When Collecting Patient Data Gets Electronic: The Upsurge of Ehealth and The Importance of Big Data to Shape Modern Health Care

peer reviewe

Intérêt de santé publique de la collaboration pharmacien d'officine et infirmières à domicile dans la réalisation de piluliers hebdomadaires : une étude quantitative observationnelle transversale

editorial reviewedIntroduction: Medication errors and/or non-compliance can jeopardize patients’ safety. This risk can be attributed to the patient self-medication and/or her/his family and friends who may not ensure optimal follow-up of medication. Caregivers could be a risk too if she/he does not prepare the medication in accordance with the prescribed treatment due to lack of time or distraction. This study analyzes the practice of preparing weekly pillboxes to mitigate the potential risk of medication errors and/or non-compliance. Methodology: We surveyed Belgian community pharmacists and nurses in the preparation of weekly pillboxes. We study their potential interest in being involved together in a collaboration. The respective skills of these two stakeholders would be used to achieve a common goal, understand a patient's treatment in its entirety to reduce the risk of medication errors and the resulting drug-related iatrogeny. In practice, interprofessional collaboration in the health care setting is not consistently delivered by all professions, a significant disparity between the home care nurse and the community pharmacists may be a barrier to efficient collaboration. Result: We describe the professional profile and collaboration interest of home care nurse and pharmacist. The added value of the collaboration was assessed by previous publication and data on drugs compliance and medication error.It was established that 58.5% of the nurses participating in the study would find it useful to set up collaborations with community pharmacist. The responses to the open-ended question about home care nurses' views on working with the community pharmacist were categorized to highlight the most relevant arguments. It has been calculated that 58.2% of home care nurses would be in favor of this collaboration. This approval by home care nurses is justified in half of the cases by the fact that the community pharmacist would have better knowledge of drugs (drug interactions and generics). The difference of 0.3% with the percentage quoted in the previous paragraph is explained by the fact that 8.8% of the participants did not give their opinion. There are 32.7% of home care nurses who are opposed to the establishment of these collaborations with the community pharmacist. The main reason for this refusal is that some home care nurses feel that discussions about a patient's medication should be done only with the doctor. For them, this is not the responsibility of the community pharmacist. Conclusion: Two main things could be improved with this collaboration. First, home care nurses' knowledge about drugs would be constantly updated and optimized. Home care nurses also believe that this would ensure better patient care if the community pharmacist had a role to play in this task. It would also have an impact on their time and workload.3. Good health and well-bein

Current Practice in Weekly Pillbox Preparation and Perceived Added Value of Future Collaboration between Community Pharmacists and Home Care Nurses in Belgium

peer reviewedMedication-related errors represent a public health burden but are mainly preventable. A strategy to reduce medication errors could be pharmacist-nurse collaboration in weekly pillbox preparation. Unfortunately, there is little inventory in the literature on the actual pharmacist-nurse collaboration in weekly pillbox preparation and its added value in the healthcare practice. Objective: To assess the weekly pillbox preparation practices among home care nurses and community pharmacists, their collaboration for this service, and its added value, ultimately aiming to promote patient safety. Methods: An extensive survey was launched in French-speaking Belgium in 2022. The study occurred across two populations: home care nurses and community pharmacists in French-speaking Belgium. A self-administered questionnaire was developed. Three main outcomes were reported: the pillbox preparation, the medication plan, and the opinion about the pharmacist-nurse collaboration. A descriptive statistical analysis was carried out. Results: A total of 260 home care nurses and 204 community pharmacists answered the questionnaire. Our survey showed that weekly pillbox preparation was mainly performed by home care nurses (100%) than by community pharmacists (49%) in the primary care of the Belgian health system. There was only sometimes (or even no) remuneration for this service. Most home care nurses (82.7%) and community pharmacists (57.6%) have already pointed out errors in the medication plan used for the weekly pillbox preparation. The pharmacist-nurse collaboration for the weekly pillbox preparation was rare in Belgium. However, the majority of community pharmacists and home care nurses (more than 90% of both groups) would like to collaborate for this act, with the principal motivation of improving patient safety. Conclusion: Our survey showed that pharmacist- nurse collaboration in the weekly pillbox preparation was perceived as helpful in primary care with the ultimate goal of patient safety. Further studies are needed to examine the impact of this intervention and if it could be cost-effective

