DRUG-RELATED PROBLEMS IN HOSPITALIZED GERIATRIC PATIENTS WITH DIABETES MELLITUS

Objective: This study aimed at analyzing drug-related problems (DRPs) in hospitalized geriatric patients with diabetes mellitus.Methods: We prospectively collected data of 26 hospitalized geriatric patients at the Gatot Soebroto Army Hospital (age, >60 year) who underwentinpatient treatment for at least 1 month between February and April 2015. Readable data were obtained from prescriptions, medical records, andindex card/nurses records. We obtained data on 299 drug treatments for 26 patients and identified 166 DRPs. These were analyzed based on thePharmaceutical Care Network Europe Version 6.2.Results: The percentage of treatment effectiveness (50.6%) and adverse drug reactions (49.4%) was predominantly due to an inappropriate drug–drug or drug–food combination, including the incidence of drug interactions (20.4%)

ANALYSIS OF 4-HYDROXYCYCLOPHOSPHAMIDE IN CANCER PATIENTS PLASMA FOR THERAPEUTIC DRUG MONITORING OF CYCLOPHOSPHAMIDE

Objective: To quantify 4-hydroxycyclophosphamide in cancer patients' plasma for therapeutic drug monitoring of cyclophosphamide.Methods: The blood was collected at 0.5 and 1 h after administration of chemotherapy. Prior to analysis, 4-OHCP in plasma was derivatized with semicarbazide HCl, then was extracted using 4 ml ethyl acetate and finally was determined by Ultra High-Performance Liquid Chromatography–tandem mass spectrometry. Chromatographic separation was conducted using waters acquity BEH C18 column (1.7 μm; 50 mm x 2.1 mm). The mobile phase consisted of formic acid 0.1% and methanol (50: 50, v/v), column temperature 30 °C and flow rate of 0.3 ml/min. Mass detection was performed on waters xevo TQD equipped with an electrospray ionization (ESI) source at positive ion mode in the multiple reaction monitoring (MRM). Cyclophosphamide was detected at m/z 260.968>139.978, 4-hydroxycyclophosphamide-semicarbazide at m/z 338.011>224.97, and hexamethylphosphoramide as internal standard at m/z 180.17>92.08.Results: The method was linear in the range of 5–1000 ng/ml for cyclophosphamide and also for 4-hydroxycyclophosphamide. The results showed that the level of 4-OHCP in 39 cancer patients was in the range of 5.02 ng/ml to 832.44 ng/ml.Conclusion: 4-hydroxycyclophosphamide was detected on 39 patient samples with the lowest level of 5.40ng/ml and the highest level was 832.44 ng/ml. This can be a parameter that the regiment of cyclophosphamide was effective

PROTON-PUMP INHIBITOR USE AND POTENTIAL DRUG INTERACTIONS IN OUTPATIENTS

Objective: This study aimed to evaluate the use and potential drug interactions of proton-pump inhibitor (PPI) in outpatients.Methods: This study is a retrospective descriptive analysis of prescriptions and medical records from outpatients in Gatot Soebroto Army Hospitalselected by purposive sampling who received PPI with one or more other drugs from July to December 2015. The analysis was conducted on 400prescriptions from 192 patients.Results: Data showed that 100% of the PPI therapy utilized was appropriate for the patients' condition, 79.00% was appropriate for the indication,79.00% was appropriate for the dosage, 79.00% had an appropriate administration duration, and 83.75% was given the appropriate drug. Thepotential of PPI interactions with other drugs was found in 324 prescriptions (81.00%) from 475 cases. Of all the cases, 42 were considered majorinteractions, 138 were moderate interactions, and 295 cases had minor interactions. There were 14 drugs that could potentially interact with PPI, suchas mycophenolate mofetil, clopidogrel, cilostazol, warfarin, iron, levothyroxine, propranolol, cyclosporine, simvastatin, atorvastatin, cyanocobalamin,sucralfate, theophylline, and antacids.Conclusion: PPI use in outpatients at the Gatot Soebroto Army Hospital was not entirely appropriate and had a large number of potential druginteractions with concurrent drugs

