Pilot evaluation of home delivery programme in haemophilia.

WHAT IS KNOWN AND OBJECTIVES: Most of the clotting factor (CF) dispensations to haemophiliac patients are centralized in a few haemophilia treatment centres, necessitating frequent visits and long travel distances. The aim was to evaluate the home delivery programme developed by the Outpatient Pharmaceutical Care Unit (OPCU) through the association of patients (ASHECOVA). METHODS: A specific software programme was designed to communicate the individual CF requirements. Dispensations were prepared in advance, and an ASHECOVA member collected and delivered to patients' homes in optimal conditions. Data regarding the programme were analysed from December 2011 to December 2017. An electronic satisfaction survey with 34 questions was conducted, asking about organizational aspects, education and communication, use of apps and satisfaction level. RESULTS AND DISCUSSION: Forty-nine patients were included and 2464 home deliveries were made, without any reported incident related to dispensation errors, drug preservation, communication or confidentiality problems. This system avoids 11.4 annual dispensation visits per patient to OCPU, and a mean travel distance, time and cost of 1189.1 km, 945.3 minutes and 373.5 euros, respectively. Overall satisfaction with home delivery was 9.7, without any change suggested in the current system. Ninety-five per cent of individuals believed that the programme improves adherence and all patients would recommend it to other patients. The most common benefits reported were less frequent visits to hospital, reducing time and cost spent on transportation. WHAT IS NEW AND CONCLUSION: The home delivery programme guarantees a proper follow-up of treatments with full patient satisfaction. This programme allows OPCU to achieve better pharmaceutical care, traceability of the process and optimization of working times and CF stock management.

Aflibercept in exudative age related macular degeneration refractory to ranibizumab.

PURPOSE: The aim of this study is to determine the effectiveness, safety and cost of aflibercept in the treatment of wet age-related macular degeneration (ARMD) refractory to ranibizumab. METHODS: Retrospective observational study was conducted on patients diagnosed with wet ARMD, and previously treated with ranibizumab. Efficacy variables assessed were changes in visual acuity (BCVA) and anatomical improvements in the most affected eye. Factors associated with improvement of BCVA with aflibercept were also studied. Adverse events related to the aflibercept administration were recorded. Cost analysis data were collected from the hospital perspective, and only taking the direct medical costs into account. Cost-effectiveness analysis was calculated using the aflibercept treatment cost, and effectiveness calculated as BCVA gained. RESULTS: A total of 50 eyes corresponding to 46 patients were included. The median follow-up period was 4.6 months (range: 1.0-6.0). Improvement in visual acuity after the first 2 doses and at the end of the follow-up period was observed in 32.0 and 28.0% of treated eyes, respectively. None of the variables studied was associated with an improvement in the BCVA after treatment. No significant differences were found in the average monthly cost between treatments. CONCLUSIONS: Aflibercept is shown to be an effective treatment in a significant number of patients resistant to treatment with ranibizumab, presenting a cost similar to that generated during the final stages of treatment with ranibizumab.

La cadena del frío de los medicamentostermolábiles en el domicilio del paciente / Cold chain for the storage of heat-labile drugs in the home

Objetivo: Valorar, de forma preliminar, las condiciones de conservación de los medicamentos termolábiles dispensados a pacientes externos, con el fin de ampliar el control de la cadena de frío al ámbito domiciliario. Métodos: El Servicio de Farmacia ofrece a los pacientes la posibilidad de validar la capacidad de la correcta conservación domiciliaria de los medicamentos termolábiles que le son dispensados. El procedimiento permite registrar la temperatura de conservación durante el transporte y en el frigorífico del paciente. A tal fin se utilizan tarjetas registradoras VarioSens(R), que se colocan en la parte externa del material de acondicionamiento del medicamento y que son programadas para hacer registros de temperatura cada 10 minutos, si ésta se encuentra fuera del rango 2-8 ºC. Resultados: En ninguno de los casos (n= 36) se mantuvo la temperatura dentro del rango establecido durante todo el periodo registrado. La temperatura media durante el transporte fue de 21,3 ± 7,0 ºC, alcanzándose más de 25 ºC en el 50% de los casos. La temperatura media de las neveras fue de 8,4 ± 3,7 ºC. En 18 casos sus temperaturas medias estaban dentro del intervalo establecido, en 16 por encima de 8 ºC y en 2 casos estuvieron por debajo de 2 ºC. Conclusiones: Los resultados obtenidos indican que hay que desarrollar medidas para mejorar las condiciones de conservación de los medicamentos termolábiles en el domicilio de los pacientes ambulatorios, para poder garantizar la efectividad terapéutica de éstos. Las nuevas tecnologías permiten ampliar el control de la cadena del frío hasta la administración del medicamento (AU)

