Pharmaceutical companies information and antibiotic prescription patterns: A follow-up study in Spanish primary care.

OBJECTIVES: To assess the impact of sources of drug information on antibiotic prescribing patterns (quantity and quality) among primary care physicians. METHODS: We conducted a cohort study on primary care physicians who were actively engaged in medical practice in 2010 in a region in north-west Spain (Galicia), fulfilling inclusion criteria (n = 2100). As the independent variable, we took the perceived utility of 6 sources of information on antibiotics, as measured by the validated KAAR-11 questionnaire. As dependent variables, we used: (1) a quality indicator (appropriate quality, defined as any case where 6 of the 12 indicators proposed by the European Surveillance of Antimicrobial Consumption Network [ESAC-Net] were better than the mean values for Spain); and, (2) a quantity indicator (high prescribing), defined as any case where defined daily doses (DDD) per 1 000 inhabitants per day of antibacterials for systemic use were higher than the mean values for Spain. The adjusted odds ratio for a change in the interquartile range (IqOR) for each sources of information on antibiotics was calculated using Generalized Linear Mixed Models. RESULTS: The questionnaire response rate was 68%. Greater perceived utility of pharmaceutical sales representatives increases the risk of having high prescribing (1/IqOR = 2.50 [95%CI: 1.63-3.66]) and reduces the probability of having appropriate quality (1/IqOR = 2.28 [95%CI: 1.77-3.01]). Greater perceived utility of clinical guidelines increases the probability of having appropriate quality (1/IqOR = 1.25 [95%CI: 1.02-1.54]) and reduces the probability of high prescribing (1/IqOR = 1.25 [95%CI: 1.02-1.54]). CONCLUSIONS: Sources of information on antibiotics are an important determinant of the quantity and quality of antibiotic prescribing in primary care. Commercial sources of information influence prescribing negatively, and clinical guidelines are associated with better indicators.

[The French National Compound Library: advances and future prospects]. / Chimiothèque Nationale - Avancées et perspectives.

The French National Compound Library (Chimiothèque Nationale) has been created in 2003 and is the federation of local collections. It contains more than 56 000 small molecules and natural compounds synthesised or isolated in different laboratories over the past years. This explains the diversity of the collection. The strength of this initiative is the ability to connect chemists and biologists for the development of hits. This development involves the synthesis of analogues or/and chemical tools to find new targets. These collaborations lead to the identification of new chemical probes. These probes able to modulate a biological function are essential to study biological pathways. They can also be useful for therapeutic applications. This article will describe the major achievements and perspectives of the French Chemical Library.

The present status and future issues regarding the use of nonprescription drugs, obtained from the results of face-to-face surveys with the inhabitants of remote islands.

This study was conducted among 252 inhabitants aged 16 years or older of small remote islands in Gotoh. The survey was conducted in a direct interview format based on a questionnaire. In the interview, the respondents were asked about the statuses of their Internet usage, purchase/use/storage of nonprescription drugs, acquisition of information regarding nonprescription drugs, as well as regulations pertaining to the sale of nonprescription drugs, including the use of postal services. Among the respondents, 7.5% were Internet users, whereas people who had past experiences in purchasing nonprescription drugs through Internet accounted for as few as 0.8% of the total number of respondents; 63.9% of the inhabitants of small remote islands did not use nonprescription drugs, additionally, most inhabitants of small remote islands did not express any need for nonprescription drugs sold through Internet. Further, the findings suggested that a large number of people felt the need for the presence of pharmacists and experts to provide them with explanations and information regarding nonprescription drugs. However, because a large number of these people were unaware of the existence of pharmacists, it is important that in the future, pharmacists should conduct "consultation meetings and briefings regarding medications." These meeting may be held in a continuous manner in these small remote islands, such that the inhabitants recognize the difference in a pharmacists' profession. It is essential that "family pharmacies/pharmacists" play a central role in promoting the supply, management, and proper use of pharmaceutical products.