The Implementation of Telepharmacy in Bangka Belitung Islands Province

Telepharmacy is a telemedicine health service in the pharmaceutical sector that uses telecommunications to assist patients located far away during the Covid-19 pandemic. Furthermore, professional organizations are responsible for continuously providing information to pharmacists, ensuring they stay updated with the latest developments in the field. Mobile applications have emerged as the primary medium through which information can be accessed. Therefore, this research aimed to determine the implementation of telepharmacy in the Bangka Belitung Islands Province using observational research with a qualitative approach. The participants comprised a total of 11 individuals and the technique employed was purposive sampling. Subsequently, the collected data were subjected to analysis using the Miles and Huberman model. The results showed that the utilization of telepharmacy commenced within Bangka Belitung Islands Province and the community pharmacy service implemented the concept in the form of Drug Information Services, drug consultation or patient counseling, and prescription services through e-prescribing. Additionally, field observations highlighted the presence of services such as home delivery of medicines, patient education, and online non-cash payments. The implementation of telepharmacy within hospitals remains absent, despite the widespread adoption of digital services facilitated by the SIMRAS application. Pharmacists also ensured the administrative compliance of their colleagues through the utilization of the SIAP application. The preliminary stages of the implementation commenced in the Bangka Belitung Islands Province.

Medication Adherence, Glycemic Control and Quality of Life in Patients with Type 2 Diabetes Mellitus: a cross-sectional study

Medication adherence is important in controlling blood sugar levels (HbA1c) in patients with Diabetes Mellitus (DM). Studies on the relationship between medication adherence and blood sugar control on the quality of life (QoL) in Type 2 DM patients are limited in Indonesia. This study aims to assess the relation between medication adherence with blood sugar control and the quality of life of Type 2 DM patients. This study used a cross-sectional design conducted at Universitas Indonesia Hospital. It used Medication Adherence questionnaires and EuroQoL 5D-5L questionnaires to assess patients’ medication adherence and quality of life. This study involved a total of 74 Type 2 DM patients with an average age of 57 ± 10.74 years. Medication adherence with good blood sugar control (HbA1c <7%) showed a significant relationship (p-value <0.05) with COR values of 3.74 (1.21 - 11.6) compared to non-adherent patients. But not on the QoL Index and VAS (Visual Analog Scale) values, where the value is lower in patients with high adherence and good blood sugar control. Factor asscociated with blood sugar controlled were comorbidites and medication adhrence while factor that associated with quality of life were comorbidities, ages, education and employment statu

Cognitive Function in Type 2 Diabetes Mellitus Patients Taking Metformin and Metformin-Sulfonylurea

The most prescribed antidiabetic drugs in Indonesian primary health care are metformin or a combination of metformin and sulfonylurea. Studies on metformin have shown various impacts on cognitive decline in patients with type 2 diabetes mellitus, whereas sulfonylurea has been shown to reduce this impact. This study aimed to compare the impacts of metformin and metformin-sulfonylurea on cognitive function and determine what factors affected it. This cross-sectional study was conducted at Pasar Minggu Primary Health Care involving 142 type 2 diabetes mellitus patients taking metformin or metformin-sulfonylurea for > 6 months and aged > 36 years. Cognitive function was assessed using the validated Montreal Cognitive Assessment Indonesian version. The effects of metformin and metformin-sulfonylurea on cognitive decline showed no significant difference, even after controlling for covariates (aOR = 1.096; 95% CI = 0.523–2.297; p-value = 0.808). Multivariate analysis showed age (OR = 4.131; 95% CI = 1.271–13.428; p-value = 0.018) and education (OR = 2.746; 95% CI = 1.196–6.305; p-value = 0.017) affected cognitive function. Since a lower education and older age are likely to cause cognitive decline, health professionals are encouraged to work with public health experts to address these risk factors for cognitive function

