Key elements for the education and counselling of patients treated with oral anticancer drugs

Purpose: The process of education and counselling of patients treated with oral anticancer drugs, aimed to achieve adequate self-management, involves different stakeholders (Le. physicians, oncology nurses, pharmacists) from primary and secondary care. However, currently no guiding principles exist on how to organize and perform education and counselling for these patients. Therefore, the purpose of this study was to develop and build consensus on key elements for the education and counselling in patients on oral anticancer drugs. Methods: A multi-method approach combining a literature search, semi-structured interviews with patients and healthcare professionals, and input from experts were used to develop an initial list of key elements. Subsequently, consensus was built in a two-round Delphi-study, involving patients and healthcare professionals from primary and secondary care. Key elements were retained if at least 80% of respondents in all groups considered the element as important or if in at least one group 90% consensus was reached. Results: The initial list contained 110 key elements, divided in 7 themes: coordination of care, patient contacts: style and content, medication counselling at the start of the treatment and during follow-up, psychosocial support, and involvement of family and friends. After the first Delphi round, 80% consensus was reached for 23 elements; 6 new key elements were added. After the second round, 80% consensus was reached for 51 out of 116 elements; 31 elements were added following the 90%-rule, yielding a list of 82 elements. Conclusion: The final list of 82 key elements, obtained in this study, could be used to develop clinical pathways that guide adequate education and counselling of patients on oral anticancer drugs. Due to the open description, the implementation of these elements can be adapted to the specific context and composition of the oncology team

Mental health of pregnant and postpartum women during the third wave of the COVID-19 pandemic: a European cross-sectional study.

OBJECTIVE To describe the mental health of perinatal women in five European countries during the third pandemic wave and identify risk factors related to depressive and anxiety symptoms. DESIGN A cross-sectional, online survey-based study. SETTING Belgium, Norway, Switzerland, the Netherlands and the UK, 10 June 2021-22 August 2021. PARTICIPANTS Pregnant and up to 3 months postpartum women, older than 18 years of age. PRIMARY OUTCOME MEASURE The Edinburgh Depression Scale (EDS) and the Generalised Anxiety Disorder scale (GAD-7) were used to assess mental health status. Univariate and multivariate generalised linear models were performed to identify factors associated with poor mental health. RESULTS 5210 women participated (including 3411 pregnant and 1799 postpartum women). The prevalence of major depressive symptoms (EDS ≥13) was 16.1% in the pregnancy group and 17.0% in the postpartum . Moderate to severe generalised anxiety symptoms (GAD ≥10) were found among 17.3% of the pregnant and 17.7% of the postpartum women. Risk factors associated with poor mental health included having a pre-existing mental illness, a chronic somatic illness, having had COVID-19 or its symptoms, smoking, unplanned pregnancy and country of residence. Among COVID-19 restrictive measures specific to perinatal care, pregnant and postpartum women were most anxious about not having their partner present at the time of delivery, that their partner had to leave the hospital early and to be separated from their newborn after the delivery. CONCLUSION Approximately one in six pregnant or postpartum women reported major depression or anxiety symptoms during the third wave of the pandemic. These findings suggest a continued need to monitor depression and anxiety in pregnancy and postpartum populations throughout and in the wake of the pandemic. Tailored support and counselling are essential to reduce the burden of the pandemic on perinatal and infant mental health

Pharmacist-led medication review in community-dwelling older patients using the GheOP(3)S-tool : general practitioners' acceptance and implementation of pharmacists' recommendations

Rationale, aims, and objectives: The Ghent Older People's Prescriptions community Pharmacy Screening (GheOP(3)S)-tool was recently developed as an explicit screening tool to detect drug-related problems (DRPs) and to help in performing medication reviews. In this study, we aimed (a) to describe the characteristics of the detected DRPs and the subsequent pharmacists' recommendations with their acceptance and implementation rate resulting from a pharmacist-led medication review using the GheOP(3)S-tool and (b) to assess the potential impact of the intervention. Method: Prospective observational study in community-dwelling older patients (70 years or older, using five or more medications). Community pharmacists performed medication reviews resulting in the documentation of GheOP(3)S-related DRPs and other DRPs with corresponding pharmacists' recommendations. Acceptance was recorded during face-to-face pharmacist-general practitioner (GP) meetings. Implementation was assessed after a 3-month follow-up by consulting the electronic pharmacy record, the patient, and/or GP. The potential impact on the number of medications, the number of GheOP(3)S-related DRPs, the anticholinergic and sedative burden quantified by the Drug Burden Index (DBI), and medication costs was assessed by a pre-post comparison of the patients' medication lists. Results: Twenty-one pharmacists detected 470 DRPs with a median (IQR) of 6 (4-8) per patient in 75 patients (about half GheOP(3)S-related DRPs and half other DRPs). Most prevalent recommendations were stopping (22.9%) and substituting (18.9%) medication. Overall acceptance was 66.9%. At follow-up, 42.9% of all recommendations were implemented. The number of GheOP(3)S-criteria (P < .001) and the DBI scores (P = .033) significantly differed from baseline. This was not the case for the number of chronic medications and medication costs. Conclusions: This study demonstrates a relatively high acceptance of pharmacists' recommendations, although implementation could be improved. Pharmacist-led medication reviews with multidisciplinary meetings using the GheOP(3)S-tool can have a potential impact on the number of DRPs and the anticholinergic and sedative burden of patients