Objective: A preliminary evaluation of the conditions in which the heat-labile drugs provided to outpatients are stored, in the attempt to extend the control of the cold chain to the home setting. Methods: The Pharmacy Service offers patients the possibility of validating the proper storage of the heat-labile drugs provided to them in their homes. The procedure makes it possible to record the storage temperature during transport and in the patient's refrigerator at home. This is achieved using VarioSens(R) data loggers, placed on the outer surface of the packaging of the medication. These recording cards were programmed to measure the temperature every 10 minutes if it was outside the range of 2 to 8 ºC. Results: In no case (n= 36) was the temperature maintained with in the established range for the entire recording period. The mean temperature during transport was 21.3 ± 7.0 ºC, with temperatures of over 25 ºC in 50% of the cases. The mean temperature of the refrigerators was 8.4 ± 3.7 ºC. In 18 cases, the mean temperatures were within the established range, in16 cases, they were over 8 ºC and in two cases, they were under 2 ºC. Conclusions: The results obtained indicate that measures must be introduced to improve the storage conditions of heat-labile drugs in the homes of outpatients in order to ensure their therapeutic efficacy. New technologies make it possible to control the cold chain until the medication is administered (AU)

[A descriptive study of erythropoietin use and cost in hematologic patients]. / Estudio de utilización y descripción de costes de eritropoyetina en pacientes hematológicos.

OBJECTIVE: To assess the effectiveness of erythropoietin use in hematologic patients; to analyze the extent to which recommendations are applied as provided by Spanish prescribing information, American Society of Clinical Oncology (ASCO) and American Society of Hematology (ASH) guidelines, as well as specific recommendations for myelodysplastic syndromes (MDSs), and to perform a descriptive analysis of costs. METHOD: A descriptive retrospective study. Patient selection was performed by Unidad de Atención Farmacéutica a Pacientes Externos (UFPE: Pharmaceutical Outpatient Care Unit) during a 3-month period of time. Follow-up was performed to month 9 after selection. RESULTS: Thirty-six patients (37% males) were included. In the group of patients with multiple myeloma and lymphomas, effectiveness was 57%; while in the MDS group it was 45-64% (depending on criteria used to measure erythroid response). Of all 24 patients (MDSs excluded) only 4 (17%) met indication criteria--adjustment to erythroid response at 4 and 8 weeks, and dosage titration when needed. Continued treatment with erythropoietin in all non-responders amounted to 59-69% of total expense for non-responders. CONCLUSIONS: There is a high percentage of therapy failures and inconsistency between erythropoietin use recommendations and clinical practice. This circumstance, as well as the high financial impact it entails, makes it essential that monitoring and follow-up strategies are implemented to contribute to an optimal usage of erythropoiesis stimulating factors.

[Designing a module for the prevention of hypersensitivity reactions in an assisted electronic prescription system]. / Diseño de un módulo para la prevención de reacciones de hipersensibilidad en un sistema de prescripción electrónica asistida.

OBJECTIVE: To develop a module for the prevention of drug-related allergies to be integrated within the assisted electronic prescription software PRISMA. METHOD: On module design potential sources of medication errors regarding drug allergies were first analyzed, and ideal module characteristics were defined. Then a review of the literature was performed to define "group allergies", and last of all master archives were created, with their required relations being established. RESULTS: A module for the prevention of drug-related allergies in the setting of an assisted electronic prescription software was designed. By interrelating tables listing active ingredients, excipients, chemical structures/functional groups, and "group allergies" prescriptions may be interactively checked, and useful information is provided to the prescribing practitioner--as well as the whole multidisciplinary team--to help him make his/her decisions.