Level of hypertension treatment adherence during pandemic

Adherence to antihypertensive medications is the cornerstone for achieving metabolic syndrome control. The aim of this study was to explore how the pandemic has affected the adherence of patients with high BP to prescribed antihypertensive drugs. This multicentre observational study utilized self-completed questionnaires among patients between June and November 2020. Overall, 842 patients were included in the study. The likelihood of adherence was assessed using the 5‐item version of the Medication Adherence Report Scale (MARS-5Professor Rob Horne). The average MARS score of the sample was 16.81, the median was 4.162, and the most common value was 3 (24.5% of respondents) for the patients treated during the pandemic. The study suggests that several sociodemographic factors but not the COVID pandemic play a role in treatment adherence

Comparative Price Analysis of Biological Products for Treatment of Rheumatoid Arthritis

Biological products for treatment of rheumatoid arthritis usually are cost effective for healthcare systems in Europe, but they are huge financial burden due to the high number of patients and the significant budget impact. The expected saving from introduction on the market of biosimilars are significant and are linked to better access and affordability. The aim of this study was to conduct comparative price analysis of biological products for rheumatoid arthritis therapy among seventeen EU countries. The point of view is that of the Bulgarian pricing and reimbursement system and the chosen countries are those from external reference basket for prices comparison at manufacturing level. All authorized biological products by EMA with therapeutic indication rheumatoid arthritis were selected. The access for treatment is evaluated as the availability of the product on the market and the prices level. We assessed the availability of all trade names in the price lists of the observed countries. The prices data was obtained from the official web pages of the responsible institutions up to date December 2017. The results show that four out of all six INNs have authorized biosimilars in EMA. Despite its earlier authorization biosimilar adalimumab is not present in any of the price lists of countries. From all eighteen countries only in Lithuania and Estonia there were no published prices of any of the selected medicinal products. Countries with higher number of biosimilar prices are Spain and France. Differences in manufacturers’ prices of reference biological products in selected countries in comparison with the lowest manufacturer price are higher with 22 to 69% while the retail prices between 62 and 95%. Differences are mostly notable for rituximab, and less notable for tocilizumab. Manufacturers’ and retail prices of biosimilar products were established only for three INNs (etanercept, rituximab, and infliximab). Manufacturers’ prices differ between 26 and 75%, while retail prices differ between 40 and 92% for biosimilars. Comparison of the differences between manufacturer prices of reference biological product and biosimilars shows 36% difference for etanercept, 39% for rituximab, and 31% for infliximab, while at retail level the differences are 11, 86, and 143%, respectively. The limitation of the study is that the prices are the official ones without discounts due to confidentiality and the real prices may be lower. The second limitation is that the methodology for pricing differs in the countries and this could also influence the prices on both levels (manufacturer and retail). Introduction of biosimilars on the national markets led to significant decrease in reimbursed prices paid by public funds and thus might benefit the patients’ access to biological therapy. The decrease of prices after biosimilars entrance on the market is not as notable as for commodity generics

Pharmaceutical care for patients with headache

Introduction: Headache cephalalgia is the condition in which individuals feel pain in different parts of the head. It is one of the most common disorders believed to be amenable to self-treatment. The pharmacist can provide significant support to patients. Aim: The aim of this study was to present the role of pharmacists in the prevention of headaches. Materials and methods: We reviewed the available information in the biggest databases on the problem. Results: Drug therapy is only part of an effective approach to the management of headaches. In many cases headache triggers can be identified and lifestyle changes instituted that reduce the frequency of attacks. Rest, sleep, and adequate hydration are often important components of successful management regimes. Patient education and detailed information for their disease can play an active role in the treatment. The reviewed literature shows the importance of the involvement of community pharmacists of the treatment of headache disorders. As the most easily approachable healthcare providers pharmacists can assist patients in finding appropriate relief of headaches and ensure rational and safe headache treatment. Conclusions: Pharmacists have a crucial role in optimizing the results of the medical therapy

Managing polypharmacy through medication review tools – pros and cons

Inappropriate polypharmacy is a common occurrence in elderly patients, resulting in increased adverse drug reactions, nonadherence, and increased healthcare costs. Medication review and deprescribing are the primary strategies described in the literature for dealing with problematic polypharmacy. To effectively carry out the medication review, various tools have been developed. These tools can support medication review in a variety of ways. Some tools include a list of medications requiring detailed attention, while others guide medical professionals with principles and algorithms for reviewing and prescribing medicines. A third category of tools focuses on tracking and identifying symptoms that may be due to drug-related problems. This article aims to present the medication review support tools used in the management of polypharmacy in the geriatric population, emphasizing their advantages and disadvantages

