Assessment of the Prescribing Pharmacist's Role in Supporting Access to Prescription-Only Medicines-Metadata Analysis in Poland.

In 2020, pharmacists in Poland received additional authority to prescribe drugs. In this study, we analyzed prescribing after the implementation of this new responsibility. We assessed how the new regulation works in practice and what it means for the healthcare system in the area of access to prescription-only medicines. Data analysis included information on the prescriptions written, the type of substance according to the ATC classification, and data on the prescribing pharmacists. The study used over 2.994 million e-prescriptions written by pharmacists in Poland, which were made available by the e-Health Center. The largest group of drugs prescribed were drugs used in the treatment of cardiovascular diseases, accounting for 25% of all prescribed medications during the time of the analysis. The next prescription groups were for drugs used in gastrointestinal diseases and metabolic disorders, and those acting on the central nervous system, the respiratory system, and the musculoskeletal system. Among pharmaceutical prescriptions, 73% were pharmaceutical prescriptions issued in pharmacies at full price to the patient. The results indicate that pharmacists are eager to use their permission to prescribe drugs in authority situations. Almost three million records showed improved patient access to medicines in the healthcare system (approximately 5% of repeat prescriptions for all patients during the study period). These data confirm the possibility of cooperation between physicians and pharmacists in strengthening the efficiency of the patient healthcare system. An important conclusion from this work is the need to create the possibility for the pharmacist to access the information resources of the implemented Internet Patient Account system, including therapeutic indications for the drugs used.

The impact of lockdown caused by the COVID-19 pandemic on glycemic control in patients with diabetes.

PURPOSE: The aim the study was to assess the impact of the lockdown due to COVID-19 on diabetes control. METHODS: The HbA1c value from a pre-lockdown visit (V1) from patients with diabetes was compared to the lockdown visit one (V2) after 3-5 months of its duration. Additional information on how the HbA1c changed and which variables can modify HbA1c during lockdown was also studied. RESULTS: Records from 65 patients (type 2 diabetes -96,9%) were eligible and revealed that: HbA1c was at the target in 60% of the patients at V2 compared to 40% at V1; HbA1c decreased and normalized in 19, but worsened in 4 participants during the lockdown. No impact on HbA1c of: sex, age, diabetes duration, therapy type and modification before the pandemic, abandonment of the treatment, previous problems with glycemic control, or change in body weight and physical activity during the lockdown, was found. The previous macrovascular complications were the only variable that affected the increase in HbA1c (p = 0.0072), OR = 5.33. CONCLUSIONS: The COVID-19 pandemic has not revealed worsened glycemic control in patients with type 2 diabetes, in general. The patients with macrovascular complications turned out to be at risk of the harmful impact of the restrictions on the HbA1c.

Poloxamer 407-Based Thermosensitive Emulgel as a Novel Formulation Providing a Controlled Release of Oil-Soluble Pharmaceuticals-Ibuprofen Case Study.

This article covers the design and evaluation of a novel drug vehicle: a thermosensitive, injectable, high-oil-content (50% w/w) emulgel providing a controlled release of lipophilic pharmaceuticals. Different vegetable (castor, canola, olive, peanut, grapeseed, linseed), mineral (paraffin) and semisynthetic (isopropyl myristate, oleic acid) oils were screened for ibuprofen (IBU) solubility and for their capacity for high-shear emulsification in a 17% (w/w) aqueous solution of poloxamer 407. Chosen emulgels were subject to a rheological evaluation, a syringeability test (TA.XT texture analyser; 2 mL syringe; 18 G, 20 G and 22 G needles) and a drug release study (48 h; cellulose membrane; 0.05 mol/L phosphate buffer at pH 7.4). Castor oil turned out to be an optimal component for IBU incorporation. Blank and drug-loaded castor oil emulgels were susceptible to administration via a syringe and needle, with the absolute injection force not exceeding 3 kg (29.4 N). The drug release test revealed dose-dependent, quasi-linear kinetics, with up to 44 h of controlled, steady, linear release. The results indicate the significant potential of high-oil-content, oil-in-water thermosensitive emulgel formulations as vehicles for the controlled release of lipophilic APIs.

The Use of Medical and Non-Medical Services by Older Inpatients from Emergency vs. Chronic Departments, during the SARS-CoV-2 Pandemic in Poland.

