Dietitians can improve accuracy of prescribing by interacting with electronic prescribing systems.

BACKGROUND: Dietitians increasingly interact with electronic health records (EHRs) and use them to alert prescribers to medication inaccuracies. OBJECTIVE: To understand renal dietitians' use of electronic prescribing systems and influence on medication accuracy in inpatients. In outpatients to determine whether renal dietitians' use of the electronic medication recording might improve accuracy. METHODS: In inpatients we studied the impact of dietetic advice on medical prescribing before and after moving from paper recommendations to ePrescribing. In outpatients, when dietitians recommended changes in dialysis units, we assessed the time to patients receiving the new medications. We trained dietitians to use the ePrescribing system and assessed accuracy of medication lists at the start and end of the study period. RESULTS: Inpatients: before the use of EHRs, 25% of proposals were carried out and took an average of 20 days. This rose to 38% using an EHR and took an average of 4 days.Outpatients: in dialysis units dietitians recommend initiating and stopping medications and advise on repeat medications. Most recommendations were during multidisciplinary team (MDT) meetings; the average time to receive medications was 10 days. Drug histories updated by dietitians increased after the start of the study and accuracy of medication lists improved from 2.4 discrepancies/patient to 0.4. CONCLUSION: Dietitians can make medication suggestions directly using EHR, delivering more timely change to patient care and improving accuracy of patients' medication lists. Allowing the whole of the MDT to contribute to the EHR improves data completeness and therefore patient care is likely to be enhanced.

The contribution of direct patient reported ADRs to drug safety signals in the Netherlands from 2010 to 2015.

PURPOSE: The purpose of this study was to investigate the contribution of patient reports to signals sent by the Netherlands Pharmacovigilance Centre Lareb to the Dutch Medicines Evaluation Board and to determine if there are certain types of signals where patient report add a distinct contribution. METHOD: All signals from 2010 until 2015 were included. First, we investigated how many patient reports were present in the signals and the characteristics of these reports compared to the health care professional and marketing authorization holders' reports. In addition to source, the analysis included ATC code of the drug, MedDRA® system organ class and preferred term for the adverse drug reaction (ADR), seriousness of the ADR, and 7 other factors like reports on over-the-counter medication, and how often an ADR listed in the important medical event terms list was present. Secondly, we determined the proportion of reports submitted by the individual groups to signals, in a cross-sectional manner. RESULTS: A total of 150 signals were included, including 1691 ADR reports. Our results show that 26.3% of all ADR reports in Dutch drug safety signals were reported by patients, and 30.5% of the patient reports in the signals contained one or more terms listed as important medical events. The proportion of reports by patients which were included the signals was 2% and 3.9% for health care professional reports and 0.2% for marketing authorization holders reports. CONCLUSION: Patients had an important contribution to signals overall, but especially for ADRs related to generic drug substitution and psychiatric ADRs.

Lanthanum carbonate is an effective hypophosphatemic agent for hemodialysis patients intolerant of other phosphate binders.

BACKGROUND: Lanthanum carbonate (LC) is a noncalcium-containing phosphate binder of proven utility in treating hyperphosphatemia in dialysis patients, and displays a good tolerability profile. OBJECTIVE: This study addressed whether this tolerability profile could result in improved phosphate control in patients intolerant of other phosphate binders, and who remain hyperphosphatemic despite intensive dietary advice and adequate dialysis provision. DESIGN, SETTING, AND PATIENTS: This 18-month study, from a large urban hemodialysis unit, studied 55 patients identified by the multidisciplinary team as fulfilling the following criteria: persistent hyperphosphatemia; intolerance of, or admitted nonadherence to, prescribed phosphate binders (either calcium-based or sevelamer); and provision of adequate dialysis (urea reduction ratio, >65%). INTERVENTION AND MAIN OUTCOME MEASURE: LC was substituted for existing phosphate binders, and results were compared between baseline and 3 months after the initiation of LC. RESULTS: A significant fall in phosphate level from 2.28+/-0.55mmol/L to 1.89+/-0.45mmol/L (7.06+/-1.70mg/dL to 5.85+/-1.39mg/dL) was evident 3 months after the medication switch (P < .001). This fall was associated with a significant increase in the number of patients achieving United Kingdom Renal Association guidelines for serum phosphate level (17% to 48%; P=.001). Mean phosphate-binder pill burden fell significantly by 3 months after the initiation of LC, from 7.8+/-3.4 tablets daily to 3.6+/-2.3 tablets daily. A small but significant increase also occurred in serum bicarbonate levels, from 23.3+/-2.2mmol/L (23.3+/-2.2 mEq/L) at baseline to 23.9+/-2.5mmol/L (23.9+/-2.5 mEq/L) at 3 months (P=.03). This was observed despite a prescribed reduction in dialysate bicarbonate concentration across the population (P=.03). CONCLUSION: This study demonstrated the utility of LC in hemodialysis patients intolerant of alternative phosphate binders, and suggests an advantage of this agent in this patient group.