Correct use of non-indexed eGFR for drug dosing and renal drug-related problems at hospital admission

PURPOSE Two to seven percent of the German adult population has a renal impairment (RI) with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. This often remains unrecognized and adjustment of drug therapy is lacking. To determine renal function in clinical routine, the CKD-EPI equation is used to calculate an indexed eGFR (ml/min/1.73m2). For drug dosing, it has to be individualized to a non-indexed eGFR (ml/min) by the patient's body surface area. Here, we investigated the number of patients admitted to urological wards of a teaching hospital with RI between July and December 2016. Additionally, we correctly used the eGFRnon-indexed for drug and dosage adjustments and to analyse the use of renal risk drugs (RRD) and renal drug-related problems (rDRP). METHODS In a retrospective observational study, urological patients with pharmacist-led medication reconciliation at hospital admission and eGFRindexed (CKD-EPI) of 15-59 ml/min/1.73m2 were identified. Indexed eGFR (ml/min/1.73m2) was recalculated with body surface area to non-indexed eGFR (ml/min) for correct drug dosing. Medication at admission was reviewed for RRD and based on the eGFRnon-indexed for rDRP, e.g. inappropriate dose or contraindication. RESULTS Of 1320 screened patients, 270 (20.5%) presented with an eGFRindexed of 15–59 ml/min/1.73m2. After readjustment, 203 (15.4%) patients had an eGFRnon-indexed of 15–59 ml/min. Of these, 190 (93.6%) used ≥ 1 drugs at admission with 660 of 1209 (54.7%) drugs classified as RRD. At least one rDRP was identified in 115 (60.5%) patients concerning 264 (21.8%) drugs. CONCLUSION Renal impairment is a common risk factor for medication safety in urologic patients admitted to a hospital. Considerable shifts were seen in eGFR-categories when correctly calculating eGFRnon-indexed for drug dosing purposes. The fact that more than half of the study patients showed rDRP at hospital admission underlines the need to consider this risk factor appropriately

Le financement à l’épisode de soins : un modèle efficient pour renforcer le lien ville-hôpital en France et au Québec ?

International audienc

Optimisation de la prise en charge de la plaie post-chirurgicale par une équipe pluridisciplinaire : étude pilote de faisabilité

International audienceObjectives: The management of post-surgical wounds is complex and suffers from a lack of coordination between the hospital and the community. The pharmacist could improve the efficiency of the care pathway by optimizing the compliance of discharge orders (DO) with current standards and reducing the associated expenditures. The objective of this study was to evaluate the impact of a multidisciplinary intervention on the quality and cost of acute post-surgical wound management.Methods: This is a pilot study, monocentric, prospective, before/after. Non-conformities (NC) of DO for post-surgical wounds were analyzed before and after a multidisciplinary intervention (development of protocols, provision of prescription aid supports, training) in 3 surgical departments. The cost of each OS filled in the community was collected and the satisfaction of community pharmacists was evaluated.Results: Out of 120 OS collected, 576 NC were detected. The intervention halved the number of DO with at least 1 NC and divided the median number of NC per order by 7. Community pharmacists were 4 times more satisfied with the quality of DO after the intervention. The cost of the multidisciplinary intervention was estimated at 787 euro. This intervention did not change the average cost per prescription.Conclusion: The multidisciplinary intervention improved the quality of post-surgical wound management by making the hospital-city pathway more fluid. The intervention requires a low investment in human resources and could be economically interesting if the costs avoided by the prevention of complications were valued.Objectifs : la prise en charge des plaies post-chirurgicales est complexe et souffre d’un manque de coordination entre l’hôpital et la ville. Le pharmacien pourrait améliorer l’efficience du parcours de soins en optimisant la conformité des ordonnances de sortie (OS) aux référentiels en vigueur et en réduisant les dépenses associées. L’objectif de cette étude était d’évaluer l’impact d’une intervention pluridisciplinaire sur la qualité et le coût de prise en charge des plaies aiguës post-chirurgicales.Méthodes : étude pilote, monocentrique, prospective, de type Avant/Après. Les non-conformités (NC) des OS pour plaies post-chirurgicales ont été analysées avant et après une intervention pluridisciplinaire (élaboration de protocoles, mise à disposition de supports, formation) dans 3 services de chirurgie. Le coût de l’exécution en ville de chaque OS a été recueilli et la satisfaction du pharmacien d’officine a été évaluée.Résultats : sur 120 OS recueillies, 576 NC ont été détectées. L’intervention a réduit de moitié le nombre d’OS présentant au moins 1 NC et divisé par 7 le nombre médian de NC par ordonnance. Les pharmaciens d’officine étaient 4 fois plus satisfaits de la qualité des OS après l’intervention. Le coût de l’intervention pluridisciplinaire a été estimé à 787 euros. Cette intervention n’a pas modifié le coût moyen par prescription.Conclusion : l’intervention pluridisciplinaire a amélioré la qualité de la prise en charge des plaies post-chirurgicales en fluidifiant le parcours hôpital-ville. L’intervention nécessite un faible investissement en ressources humaines et pourrait être économiquement intéressante si les coûts évités par la prévention des complications étaient valorisés

