Baclofen in gamma-hydroxybutyrate withdrawal: patterns of use and online availability.

PURPOSE: Gamma-hydroxybutyrate (GHB) withdrawal is a life-threatening condition that does not always respond to standard treatment with benzodiazepines. Baclofen has potential utility as a pharmacological adjunct and anecdotal reports suggest that it is being used by drug users to self-manage GHB withdrawal symptoms. Here, we investigate current patterns of use and the online availably of baclofen. METHODS: Data triangulation techniques were applied to published scientific literature and publicly accessible Internet resources (grey literature) to assess the use of baclofen in GHB withdrawal. An Internet snapshot survey was performed to identify the availability of baclofen for online purchase and the compliance of retailers with the UK regulations. Data were collected according to pre-defined criteria. RESULTS: A total of 37 cases of baclofen use in GHB withdrawal were identified in the scientific literature, as well as 51 relevant discussion threads across eight Internet forums in the grey literature. Baclofen was available to purchase from 38 online pharmacies, of which only one conformed to the UK regulations. CONCLUSIONS: There is limited published evidence on the use of baclofen in GHB withdrawal, but both scientific and grey literature suggests clinical utility. Online pharmacies are readily offering prescription-only-medication without prescription and due to inadequate regulation, pose a danger to the public.

The practice of OTC counseling by community pharmacists in Parana, Brazil / La práctica del asesoramiento en OTC por farmacéuticos comunitarios de Paraná, Brasil

Background: In order to provide appropriate advice to the patient at the time of dispensing and over-the-counter (OTC) medication counseling, community pharmacists need access to current and reliable information about medicines. Brazilian pharmacists have assumed new functions such as prescribing medication, in a dependent model, based in protocols. Objective: To examine the practice of community pharmacists in a Brazilian State, focusing on OTC recommendation. Method: A cross-sectional survey of community pharmacists in a state of Brazil was conducted from October 2013 to January 2014, with data collection through a pre-piloted self-administered anonymous survey via Survey Monkey® platform. Following ethical approval, the online instrument was sent to 8,885 pharmacists registered in Parana State, Brazil, focusing on professionals working in community pharmacies. The questionnaire assessed the community pharmacy setting, the search for information, the knowledge of the evidencebased practice, the important factors to consider when recommending an OTC medicine, and the pharmacist prescribing. Responses were imported into SPSS® (version 22.0) for analysis. Nonparametric tests were used to assess the association between responses and demographic information with a significance level less than 5% (p<0.05). Results: Of the pharmacists, 97.4% dispensed medications and counseled patients for a median of six hours per day. Product's efficacy (97%) and adverse effects (62.3%) were the most important factors taken into account when counseling a nonprescription medicine. Few pharmacists knew the meaning of terms related to evidence-based health. Most respondents agreed that pharmacists have the necessary training to prescribe. Conclusion: Over-the-counter medication counseling is a daily practice among Brazilian pharmacists. Learning needs exist for community pharmacists in relation to evidence-based practice. Thus, sources of information with good evidence could be used daily by community pharmacists, especially as regards nonprescription medication counseling (AU)

Antecedentes: Para proporcionar asesoramiento adecuado al paciente en la dispensación de medicamentos over-the-counter (OTC), los farmacéuticos comunitarios necesitan acceso a información actual y fiable sobre medicamentos. Los farmacéuticos brasileños han asumido nuevas funciones, tales como la prescripción de la medicación, en un modelo independiente basado en protocolos. Objetivo: Examinar la práctica de los farmacéuticos comunitarios en un estado de Brasil, centrándose en las recomendaciones de OTC. Métodos: Se realizó un estudio transversal de farmacéuticos comunitarios en un estado de Brasil entre octubre 2013 y enero 2014, con recogida de datos mediante un cuestionario auto-administrado, pre-pilotado y anónimo en una plataforma Survey Monkey®. Después de la aprobación ética, se envió el instrumento online a 8.885 farmacéuticos registrados en el estado de Paraná (Brasil), centrándose en los profesionales que trabajan en farmacia comunitaria. El cuestionario evaluaba el establecimiento de la farmacia comunitaria, la busca de información, el conocimiento de las prácticas basadas en la evidencia, los factores importantes a considerar cuando se recomienda un medicamento OTC, y la prescripción del farmacéutico. Las respuestas se importaron a SPSS® (versión 22.0) para su análisis. Se usaron pruebas no paramétricas para evaluar la asociación entre respuestas y la información demográfica con un nivel de significancia de menos del 5% (p<0,05). Resultados: El 97,4% de los farmacéuticos dispensaba medicamentos y aconsejaba a pacientes durante una mediana de seis horas por día. Los factores más importantes a tener en cuenta cuando se aconsejaba un medicamento sin receta eran la eficacia del producto (97%) y los efectos adversos (62,3%). Pocos farmacéuticos conocían el significado de los términos relacionados con la práctica basada en la evidencia. La mayoría de los respondentes estaban de acuerdo con que los farmacéuticos tienen la formación necesaria para prescribir medicamentos. Conclusión: El asesoramiento en medicamentos overthe- counter es una práctica diaria entre los farmacéuticos brasileños. Existen necesidades formativas de los farmacéuticos comunitarios en relación a la práctica basada en la evidencia. Así, los farmacéuticos comunitarios podrían usar a diario las fuentes de información con buena evidencia, especialmente relativas al asesoramiento de medicación sin receta (AU)