Pendidikan dan Pelatihan untuk Peningkatan Kompetensi Apoteker terkait Telefarmasi: Scoping Review

Antihypertensive and antidiabetic drugs in chronic kidney disease (CKD) patients undergoing hemodialyThe high demand for telepharmacy services led to the urge for proper training and education to enhance its quality. This review aimed to assess the implementation and outcomes of telepharmacy training and education programmes. This scoping review was conducted on ScienceDirect, Sage Journal, SpringerLink, and Google Scholar databases using keywords “training” OR “education” AND “telepharmacy,” “training” OR “education” AND “digital competency” AND “pharmacy.” Only English-written articles published between 2000 – 2023, original research and brief report were included in this review. Eight of 171 articles met the criteria and the study’s objectives. Those studies discussed telepharmacy learning programmes for pharmacy students in the USA (5 articles), UAE (2 articles), and Malaysia (1 article). The learning methods included didactic learning, case-based study, simulation/roleplay, and clerkship employing technological tools. Rubrics, quizzes, questionnaires, and objective structured clinical examination (OSCE) were used as assessment methods. All studies reported improved students’ knowledge, perceptions, and telepharmacy competencies. In conclusion, the telepharmacy learning programmes have effectively upgraded students’ knowledge and skills by various methods at every level. However, there remains a considerable need for evidence on suitable training for pharmacists to improve their telepharmacy competencies and service quality.Peningkatan kebutuhan pelayanan telefarmasi mengarah pada urgensi pendidikan dan pelatihan telefarmasi untuk meningkatkan kualitas layanannya. Tujuan dari artikel ini adalah mengkaji implementasi program pendidikan dan pelatihan telefarmasi serta output yang dihasilkan. Kajian scoping dilakukan pada literatur dari pangkalan data ScienceDirect, Sage Journal, SpringerLink, dan Google Scholar menggunakan kata kunci “training” atau“education” dan “telepharmacy,” “training” atau “education” dan “digital competency” AND “pharmacy.” Hanya artikel berbahasa Inggris, dipublikasikan pada periode 2000 – 2023 serta merupakan hasil riset dan laporan singkat yang diikutsertakan pada kajian ini. Delapan dari 171 artikel yang ditemukan memenuhi kriteria inklusi dan tujuan kajian. Studi tersebut membahas implementasi dan evaluasi program pendidikan terkait telefarmasi di negara Amerika (5 artikel), Arab (2 artikel), dan Malaysia (1 artikel). Metode pembelajaran yang digunakan meliputi paparan, pembelajaran berbasis kasus, simulasi/roleplay, dan magang menggunakan berbagai media teknologi. Metode penilaian menggunakan rubrik, kuis, kuesioner, dan objective structured clinical examination (OSCE). Seluruh penelitian melaporkan peningkatan pengetahuan, persepsi dan kompetensi telefarmasi mahasiswa. Dapat disimpulkan bahwa program pembelajaran terkait telefarmasi efektif untuk meningkatkan pengetahuan dan kemampuan mahasiswa dengan berbagai metode pada setiap tingkat. Namun, masih sangat dibutuhkan bukti program pelatihan yang sesuai bagi apoteker untuk meningkatkan kompetensi dan kualitas pelayanan telefarmasi

Potential of UK and US newspapers for shaping patients' knowledge and perceptions about antidiabetic medicines: a content analysis