Preferences and perceptions of pharmacy students on the sectoral development of community pharmacy in Belgium

peer reviewedIntroduction:Building the future of the pharmacist profession today must be done by listening to the actors of tomorrow. Their wishes and main motivations must be integrated into reflections. The university needs to understand how students plan for their future professions. Consistency between teaching and sectoral development is at the heart of university concerns: anticipating professional changes can help the academic body build flexible programmes to align with professional development and best prepare actors of tomorrow.Objectives:To assess the preferences and perception of Master's students in pharmaceutical sciences among various potential sectoral evolution in the field of pharmacies open to the public. This researchquestions how future pharmacists rank in order of importance and preference for the potential sectoral developments in their profession.Methods: An online questionnaire was sent to Belgian student in pharmaceutical sciences to understand their preferences concerning the various missions expected to be part of the role of pharmacists in the years to come. Some of these missions already exist in Belgium, others already exist abroad, and others still need to be the responsibility of the pharmacist at present. The questionnaire used a best-worst scaling (BWS) approach to determine a hierarchy of preferences on a set of attributes describing the potential sectoral developments in community 389pharmacists. The BWS then makes it possible to classify preferences based on choices and to compare preferences among all the attributes considered. Respondents do not only express their preferences among the proposed attributes but also provide information through their responses as to the most preferable and least preferable attributes in their eyes. The research team agreed on a list of 18 attributes to characterize the profession of community pharmacists and its potential sectoral developments. The 18 attributes were: preparation and dispensing of medication, pharmaceutical care, adjustment/substitution, continuity of treatment, care monitoring/risk prevention, medication review, self-medication, prescription, adherence support, health prevention and promotion, drug analysis, inter-professional collaboration, pharmaceutical care, vaccination, screening, withdrawal/deprescription, return home after hospitalization and home care.Results: The topics for which students showed the greatest interest were delivery of medication with advice on the proper use, prevention, identifying and resolving potential drug-related problems or even assisting the patient in a self-medication situation.The themes with the lowest interest were Greenpharmacy, the collection of used products and sustainable practices.Conclusion: Future pharmacists do not wish to replace medical doctorsand have little interest in diagnosis, prescription and laboratory analysis. Moreover, the lack of interest of future pharmacists in Greenpharmacy raises questions. Making students aware of this significant environmental challenge should be encouraged

Economics of dialysis dependence following renal replacement therapy for critically ill acute kidney injury patients

Background The obective of this study was to perform a cost-effectiveness analysis comparing intermittent with continuous renal replacement therapy (IRRT versus CRRT) as initial therapy for acute kidney injury (AKI) in the intensive care unit (ICU). Methods Assuming some patients would potentially be eligible for either modality, we modeled life year gained, the quality-adjusted life years (QALYs) and healthcare costs for a cohort of 1000 IRRT patients and a cohort of 1000 CRRT patients. We used a 1-year, 5-year and a lifetime horizon. A Markov model with two health states for AKI survivors was designed: dialysis dependence and dialysis independence. We applied Weibull regression from published estimates to fit survival curves for CRRT and IRRT patients and to fit the proportion of dialysis dependence among CRRT and IRRT survivors. We then applied a risk ratio reported in a large retrospective cohort study to the fitted CRRT estimates in order to determine the proportion of dialysis dependence for IRRT survivors. We conducted sensitivity analyses based on a range of differences for daily implementation cost between CRRT and IRRT (base case: CRRT day $632 more expensive than IRRT day; range from$200 to $1000) and a range of risk ratios for dialysis dependence for CRRT as compared with IRRT (from 0.65 to 0.95; base case: 0.80). Results Continuous renal replacement therapy was associated with a marginally greater gain in QALY as compared with IRRT (1.093 versus 1.078). Despite higher upfront costs for CRRT in the ICU ($4046 for CRRT versus $1423 for IRRT in average), the 5-year total cost including the cost of dialysis dependence was lower for CRRT ($37 780 for CRRT versus $39 448 for IRRT on average). The base case incremental cost-effectiveness analysis showed that CRRT dominated IRRT. This dominance was confirmed by extensive sensitivity analysis. Conclusions Initial CRRT is cost-effective compared with initial IRRT by reducing the rate of long-term dialysis dependence among critically ill AKI survivor

Public health impact and return on investment of Belgium’s pediatric immunization program

