Impact of a community pharmacist-led medication review on medicines use in patients on polypharmacy - a prospective randomised controlled trial

In 2010 the 'Polymedication Check' (PMC), a pharmacist-led medication review, was newly introduced to be delivered independently from the prescriber and reimbursed by the Swiss health insurances. This study aimed at evaluating the impact of this new cognitive service focusing on medicines use and patients' adherence in everyday life.; This randomised controlled trial was conducted in 54 Swiss community pharmacies. Eligible patients used ≥4 prescribed medicines over >3 months. The intervention group received a PMC at study start (T-0) and after 28 weeks (T-28) while the control group received only a PMC at T-28. Primary outcome measure was change in patients' objective adherence, calculated as Medication Possession Ratio (MPR) and Daily Polypharmacy Possession Ratio (DPPR), using refill data from the pharmacies and patient information of dosing. Subjective adherence was assessed as secondary outcome by self-report questionnaires (at T-0 and T-28) and telephone interviews (at T-2 and T-16), where participants estimated their overall adherence on a scale from 0-100 %.; A total of 450 patients were randomly allocated to intervention (N = 218, 48.4 %) and control group (N = 232, 51.6 %). Dropout rate was fairly low and comparable for both groups (N Int = 37 (17.0 %), NCont = 41 (17.7 %), p = 0.845). Main addressed drug-related problem (DRP) during PMC at T-0 was insufficient adherence to at least one medicine (N = 69, 26.7 %). At T-28, 1020 chronic therapies fulfilled inclusion criteria for MPR calculation, representing 293 of 372 patients (78.8 %). Mean MPR and adherence to polypharmacy (DPPR) for both groups were equally high (MPRInt = 88.3, SD = 19.03; MPRCont = 87.5, SD = 20.75 (p = 0.811) and DPPRInt = 88.0, SD = 13.31; DPPRCont = 87.5, SD = 20.75 (p = 0.906), respectively). Mean absolute change of subjective adherence between T-0 and T-2 was +1.03 % in the intervention and -0.41 % in the control group (p = 0.058). The number of patients reporting a change of their adherence of more than ±5 points on a scale 0-100 % between T-0 and T-2 was significantly higher in the intervention group (NImprovement = 30; NWorsening = 14) than in the control group (NImprovement = 20; NWorsening = 24; p = 0.028).; Through the PMC pharmacist were able to identify a significant number of DRPs. Participants showed high baseline objective adherence of 87.5 %, providing little potential for improvement. Hence, no significant increase of objective adherence was observed. However, regarding changes in subjective adherence of more than ±5 % the PMC showed a positive effect.; Clinical trial registry database, NCT01739816 ; first entry on November 27, 2012

Clinical pharmacy services and evaluation of medicines use : the case of the swiss polymedication check

