Farmaceutisch onderzoek

816 artikelen

13 dec 2018

Medicatiegerelateerde heropnames binnen 30 dagen na ontslag

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1686
  • Auteur(s):
    Elien B. Uitvlugt a*, dr. Marjo J.A. Janssen b, dr. Eva L. Kneepkens c, dr. Bart J.F. van den Bemt d, prof. dr. Patricia M.L.A. van den Bemt e en dr. Fatma Karapinar f

Medicatiegerelateerde heropnames binnen 30 dagen na ontslag

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.

11 dec 2018

Taperingstrips als hulpmiddel om antidepressiva verantwoord af te kunnen bouwen

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1687
  • Auteur(s):
    Peter C. Groot a* en Jim van Os abc

Taperingstrips als hulpmiddel om antidepressiva verantwoord af te kunnen bouwen

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.

10 dec 2018

Het effect van de apotheker op de intensive care

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1672
  • Auteur(s):
    Ithamar Brinkman

Het effect van de apotheker op de intensive care

06 dec 2018

Valproïnezuurintoxicatie bij een oudere patiënt: let op de vrije fractie

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1671
  • Auteur(s):
    Ithamar Brinkman

Valproïnezuurintoxicatie bij een oudere patiënt: let op de vrije fractie

03 dec 2018

Het effect van geïnhaleerde glycopyrroniumbromide op ernstige speekselvloed en kwijlen bij patiënten met de ziekte van Parkinson

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1685
  • Auteur(s):
    J.B. Masselink a*, L. van Velzen b, L.D.A. Dorresteijn c, J.A.M. van der Palen de en K.L.L. Movig f

Het effect van geïnhaleerde glycopyrroniumbromide op ernstige speekselvloed en kwijlen bij patiënten met de ziekte van Parkinson

The effect of glycopyrronium inhalation on sialorrhea and drooling in patients with Parkinson’s disease

OBJECTIVE

To investigate the safety and tolerability of glycopyrronium inhalation powder using different dosing regimens and to determine the decrease of drooling in patients with Parkinson’s disease.

DESIGN

We conducted a 5-week safety study.

METHODS

Following a baseline week, each participant used glycopyrronium inhalations during four weeks, with weekly changing dosing regimes. The safety and tolerability was determined by monitoring side effects and the experience of participants. The decrease in drooling was determined by comparing the mean sialorrhea scores obtained every week. An interim analysis was performed after including seven participants.

RESULTS

Side effects occurred in 71.4% of participants, which led to discontinuation of the study in three out of seven participants. The most common side effects were coughing and headache. Side effects that caused discontinuation were a swollen tongue, dry mouth, and gastro-enteritis. No unknown side effects of glycopyrronium led to discontinuation. Four participants experienced improvement in sialorrhea and three participants continued inhalation treatment after completion of the study. Two participants mentioned an instant effect after inhalation of glycopyrronium.

CONCLUSION

Despite the reported side effects and the fact that we performed an interim analysis, we believe that glycopyrronium inhalations could be considered after failing of oral therapy.

29 nov 2018

Verloopt farmaceutische zorg bij vervolguitgiftes van cardiovasculaire medicatie volgens de richtlijnen?

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1683
  • Auteur(s):
    Lyda Blom *

Verloopt farmaceutische zorg bij vervolguitgiftes van cardiovasculaire medicatie volgens de richtlijnen?

Does pharmaceutical care for repeated deliveries of cardiovascular medication comply with the guidelines?

BACKGROUND

Dutch community pharmacies can subscribe to a program where a patient as mystery guest visits their pharmacy to investigate their pharmaceutical care.

OBJECTIVE

To evaluate whether the pharmaceutical care provided to patients who receive repeated deliveries of cardiovascular medication is in line with the professional guidelines.

METHODS

Observations of repeated drug deliveries of cardiovascular medication to patients, who visit their pharmacy accompanied by a mystery guest (observer). In addition, interviews with patients about their pharmacy experiences.

RESULTS

In 950 pharmacies a patient receiving one or more repeated drug deliveries of cardiovascular medication was observed. Pharmacy employees communicated with patients correctly and in almost all cases verified patient identity (93.7%) by asking at least two questions (mostly patient name and date of birth). Medication was delivered almost always with a patient package insert (93%), which includes complete drug information. As such, pharmacies complied with the professional guidelines.

In addition 5275 patients belonging to 900 pharmacies were interviewed. Most of the patients would appreciate to be asked at the pharmacy about their medication problems (77.7%), although 62% never had received this question. Similarly, the observations demonstrated that a minority of all patients were asked about their medication problems or questions (19.7%). In this respect, pharmacies do not comply with the professional guidelines.

CONCLUSION

In repeated drug delivery contacts pharmacists follow the guidelines about the verification of patient identity and the provision of drug information, but do not comply with the recommendation to ask patients about their medication problems or whether they have questions.