ObjectiveWe evaluated the public health impact and return on investment of Belgium’s pediatric immunization program (PIP) from both healthcare-sector and societal perspectives.MethodsWe developed a decision analytic model for 6 vaccines routinely administered in Belgium for children aged 0–10 years: DTaP-IPV-HepB-Hib, DTaP-IPV, MMR, PCV, rotavirus, and meningococcal type C. We used separate decision trees to model each of the 11 vaccine-preventable pathogens: diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, Streptococcus pneumoniae, rotavirus, and meningococcal type C; hepatitis B was excluded because of surveillance limitations. The 2018 birth cohort was followed over its lifetime. The model projected and compared health outcomes and costs with and without immunization (based on vaccine-era and pre–vaccine era disease incidence estimates, respectively), assuming that observed reductions in disease incidence were fully attributable to vaccination. For the societal perspective, the model included productivity loss costs associated with immunization and disease in addition to direct medical costs. The model estimated discounted cases averted, disease-related deaths averted, life-years gained, quality-adjusted life-years gained, costs (2020 euros), and an overall benefit–cost ratio. Scenario analyses considered alternate assumptions for key model inputs.ResultsAcross all 11 pathogens, we estimated that the PIP prevented 226,000 cases of infections and 200 deaths, as well as the loss of 7,000 life-years and 8,000 quality-adjusted life-years over the lifetime of a birth cohort of 118,000 children. The PIP was associated with discounted vaccination costs of €91 million from the healthcare-sector perspective and €122 million from the societal perspective. However, vaccination costs were more than fully offset by disease-related costs averted, with the latter amounting to a discounted €126 million and €390 million from the healthcare-sector and societal perspectives, respectively. As a result, pediatric immunization was associated with overall discounted savings of €35 million and €268 million from the healthcare-sector and societal perspectives, respectively; every €1 invested in childhood immunization resulted in approximately €1.4 in disease-related cost savings to the health system and €3.2 in cost savings from a societal perspective for Belgium’s PIP. Estimates of the value of the PIP were most sensitive to changes in input assumptions for disease incidence, productivity losses due to disease-related mortality, and direct medical disease costs.ConclusionBelgium’s PIP, which previously had not been systematically assessed, provides large-scale prevention of disease-related morbidity and premature mortality, and is associated with net savings to health system and society. Continued investment in the PIP is warranted to sustain its positive public health and financial impact

Comparative analysis of healthcare use in patients with rheumatoid arthritis and control subjects without chronic disease

peer reviewe

Discounting health gain: a different view

ABSTRACTAt least since the Age of Enlightenment, good health has been a tenet for society. Healthy societies could learn better, work harder, improve their wealth, and live longer. Today societies focus on life expectancy, as we value long and healthy lives. As illustrated by the provision of COVID-19 vaccines first for the elderly, societies value life-saving actions. Paradoxically, health economic assessments conventionally devalue long-lasting health through the practice of discounting health benefits along with costs. However, health, with its intrinsic and instrumental characteristics, is not synonymous with money cash, a tradeable asset that devalues with time. If improving healthy life expectancy is a societal ambition, it seems counter-intuitive to value future health less as a result of an artificial mathematical construct when evaluating economically new medical interventions. In this paper, we investigate the application of discounting health in healthcare and consider paradoxical findings, especially in relation to disease prevention with vaccination. We argue that there is no economically sustainable argument to discount health gains, except for the benefit of the payer with a goal of spending less on life-saving products. If that is the objective for discounting health, there are other means to achieve the same goal in a more transparent and simpler way. From the long-term perspective of healthcare development, not discounting health gains would encourage research that values long-term effects. This in turn has the potential to benefit the investor, the payer, and the patient/consumer, improving the situation from multiple perspectives

Personalized medicine : pharmacoeconomics aspects

peer reviewedL’essor et l’implantation de la médecine personnalisée devraient permettre l’amélioration de la qualité de la prestation des soins ainsi que le développement de solutions thérapeutiques novatrices et adaptées. Dans une société où les ressources de soins de santé ne sont pas illimitées, la question du coût et de l’efficience économique de la médecine personnalisée est importante. De nombreuses études pharmacoéconomiques ont été réalisées et une partie substantielle d’entre elles suggèrent que la médecine personnalisée amène une meilleure santé, mais à un plus grand prix. Cependant, les méthodes pharmacoéconomiques développées ces dernières années devront être adaptées dans le futur afin de mieux prendre en compte la complexité de la problématique, notamment la capacité et la fiabilité des tests destinés à cibler au mieux les patients, mais aussi le cheminement complet des patients du début à la fin de la prise en charge.Personalized medicine : pharmacoeconomic aspects Summary : The development and establishment of personalized medicine should allow the improvement of the quality of the care services as well as of the development of new and adapted therapeutic solutions. In a society, whose resources for health care are not endless, the issue of costs and economic effectiveness of personalized medicine is important. Numerous pharmacoeconomic studies have been conducted and many of them suggest that personalized medicine leads to better health, but at higher cost. However, the pharmacoeconomic methods developed over recent years will have to be adapted to better take into account the complexity of the problem, especially the capacity and the reliability of tests to best target patients, and also the whole care process of patients