Het Nederlands Platform voor Farmaceutisch Onderzoek (NPFO) presenteert onderzoek in de farmaceutische wetenschappen. De nadruk ligt op klinische toepassing zoals medicatieveiligheid, patiëntenzorg, formulering, analyse, farmacologie en casuïstiek.
Efficacy and efficiency of antibiotics switch at the hospital pharmacy
OBJECTIVE
An earlier switch to oral antibiotics (AB po) can reduce inappropriate use of intravenous antibiotics (AB iv) and comes with certain benefits: decreased workload, reduced risk of complications, and decreased patient discomfort. Therefore, we examined how an earlier switch from AB iv to AB po can be executed optimally in a hospital setting.
DESIGN
Prospective, explorative intervention study.
METHODS
Besides the self-developed decision support system to detect AB iv, three intervention phases have been set up. Phase 1: pharmacist reports to the microbiologist in the Antimicrobial stewardship team (A-Team). Afterwards, the microbiologist discusses the option of switching to AB po with the treating physician. Phase 2: the pharmacist discusses the option of switching to AB po with the treating physician. Phase 3: the pharmacist only checks required data for earlier switch to AB po.
RESULTS
713 AB iv have been prescribed for 555 patients during the three phases and follow-up. For phase 1, 2 and 3 effectiveness was 39%, 48% and 50%, respectively, and pharmacist spent 3.2, 1.4 and 1.0 hours per day, respectively, on AB Switch. Phase 3 has been performed during follow-up thus achieving better effectiveness (67%) and better efficiency (0.9 hours per day).
CONCLUSION
These improvements are due to trainings provided by the A-Team, improved documentation of physicians (including indication and antibiotics policy), and increased awareness to switch earlier to AB po.
Guidance by physicians and pharmacists during antidepressant therapy: patients’ needs and suggestions for improvement
OBJECTIVE
Guidance of patients treated with antidepressants is paramount for successful therapy. The aim was to assess patients’ needs and suggestions for improvement of guidance by physicians and pharmacists during second generation antidepressant (SGA) therapy.
DESIGN
Five focus group discussions were held with a total of 34 patients using an SGA.
METHODS
The discussions were conducted flexibly and responsively using a semistructured topic list. All focus group discussions were video-recorded and transcripts were analysed using ATLAS.ti for coding, thematic and open analysis.
RESULTS
Participants stated they were in need of better guidance. They suggested improving content of information during decisional moments, patient-health care professional communication and communication in-between health care professionals, and finally, organisation of guidance. Barriers to achieving improved guidance were cited.
CONCLUSION
Content, communication and organisation of guidance are pivotal for achieving optimal guidance. Participants mentioned that their current experienced guidance had limitations and brought up solutions for improvement. A next step would be to discuss the suggested solutions with health care professionals to assess their views and to discuss the possibility for implementation. After implementation, future studies could be aimed at determination of its impact on patients’ treatment efficacy, quality of life, treatment satisfaction and healthcare costs.
The elderly migrant as customer at the pharmacy
BACKGROUND
Non-Western older immigrants experience poorer health outcomes than their Western counterparts, potentially due to limited access to health care services. A majority of the non-Western older immigrants has language problems and low health skills. As a consequence, they experience problems in their medication adherence and compliance.
OBJECTIVE
We tried to get more insight in how the older Moroccan-Dutch migrants and their next of kin at the pharmacy value their medication, how they adhere to medication and safe medication use.
DESIGN and METHODS
Semi-structured interviews were conducted with 20 older Moroccan-Dutch migrants (55 years or older, using five or more prescribed medicines) and 20 next of kin who support an older migrant for medication intake. Interviews were analysed using a qualitative research methodology. To reach the older migrants we deployed a so-called ethnic community health worker (CHW) at the pharmacy. She speaks the same language as the older migrants and has knowledge of the barriers they experience in medication adherence.
RESULTS
The older migrants could name the chronic disease for which they use medication. It seems hard for them to adhere to a medication intake regime due to daily hassles. When asking for more concrete knowledge about medication compliance skills, this topic seems to be a taboo and the older migrants fall silent. The older migrants and their next of kin agree that assistance for adherence to medication is necessary. The next of kin feel responsibility for this issue.
CONCLUSION
More attention to a firm relationship with the older migrants in the pharmacy is needed to talk about the problems they experience with medication adherence. Next to this, more attention should be paid to support their next of kin.