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.
The positive effect of clinical decision support shown at the time of prescribing
BACKGROUND
Clinical decision support system (CDSS) should help healthcare providers to make better decisions. For optimal performance, a CDSS uses algorithms taking various factors in consideration. For pharmacy practice, a CDSS often generates a patient list that is reviewed by a pharmacist and the physician is contacted in case of a clinically relevant signal. In our hospital we implemented five algorithms that alert the physician directly at the time of prescribing to treat the patient in line with the guidelines.
OBJECTIVE
To evaluate the effect of implementation of algorithms for medication surveillance shown directly to the physician at the time of prescribing.
DESIGN
Prospective intervention study.
METHODS
We analyzed the change in treatments in line with the guidelines and the percentage of correct follow-up after the advice was shown. We examined the implementation of five algorithms. These were the algorithms for gastric protection, methotrexate, vitamin D, hyponatremia and therapeutic drug monitoring of aminoglycosides and vancomycin.
RESULTS
For all algorithms the percentage of treatments in line with the guidelines increased significantly. The percentage of increase varied from 11 to 36% and in three of the five CDSSs the percentage was above 80% after implementation. For the algorithm gastric protection, the advice was accepted in 45% of all signals versus 4.3% in case of the classical drug-drug interaction signals.
CONCLUSION
Algorithms for medication surveillance that are shown to the physician at the time of prescribing increase the compliance with the guidelines.
VKA policy in the DOAC era: phenprocoumon versus acenocoumarol
BACKGROUND and OBJECTIVE
Vitamin K antagonists (VKAs) are still used for the prevention of thromboembolic events. In Europe acenocoumarol and phenprocoumon are frequently prescribed. In the Netherlands acenocoumarol is the most prescribed VKA.
DESIGN and METHODS
This article describes the differences between these two drugs: acenocoumarol and phenprocoumon.
RESULTS and CONCLUSION
Phenprocoumon is characterized by an extremely long half-life (160 hours), which leads to a better time in therapeutic range. Phenprocoumon dosing however, is more difficult and requires more often vitamin K interventions. Due to pharmacogenetic differences between these two anticoagulants, phenprocoumon is probably less sensitive to drug-drug interactions.