Farmaceutisch onderzoek

855 artikelen

20 aug 2019

Het effect van een Kwetsbare Ouderen Team op geneesmiddelgerelateerde problemen na ontslag uit het ziekenhuis

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1701
  • Auteur(s):
    G.H.M. Ponjee a*, H.W.P.C. van de Meerendonk b, M.J.A. Janssen c en F. Karapinar-Çarkit d

Het effect van een Kwetsbare Ouderen Team op geneesmiddelgerelateerde problemen na ontslag uit het ziekenhuis

The effect of a Geriatric Stewardship on drug-related problems after hospital discharge

OBJECTIVE

To assess the effect of a Geriatric Stewardship on drug-related problems (DRPs) reported by patients after discharge.

DESIGN

An implementation study (pre-post design).

METHODS

Hospitalized patients aged ≥ 65 years with polypharmacy and a risk factor for frailty were included from February 2017 until August 2018. The pre-group received usual care (control: no medication review). The post-group received the Geriatric Stewardship intervention. This consisted of an extended medication review based on a (1) review of the medication list and clinical records to draft initial recommendations, (2) consultation with the general practitioner and community pharmacist to discuss the hospital based recommendations, (3) patient interview to assess patient needs, and (4) multidisciplinary evaluation of all the previous steps by a hospital pharmacist and a geriatrician to draft final recommendations.

Two weeks post-discharge, patient-reported DRPs were assessed by telephone using a validated questionnaire. DRPs were classified into: drug-related complaints, practical problems, and questions about medication. The primary outcome was the number and type of DRPs per patient.. Secondary, in the intervention group the number of initial recommendations that were altered after consultations with PCPs and patient interviews was assessed. A poisson regression was used to compare the groups on the primary outcome.

RESULTS

In total, 127 patients were analyzed (control: 74, intervention: 53). Intervention patients reported fewer DRPs compared to control, 2.8 versus 3.3 per patient (RRadjusted = 0.83, 95% CI = 0.66-1.05). The difference was due to a halving in drug-related complaints (P < 0.05). Nearly 30% of the initial recommendations based on the patient’s medication list and clinical records were discarded or modified after consultations with primary care providers and patient interviews.

CONCLUSION

The implementation of a Geriatric Stewardship tends to reduce DRPs after discharge, which provides a good indication for further research. One in three initial medication review recommendations were altered due to PCPs and patient input. This shows that medication reviews should not be based on clinical records only. Patient participation and consultations with primary care providers contributes to a medication review that is tailored to the patient’s individual preferences and medical history.

15 aug 2019

Effect van beslissingsondersteuning op het verminderen van interacterende medicatiecombinaties op de intensive care

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1703
  • Auteur(s):
    M.S. Ongering a*, T. Bakker b, D.A. Dongelmans c, N.F. de Keizer b, A. Abu-Hanna b en J.E. Klopotowska b

Effect van beslissingsondersteuning op het verminderen van interacterende medicatiecombinaties op de intensive care

Effect of a clinical decision support system on reducing drug-drug interactions in the intensive care unit

BACKGROUND

Patients in the intensive care unit (ICU) are at a higher risk of medication-related harm due to potential drug-drug interactions (DDIs). This increased risk is related to the high number of drugs administered. Clinical decision support systems (CDSSs) have the potential to reduce potential DDIs (pDDIs) and improve medication safety.

OBJECTIVE

To evaluate the effect of a CDSS on the incidence of serious pDDIs in the ICU of an academic hospital.

DESIGN and METHODS

This study was conducted at the ICU department of the Amsterdam UMC (location AMC) in the Netherlands. Interrupted time series analysis was used to evaluate the effect of a CDSS. This CDSS generated pDDI alerts during prescribing. Data on medication administrations, pDDIs and pDDI alerts were gathered a year before and a year after implementation of the CDSS from April 2011 till April 2013. The primary outcome was the rate of serious pDDIs per 100 medication administrations. Secondary outcomes were the proportions of overridden pDDI alerts and monitoring actions related to pDDI alerts.

RESULTS

In total 2711 patients having 58.455 drugs administered were included. The rate of serious pDDIs did not significantly change after CDSS implementation (P = 0,098). The mean proportion of overridden pDDI alerts was high: 97% (total: 11.592 alerts). The mean proportion of pDDI alerts followed by a monitoring action varied between alert types (5,8-44,9%).

CONCLUSION

The implementation of a CDSS did not result in a decrease of serious pDDIs at the ICU. Lack of agreement on which pDDIs are clinically relevant for the ICU may explain our findings, since almost all alerts were overridden. Future research should focus on identifying which pDDIs are important in the ICU setting.

13 aug 2019

Melk is goed voor elk?

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1689
  • Auteur(s):
    Herman Vromans

Melk is goed voor elk?

