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1.
J Pharm Pract ; 34(2): 224-229, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31370729

RESUMO

BACKGROUND: Few published studies have examined the relationship between pharmacy location and retention in care or clinical outcome in people living with HIV (PLWH). OBJECTIVE: The study purpose was to determine whether using an on-site/in-clinic pharmacy to obtain antiretroviral therapy increased retention in care and virologic suppression rates. METHODS: PLWH attending a Ryan White outpatient clinic in an academic center were matched based on age and insurance. Rates of retention in care ( ≥2 medical visits/calendar year) were assessed between patients using a pharmacy on-site in the clinic versus patients use off-site pharmacy options. Virologic suppression [viral load(VL)<200 copies/mL], completing ≥2 VL, and CD4 count were compared between pharmacy types. RESULTS: 137 on-site pharmacy patients and 274 off-site pharmacy patients met inclusion and matching criteria. 91.2% of on-site pharmacy users attended ≥2 clinic visits compared to 83.2% of off-site pharmacy users (P = .0275) and were approximately twice as likely to complete ≥2 clinic visits (odds ratio: 2.032; 1.071-3.857). A similar proportion of the on-site pharmacy group achieved virologic suppression compared to the off-site pharmacy group (92.7% vs 89.1%; P = .239, respectively). CONCLUSIONS: On-site pharmacies may provide an opportunity to positively impact retention in care and clinical outcomes for PLWH.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Farmácias , Farmácia , Retenção nos Cuidados , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Pacientes Ambulatoriais , Estudos Retrospectivos
2.
Am J Emerg Med ; 37(1): 174.e5-174.e6, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30274763

RESUMO

Clinical practice guidelines recommend protamine sulfate for reversal of enoxaparin associated bleeds dependent on the time from last administration and dose of enoxaparin. We present a case of a hemodynamically unstable patient with an enoxaparin induced abdominal wall hematoma/hemorrhage and the previous enoxaparin administration 21.5 h prior to presentation with a therapeutic anti-Xa assay (0.8 IU/mL) upon assessment in the emergency department. Along with resuscitative efforts, an interdisciplinary team collaborated to administer protamine sulfate 50 mg intravenous once (0.5 mg per 1 mg of enoxaparin) to reverse the therapeutic anticoagulation. Our case demonstrates the importance of monitoring renal function and the potential for accumulation of enoxaparin in patients with renal dysfunction leading to prolonged therapeutic anti-Xa assays. With the availability of anti-Xa assays, future reversal recommendations of enoxaparin associated bleeds using protamine sulfate should include the initial anti-Xa assay as a guide for the dosing regimen.


Assuntos
Anticoagulantes/efeitos adversos , Enoxaparina/efeitos adversos , Hematoma/induzido quimicamente , Hematoma/tratamento farmacológico , Antagonistas de Heparina/uso terapêutico , Protaminas/uso terapêutico , Parede Abdominal/diagnóstico por imagem , Idoso , Esquema de Medicação , Serviço Hospitalar de Emergência , Feminino , Hematoma/complicações , Hematoma/diagnóstico por imagem , Humanos , Insuficiência Renal Crônica/complicações , Fatores de Tempo , Tomografia Computadorizada por Raios X
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