Barriers to medication counselling for people with mental health disorders : A six country study

Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders. Objective: The objective of this study was to compare and contrast barriers pharmacy students perceive toward providing medication counselling for people with mental health disorders in Australia, Belgium, Estonia, Finland, India and Latvia. Methods: Barriers identified by third-year pharmacy students as part of the International Pharmacy Students' Health Survey were content analysed using a directed approach. Students' responses were categorised as pharmacist related, patient related, health-system related, or social or cultural related. Quantitative data were analysed using SPSS version 14.0. Results: Survey instruments were returned by 649 students. Of the respondents, 480 identified one or more barriers to medication counselling for people with mental health disorders. Patient related factors accounted for between 25.3% and 36.2% of barriers identified by the pharmacy students. Pharmacist related factors accounted for between 17.6% and 45.1% of the barriers identified by the pharmacy students. Students in India were more likely to attribute barriers to pharmacist and social and cultural related factors, and less likely to healthsystem related factors, than students studying in other countries. Conclusion: The nature of barriers identified by pharmacy students differed according to the country in which they studied. Undergraduate and postgraduate pharmacy education programs may need to be amended to address common misconceptions among pharmacy students.publishersversionPeer reviewe

SARS-CoV-2 infections and impact of the COVID-19 pandemic in pregnancy and breastfeeding: Results from an observational study in primary care in Belgium

COVID-19 also affects pregnant and breastfeeding women. Hence, clinicians and policymakers require reliable evidence on COVID-19 epidemiology and consequences in this population. We aimed to assess the susceptibility of pregnant women to SARS-CoV-2 and women’s perceived impact of the pandemic on their breastfeeding practices, medical counseling and social support. We performed a cross-sectional study using an online survey in primary care in Belgium. Pregnant and breastfeeding women and women who breastfed in the preceding four weeks were eligible to participate. The survey was distributed through social media in April 2020. In total, 6470 women participated (i.e., 2647 pregnant and 3823 breastfeeding women). Overall, 0.3% of all respondents reported to have tested positive for SARS-CoV-2, not indicating a higher susceptibility of pregnant women to contracting COVID-19. More than 90% refuted that the pandemic affected their breastfeeding practices, nor indicated that the coronavirus was responsible for breastfeeding cessation. Half of the women even considered giving longer breastmilk because of the coronavirus. In contrast, women’s medical counseling and social support were negatively affected by the lockdown. Women without previous breastfeeding experience and in the early postpartum period experienced a higher burden in terms of reduced medical counseling and support. In the future, more consideration and alternative supportive measures such as tele-visits by midwives or perinatal organizations are required for these women

Collaborative approach to Optimise MEdication use for Older people in Nursing homes (COME-ON): study protocol of a cluster controlled trial

BACKGROUND: Ageing has become a worldwide reality and presents new challenges for the health-care system. Research has shown that potentially inappropriate prescribing, both potentially inappropriate medications and potentially prescribing omissions, is highly prevalent in older people, especially in the nursing home setting. The presence of potentially inappropriate medications/potentially prescribing omissions is associated with adverse drug events, hospitalisations, mortality and health-care costs. The Collaborative approach to Optimise MEdication use for Older people in Nursing homes (COME-ON) study aims to evaluate the effect of a complex, multifaceted intervention, including interdisciplinary case conferences, on the appropriateness of prescribing of medicines for older people in Belgian nursing homes. METHODS/DESIGN: A multicentre cluster-controlled trial is set up in 63 Belgian nursing homes (30 intervention; 33 control). In each of these nursing homes, 35 residents (≥65 years) are selected for participation. The complex, multifaceted intervention comprises (i) health-care professional education and training, (ii) local concertation (discussion on the appropriate use of at least one medication class at the level of the nursing home) and (iii) repeated interdisciplinary case conferences between general practitioner, nurse and pharmacist to perform medication review for each included nursing home resident. The control group works as usual. The study period lasts 15 months. The primary outcome measures relate to the appropriateness of prescribing and are defined as (1) among residents who had at least one potentially inappropriate medication/potentially prescribing omission at baseline, the proportion of them for whom there is a decrease of at least one of these potentially inappropriate medications/potentially prescribing omissions at the end of study, and (2) among all residents, the proportion of them for whom at least one new potentially inappropriate medication/potentially prescribing omission is present at the end of the study, compared to baseline. The secondary outcome measures include individual components of appropriateness of prescribing, medication use, outcomes of the case conferences, clinical outcomes and costs. A process evaluation (focusing on implementation, causal mechanisms and contextual factors) will be conducted alongside the study. DISCUSSION: The COME-ON study will contribute to a growing body of knowledge concerning the effect of complex interventions on the use of medicines in the nursing home setting, and on factors influencing their effect. The results will inform policymakers on strategies to implement in the near future. TRIAL REGISTRATION: Current Controlled Trials ISRCTN66138978