08 aug 2019

Optimale pijnstilling bij laparoscopische darmchirurgie met focus op intrathecale toediening van morfine

  • Rubriek:
    Overzichtsartikel
  • Identificatie:
    2019;4:a1710
  • Auteur(s):
    Mark V. Koning a* en Liesbeth J. Ruijgrok b

Optimale pijnstilling bij laparoscopische darmchirurgie met focus op intrathecale toediening van morfine

Optimal analgesia after laparoscopic segmental colon resections with a focus on intrathecal morphine

BACKGROUND

Analgesia after laparoscopic segmental colon resections remains controversial. Epidural analgesia and systemic opioids per patient-controlled analgesia (PCA) are commonly used methods of analgesia in The Netherlands. A promising method of analgesia is intrathecal morphine because its analgesic properties fit the pain after laparoscopic surgery.

METHODS and RESULTS

Recently, a Dutch randomized controlled trial showed an enhanced recovery with intrathecal morphine when compared to an intravenous loading dose and a PCA pump of piritramide. Furthermore, the patients reported lower pain scores in the intrathecal morphine group. Still, the side effects warrant prophylactic measures for pruritus, nausea and vomiting. Late respiratory depression does not occur when a low dose (< 500 µg) is used and no concomitant sedatives are administered. If one adopts this analgesic technique, one should be cautious of the administered concentration since dilution could lead to dosing errors.

06 aug 2019

Het gebruik van restanten van monoklonale antilichaamproducten; een studie naar de microbiologische veiligheid

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1688
  • Auteur(s):
    Herman Vromans

Het gebruik van restanten van monoklonale antilichaamproducten; een studie naar de microbiologische veiligheid

01 aug 2019

Het effect van medicatieverificatie bij poliklinische internegeneeskundepatiënten

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1709
  • Auteur(s):
    Suzanne van der Gaag a, dr. Marjo J.A. Janssen b, Hanneke Wessemius c, dr. Carl E.H. Siegert d en dr. Fatma Karapinar-Çarkit e*

Het effect van medicatieverificatie bij poliklinische internegeneeskundepatiënten

An evaluation of medication reconciliation at an outpatient internal medicines clinic

BACKGROUND

Several international guidelines recommend the implementation of medication reconciliation.

OBJECTIVE

To evaluate the impact of medication reconciliation at an outpatient internal medicines clinic.

DESIGN

A prospective before-and-after study was conducted in the OLVG hospital, Amsterdam.

METHODS

At the internal medicines clinic, all adults (≥ 18 years of age) with a written informed consent and using more than one drug chronically (≥ 3 months) were included. In the usual care group no structural medication reconciliation was performed. In the intervention group, one week before the visit, the patient’s actual medication use (name, dosage, frequency) was assessed by phone by a pharmacy technician.

The primary outcome was the proportion of patients with unintentional discrepancies between documented and actual medication use. Secondary outcomes were the time needed by the physician to discuss medication-related topics during the outpatient visit, patient knowledge of medication changes, and patient satisfaction. Descriptive analysis and logistic regression was used to analyze the outcomes.

RESULTS

A total of 308 patients were included: 157 usual care, 151 intervention. The proportion of patients with an unintentional discrepancy decreased significantly by medication reconciliation: usual care 83%, intervention 39% (adjusted OR = 0.14, CI = 0.08-0.25). The physician used similar amounts of time to discuss drug-related topics in both groups (P = 0.316). Patients’ knowledge regarding medication changes increased non-significantly from 71% to 84% after medication reconciliation in the intervention group (P =0.058, adjusted OR = 1.35, CI = 0.64-3.64). Patients in both groups were equally satisfied with the physicians’ communication.

CONCLUSION

Similar to previous studies, medication reconciliation significantly decreased discrepancies with 50%. Further research is needed to assess the impact of medication reconciliation on clinical outcomes (e.g. adverse drug events).

30 jul 2019

Een alternatief voor capecitabine bij handvoetsyndroom

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1690
  • Auteur(s):
    Jacqueline Hugtenburg

Een alternatief voor capecitabine bij handvoetsyndroom

25 jul 2019

Hoe doseer je geneesmiddelen bij obese patiënten? 2

  • Rubriek:
    Overzichtsartikel
  • Identificatie:
    2019;4:a1705
  • Auteur(s):
    Elena C. Warmerdam, MSc a* en dr. Lisanne L. Krens b

Hoe doseer je geneesmiddelen bij obese patiënten?

How should drugs be dosed in obese patients?

