por Sociedades y Comisiones Médicas. Población y métodos. Estudio analítico, observacional y retrospectivo, en que se analizaron los fármacos en unidades posológicas, costos e importancia en el presupuesto anual 2011. Se analizó la información contenida en los prospectos aprobados por la ANMAT, en el Vademécum Neonatal de la Sociedad Argentina de Pediatría y en los Formularios de la Confederación Médica Argentina y de la Comisión Nacional del Medicamento. Resultados. Durante 2011 se dispensaron 102 medicamentos (91 fármacos). Los suministrados con más frecuencia fueron: antiinfecciosos de uso sistémico (24,51%), medicamentos para sangre y órganos hematopoyéticos, sistema cardiovascular y sistema nervioso (12,72% cada uno). El gasto total fue de 263 285,52 pesos. Sólo 21 medicamentos representaron el 90,73% del costo. De 14 medicamentos de este grupo, 1 tenía información sobre neonatología en todos sus prospectos, 4 solo en alguna de sus presentaciones y en 9 no se mencionaba. El Vademécum Neonatal informaba sobre 12/14 medicamentos, mientras que los Formularios contenían 9/14. Conclusiones. Los medicamentos más usados fueron los antiinfecciosos sistémicos. Veintiún medicamentos representaron el 90,73% del costo anual en fármacos. De 14 de ellos, solo 1 tenía información en todos los prospectos para su uso en neonatología y 9 se utilizaron sin licencia.

Es el consentimiento informado, suficientemente informado / Is informed consent sufficient information

Objetivo: describir las características principales del consentimiento informado y establecer en qué medida se explicitan los riesgos involucrados en las acciones por realizar. Método: de 18 instituciones de atención de salud pública y privada se obtuvo un conjunto no aleatorio de formatos que tales instituciones emplean para obtener el consentimiento informado de los pacientes. Resultados: se lograron reunir 190 formatos distintos para el fin perseguido. A grandes rasgos se podían clasificar en 151 (79,4 por ciento documentos que proporcionaban una autorización amplia y 39 (20,5 por ciento) estructurados para un fin especifico, usualmente enunciado en el titulo del formulario. Ningún documento cuantificaba riesgos. Comentario: el primer grupo de formularios es el que presenta aspectos más cuestionables, por otorgar autorización amplia para tratamientos médicos, quirúrgicos y anestesia en términos muy generales de suerte que el enfermo difícilmente podría opinar sobre el asunto. Con el segundo tipo encontrado la situación no cambio demasiado. En ambos se enfatiza que el enfermo está enterado de los riesgos a los que será sometido aunque la expresión de estos fue vaga. Conclusiones: es indispensable introducir modificaciones a la información que se entrega en muchos de los documentos que buscan obtener el consentimiento de los enfermos para que efectivamente constituya una aceptación informada. No basta con un simple listado o enumeración de los posibles efectos adversos o complicaciones involucrados.

Objective: to describe the main aspects considered in documents in use designed to obtain informed consent of patients and if they point out the risks involved in a Quantified way. Method: a non-random sample in18 institutions providing public and private health services was obtained of the documents in use to get the informed consent of patients. Results: 190 different documents were obtained. These could be classified as follows: 151 (79.4 percent) providing authorization in a general fashion for medical and surgical procedures including anesthesia and 39 (20.5 percent) informing the name of the specific procedure and emphasizing that the patient was aware of the risks involved. none giving numbers. Comment: the first group of documents offers the patient the situation in such a general way that he/she can hardly express a clear opinion on the presented issue. The situation remains about the same in the second group, always pointing out that the patient is perfectly aware of the risks he should assume. Conclusions: it is an absolute requirement to inform the patient de specific probabilities of each risk involved in the procedure he is about to consent. Clearly is not enough with a simple list of possible adverse outcomes.