The impact of pharmacist-initiated interventions in improving acute coronary syndrome secondary prevention pharmacotherapy prescribing upon discharge.

WHAT IS KNOWN AND OBJECTIVES: Pharmacists have the knowledge regarding optimal use of medications and the ability to influence physician prescribing. Successful interventions by a pharmacist to implement cardioprotective medications to a coronary artery disease patient's regimen would not only improve the patient's quality of care but may also increase his or her likelihood of survival. Therefore, the aim of this study was to (i) evaluate the effectiveness of pharmacist initiated interventions in increasing the prescription rates of acute coronary syndrome (ACS) secondary prevention pharmacotherapy at discharge, and to (ii) evaluate the acceptance rate of these interventions by prescribers. METHODS: This was a comparative study with a pre-intervention and post-intervention design. In the pre-intervention phase, a retrospective cross-sectional audit was performed. Patients with a diagnosis of acute coronary syndrome admitted to the hospital in the period from 2008 to January 2010 were identified from medical records and served as a historical control. The second phase (intervention phase) was conducted from the beginning of March to the end of September 2010. Two random samples of 190 patients with ACS were included. During the intervention phase, two hospital pharmacists made rounds with the cardiology team and gave secondary prevention recommendations when needed. The major reference for the recommendations was the Malaysian guidelines. RESULTS AND DISCUSSION: A total of 72 interventions were made by pharmacists of which drug initiation was most common (59.7%) followed by recommendations to change to another medication (23.6%) and optimization of medication dosing (16.6%). Most recommendations (72.2%) were accepted by prescribers. Majority of accepted recommendations were with ß-blockers (38.46%) followed by those with angiotensin-converting-enzyme inhibitors (ACEI) (28.8%). The intervention had a significant impact on the utilization rates of ß-blockers (increased from 75.8% to 84.7%, P = 0.028), angiotensin-converting-enzyme inhibitors/angiotensin II receptor bockers (from 65.3% to 74.7%, P = 0.044) and statins (from 91.6% to 98.4%, P = 0.002). The intervention had also led to a significant increase in the utilization rates of all these four classes together (from 42.6% to 62.6%, P = 0.001). WHAT IS NEW AND CONCLUSION: The study showed that the presence of a pharmacist on cardiology units increased the use of beta-blockers, aspirin, and statins for the secondary prophylaxis of ACS.

Molecular analysis of Hb Q-H disease and Hb Q-Hb E in a Singaporean family.

Hb Q (alpha 74Asp-His) results from a mutation in the alpha-gene such that abnormal alpha Q-chains are synthesized. The alpha Q-chains combine with the normal Beta A-chains to form abnormal Hb alpha 2Q beta 2A (Hb Q). Hb Q-H disease is rare, and has been reported only in the Chinese. We report here a Chinese family, were the mother diagnosed with Hb Q-H disease and the father with Hb E heterozygosity and a child with Hb Q-E-thalassemia. Thalassemia screening of the mother's blood revealed a Hb level of 6.8g/dl with low MCV and MCH. Her blood film was indicative of thalassemia. Cellulose acetate electrophoresis showed Hb H and Hb Q with the absence of Hb A. Globin chain biosynthesis was carried out and alpha Q- and beta-chains were detected. Normal alpha- chains were absent. Digestion of the mother's DNA with Bam HI and Bgl II followed by hybridization with the 1.5 kb alpha-Pst probe showed a two alpha-gene deletion on one chromosome and the -alpha Q chain mutant with the -alpha 4.2 defect on the other chromosome. DNA amplification studies indicated the two-gene deletion to be of the -SEA/ defect. The patient was concluded to possess Hb Q-H disease (--SEA/-alpha 4.2Q). Cellulose acetate electrophoresis of the father's blood showed the presence of Hb A, F and E. Molecular analysis of the father's DNA confirmed an intact set of alpha-genes (alpha alpha/alpha alpha). Globin chain biosynthesis of fetal blood of their child showed gamma, beta A, beta E, alpha A and alpha Q-chains. Molecular analysis of the child's DNA showed one alpha-gene deletion, thus giving a genotype of alpha alpha/-alpha 4.2Q beta beta E.

Comprehension of antibiotic instructions in an outpatient Malaysian practice.

Patients may not comply with antibiotic instructions because they do not understand them. The aim of this study was to assess outpatients' ability to comprehend their antibiotic prescription labels. Two hundred and five subjects on oral antibiotic regimens from an outpatient clinic and pharmacy of a district hospital were selected in this survey. All patients were interviewed by trained clinical pharmacy students. They were asked to read the labels and then how they would take their antibiotics. The results show that 119 (58.1%) patients could interpret the label. Forty-nine (23.9%) patients knew the name of antibiotics and interpreted the directions of use correctly. One hundred sixteen (56.6%) subjects were able to recall the auxiliary information. However, only 44 (21.4%) patients were able to comprehend complete antibiotic instruction. This study demonstrates that a significant proportion of patients could not interpret the labeling instruction. The comprehension level of patients was low and significantly associated (P < 0.05) with the ability of patient to read the label contents. These observations illustrate the need for physicians and pharmacists to provide antibiotic instructions and review these instructions with the patient.