BACKGROUND

Overweight and obesity are a common problem, however the dosing of drugs in obese patients is challenging due to the lack of dosing advice for these patients. In obese patients the bioavailability of drugs can be different. In general the volume of distribution increases with bodyweight and therefore drug metabolism may be changed in obese patients compared to normal-weight patients. Formulas to estimate kidney function may give an incorrect estimation in the obese; formulas indexed for body surface area – like MDRD and CKD-epi – underestimate the kidney function in obese patients. Moreover cytochrome P450 metabolism may also be altered in obese patients.

METHODS and RESULTS

For these reasons a simple, unambiguous, general advice on drug dosing in obese patient cannot be given. As a consequence a recommendation on dosing must be formulated for every single drug. In this manuscript we present a step-by-step plan which helps to formulate a pragmatic advice for drug dosing in obese patients when prescribing data is lacking.

19 jul 2019

Farmacogenetisch paspoort voor relevante genetische variatie met betrekking tot geneesmiddelgebruik

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1687
  • Auteur(s):
    Martina Teichert

Farmacogenetisch paspoort voor relevante genetische variatie met betrekking tot geneesmiddelgebruik

09 jul 2019

Telefonische medicatieverificatie voor het signaleren van discrepanties na eerdere preoperatieve screening

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1706
  • Auteur(s):
    M.G.M. Heijnen a*, L.L.G. Šebek b en C.F.M. Heetman-Meijer c

Telefonische medicatieverificatie voor het signaleren van discrepanties na eerdere preoperatieve screening

Additional medication reconciliation by telephone to indicate discrepancies after preoperative screening

BACKGROUND

Medication reconciliation (MR) as part of the preoperative screening (POS) is widely used for identifying current medication use and potential medication related problems in patients who are scheduled for surgery. Since the POS is carried out up to three months before hospitalisation, discrepancies in the medication use may be introduced after the POS. Therefore, an additional medication reconciliation was introduced for patients who had visited the POS more than seven days ago. Patients were interviewed by telephone two to three days before hospitalisation.

OBJECTIVE

To study whether an additional medication reconciliation by telephone two to three days before hospitalisation is effective in identifying recent discrepancies in the medication use. Secondary objectives were to define the relevance of each discrepancy and to investigate the time needed for the additional MR by phone.

DESIGN and METHODS

In this retrospective, observational study, we included all patients who were interviewed by phone in January 2018. Any mutation in medication profile following the interview was defined as a discrepancy. Both the type and the relevance of each discrepancy were recorded. The relevance of each discrepancy was independently scored by two separate pharmacists. Also, the time investment of 73 additional MRs by phone in June 2018 was assessed.

RESULTS

A total of 142 patients were included. In 39% of the patients at least one discrepancy was found during MR by phone. 101 discrepancies were found, of which 49 were moderately to very relevant. An MR by phone took approximately 8.1 minutes per patient.

CONCLUSION

An additional medication reconciliation by phone two to three days before hospitalisation is effective in identifying discrepancies and leads to a more accurate medication overview.

03 jul 2019

Het effect van een zorgprotocol op het percentage patiënten met supratherapeutische clozapinespiegels tijdens ziekenhuisopname

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1704
  • Auteur(s):
    M.I. Koole a*, E.E. Roelofsen b, E. Baptist c, R. van der Meer d, E.B. Wilms e en L.E. Visser f

Het effect van een zorgprotocol op het percentage patiënten met supratherapeutische clozapinespiegels tijdens ziekenhuisopname

The effect of a therapeutic guideline on the percentage of patiënts with supratherapeutic clozapine blood levels during hospital admission

BACKGROUND

Hospitalized patients on clozapine are at risk for dysregulation of their clozapine blood concentration due to smoking cessation, (pre-existing) infections and the use of drugs which influence the metabolism of clozapine. In July 2017 a therapeutic guideline was implemented in the Haga Teaching Hospital and Haaglanden Medical Centre to monitor patients during hospital admission to prevent clozapine toxicity.

OBJECTIVE

Primary objective was to study the effect of the guideline by comparing the percentage of hospitalized patients with one or more serum clozapine levels > 0,80 mg/L and/or > 50% increase of their serum clozapine level during admission, before and after implementation of the guideline.

DESIGN

We conducted a non-interventional retrospective study.

METHODS

In a period of ten months before and after the implementation of the guideline, data from all hospitalized patients 18 years using clozapine for schizophrenia were collected from electronic patient files.

RESULTS

In 90% of all patients an intervention was necessary according to the guideline. There was no significant difference between the percentage of patients with supratherapeutic clozapine levels before and after the implementation of the guideline (P = 0,695). The involvement of the hospital pharmacist improved significantly after implementation of the therapeutic guideline (number of interventions; P < 0,001). The hospital pharmacist recommended the involvement/consultation of the psychiatrist in 39% of the admissions after implementation of the guideline.