23 nov 2018

Stroomdiagram ECG-monitoring bij QT-verlengende antidepressiva

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1666
  • Auteur(s):
    Ciske van den Oever

Stroomdiagram ECG-monitoring bij QT-verlengende antidepressiva

20 nov 2018

Geneesmiddelgerelateerde heropnames

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1665
  • Auteur(s):
    Ciske van den Oever

Geneesmiddelgerelateerde heropnames

15 nov 2018

Effectiviteit en efficiëntie van antibioticaswitch in de ziekenhuisapotheek

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1684
  • Auteur(s):
    D. Mitrovic a*, S. Begari b, K. Waar c en R. de Vries d

Effectiviteit en efficiëntie van antibioticaswitch in de ziekenhuisapotheek

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.

08 nov 2018

Begeleiding door artsen en apothekers tijdens antidepressivagebruik: behoeften van patiënten en suggesties ter verbetering

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1682
  • Auteur(s):
    M. Nederlof ab, D.C. Cath cd, L.J. Stoker a, A.C.G. Egberts ae en E.R. Heerdink aef*

Begeleiding door artsen en apothekers tijdens antidepressivagebruik: behoeften van patiënten en suggesties ter verbetering

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.

06 nov 2018

Fluoropyrimidines altijd op basis van DPYD-genotypering doseren

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1655
  • Auteur(s):
    Lonneke Timmers

Fluoropyrimidines altijd op basis van DPYD-genotypering doseren

02 nov 2018

De oudere migrant als klant in de openbare apotheek

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1681
  • Auteur(s):
    Bas Steunenberg *

De oudere migrant als klant in de openbare apotheek

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.

25 okt 2018

Identificeren van micro-organismen bij aseptische handelingen

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1680
  • Auteur(s):
    Frits A. Boom a*, Tjitske Veenbaas b, Mirjam Crul c, Milenko J.A.M.P. Pavičić d en Judith M. Ris a

Identificeren van micro-organismen bij aseptische handelingen

Identification of microorganisms in aseptic handling

OBJECTIVE

Determination of the relevance of identification of microorganisms found by microbiological Environmental Monitoring (isolates from EM) during aseptic handling.

METHODS

Identification of isolates from EM by microscopical examination, gram and spore staining and/or by MALDI-TOF. Isolates from EM in five hospital pharmacies were collected during one year and subdivided in 7 groups: Gram-positive and Gram-negative cocci, Gram-positive non-spore forming rods, Gram-positive spore forming rods, Gram-negative rods, fungi and yeast.

RESULTS

Gram-positive cocci were found in most cases (70-80 %), followed by Gram-positive rods (non-spore forming and spore forming; around 20%). Our results are comparable with the cleanroom microflora found in the pharmaceutical industry. The two cases described in this article, show that auditing gives more information about possible sources and causes of contamination than identification of micro-organisms.

CONCLUSION

The aim of identification is finding sources of contamination, resulting in corrective actions if EM results exceed the alert or action levels. We believe that the added value of identification, as a routine activity during aseptic handling is doubtful. However, knowing it is important to check if the cleanroom microflora is comparable to the expected microflora, we advise to do this once by using around 100 isolates from EM out of the LAF or biosafety cabinet and to repeat this every 3 years.

Identification is also valuable while building activities are taking place in the neighborhood of the cleanroom. Deviations from the expected cleanroom microflora will be indicative for inadequate preventive measures against contamination resulting from the building activities.

18 okt 2018

Deeltjesgrootte bepaalt immunogeniciteit aggregaten van monoklonale antilichamen

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1670
  • Auteur(s):
    Herman Vromans

Deeltjesgrootte bepaalt immunogeniciteit aggregaten van monoklonale antilichamen

15 okt 2018

Wat moeder ons vertelt

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1669
  • Auteur(s):
    Herman Vromans

Wat moeder ons vertelt

10 okt 2018

Morele dilemma’s van openbaar apothekers

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1679
  • Auteur(s):
    Martine Kruijtbosch ab*, Wilma Göttgens-Jansen c, Annemieke Floor-Schreudering ab, Evert van Leeuwen c en Marcel Bouvy b

Morele dilemma’s van openbaar apothekers

Moral dilemmas of community pharmacists: a narrative study

BACKGROUND

Pharmacists are increasingly involved in patient care. This new role in a complex healthcare system with demanding patients may lead to moral dilemmas. There has been little research into pharmacy ethics, and existing data are limited by their retrospective nature and small sample sizes. A thematic overview of the moral dilemmas experienced by community pharmacists is still missing.

OBJECTIVE

To make a thematic overview of moral dilemmas experienced in daily pharmacy practice. Setting Dutch community pharmacy.

METHODS

Dutch community pharmacists wrote a narrative about a moral dilemma they had experienced in clinical practice. The narratives were analysed using qualitative content analysis to identify underlying themes. Main outcome measure: themes of moral dilemmas.

RESULTS

Twenty-two themes were identifed in 128 narratives. These moral dilemmas arose predominantly during pharmacists contact with patients and other health professionals. The relationship between the pharmacist, patient and other health professionals was complicated by other parties, such as legal representatives, health insurance companies, and regulators.

CONCLUSION

The moral dilemmas experienced by community pharmacists are more diverse than previously reported. The main dilemmas arose in their professional contacts, frequently when their professional autonomy was challenged by the behaviour of patients and other health professionals.