DRUGS AND THERAPEUTIC INFORMATION SERVICE PROVIDED BY CLINICAL PHARMACISTS FOR AN IMPROVED PATIENT CARE: AN EXPERIENCE FROM A TERTIARY CARE TEACHING HOSPITAL

Objective: To assess the quality of drug information (DI) services provided by clinical pharmacists in a South Indian tertiary care teaching hospital.Methods: All answered DI queries by the Department of Clinical Pharmacy are documented electronically. To assess the quality of DI services, aquality assessment panel was constituted comprising the senior clinical pharmacists, and a quality assessment checklist was developed and appliedfor assessing the quality of DI services.Results: During the 12-month study period, a total of 1204 DI queries were received. The majority (48.76%) of DI queries was received during wardrounds by the clinical pharmacists and among them 61% of the queries was for better patient care. The highest numbers of queries (48%) werereceived from post-graduate medical students followed by the physicians (16%) and interns (8%). The most common DI queries were requested toknow the dosage/administration (22%), followed by cancer chemotherapy dosing (15.70%), adverse drug reactions (8%), drug use in pregnancy/lactation (7.56%), and drug-drug interactions (6.48%). The highest number of queries were from Department of Medicine (26%) followed by SurgeryDepartment (19.35%), Department of Pediatrics (15.61%) and Department of Dermatology (8.47%). The majority of the queries were answeredimmediately (64%). As per the quality assessment checklist, 64.5% queries were rated as excellent in quality followed by good (35.8%) and only 3.5%DI queries were required improvement.Conclusion: The quality of DI service was found satisfactory based on the rating.Keywords: Drug Information, Quality Assurance, Clinical Pharmacists, Medicine InformationÂ

Access to anti-cancer drugs in India: Is there a need to revise reimbursement policies?

The aim of this study was to examine the access of Indian cancer patients to optimum cancer care under selected government schemes by reviewing reimbursement schemes for cancer care in India.Methods: All cancer care reimbursement schemes in India were identified and three highly utilized schemes (VAS, RAS, CMCHS) were selected. Quality of breast, colorectal, lung, head & neck, and gastric cancer care was reviewed with respect to NCCN guidelines. Direct medical costs and shortage of budget in reimbursed amounts were calculated for each listed chemotherapy regimen.Results: Medical oncology practice following the schemes’ formularies is inferior to recommendations by the NCCN guidelines. Innovative treatment (targeted therapies) like trastuzumab, pertuzumab (breast), bevacizumab, cetuximab, panitumumab (colorectal), erlotinib, gefitinib, crizotinib, and nivolumab (lung) are either not reimbursed (VAS, CMCHS) or partially reimbursed (RAS). Average shortage of budget was found to be 43% (breast), 55% (colorectal), 74% (lung), 7% (head & neck), and 51% (gastric cancer).Conclusions: Policy makers should consider addition of newer treatments, exclusion of sub-optimal treatments, increments in per patient budget and optimization of supportive care, which may contribute to improvements in survival and quality of life for Indian cancer patients

Amelioration of quality of life and lung function of chronic obstructive pulmonary disease by pranic healing as adjuvant therapy

AimsTo study the effects of Pranic Healing (PH), as a complementary therapy to improve lung function, physiological condition and quality of life of Chronic Obstructive Pulmonary Disease (COPD) patients.MethodsRandomised, double-blind, placebo-controlled, pilot study. 21 males with a mean age of 61.6 years and COPD stage II were randomly allocated to PH and control groups. The PH group received PH sessions thrice weekly during the study. The control group received Sham PH. Data was collected during baseline and four scheduled visits of the participants during six months. The primary outcome of the study was to access the reduction in COPD symptoms and to increase participation in physical and social activities by evaluating Spirometry, St George’s Respiratory Questionnaire (SGRQ), 6 Minute Walk Test (6MWT) and Hamilton Rating Scale for Depression (HRSD).ResultsSignificant improvement for PH group in Forced Expiratory Volume in the first second (p=0.02), SGRQ domains of Activity (p=0.006), Impact (p=0.002), Total (p=0.000), and non-significant change in Symptom domain (p=0.44). PH group showed a positive tendency in 6 MWT and HRSD scores with insignificant difference between the groups. No serious adverse events occurred during the study.ConclusionPH as an adjunct to conventional treatment can improve lung function and quality of life of COPD subjects

Pharmacist-Initiated Medication Error-Reporting and Monitoring Programme in a Developing Country Scenario

Medication errors (MEs) often prelude guilt and fear in health care professionals (HCPs), thereby resulting in under-reporting and further compromising patient safety. To improve patient safety, we conducted a study on the implementation of a voluntary medication error-reporting and monitoring programme. The ME reporting system was established using the principles based on prospective, voluntary, open, anonymous, and stand-alone surveillance in a tertiary care teaching hospital located in South India. A prospective observational study was carried out for three years and a voluntary Medication Error-reporting Form was developed to report medication errors MEs that had occurred in patients of either sex were included in the study, and the reporters were given the choice to remain anonymous. The analysis was carried out and discussed with HCPs to minimise the recurrence. A total of 1310 medication errors were reported among 20,256 hospitalised patients and the incidence was 6.4%. Common aetiologies were administration errors [501 (38.2%)], followed by prescribing and transcribing errors [363 (28%)]. Root-cause of these MEs were distractions, workload, and communications. Analgesics/antipyretics (19.4%) and antibiotics (15.7%) were the most commonly implicated classes of medications. A clinical pharmacist initiated non-punitive anonymous ME reporting system could improve patient safety