The COVID-19 pandemic has forced numerous changes in medical care. The monitoring of current needs and problems among the elderly in health care facilities seems to be essential. This study aims to assess the difference in terms of the use of medical and non-medical services before planned or emergency hospitalisation by the older population during the strict lockdown period due to the SARS-CoV-2 pandemic in Poland. The study used the FIMA (Fragebogen zur Inanspruchnahme medizinischer und nicht-medizinischer Versorgungsleistungen im Alter) questionnaire. Patients admitted on a planned basis (n = 61) were on average 4 years younger, self-administered the questionnaire more frequently and used the services of different types of therapists. Patients admitted on an emergency basis (n = 60) were more likely to visit general practitioners and other specialists and used the carer's allowance benefits. In the case of the elderly, emergency hospitalisation during the pandemic is more frequently preceded by seeking outpatient care in specialists in various fields, covered by insurance. The chronically ill use the services of various therapists while awaiting hospitalisation, usually not covered by health insurance. For both groups, the age > 73 years is critical for the use of assisting means and completing the self-administered questionnaire, which can be used in planning the health care in these patients.

Molecular Mobility and Stability Studies of Amorphous Imatinib Mesylate.

The proposed study examined the characterization and stability of solid-state amorphous imatinib mesylate (IM) after 15 months under controlled relative humidity (60 ± 5%) and temperature (25 ± 2 °C) conditions. After 2 weeks, and 1, 3, 6, and 15 months, the samples were characterized using differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), X-ray powder diffractometry (XRPD), attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) and scanning electron microscopy (SEM). Additionally, the amorphous form of imatinib mesylate was obtained via supercooling of the melt in a DSC apparatus, and aged at various temperatures (3, 15, 25 and 30 °C) and time periods (1-16 h). Glass transition and enthalpy relaxation were used to calculate molecular-relaxation-time parameters. The Kohlrausch-Williams-Watts (KWW) equation was applied to fit the experimental enthalpy-relaxation data. The mean molecular-relaxation-time constant (τ) increased with decreasing ageing temperature. The results showed a high stability of amorphous imatinib mesylate adequate to enable its use in solid dosage form.

Stability evaluation of thermosensitive drug carrier systems based on Pluronic F-127 polymer.

The aim of this study was to evaluate the stability of thermosensitive systems based on Pluronic F-127 polymer, in aspects of their possible application in novel drug technology. A formulation was prepared without any active ingredient, consisting of 16% (w/w) of polymer dissolved in aqueous medium. Such preparation was autoclaved and then subjected to 3-month conditioning at elevated (40 degrees) and reduced (5 degrees C) temperature. Rheological parameters: viscosity, consistency and sol-gel transition characteristics were studied in 1-month interval. The significance of measured changes was evaluated by proper statistical analyses. Significant changes exceeding the established criteria (+/- 10% of every initial value) were observed during the study. Furthermore, total involution of sol-gel transition phenomenon was observed in samples stored at 40 degrees C. Results indicate the lack of stability in tested formulation at both of storage conditions. However, some regularity indicates that the stability at reduced temperature could be confirmed, if only the concentration of polymer and the measurements schedule were slightly modified.

The use of kinetic N-order model in description of active substance release from various drug forms. Part 1. Premises and mathematical analysis of the N-order model.

The paper presents the premises and equations which are the basis of the mathematical n-order model, which contrarily to standard models based on the laws of chemical kinetics, i.e. 0-order and 1-order kinetics, enables categorization of the investigated process taking into account two parameters: the rate at which it occurs, and actual order, which it is distinguished by. Standard models, which assume in advance the kinetic order of the described processes, may be used with satisfactory accuracy to analyze only a low percentage of performed experiments. However, as shown in practice, the order of many physico-chemical processes, including those which are most interesting for us, active substance release from the drug form, may assume intermediate values, what is manifested as various types of "smooth non-linearities" in the obtained release profiles, which cannot be explained on the basis of assumed standard theories. N-order model may be numbered among the group of physical mathematical models based on the premises of chemical kinetics, possessing the analytical structure of internally non-linear function. It is characterized by two parameters: release rate constant K and order coefficient N.

The use of kinetic N-order model in description of active substance release from various drug forms. Part 2. Analysis of paracetamol and sodium diclofenac release from methylcellulose.

The first part of the monograph presented the premises and equations which are the basis for the proposed mathematical n-order model. This non-linear physical model obeying the laws of chemical kinetics was used to describe the processes of active substance release from drug form. The possibilities of its application in the mathematical description and detailed analysis of the kinetics of paracetamol and sodium diclofenac release from various viscosity gels based on methylcellulose were investigated. Moreover, the effect of temperature on the release profiles of the above-mentioned active substances from investigated formulations was analyzed. On the basis of a series of performed experiments and detailed comparative statistical analysis of the estimators of two parameters characterizing n-order model: release rate constant K and order coefficient of the release process N, it was demonstrated that the active substance release rate from formulations with uncontrolled release is correlated with actual order of the process. Also, the proposed n-order model was compared with models obeying the laws of chemical kinetics: 0-order model, 1-order model and with diffusion Higuchi "square root of time" model, and the comparison demonstrated superiority of the n-order model over standard models. A non-linear statistical analysis was performed by means of computer software Statistica Pl. v. 7.1 manufactured by StatSoft Polska and Mathematica v. 5.0 manufactured by Wolfram Research.