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.
Medication-related readmissions within 30 days after discharge
OBJECTIVE
Primary aim: to identify the percentage and preventability of unplanned readmissions ≤ 30 days of discharge due to medication related problems. Secondary aims: to assess which types of medication were responsible for potentially preventable readmissions and potential causes of these readmissions.
DESIGN
We conducted a cross-sectional observational study.
METHODS
Patients (≥ 18 years) with a 30-day unplanned readmission after discharge from a participating department were included. Residents of these departments and a pharmacist reviewed files of readmitted patients. During multidisciplinary meetings, potentially preventable cases were discussed and consensus was reached. The percentage of readmissions that were medication related, and potential preventability were assessed. For potentially preventable readmissions, types of medication responsible for the readmission and potential causes were assessed. Potential causes were categorized into three categories: problems due to transitions in care, prescribing, and adherence.
RESULTS
426 readmissions were included. Nineteen percent was medication related and 38% of these were potentially preventable. Most common types of medication responsible for potentially preventable readmissions were: diuretics (20%), drugs used to treat diabetes (17%) and cardiac therapy/beta blocking agents (13%). Potential causes of these readmissions were problems due to prescribing (43%), transitions in care (23%), and adherence (33%).
CONCLUSION
Thirty-eight percent of medication related readmissions is potentially preventable. Problems with prescribing, transitions in care and adherence might be good starting points for implementing interventions to reduce medication related readmissions.
Antidepressant tapering strips to help people come off medication more safely
BACKGROUND
Antidepressants are commonly prescribed for many mental disorders, including psychosis. Withdrawal effects, resulting from inappropriately short duration of tapering or lack of flexibility in prescribing gradual reduction, are common.
OBJECTIVE and DESIGN
An observational study was conducted of the use of “tapering strips”, which allow gradual dosage reduction and minimise the potential for withdrawal effects.
METHODS
A tapering strip consists of antidepressant medication, packaged in a roll of small daily pouches, each with the same or slightly lower dose than the one before it. Strips come in series covering 28 days.
RESULTS
Of 1194 users of tapering strips, 895 (75%) wished to discontinue their antidepressant medication. In these 895, median length of antidepressant use was 2-5 years (IQR = 1-2 years ≥ 10 years). Nearly two-thirds (62%) had unsuccessfully attempted withdrawal before (median = two times before, IQR = 1-3). Almost all of these (97%) had experienced some degree of withdrawal, with 49% experiencing severe withdrawal (7 on a scale of 1-7, IQR = 6-7). The most common medications were paroxetine (n = 423, 47%) and venlafaxine (n = 386, 43%). Of the 895 wishing to discontinue, 636 (71%) succeeded in tapering their antidepressant medication completely, using a median of two tapering strips (IQR = 1-3) over a median of 56 days (IQR = 28-84).
CONCLUSION
Tapering strips represent a simple and effective method of achieving a gradual dosage reduction.