Poisonings and clinical toxicology: a template for Ireland.

BACKGROUND: Poisons information is accessed around the clock in the British Isles from six centres of which two are in Ireland at Dublin and Belfast accompanied by consultant toxicologist advisory service. The numbers of calls in Ireland are down to about 40 per day due to easy access to online data bases. Access to Toxbase, the clinical toxicology database of the National Poisons Information Service is available to National Health Service (NHS) health professionals and to Emergency Departments and Intensive Care units in the Republic of Ireland. There are 59 Toxbase users in the Republic of Ireland and 99 % of activity originates in Emergency Departments. All United States Poison Control Centres primarily use Poisindex which is a commercial database from Thomson Reuters. RESULTS: Information on paracetamol, diazepam, analgesics and psycho-active compounds are the commonest queries. Data from telephone and computer accesses provide an indicator of future trends in both licit and illicit drug poisons which may direct laboratory analytical service developments. Data from National Drug-Related Deaths Index is the most accurate information on toxicological deaths in Ireland. Laboratory toxicology requirements to support emergency departments are listed. CONCLUSIONS: Recommendations are made for a web-based open access Toxbase or equivalent; for a co-location of poisons information and laboratory clinical toxicology; for the establishment of a National Clinical Toxicology Institute for Ireland; for a list of accredited medical advisors in clinical toxicology; for multidisciplinary case conferences in complex toxicology cases for coroners; for the establishment of a national clinical toxicology referral out-patients service in Ireland.

Impacto de un modelo integrado para el uso racional de antimicrobianos (proyecto Miura) en una área de salud / Impact of integrated model for rational use of antibiotics in a health area (project MIURA)

Fundamento: MIURA (Modelo Integrado para el Uso Racional de Antimicrobianos) es un proyecto que se inicio en enero de 2004 y finalizó en diciembre de 2006. Mediante intervenciones trimestrales y formativas dirigidas a médicos, farmacéuticos y pacientes, pretendió mejorar el uso de antibióticos en un área de salud. El objetivo ha sido analizar la evolución en el consumo de antibióticos y evaluar la repercusión de la implantación de este proyecto en un área de salud. Método: Se realizó un estudio comparativo sobre la evolución de la dispensación de antibióticos con receta durante los periodos 2000-03 (pre-MIURA), 2004-06 (MIURA) y 2007-08 (post-MIURA) en el Departamento de Salud 11 de la Comunidad Valenciana. La información se obtuvo a través de la aplicación informática GAIA (Generalitat Valenciana) que recoge información sobre los medicamentos facturados por las oficinas de farmacia a través de las recetas oficiales. Como unidad técnica de medida se empleó la DHD (Dosis diaria definida/1.000 Habitantes/Día). Resultados: Durante el periodo de implantación del proyecto (2004 a 2006), se detectó un descenso global de 4,02 DHD en el consumo de antibióticos, lo que representa una reducción global y significativa del 15% (p<0.05). Durante el periodo del MIURA se observó una disminución estadísticamente significativa en los valores de DHD para los grupos terapéuticos de macrólidos (especialmente claritromicina) y de cefalosporinas; también se detectó una disminución, aunque no significativa, para el grupo de las quinolonas, mientras que los grupos correspondientes a las penicilinas y a otros antibióticos no presentaron cambios. En el periodo post-MIURA se detectó un nuevo incremento en la dispensación de los antibióticos. Conclusiones: El programa MIURA ha influido positivamente en la disminución de la prescripción de antibióticos en nuestra área de salud, como demuestra el descenso en DHD durante el periodo de intervenciones(AU)