Managing polypharmacy through medication review tools – pros and cons

Inappropriate polypharmacy is a common occurrence in elderly patients, resulting in increased adverse drug reactions, nonadherence, and increased healthcare costs. Medication review and deprescribing are the primary strategies described in the literature for dealing with problematic polypharmacy. To effectively carry out the medication review, various tools have been developed. These tools can support medication review in a variety of ways. Some tools include a list of medications requiring detailed attention, while others guide medical professionals with principles and algorithms for reviewing and prescribing medicines. A third category of tools focuses on tracking and identifying symptoms that may be due to drug-related problems. This article aims to present the medication review support tools used in the management of polypharmacy in the geriatric population, emphasizing their advantages and disadvantages

SCREENING AND RISK ASSESSMENT FOR DEPRESSION IN COMMUNITY PHARMACY- PILOT STUDY

Background: Depression is the most common mental illness affecting more than 300 million people worldwide and is a significant risk factor for morbidity and mortality. In most cases, it may remain undetected in primary care. Comprehensive screening tools for diagnosing depression might facilitate early detection. As the most accessible health professionals, pharmacists can play an important role in helping to identify individuals at risk. Objective: To differentiate individuals at risk of depression who are seeking a pharmacist consultation and are promptly directed to a psychiatrist. Methods: Depression screening tools The Patient Health Questionnaire (PHQ-2) and (PHQ-9) were applied to 83 individuals with symptoms such as feeling down, tiredness and sleep disturbances for more than 2 weeks, who seek consultation at a pharmacy. Screening with the PHQ-2 was the first step. Patients who screen positive were further evaluated with the PHQ-9. Results: In 70% of the individuals, the PHQ-2 test was positive. After completing PHQ-9, it was found that approximately 55% out of them had indications of mild to moderate depression and were directed to a psychiatrist for further evaluation. Over 50% of suspected depressive individuals had a concomitant chronic disease. Conclusion: Screening for depression should be a routine part of healthcare. Particular attention should be paid to patients with comorbid chronic illnesses, as depression often remains hidden, thus leading to more difficult diagnosis and treatment. Screening would also increase the recognition of depression in patients who have few emotional symptoms but many somatic ones

Analysis of the pharmacotherapeutic effectiveness of the tyrosine kinase inhibitors therapy in patients with Chronic Myeloid Leukemia in a single hematology center in Plovdiv, Bulgaria

Aim. The aim of this study is to evaluate treatment retrospectively, response to the therapy and outcomes in patients with chronic myeloid leukemia (CML) and to what extent the European recommendations of LeukemiaNET (ELN) are followed at the Hematology Clinic, University Hospital “St. Georgi”, MU Plovdiv. Methods. All patients with Ph+, BCR-ABL1+ CML who were treated and observed between 01.01.2018 and 12.31.2022 at the clinic were included in the study and were analyzed retrospectively. Results. One hundred and eighty-eight patients with a mean age of 61.26 (21–91) years were analyzed. 151 (80.3%) were in chronic phase (CP), 27 (14.4%) in accelerating one and 10 (5.3%) in blast crisis. The actual overall survival rate was 79.26%, while for CP it is very high – 86.75%, and the mortality rate is 20.74%. All patients received some form of tyrosine kinase inhibitors therapy (TKIs-therapy). The first line TKI was imatinib in 120 patients (64%), and 68 (36%) received a second-generation TKI. Treatment response was monitored with TKIs by RT-qPCR. Conclusion. CML patients treated in the hematology clinic receive standard care in accordance with ELN and BMSH recommendations. Overall survival (OS) in routine care is comparable to published data from international studies. Molecular monitoring provides a good basis for disease control in CP. There are unmet needs in the treatment of patients in advanced stages

Micro and macro analysis on the burden of COPD hospitalizations on the Bulgarian healthcare system

The aim of this study was to investigate the economic burden of Chronic Obstructive Pulmonary Disease (COPD)-related hospitalizations on a macro and micro level. Macro analysis was performed on the rate of DDD utilisation of COPD medicines, time of their inclusion in the reimbursement lists and the number of hospitalizations. On a micro level, a study of 426 patients with COPD was conducted to investigate the exacerbation and hospitalization rate relative to pharmacotherapy. A regression model, descriptive analysis, and Kruskal–Wallis non-parametric analysis were conducted. New drugs enter the market relatively quickly but are slow to be introduced into prescribing practices. The medicines’ utilization in Bulgaria has increased from 20 to 21 million DDD for all therapeutic groups, especially for long-acting beta-agonists/long-acting muscarinic antagonists (LABA/LAMA) fixed-dose combinations. A marked increase in hospitalization rates was observed despite lower numbers of registered and monitored COPD patients nationally. However, the hospitalization rates due to exacerbations remained around 18–19%. Variation was observed in the number of hospitalizations for the studied period: increasing during the period 2013–2014 and decreasing over the following two years. This trend was also observed for the number of health insured COPD patients. The hospitalization costs increased from 5.2 to 5.7 million BGN. A statistically significant decrease in the number of hospitalizations for LAMA/LABA patients vs. LABA/inhaled corticosteroids (ICS) patients was observed. Overall, frequent hospitalizations increased the total cost of COPD therapy. Patients on new medicines with improved inhaler devices seem to suffer fewer hospitalizations