Single pharmacy governed denosumab home administration: optimal adherence by means of a fracture liaison service (FLS) and home care collaboration.

Low adherence for denosumab (Dmab, Prolia®) is of major concern. Dutch pharmacies deliveries were calculated recently being 76.5% for a total of 3 injections. INTRODUCTION: Comparing a model where the prescriber maintains responsibility for adherence (model HC1) (Dmab is purchased and dispensed by patient's own community pharmacy and administered through a home care service (HC)) or an all-in-one model where the pharmacist maintains responsibility for the adherence (Dmab is purchased, dispensed, and administered by a pharmacist's HC) (HC2). METHODS: We counted the number of Dmab injections, follow-up appointments on time, Dmab administrations delayed to a maximum of 60 days, the number of Dmab discontinuations, and all causes legally traceable under EU privacy act (EDPR). RESULTS: Home care started by 2014 (study closure in 2021) and included 711 Dmab injections to 256 unique patients: HC1: 536 and HC2: 175 orders. The whole group received on average 2.8 Dmab injections by consistent intervals of about 182 days. Average administration after the latest Dmab injection: 272.8 days (HC1: 362.0 and HC2: 124.0 days). Administration of a subsequent injection > 60 days occurred in 26.6% (HC1: 38.8% and HC2: 6.2%; OR = 9.49). After adjustment for no more than three Dmab injections administered per patient, it occurred in 27.3% (HC1: 51.8% and HC2 4.4%; OR = 23.34). CONCLUSION: It was possible to achieve 94% adherence for Dmab injections treatment just by transferring the complete supply chain to one pharmacy-initiated home care provider after treatment initiation by either a physician or FLS health care professional.

Drug-utilization study on Curaçao.

The drug use on Curaçao was evaluated with the help of the prescription forms of twelve community pharmacies at Curaçao over a period of three months. The emphasis of the study was on three therapeutic groups: the systemic antibiotics, the psycholeptics and the anti-inflammatory and antirheumatic drugs. Within the group of systemic antibiotics broad-spectrum antibiotics were very frequently prescribed compared with the small-spectrum penicillins. The consumption of psycholeptics, particularly benzodiazepines, on Curaçao is remarkably low in comparison with drug utilization data of Denmark and the Netherlands. In contrast, the number of defined daily doses per 1,000 persons per day of antirheumatic drugs is higher compared with data from these two countries. Within the analysed groups, large differences occur between the two most important kinds of insurance, i.c., the poor people (PP) and social insurance bank (SVB) insurance. The PP-insured patients consume in the case of antibiotics and antirheumatic drugs almost twice as many and in the case of psycholeptics even five times as many as the SVB-insured patients do. A few calculations of prices prove that the extra amount of drugs consumed by PP-insured has important financial consequences.