Background: MIURA (Integrated Model for the Rational Use of Antimicrobials) is a project that began in January 2004 and ended in December 2006. Through quarterly and training interventions intented for physicians, pharmacists and patients, pretends to improve antibiotic use in a health area. The goal was to analyze the evolution of antibiotic consumption and assess the impact of implementing this project in a health area. Method: A comparative study on the evolution of antibiotic dispensed during the periods 2000-03 (pre-MIURA), 2004-06 (MIURA) and 2007-08 (post-MIURA) in the Department of Health 11 of Valencia was conduced. Antibiotics information was obtained through the GAIA application (Generalitat Valenciana) that collects information about the drugs billed by the pharmacy through the official prescriptions. Technical unit of measurement was used DHD (daily dose defined/1.000 inhabitants / day). Results: During the implementation of the project (2004-2006), antibiotic consumption was reduced in 4.02 DHD. It represents a statistically significant overall reduction from 15% (p= <0.05). Since interventions started, a statistically significant decrease in DHD values was observed for macrolides (especially clarithromycin) and cephalosporines. It also exist an average decrease, not significant, for the group of quinolones, whereas penicillins and other antibiotics haven’t showed variability in the consumption data. In the post-MIURA period was detected a further increase in the dispensing of antibiotics. Conclusions: MIURA program has positively influenced on decreasing antibiotic prescription in our health area, as shows the decrease in DHD during the interventions(AU)

Repercusiones de la retirada de la tioridazina / Repercussions of the withdrawal of thioridazine

Introducción. Como consecuencia de la retirada del mercado de la tioridazina, pacientes que habían sido tratados con este fármaco requieren un nuevo abordaje terapéutico. Observamos casos de ingreso en la unidad de agudos por descompensación tras la retirada de tioridazina y que presentan difícil manejo terapéutico. Se realiza una descripción de las características clínicas y de la pauta farmacológica que lleva a la estabilización del paciente. Resultados. La muestra obtenida en nuestra unidad es de 15 pacientes con una media de 20 años de estabilidad previa a la retirada de tioridazina. Representan un 6% de todos los pacientes en tratamiento con tioridazina durante2005 en nuestra región sanitaria. Presentaron un perfil psicopatológico común: patrón afectivo sobreañadido a la clínica psicótica, predominando labilidad emocional y tendencia a hipertimia de difícil manejo farmacológico. En un 27%se consiguió estabilidad con fenotiazinas piperazinas en monoterapia; en un 60 % requirieron la asociación con eutimizante y/o a antipsicótico atípico. Un 20% se estabilizaron con antipsicóticos atípicos en monoterapia. En un 40% pauta moseutimizante para manejar la inestabilidad afectiva y un 27 % presentaron respuesta a tratamiento con terapia electroconvulsiva (TEC), que se prescribe de segunda elección debido a la resistencia al tratamiento farmacológico asociado a gravedad. Conclusiones. Proponemos iniciar un tratamiento con el grupo de fenotiazinas piperazinas valorando la introducción de un eutimizante y/o TEC. Se ha producido un 33% de reingresos; un 40 % de los casos han requerido centros demedia/larga estancia y registramos un suicidio consumado. Observamos un elevado coste tanto de recursos asistenciales, económicos como de calidad de vida (autonomía, habilidades sociales y nivel cognitivo) en nuestra muestra tras la retirada de tioridazina (AU)

