Patient experiences and opinions on medication review: a qualitative study.

BACKGROUND: Medication reviews are a structured critical evaluation of a patient's pharmacotherapy, carried out by a healthcare professional, but are not yet a routine pharmaceutical service in Belgium. A pilot project to initiate an advanced medication review (= type 3 medication review) in community pharmacies was set up by the Royal Pharmacists' Association of Antwerp. AIM: To investigate the experiences and opinions of patients who participated in this pilot project. METHOD: Qualitative study through semi-structured interviews with participating patients. RESULTS: Seventeen patients from six different pharmacies were interviewed. The medication review process with the pharmacist was perceived as positive and instructive by fifteen interviewees. The extra attention that the patient received was highly appreciated. However, the interviews revealed that patients did not fully understand the purpose and structure of this new service or were aware of the subsequent contact and feedback with the general practitioner. Medication reviews in the home setting put patients more at ease, were highly appreciated, and enabled also to address practical problems such as drug dosing or storage requirements. CONCLUSION: This qualitative study analysed patients' experiences during a pilot project on the implementation of type 3 medication review. Although most patients were enthusiastic about this new service, a lack of patients' understanding of the whole process was also observed. Therefore, better communication to patients by pharmacists and general practitioners about the goals and components of this type of medication review is needed, with the added benefit of increased efficiency.

Pulmonary arterial hypertension associated with a congenital heart defect: advanced medium-term medical treatment stabilizes clinical condition.

OBJECTIVE: Pulmonary arterial hypertension (PAH) associated with congenital heart defect (CHD), and especially Eisenmenger syndrome, is associated with impaired exercise tolerance and reduced quality of life. In this study, we describe medium-term follow-up of adult patients with PAH associated with CHD, treated in a single center with different types of advanced medication. DESIGN: The treatment and clinical course of 15 patients (11 female, median age 53, range 28-74 years) with PAH associated with CHD is retrospectively described. Data on patient characteristics, exercise test, right-heart catheterization, and type of advanced therapy were collected from medical files. Advanced medical therapy consisted of either intravenous prostacyclin, or endothelin receptor antagonists, or phosphodiesterase-5-inhibitors. Additional therapy was started in case of persistent clinical deterioration or insufficient improvement with monotherapy. RESULTS: All patients (10 patients with Eisenmenger syndrome, 5 patients with a closed defect and PAH) were exposed to different durations of advanced medication. Median period of treatment was 2.5 (range 0.7-6.3) years. Atrial septal defect, type secundum, was the most frequent underlying diagnosis (n = 10). Most patients (n = 9) received a combination of advanced medical therapy. Six-minute walk distance (6-MWD) remained unchanged with an increase of 44 +/- 78 m (P = 0.2) and 41 +/- 80 m (P = 0.3) compared with baseline after respectively 1 and 2 years of treatment. Younger age was associated with better performance (beta = -7 m per year, P < 0.05), patients younger than 45 years showed a greater improvement in 6-MWD after 2 years of treatment (P < 0.05). During a mean follow-up of 23 (range 4-58) months, mean pulmonary arterial pressure (53 +/- 24-49 +/- 17 mmHg, P = 0.3) and pulmonary vascular resistance (770 +/- 1090-650 +/- 444 dynes s/cm5, P = 0.7) showed no deterioration. CONCLUSION: Advanced treatment strategies in patients with PAH associated with CHD are useful. The treatment effect seems to be one of disease stabilization and decreasing the rate of deterioration. Younger age was associated with a greater improvement of 6-MWD.