Analyse pharmaceutique des prescriptions médicamenteuses en établissement de santé : comparaison France-Québec

International audienceObjectives: The pharmaceutical analysis of drug prescriptions is one of the key steps in the drug circuit. This mandatory regulatory practice in France and Quebec is based on national standards. The main objective of this work was to compare the practical methods of pharmaceutical analysis performed in French and Quebec university hospitals. Methods: This is a prospective comparative survey conducted in 2 French and Quebec university hospital centres among pharmacists and pharmacy residents. Results: The response rate to the survey was 60% (45/75). Between 16 and 22 elements were deemed necessary to structure the centralized, decentralized or mixed pharmaceutical analysis. The chronological ranking of these elements was comparable between the French and Quebec participants. All participants were in favour of the development of initial and continuing training in pharmaceutical analysis. Finally, the majority of participants were against using individual pharmaceutical analysis performance indicators to optimize the process (82%; 37/45). Conclusions: The French-Quebec practice of prescription analysis by a ward-pharmacist complies with national standards. The main differences in the practice of pharmaceutical analysis are related to the types of organization, the tools available and the length of time pharmacists have been deployed in care units in France and Quebec

Analyse comparative du cadre juridique et normatif encadrant la pratique de la pharmacie au Canada (Québec), en France, en Suisse (Genève) et en Belgique

peer reviewe

Le financement à l’épisode de soins : un modèle efficient pour renforcer le lien ville-hôpital en France et au Québec ?

International audienc

Evaluating the costs of adverse drug events in hospitalized patients: a systematic review

Abstract Background Adverse drug events (ADEs) are not only a safety and quality of care issue for patients, but also an economic issue with significant costs. Because they often occur during hospital stays, it is necessary to accurately quantify the costs of ADEs. This review aimed to investigate the methods to calculate these costs, and to characterize their nature. Methods A systematic literature review was conducted to identify methods used to assess the cost of ADEs on Medline, Web of Science and Google Scholar. Original articles published from 2017 to 2022 in English and French were included. Economic evaluations were included if they concerned inpatients. Results From 127 studies screened, 20 studies were analyzed. There was a high heterogeneity in nature of costs, methods used, values obtained, and time horizon chosen. A small number of studies considered non-medical (10%), indirect (20%) and opportunity costs (5%). Ten different methods for assessing the cost of ADEs have been reported and nine studies did not explain how they obtained their values. Conclusions There is no consensus in the literature on how to assess the costs of ADEs, due to the heterogeneity of contexts and the choice of different economic perspectives. Our study adds a well-deserved overview of the existing literature that can be a solid lead for future studies and method implementation. Trial registration PROSPERO registration CRD42023413071