Introduction. As a consequence of the withdrawal of thioridazine from the market, patients who have been treated with this drug require a new therapeutic approach. We have observed patients who require admission to acute unit due to decompensation resulting from the withdrawal of thioridazine who present a difficult management of therapeutic regime. The clinical characteristics and drug treatment needed to stabilize the patient are described. Results. The sample obtained in our unit included15 patients with a mean of 20 years of stability prior to withdrawal of thioridazine. This represents 6% of all the patients treated with thioridazine in 2005 in our healthcare area. They had a common psychopathological profile: affective pattern in addition to the psychotic symptomatology with predominance of emotional lability and hypomaniac tendency which is difficult to control pharmacologically. Clinical stabilization was obtained in 27% of patients by means of piperazine phenothiazines in monotherapy. An association with mood stabilizer and/or an atypical antipsychotic in 60% of patients was needed. In 40 % we prescribed a mood stabilizer to manage affective instability and 27% responded to electroconvulsive therapy (ECT) treatment, which is indicated as a second option due to resistance to pharmacological treatment and/or presenting a serious condition. Conclusions. We propose starting treatment with a group of piperazine phenothiazines, evaluating the introducing of mood stabilizers and/or ECT in each case. There have been 33% re-admissions, 40% of which required medium/long-term stay centers and one of which committed suicide. We demonstrate a high cost in terms of care, economic resources and of quality of life (autonomy, social skills and cognitive level) in our sample as a result of Meleril® (thioridazine) withdrawal of the market (AU)

Gestión de la información de medicamentos mediante la intranet de un centro hospitalario / Drug information management through the intranet of a hospital center

Objetivo: En el presente trabajo se describe la metodología deimplantación y validación de un recurso de red incluido en la intranetdel Hospital, para almacenar y difundir la información delCentro de Información de Medicamentos (CIM) de un servicio defarmacia en un centro hospitalario.Método: Un grupo de trabajo diseñó la estructura, contenido,necesidades de memoria, prioridades de acceso de los usuarios yuna encuesta para evaluar la calidad.Resultados: El recurso obtenido de 70 Gb de capacidad seestructuró mediante documentos HTML incluyendo archivosde diferente formato con 12 áreas temáticas. Se establecieron2 niveles de prioridad de acceso según el usuario y dos responsablesdel recurso. La encuesta realizada tras tres meses de utilizaciónmostró que el 69% de los usuarios, consideró el recurso muyútil, y el 31% lo calificó de útil. La estructura final, según los resultadosde la encuesta fue de 11 áreas temáticas.Conclusiones: La utilización de la intranet del hospital paraincluir y estructurar la información del CIM puede realizarse deuna forma sencilla y económica. Además, la participación detodos los usuarios en su diseño y estructura, puede facilitar la utilidadpráctica de esta herramienta y aumentar su calidad

Objective: This paper describes the methodology used for theimplementation and validation of a network resource incorporatedto the intranet of the Hospital, in order to retain and disseminateinformation from the Drug Information Center (DIC) of a pharmacyservice in a hospital center.Method: A working group designed the structure, contents,memory needs, priority of access for users and a quality assessmentquestionnaire.Results: The resource developed by the working group had acapacity of 70 Gb and its structure was based on HTML documents,including files with different format and 12 theme areas.Two levels of priority of access were established depending on theuser and two persons were in charge of the resource. The questionnairewas delivered after three months of use. Sixty nine percent of the users regarded the resource as very useful and 31%, asuseful. The final structure, according to the results of the survey,had 11 theme areas.Conclusions: The use of the hospital Intranet in order toinclude and organize DIC information can be very simple and economic.Furthermore, the involvement of all the users in its designand structure can facilitate the practical use of this tool andimprove its quality

Patient education and consumer medicine information: a study of provision by Queensland rural and remote area Registered Nurses.