CONCLUSION

The therapeutic guideline did not reduce the number of patients with supratherapeutic clozapine levels. However, the involvement of the hospital pharmacist resulted in earlier involvement of the psychiatrist. According to the guideline an intervention was necessary in most patients (90%). All patients with supratherapeutic clozapine levels (n = 28) had an infection and/or an elevated CRP which suggests early dose reductions are required.

27 jun 2019

Eerste instrument voor opsporen patiënten met hoog risico op medicatiefouten na ontslag intensive care

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1686
  • Auteur(s):
    Martina Teichert

Eerste instrument voor opsporen patiënten met hoog risico op medicatiefouten na ontslag intensive care

17 jun 2019

Ontwikkelingen van farmaco-economisch onderzoek vanuit historisch perspectief

  • Rubriek:
    Overzichtsartikel
  • Identificatie:
    2019;4:a1699
  • Auteur(s):
    L. Westerink ab*, E. Dvortsin b en M.J. Postma ac

Ontwikkelingen van farmaco-economisch onderzoek vanuit historisch perspectief

Developments in pharmacoeconomic research from a historical perspective

BACKGROUND

Economic evaluations in healthcare are continuously being developed and increasingly applied. Health technology assessments provide insights into the health benefits of medical interventions compared to the treatment costs.

OBJECTIVE and DESIGN

This article gives an overview of historical, current and future developments in health economics, with a broader perspective on control of healthcare costs in the Netherlands.

RESULTS

At national level, pharmacoeconomics play a major role when reimbursement is requested for a medical intervention. Pharmacoeconomic outcomes are increasingly used for price negotiations to arrive at a cost-effective price for the Netherlands. New trends are introductions to the market with market access agreements, the inclusion of real world evidence and the exploration of realizing reimbursement of medicines at European level instead of per country.

CONCLUSION

Economic evaluations in healthcare provide insights into costs, savings and health effects of new treatments, and are performed in line with strict national and international requirements. The Dutch government applies these evaluations when deciding on the reimbursement of medical interventions. The aim of the government is to gain maximum health benefits for society within the total healthcare budget.

11 jun 2019

Langetermijneffecten van anticholinergica en sedativa op de cognitieve en fysieke functie

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1685
  • Auteur(s):
    Salima Kada

Langetermijneffecten van anticholinergica en sedativa op de cognitieve en fysieke functie

04 jun 2019

De kosteneffectiviteit van maagbescherming met protonpompremmers bij gebruikers van laaggedoseerde salicylaten

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1707
  • Auteur(s):
    Sek Hung Chau a†*, Reinier L. Sluiter b†, Wietske Kievit c, Michel Wensing cd, Martina Teichert cef en Jacqueline G. Hugtenburg a

De kosteneffectiviteit van maagbescherming met protonpompremmers bij gebruikers van laaggedoseerde salicylaten

Cost effectiveness of gastroprotection with proton pump inhibitors in older low-dose acetylsalicylic acid users in the Netherlands

OBJECTIVE

The present study aimed to assess the cost-effectiveness of concomitant proton pump inhibitor (PPI) treatment in low dose acetylsalicylic acid (LDASA) users at risk of upper gastrointestinal (UGI) side effects as compared to no PPI co-medication with attention to the age-dependent influence of PPI-induced side effects.

DESIGN and METHODS

A Markov model was developed to compare the strategy of PPI co-medication to no PPI in older LDASA users at risk of UGI side effects. As PPIs reduce the risk of UGI bleeding and dyspepsia, these risk factors were modelled together with PPI side effects for 60-69, 70-79 (base case) and 80 years and older LDASA users. Incremental cost-utility ratios (ICURs) were calculated as cost per quality-adjusted life year (QALY) gained per age category. Furthermore, a budget impact analysis (BIA) assessed the expected changes in expenditure of the Dutch health care system following the adoption of PPI co-treatment in all LDASA users potentially at risk of UGI side effects.

RESULTS

PPI co-treatment of 70-79-year-old LDASA users, as compared to no PPI, resulted in incremental costs of €100.51 at incremental effects of 0.007 QALYs with an ICUR of €14,671/QALY. ICURs for 60-69-year-old LDASA users were €13,264/QALY and €64,121/QALY for 80 years and older patients. Initiation of PPI co-treatment for all Dutch LDASA users of 60 years and older at risk of UGI side effects but not prescribed a PPI (19%) would have cost €1,280,478 in the first year.

CONCLUSION

PPI co-medication in LDASA users at risk of UGI side effects generally is cost-effective. However, this strategy becomes less cost-effective with higher age, particularly in patients aged 80 and older, mainly due to the increased risks of PPI-induced side effects.

30 mei 2019

Gecontra-indiceerde geneesmiddelvoorschriften bij kinderen

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1684
  • Auteur(s):
    Jacqueline Hugtenburg

Gecontra-indiceerde geneesmiddelvoorschriften bij kinderen