Nederlands Platform voor Farmaceutisch Onderzoek
Substitution of Parkinson disease medication surrounded with problems
To get an insight in the extent of substitution of Parkinson disease medication in the Netherlands, and to see whether such substitutions lead to drug-related problems. In addition, we investigated the exchange of information between healthcare providers and patients in case of such a substitution.
DESIGN AND METHODS
Questionnaires among pharmacists and patients, and interviews with patients, pharmacists, neurologists and health insurance companies.
64 out of 123 responding patients (52%) mentioned that they had experienced substitution. Reasons for pharmacists to substitute are the so-called ‘preference policy’, logistic and financial considerations, and unfamiliarity or disagreement with the KNMP substitution guideline. About half of patients who were confronted with substitution had subsequently experienced adverse reactions. One out of three patients had been asked for their permission to substitute. Similar percentages were given by pharmacists. The neurologists were less often informed. 16 of the 71 responding pharmacists decided to substitute, also when ‘medical need’ was mentioned.
Substitution of Parkinson disease medication often takes place ignoring medical guidelines, governmental rules and practices such as informing patients and consulting professionals. Some pharmacists feel ‘squeezed’ between the policy of health insurance companies, negative financial consequences if they deviate from this policy, availability problems of many drug products, and the KNMP guideline stating that substitution of Parkinson disease medication should be avoided.
|Datum:||15 november 2016|
Effect van therapietrouw op exacerbaties is moeilijk te schatten met beschikbare real life data voor astma en COPD
Lucas Goossens a*, Jetty Overbeek b, Maurice Driessen c en Maureen Rutten-van Mölken aLees abstract
Effect of medication compliance on exacerbations is hard to estimate with available real life data for asthma and COPD
Effectiveness of long-acting bronchodilators and inhaled corticosteroids has been established in clinical trials. Their effectiveness in real life is not well documented.
To investigate to what extent it is possible to estimate the effect of medication compliance on the risk of asthma and COPD exacerbations, using data from community pharmacies and GP practices.
DESIGN AND METHODS
A cohort of 2294 asthma patients and 1559 COPD patients (≥ 18 years old) was compiled from linked databases of the PHARMO Institute. They were followed 1-4 years. Two measures of compliance were applied: (1) ‘actual use’ on a certain day, defined as the availability of medication on that day; (2) ‘long-term compliance’, which was assumed if there was actual use on at least 80% of the study period. Cox proportional hazards models were used to estimate associations of compliance and exacerbations, with and without adjustment for patients’ baseline characteristics (age, body mass index, gender, smoking history, disease severity). The adjusted analysis was applied on a subset of patients.
Without statistical adjustments, compliance was associated with a shorter time to exacerbations. After adjustment for baseline characteristics, the associations disappeared, but no protective effect was found. The same results were found in the subset when no adjustment was applied.
Registrations should be improved in order to enable the estimation of the real life effect of medication compliance on the risk of exacerbations in asthma and COPD patients.
|Datum:||11 november 2016|
Anti-Xa-activiteit van therapeutisch nadroparine bij verminderde nierfunctie en behandeling conform richtlijn Nederlandse federatie voor Nefrologie: vergelijking met standaarddosis bij normale nierfunctie
A.L. van Ojik a*, M. Hemmelder b, M. Hoogendoorn b, R. Folkeringa c, R. Smit de, H.J. Derijks df, R.J. van Marum gh, S.H. Hofma c en E.N. van Roon aiLees abstract
Anti-Xa activity of therapeutic nadroparin in patients with renal impairment treated according to the Dutch Federation of Nephrology guideline: comparison with standard dosing in patients with normal renal function
To determine equivalence of the mean anti-Xa activity (aXa) in patients with eGFR < 60 mL/min treated with a reduced therapeutic dose of nadroparin using the dosage guideline of the Dutch Federation of Nephrology (NfN) and patients with eGFR > 60 mL/min receiving a standard therapeutic dose of nadroparin.
Prospective, observational, multicentre, cohort study.
In three general teaching hospitals, patients were included between July 2014 and April 2016 if they met inclusion criteria: age > 18 years, therapeutic dose of nadroparin, subcutaneous administration for at least three days and written informed consent. Exclusion criteria were: dialysis, participation in another study and use of anti-Xa inhibitors other than nadroparin or four-factor prothrombin complex concentrate within seven days before the start or during the study. After at least three adjusted doses on the third day of therapy a blood sample was drawn four hours after administration of nadroparin (therapeutic range: 0.6-1.0 IU/mL).