AIMS AND OBJECTIVES: The aim of the larger study was to ascertain the medication practices of registered and enrolled nurses in rural and remote areas of Queensland after the introduction of the Health (Drugs and Poisons) Regulation. This paper reports on the findings of the role of registered nurses and their confidence in the ability to provide information on medications in a way that the client understands; the frequency of the provision of information to clients prior to discharge; and the frequency of Indigenous Health Workers or interpreters for people without English as a first language. BACKGROUND: Queensland employs approximately 17% of the Australian registered nurse workforce. In 1996 Queensland changed the Health (Drugs and Poisons) Regulation to allow specific registered nurses, who had undertaken approved postgraduate education and training programmes, to become endorsed for an expanded medication practice role. In particular, it allowed endorsed nurses to administer and supply (but not prescribe) drugs listed in a drug formulary to certain clients using protocols. It was not clear, however, whether the changes to the Regulation reflected the scope of practice, thereby providing adequate legal protection for the nurse. DESIGN: During 2001-02 an exploration of the medication practices of rural and remote area nurses was conducted by the use of a cross-sectional postal survey. Phase 1 of the study used a facility audit to ascertain facility medication practices and phase 2 of the study used a postal survey to ascertain nurses' medication practices. METHOD: All nurses employed in rural and remote health facilities in Queensland were eligible to participate in the study. The nurse registering authority's (the Queensland Nursing Council) register was used to generate a non-proportional stratified random sample. Of the 1999 questionnaires sent, there were 668 respondents. Of these, 520 were registered nurses. RESULTS: The data indicated that there was a difference between endorsed and unendorsed registered nurses' medication practice. In particular, it was apparent that endorsed registered nurses were more likely to believe they could explain the side-effects of medication to clients in a way the patient understood; provided medication education to clients on discharge; and used Indigenous Health Workers or interpreters to explain medications to those clients for whom English was not a first language. However, it was apparent that <50% of all Registered Nurses were providing client medication education or using Indigenous Health Workers or interpreters. CONCLUSION: It is apparent that the changes to the Regulation have ensured that Registered Nurses who have undergone postgraduate education to enhance their medication practice are more likely to provide client education and consumer medication information. However, the results suggest that the majority of registered nurses in Queensland, whilst believing they have sufficient knowledge of pharmacology to provide client education, often do not provide appropriate medication advice to clients, particularly on discharge from the acute setting. RELEVANCE TO CLINICAL PRACTICE: It is well recognized that the provision of medication education to clients has several benefits to both the client and the health care system. The lack of client medication education indicated in this study compromises patient's safety as well as their compliance with their medication regime.

Community pharmacy in Australia.

This article describes the evolution of community pharmacy in the Australian health system, and assesses its current and potential future contribution to health care. A central theme is the unique extent and accessibility of community pharmacy to the public, with a vast and dispersed infrastructure that is funded by private enterprise. The viability of community pharmacy as a retail trade depends on a diversification of its service roles and retention of its product-supply roles. Initiatives by the pharmacy profession, the pharmacy industry and the Australian Government are likely to give community pharmacy an increasingly prominent place in health promotion and primary, secondary and tertiary prevention, especially in relation to the management of chronic diseases.

Practicing health promotion through pharmacy counseling activities.

Dramatic changes in the U.S. health care system have emphasized the need to promote good health. To achieve this, different types of health care professionals have now started working together. These teams often include participants, such as doctors, pharmacists, and nurses. However, there are many health professionals, such as pharmacists, working in noninstitutionalized settings, such as pharmacies, who are not being fully utilized. One of the ways pharmacists can promote good health is by counseling patients. This article provides some insights regarding the various health promotion activities that are or can be performed by pharmacists. Health promotion educators can play a significant role in educating pharmacists to become effective health promoters. Some hypothetical scenarios and examples, as well as models, are also provided to demonstrate active health promotion through pharmacist counseling activities.

Grado de aceptación y utilidad de un boletín terapéutico en la práctica farmacéutica / Degree acceptance and utility of a pharcotherapeutic bulletin in pharmaceutical practise