This thesis aimed at giving a general overview over clinical pharmacy services already performed in the Swiss hospital setting and discussing the strengths and limitations of pharmacist-led medication reviews in primary care by evaluating the Swiss Polymedication Check. In addition, specific opportunities for further clarification through pharmacist-led interventions are highlighted in order to select patients at highest needs for future services. Project A aimed at presenting an overview of existing clinical pharmacy services in the hospital care setting. We performed the first comprehensive survey of clinical pharmacy practice in Switzerland. Our data show considerable regional differences concerning the extent of implementation and pattern of clinical pharmacy services, which points out to the existing crucial gap in seamless care activities. In order to approach the topic of drug-related problems in patient care from a solution-oriented perspective, the potential of pharmacist-led medication reviews in various settings became a focus of the Pharmaceutical Care Network Europe (PCNE) and was extensively discussed at several meetings and workshops. Findings of project A: - In Switzerland, regional differences in the extent of implementation and pattern of clinical pharmacy services are observed, highlighting a crucial gap in seamless care activities. - The Pharmaceutical Care Network Europe agreed to a definition for medication reviews and encourages pharmacists to offer pharmaceutical care regardless of the setting. - Medication reviews offer an excellent opportunity to detect drug-related problems and initiate pharmaceutical care as a contribution within patient care. - The impact of medication reviews is directly linked to the subsequently provided intervention to solve a detected drug-related problem and to the acceptance rate of this recommendation by the patient and/or the prescriber. Project B extensively studied the Polymedication Check (PMC), a cognitive and directly remunerated pharmacist-led medication review service in Switzerland. For the first time in the Swiss health care system, a new nationally implemented cognitive service underwent an in-depth evaluation process in daily life setting. Two years after the launch of the service, the Pharmaceutical Care Research Group of the University of Basel initiated an evaluation project (evalPMC) aiming at investigating the impact of the service on medicines use and humanistic outcomes. Findings of project B: - The Polymedication Check underwent an in-depth evaluation process in a prospective randomised controlled trial performed in the German and French part of Switzerland. - No significant impact of the pharmacist-led intervention was shown on objective adherence, while subjective adherence was improved shortly after the intervention. - In addition, patients’ knowledge on medicines was improved by the intervention and patient’s acceptance of the service was high. - The evalPMC project highlighted the need for a re-engineering of the service in order to focus on patients at highest risks for drug-related problems and approach them with tailored interventions. - Moreover, a follow-up meeting may become an important element in a future service, following the concept of a continuous pharmaceutical care process. - Pharmacists were highly motivated to perform PMCs once they had overcome the barrier of ‘the first is the worst’. Project C based on the main conclusion of Project B (need for more tailored interventions to targeted patients) and investigated the potential of the community pharmacy setting to offer the pharmacist’s skills purposefully to patients with individual needs. Patient-centred counseling may become more sensitised for specific and underestimated drug-related problems, i.e. swallowing difficulties with medication intake. We therefore developed an in-depth patient self-report questionnaire, which was used in a cohort of patients with systemic sclerosis (SSc) from the European Centre for the Rehabilitation of Scleroderma Rheinfelden, Switzerland. Findings of project C: - Existing campaigns performed by community pharmacies offer a wide range for future services aiming at improving therapy efficacy and patient safety. - Unreached biomarkers despite drug therapy as well as swallowing difficulties with medication intake need further clarification by a health professional to rule out inadequate coping strategies or non-adherence. - Patient self-reports may guide health professionals in the future when providing tailored counseling, choosing therapy options, or optimising a patient’s medication profile. In conclusion, this thesis showed an increase of the involvement of clinical pharmacists in patient care in Switzerland. Regardless of the setting, the traditional role of pharmacists is currently expanding to a respected contributor and key partner for interprofessional collaboration in patient care. Pharmacists’ contributions to patient care are no longer limited to medicines supply only. Multiple opportunities for new services are opening up and their implementation is becoming of crucial importance to tackle the challenges posed by the demographic change and a lack of human and financial resources. In order to overcome internal and external barriers, pharmacists need to assume more responsibility and train their skills in clinical pharmacy practice and interprofessional collaboration. The patients proved to be highly motivated to follow pharmaceutical care models, which is a very promising finding for the development of future services

Reduced incidence of atrial fibrillation after cardiac surgery by continuous wireless monitoring of oxygen saturation on the normal ward and resultant oxygen therapy for hypoxia

Objective: Monitoring of cardiac surgical patients after transfer from the intensive care unit to the normal ward is incomplete. Undetected hypoxia, however, is known to be a risk factor for occurrence of atrial fibrillation. We have utilized Auricall® for continuous wireless monitoring of oxygen saturation and heart rate until discharge. The object of the study was to analyze if oxygen therapy as a result of Auricall® alerts of hypoxia can decrease the incidence of postoperative atrial fibrillation. Methods: Auricall® is a wireless portable pulse oximeter. An alert is generated depending on preset threshold values (heart rate, oxygen saturation). Over a period of 6 months, 119 patients were monitored with the Auricall® following coronary artery bypass graft and/or valve surgery. Oxygen therapy was started subsequent to an oxygen saturation below 90%. These patients were compared with a cohort of 238 patients from the time period before availability of Auricall®. The patient characteristics were comparable in both groups. In a retrospective study, the incidence of atrial fibrillation was measured in both groups. Results: The postoperative AF was observed in 22/119 patients (18%) in group I and in 66/238 patients (28%) in group II. This difference between the two groups approached significance (p=0.056). In the subgroup of patients with coronary artery bypass graft with our without simultaneous valve surgery (n=312), Auricall® monitoring resulted in a significantly reduced incidence of atrial fibrillation (14% vs 26%, p=0.016). Conclusions: Continuous monitoring of oxygen saturation on the normal ward and subsequent oxygen therapy for hypoxia can reduce the incidence of atrial fibrillation in a subgroup of patients after cardiac surgery. Prospective randomized trials are warranted to confirm these dat