97 patients with eGFR < 60 mL/min and 100 patients with eGFR > 60 mL/min were included. The mean aXa was 0.63 IU/mL respectively 0.62 IU/mL (P for equivalence = 0.015). In the group with renal impairment 52%, 12% respectively 37% of the patients achieved sub-, supra- and therapeutic aXa, compared with 47%, 7% respectively 46% in the group with normal renal function (P = 0.30).
This study shows that in patients with renal impairment a dosage reduction of therapeutic nadroparin using the dosage guideline of the NfN results in aXa that is equivalent with standard dose treatment in patients with normal renal function.
|Datum:||7 november 2016|
Parkinson’s disease, levodopa use and the risk of melanoma
Changes in melanin concentration in the melanocytes of the skin play an important role in the genesis of skin cancer, while in Parkinson’s disease a reduction occurs of the amount of neuromelanin (the form of melanin in the substantia nigra). Melanin thus plays a role in both illnesses, but the exact connection between both diseases is still unknown.
To define the risk of developing malignant melanoma as a possible side effect of levodopa use in patients with Parkinson’s disease.
DESIGN AND METHODS
Literature review using PubMed.
We found no evidence of a significantly increased risk of developing melanoma due to levodopa use. However, there is a bi-directional relationship between Parkinson’s disease and malignant melanoma.
Based on this literature study we suggest to alert Parkinson patients to the increased risk of melanoma.
|Datum:||27 oktober 2016|
R. Smit a*, R.J. van Marum bc, N.C.V. Péquériaux d, A.A.M.J. Hollander e, M.W.P. Bleeker f, W.A.J.J. Hermens a en H.J. Derijks ag
|Datum:||25 oktober 2016|
E. Boerrigter a, A.T.M. Wasylewicz b, R.J.E. Grouls c en C.H.M. Kerskes d*
|Datum:||25 oktober 2016|
E.S. Koster a* en E.H.H. Wiltink bLees abstract
Postoperative pain management in Dutch hospitals
To assess procedures regarding postoperative pain management in Dutch hospitals. Many postoperative patients experience pain. Inadequate pain control hampers patient recovery and may prolong hospital admission.
DESIGN AND METHODS
Structured questionnaires were used to describe the procedures in the participating hospitals. Furthermore, data on executed pain measurements and pain control were collected for both admitted and recently discharged patients.
Data were collected in 30 Dutch hospitals. All 30 hospitals had a protocol describing pain management. Postoperative pain was included most often (n = 28). In 28 hospitals the protocol described treatment of pain and in 25 hospitals pain measurement was described. We included 160 admitted and 155 recently discharged patients. For 94% of the admitted patients and 88% of the discharged patients, pain measurements were recorded during their hospital admission. For approximately half of the patients, three pain measurements per day were conducted. In both groups, for 74% a pain treatment strategy was described.
All hospitals had a guideline describing procedures for postoperative pain management. Most of the time patients have been treated according to the pain protocol.
|Datum:||11 oktober 2016|
L. Ariaans-Silkens a*, M.G.J. Meevis-Hendriks b en E.A. van Dijk cLees abstract
Experiences with pharmaceutical consultation prior to outpatient visit: a pilot study
To assess the feasibility and appropriateness of a pharmaceutical consultation prior to an outpatient visit for performing medication reconciliation and identifying potential drug-related problems (DRPs), and to identify factors that indicate when physicians consider a follow-up pharmaceutical consultation desirable.
DESIGN AND METHODS
In this pilot study, adult patients who used medication were invited for a pharmaceutical consultation by a pharmacy technician prior to their visit to the outpatient clinic of internal medicine. The pharmacy technician performed medication reconciliation based on electronically generated pharmacy dispensing data. A checklist was used to identify potential DRPs. The physician was asked for which patients a follow-up pharmaceutical consultation was considered desirable.
The pharmaceutical consultation took about 15 minutes, half of which was preparation. Electronically generated pharmacy dispensing data were accurate for only 29% of all patients. Per patient, 2.9 medication records had to be adjusted. 31% of consulted patients reported a DRP with the current medication. Nearly 10% reported intentional noncompliance. Physicians indicated repeating the pharmaceutical consultation was desirable for 26% of all consulted patients. Physicians were more likely to consider follow-up desirable if they were not oncology specialists, if available consultation time was 10 minutes or less, and if patients were over 75 years old and used three or more medicines.
A pharmaceutical consultation by a pharmacy technician prior to an outpatient visit provides useful information on current medication use and DRPs, but the required time limits routine implementation. Future research is needed to identify risk patients that will benefit most from a pharmaceutical consultation.
|Datum:||3 oktober 2016|