Health-related quality of life assessment using St. George's respiratory questionnaire in asthmatics on inhaled corticosteroids

Context : Chronic diseases like asthma have significant effects on patients′ health-related quality of life (HRQoL). HRQoL measures additional indices as compared to objective measurements like spirometry. Aims: To assess and compare disease-specific quality of life in asthma patients using St. George′s Respiratory Questionnaire (SGRQ) receiving fluticasone, beclomethasone, and budesonide (BUD). Settings and Design: A prospective, open label, randomized, parallel group study conducted at a tertiary care teaching hospital in South India. Materials and Methods: A 6-month follow-up of 277 patients with mild, moderate, and severe persistent asthma was randomized to receive fluticasone propionate (FP), BUD, or beclomethasone dipropionate (BDP) in equipotent doses according to their global initiative on asthma (GINA) severity. Statistical analysis used: Data analyzed using SPSS version: 13.0. General linear-repeated measures using the post-hoc bonferroni method assessed significance between treatment groups. Results: Significant decrease (P < 0.05) in each SGRQ domains and total scores as well as improvement in FEV 1 (P < 0.05) was observed in all study subjects. A significant early response (P < 0.05) was noted after 15 days treatment in patients receiving FP with respect to SGRQ (activity, impact and total) scores and dyspnea indices, but not FEV 1 . This improvement with FP was due to its greater effect in patients with moderate and severe persistent asthma. No difference was noted subsequently in all outcome measures studied until 6 months. Conclusions: There was evidence for an early QoL improvement to FP as compared to BUD or BDP in moderate and severe persistent asthma. Subsequently, the three ICS showed similar improvements in lung functions and dyspnea indices throughout the study

Knowledge, beliefs, and practice of pregnant women regarding medication use during pregnancy: a hospital-based cross-sectional study

The purpose of this study was to assess the knowledge, beliefs, and practice (KBP) of pregnant women on medication use during pregnancy, and to identify the factors influencing KBP. A cross-sectional study was conducted in the Department of Obstetrics & Gynaecology of a tertiary care hospital over a period of nine months. Pregnant women receiving at least one medication were included in the study. A 19-item questionnaire was developed, validated, and used for assessing the KBP of pregnant women. Logistic regression analysis was used to identify the factors influencing the KBP. A total of 422 pregnant women with a mean (SD) age of 24.6 (4.05) years were included in the study. Pregnant women were having less knowledge on ‘unsafe medications’ and ‘important medications’ during pregnancy, wrong belief on ‘stopping all medications during pregnancy’, and less practice of ‘asking Pharmacist how to take medications’. It was identified hat the age, education, occupation, and area of living were the factors influencing the knowledge and practice of pregnant women on medication use. This study identified the need for improvement in knowledge and practice of pregnant women who are young, having nil or low level of education, no occupation, and living in rural areas.IMPACT STATEMENT What is already known on this subject? Knowledge and beliefs on medication use play a vital role in medication adherence among pregnant women. Crisis in rural healthcare along with socio-demographic conditions and literacy status of Indian women may have contributed to the lack of understanding about use of medications during pregnancy. What the results of this study add? The knowledge of pregnant women was found to be insufficient on ‘unsafe medications’ and ‘important medications’ during pregnancy. Majority of the pregnant women believe that it is better for the foetus if they ‘stop taking all medications during pregnancy’. ‘Not asking Pharmacist how to take medications’ is one important practice in India contributes less knowledge on medication use. What the implications are of these findings for clinical practice and/or further research? There is a need for improvement in knowledge and practice of medication use among pregnant women who are young, having nil or low level of education, no occupation, and living in rural areas

An adverse drug interaction of haloperidol with levodopa

Drug interactions are known to play a significant role in the incidence of adverse drug reactions (ADRs) both in the community and in hospitals. Both the newer atypical antipsychotics and their more traditional counterparts are subject to drug - drug interactions amongst themselves, with other psychotropics, and with the agents used in the treatment of various physical ailments. The most common interactions encountered in clinical practice are pharmacodynamic in nature. It is well established that antipsychotic drugs reduce the efficacy of levodopa in parkinson′s disease by blockade of dopamine receptors in the corpus striatum. The case reported here illustrates a common pharmacodynamic drug interaction of haloperidol with levodopa in a 60-year-old female patient

Access to anti-cancer drugs in India: Is there a need to revise reimbursement policies?

The aim of this study was to examine the access of Indian cancer patients to optimum cancer care under selected government schemes by reviewing reimbursement schemes for cancer care in India.Methods: All cancer care reimbursement schemes in India were identified and three highly utilized schemes (VAS, RAS, CMCHS) were selected. Quality of breast, colorectal, lung, head & neck, and gastric cancer care was reviewed with respect to NCCN guidelines. Direct medical costs and shortage of budget in reimbursed amounts were calculated for each listed chemotherapy regimen.Results: Medical oncology practice following the schemes’ formularies is inferior to recommendations by the NCCN guidelines. Innovative treatment (targeted therapies) like trastuzumab, pertuzumab (breast), bevacizumab, cetuximab, panitumumab (colorectal), erlotinib, gefitinib, crizotinib, and nivolumab (lung) are either not reimbursed (VAS, CMCHS) or partially reimbursed (RAS). Average shortage of budget was found to be 43% (breast), 55% (colorectal), 74% (lung), 7% (head & neck), and 51% (gastric cancer).Conclusions: Policy makers should consider addition of newer treatments, exclusion of sub-optimal treatments, increments in per patient budget and optimization of supportive care, which may contribute to improvements in survival and quality of life for Indian cancer patients