La prescripción electrónica asistida: instrumento clave para la disminución de los problemas relacionados con los medicamentos en el hospital / Computerized physician order entry: a key instrument for reducing drug-related problems in hospitals

Objetivo: Evaluar el efecto de la implantación de la prescripción electrónica asistida (PEA) en una unidad clínica sobre los problemas relacionados con los medicamentos (PRM) y sobre el grado de aceptación de las intervenciones farmacéuticas. Métodos: Estudio prospectivo, casi experimental. Se revisaron las prescripciones farmacológicas de un servicio de medicina interna durante dos periodos secuenciales de 3,5 meses cada uno (antes y después de la implantación de la PEA). Se registraron todos los PRM detectados en ambas fases. Se analizó también la aceptación de la intervención farmacéutica ante cada error. Resultados: Durante los 7 meses del estudio se detectaron un total de 4.023 PRM, 3.785 en la fase de prescripción manual (PM) y 238 en la fase de PEA; la tasa de PRM por paciente ingresado era de 16,9 en PM y de 1,07 en PEA, lo que supone una reducción estadísticamente significativa del 93,67%. Si omitimos los PRM de identificación de la orden médica, se obtiene una reducción del 43,21%. Con la introducción de la PEA, desaparecieron los PRM de identificación de la orden médica y de transcripción en farmacia, disminuyeron los de dosis no adecuada, duración no adecuada e interacciones, y aumentaron los de error en la identificación del medicamento. Conclusiones: La implantación de la PEA ha disminuido de forma significativa la tasa total de PRM y la de PRM de importancia mayor. La proporción de intervenciones farmacéuticas no contestadas por el médico ha disminuido significativamente (AU)

Objective: To evaluate the effect of the implementation of computerized physician order entry (CPOE) in a clinical unit on drug related problems (DRP) and on the degree of acceptance of the pharmaceutical interventions. Methods: In this prospective, quasi-experimental study, the drug prescriptions of an internal medicine service were revised over two sequential periods of 3.5 months each (before and after the implementation of the CPOE). All the DRP detected in both phases were recorded. The acceptance of the pharmaceutical intervention in each error was also analysed. Results: In the 7 months of the study, a total of 4,023 DRP were detected, 3,785 in the manual prescription (MP) phase and 238 in the CPOE phase, the rate of DRP per patient admitted being 16.9 in MP and 1.07 in CPOE. This constitutes a statistically significant reduction of 93.67%. If we omit the DRP in the identification of the physician’s order, we obtain a reduction of 43.21%. With the introduction of CPOE, the DRP in the identifi cation of the physician’s order and of transcription in the pharmacy disappeared, those pertaining to unsuitable dose and unsuitable duration and interactions fell, and those involving an error in the identification of the medicinal product increased. Conclusions: The implementation of the CPOE significantly reduced the total rate of DRP and the rate of DRP of major importance. The proportion of pharmaceutical interventions unanswered by the physician has been reduced significantly (AU)

Online, direct-to-consumer access to insulin: patient safety considerations and reform.

The online, direct-to-consumer (DTC) medical marketplace is proliferating more rapidly than regulation is evolving to ensure proper patient safety and public health controls. Along with this growing body of unrestrained medical testing and pharmaceuticals offered DTC online, most types of insulin and insulin administration products may now be purchased without prescriptions or physician guidance. Given the relatively significant risks of insulin use, the abuse potential, the high prevalence of diabetes mellitus, and the rising population of uninsured and underinsured, it is imperative to reform the online DTC medical marketplace to ensure that patient safety and public health are protected.