BACKGROUND: Information about how newspapers portray antidiabetic medicines to readers is lacking. This study investigated the reporting on antidiabetic medicines in the most widely circulated newspapers published in the United Kingdom (UK) and the United States (US) over a 10-year period. METHODS: The Nexis UK database was used to identify and select relevant articles. Systematic content analysis of the articles which met the inclusion criteria (articles of any format that contained reference to antidiabetic medicines) within the highest circulated newspapers in the UK and US between 2009 and 2018 was conducted. Inter-rater reliability of coding was established using a 10% sample of the identified articles. RESULTS: A total of 560 (369 UK and 191 US) relevant newspaper articles were retrieved. In the UK, the number of relevant articles showed a slightly increasing trend over the study period, while in the US, article numbers declined over the study period. Safety/risk of antidiabetic medicines was the most frequent theme covered by the articles (34.6%). Over one-third of the newspaper articles were written from a clinical perspective (37.7%). Insulin was the most commonly discussed class of antidiabetic medicine (23.1%). Control of blood sugar levels (53.1%) and side effects/toxicity (92.7%) were the most frequently reported benefit and risk of antidiabetic medicines, respectively. The most frequently reported organ systems harmed by antidiabetic medicines were the cardiovascular, endocrine and gastrointestinal systems. The UK newspapers were more likely to report the benefits of antidiabetic medicines (p = 0.005), while the US articles were more likely to report on harms/risks (p = 0.001). The majority of relevant articles (91.8%) were judged as having a balanced judgement, while 8.2% of the articles were rated as exaggerated. CONCLUSIONS: This study has revealed that antidiabetic medicines are indeed reported on by UK and US newspapers. As media portrayal has the potential to negatively or positively influence patients’ views of their medication for diabetes, healthcare professionals should check on patients’ beliefs and knowledge about their medication and proactively provide objective and balanced information (including promotion of medication adherence)

Adherence to metformin in adults with type 2 diabetes: a combined method approach

BACKGROUND: Medication adherence, one of the most important aspects in the process of optimal medicines use, is unfortunately still a major challenge in modern healthcare, and further research is required into how adherence can be assessed and optimised. The aim of this study was to use a combined method approach of self-report and dried blood spot (DBS) sampling coupled with population pharmacokinetic (PopPK) modelling, to assess adherence to metformin in adult patients with type 2 diabetes. Further aims were to assess metformin exposure levels in patients, determine factors associated with non-adherence with prescribed metformin, and to explore the relationship between adherence and therapeutic outcomes. METHODS: A combined method approach was used to evaluate metformin adherence in patients with type 2 diabetes who had been prescribed metformin for a minimum period of 6 months. Patients were recruited from consultant-led diabetic outpatient clinics at three hospitals in Northern Ireland, UK. Data collection involved self-reported questionnaires [Medication Adherence Report Scale (MARS), Beliefs about Medicines Questionnaire and Centre for Epidemiologic Studies Depression Scale], direct measurement of metformin concentration in DBS samples, and researcher-led patient interviews. The DBS sampling approach was coupled with population pharmacokinetic (PopPK) modelling, which took account of patient characteristics, metformin dosage and type of formulation prescribed (immediate or sustained release). RESULTS: The proportion of patients considered to be adherent to their prescribed metformin, derived from self-reported MARS scores and metformin concentration in DBS samples, was 61.2% (74 out of 121 patients). The majority (n = 103, 85.1%) of recruited patients had metformin exposure levels that fell within the therapeutic range. However, 17 patients (14.1%) had low exposure to metformin and one patient (0.8%) had undetectable metformin level in their blood sample (non-exposure). Metformin self-administration and use of a purchased adherence pill box significantly increased the probability of a patient being classified as adherent based on logistic regression analysis. Both HbA1c and random glucose levels (representing poor glycaemic control) in the present research were, however, not statistically linked to non-adherence to metformin (P > 0.05). CONCLUSIONS: A significant proportion of participating patients were not fully adherent with their therapy. DBS sampling together with the use of a published PopPK model was a useful, novel, direct, objective approach to estimate levels of adherence in adult patients with type 2 diabetes (61.2%). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40545-022-00457-5

General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial

BACKGROUND: Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. METHODS: A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. RESULTS: Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4-13] to 5 [0-11] vs 8 [3-13] to 7 [3-12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0-3] to 1 [0-2] vs 1 [0-2] to 1 [0-3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of - £229.0 (95% CI - 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI - 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). CONCLUSION: The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. TRIAL REGISTRATION: ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498