Introducción: Sendagaiak es un boletín terapéutico elaborado por los CIM de los COF de Euskadi. Los diferentes números incluyen varios tipos de artículos: monografías de medicamentos, revisiones de patologías, notas informativas, revisiones de grupos terapéuticos, artículos sobre conocimientos generales y fichas de principios activos. Para evaluar la satisfacción y utilidad práctica de Sendagaiak en la práctica farmacéutica, hemos realizado un estudio transversal entre los lectores. Métodos: junto con el ejemplar de noviembre-diciembre de 2000 se remitió una encuesta y un sobre-respuesta. Se admitieron encuestas hasta abril de 2001. Los resultados fueron procesados con Microsoft Access® y Excel(R). Resultados: Se recibieron 218 respuestas. Leen habitualmente Sendagaiak 90,8% y sólo a veces 9,2%. 78,4% encontraron artículos interesantes en casi todos los números, 13,8% en la mitad y 7,8% en ocasiones. La aceptación de los distintos tipos de artículos es similar. El formato es bueno o muy bueno para el 89,9% y regular para el resto. El lenguaje utilizado es claro y asequible para todos. Todas las respuestas califican a Sendagaiak bastante o muy interesante. En el último año Sendagaiak ha resultado útil para resolver un problema concreto para el 88,6% de los farmacéuticos. Discusión: Sendagaiak es una publicación bien adaptada a las necesidades de la práctica farmacéutica, puesto que en la mayoría de los números se encuentran artículos interesantes, habitualmente permite resolver problemas y su formato y lenguaje son adecuados. La favorable aceptación del boletín y la similar valoración de los diversos tipos de artículos indican que Sendagaiak satisface los diferentes requerimientos profesionales de los lectores (AU)

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Pharmacy benefit management: enhancing the applicability of pharmacoeconomics for optimal decision making.

Previous research indicates that in order to make pharmacoeconomic information applicable and useful for pharmaceutical benefit management (PBM) companies, several aspects need to be considered and improved. These include: timely availability of information, head-to-head comparators, peer-reviewed publications, independent sponsorship of pharmacoeconomic studies, use of relevant populations in research and published pharmacoeconomic models, and pharmacoeconomics training for pharmaceutical companies' sales personnel. In addition to these measures, guidelines have been playing an important role in improving the applicability of pharmacoeconomic information. This paper examines the progress to date in enhancing the applicability of pharmacoeconomics for optimal PBM decision making. The greatest improvements have been made in enhancing the quality of pharmacoeconomic research and the quality of peer-reviewed publications. Direct comparator studies are starting to emerge, but in limited numbers. The need for additional training of pharmaceutical representatives and PBM staff members remains a critical issue.

Physician-patient communication about over-the-counter medications.

The purpose of this study was to describe physician-patient communication about over-the-counter medications using a data set comprised of audio-tapes and transcripts of 414 primary care medical visits. The data set was collected during 1995 at the family practice and general medicine clinics at the University of New Mexico Health Sciences Center. Twenty-seven resident physicians and 414 of their adult patients participated. Fifty-seven percent of patients reported using one or more OTC medications during the past month. Analgesics, cold or allergy products, and antacids were the most commonly used OTC medications. White patients were significantly more likely to have reported using an analgesic in the past month than non-white patients. Female, white, and younger patients were more likely to have reported using a cold or allergy product in the past month than male, non-white, and older patients. Approximately 58% of patients discussed OTC medications with their physicians. Older patients and female patients as well as patients who reported using an antacid in the past month were significantly more likely to have discussed OTC medications with their physicians. Physicians asked questions about OTC medications during only 37% of encounters. Patients asked questions about OTC medications during 11% of encounters. Patient ethnicity did not influence physician or patient question-asking and information-giving about OTC medications. Male physicians were more likely to state information and ask questions about OTC medications than female physicians. Patients were more likely to ask male physicians questions about OTC medications. Physicians were more likely to state OTC information to and ask OTC questions of female and older patients. Physicians were more likely to ask less educated patients questions about OTC medications. Less educated patients were more likely to ask physicians questions about OTC medications. Despite the fact that more than half of all patients reported using OTC medications, physicians asked questions about OTC use during only approximately one-third of encounters. Of patients who reported using an OTC medication in the past month, 58% did not tell their physicians, yet only 14% of patients believed that it was not important for the physician to know about their OTC use. Physician-patient communication about OTC medications should be encouraged so that the patient becomes a collaborative partner in medication management.