Land under pressure - The state of large-scale land acquisitions in the World : Preliminary Results from the Land Matrix Partnership (ILC, CDE, CIRAD, GIGA, GIZ)

Présentation (15 diapos)International audienc

Creating a public tool to assess and promote transparency in global land deals : the experience of the Land Matrix

The Beta version of the Land Matrix (Land Matrix 2012) was launched in April 2012 as a tool to promote public participation in building a constantly evolving database on large-scale land deals, and making the data visible and understandable. The aim of the Land Matrix partnership is to promote transparency and open data in decisionmaking over land and investment, as a step towards greater accountability. Since its launch, the Land Matrix has attracted a high degree of attention, and stirred some controversy. It provides valuable lessons on the challenges and benefits of promoting open data on practices that are often shrouded in secrecy. This paper critically examines the ongoing efforts by the Land Matrix partnership to build a public tool to promote greater transparency in decision-making over land and investment at a global level. It intends to provoke discussion of the extent to which such a tool can ultimately promote greater transparency and be a step towards greater accountability and improved decision-making. It will present the Land Matrix and its value addition, before detailing the challenges it encountered related to the measurement of the largescale land acquisition phenomenon. It will then specify how it intends to address these issues in order to establish a dynamic and participatory tool for open developmenthttp://www.tandfonline.com/loi/fjps20hb2016Agricultural Economics, Extension and Rural Developmen

Are our data ready for the next global challenges? Resilient data for resilient societies and economies.

Keywords: Covid-19; Data; New challenges; Resilient societie

Proposal of standardization to assess adherence with medication records: methodology matters

Medication adherence is the process by which patients take their medication as prescribed and is an umbrella term that encompasses all aspects of medication use patterns. Ambiguous terminology has emerged to describe a deviation from prescribed regimen, forcing the European ABC Project to define 3 phases of medication use: initiation, implementation, and discontinuation. However, different measures of medication adherence using medication records are currently available that do not always distinguish between these phases. The literature is lacking standardization and operationalization of the assessment methods.; To propose a harmonization of standards as well as definitions of distinct measures and their operationalization to quantify adherence to medication from medication records.; Group discussions and consensus process among all coauthors. The propositions were generated using the authors' experiences and views in the field of adherence, informed by theory.; The concepts of adherence measures within the new taxonomy were harmonized, and the standards necessary for the operationalization of adherence measures from medication records are proposed. Besides percentages and time-to values, the addition of a dichotomous value for the reinitiation of treatment is proposed. Methodological issues are listed that should be disclosed in studies on adherence.; The possible impact of the measures in adherence research is discussed. By doing this, the results of future adherence research should gain in accuracy. Finally, studies will become more transparent, enabling comparison between studies

Acquired resistance to anti-PD1 therapy in patients with NSCLC associates with immunosuppressive T cell phenotype

Immune checkpoint inhibitor treatment has the potential to prolong survival in non-small cell lung cancer (NSCLC), however, some of the patients develop resistance following initial response. Here, we analyze the immune phenotype of matching tumor samples from a cohort of NSCLC patients showing good initial response to immune checkpoint inhibitors, followed by acquired resistance at later time points. By using imaging mass cytometry and whole exome and RNA sequencing, we detect two patterns of resistance¨: One group of patients is characterized by reduced numbers of tumor-infiltrating CD8$^{+}$ T cells and reduced expression of PD-L1 after development of resistance, whereas the other group shows high CD8$^{+}$ T cell infiltration and high expression of PD-L1 in addition to markedly elevated expression of other immune-inhibitory molecules. In two cases, we detect downregulation of type I and II IFN pathways following progression to resistance, which could lead to an impaired anti-tumor immune response. This study thus captures the development of immune checkpoint inhibitor resistance as it progresses and deepens our mechanistic understanding of immunotherapy response in NSCLC