Oncologic Home-Hospitalization Delivers a High-Quality and Patient-Centered Alternative to Standard Ambulatory Care: Results of a Randomized-Controlled Equivalence Trial

PURPOSE- Given the increasing burden of cancer on patients, health care providers, and payers, the shift of certain outpatient procedures to the patients' homes (further indicated as oncologic home-hospitalization [OHH]) might be a high-quality, patient-centered, and cost-effective alternative to standard ambulatory cancer care (SOC). METHODS- A randomized-controlled trial was conducted to evaluate the quality of a locally implemented model for OHH (n = 74) compared with SOC (n = 74). The model for OHH consisted of home administration of certain subcutaneous cancer drugs (full OHH) and home nursing assessments before ambulatory systemic cancer therapy (partial OHH). Quality was evaluated based on patient-reported quality of life (QoL) and related end points; service use and cost data; safety data; patient-reported satisfaction and preferences; and model efficiency. An equivalence design was used for primary end point analysis. Participants were followed during 12 weeks of systemic cancer treatment. RESULTS- This trial demonstrated equivalence of both models (OHH v SOC) in terms of patient-reported QoL (95% CI not exceeding the equivalence margin of 10%). Full OHH resulted in significantly less hospital visits (mean of 5.6 ± 3.0 v 13.2 ± 4.6; P = .011). Partial OHH reduced waiting times for therapy administration at the day care unit with 45% per visit (2 hours 36 minutes ± 1 hour 4 minutes v 4 hours ± 1 hour 4 minutes; P < .001). No safety issues were detected. Of the intervention group, 88% reported to be highly satisfied with the OHH model, and 77% reported a positive impact on their QoL. At study end, 60% of both study arms preferred OHH above SOC. CONCLUSION- The shift of particular procedures from the outpatient clinic to the patients' homes offers a high-quality and patient-centered alternative for a large proportion of patients with cancer. Further research is needed to evaluate potential cost-efficiency

Women’s beliefs about medicines and adherence to pharmacotherapy in pregnancy: Opportunities for community pharmacists?

Background During pregnancy women might weigh benefits of treatment against potential risks to the unborn child. However, non-adherence to necessary treatment can adversely affect both mother and child. To optimize pregnant women’s beliefs and medication adherence, community pharmacists are ideally positioned to play an important role in primary care. Objective This narrative review aimed to summarize the evidence on 1) pregnant women’s beliefs, 2) medication adherence in pregnancy, and 3) community pharmacists’ counselling during pregnancy. Method Three search strategies were used in Medline and Embase to find original studies evaluating women’s beliefs, medication adherence and community pharmacists’ counselling during pregnancy. All original descriptive and analytic epidemiological studies performed in Europe, North America and Australia, written in English and published from 2000 onwards were included. Results We included 14 studies reporting on women’s beliefs, 11 studies on medication adherence and 9 on community pharmacists’ counselling during pregnancy. Women are more reluctant to use medicines during pregnancy and tend to overestimate the teratogenic risk of medicines. Risk perception varies with type of medicine, level of health literacy, education level and occupation. Furthermore, low medication adherence during pregnancy is common. Finally, limited evidence showed current community pharmacists’ counselling is insufficient. Barriers hindering pharmacists are insufficient knowledge and limited access to reliable information. Conclusion Concerns about medication use and non-adherence are widespread among pregnant women. Community pharmacists’ counselling during pregnancy is insufficient. Further education, training and research are required to support community pharmacists in fulfilling all the opportunities they have when counselling pregnant women

Seamless care: naar een veiliger overgang tussen ziekenhuis en thuis

Elk jaar worden in België duizenden patiënten gehospitaliseerd. De meerderheid van deze mensen nemen bij opname al geneesmiddelen, of krijgen in het ziekenhuis (bijkomende) geneesmiddelen voorgeschreven. In het kader van de patiëntveiligheid is het belangrijk dat bij opname én ontslag deze behandeling zonder onderbreking of wijziging wordt voortgezet. Dit is echter niet altijd het geval. In opdracht van het Kenniscentrum voor de Gezondheidszorg (KCE) onderzochten wij wat de geneesmiddelgerelateerde problemen zijn bij opname en ontslag uit het ziekenhuis, en wat mogelijke oplossingen zijn voor deze problemen. De knelpunten die in focusgesprekken met een 100-tal zorgverleners en patiënten in kaart werden gebracht, bevinden zich op verschillende niveaus. Zo blijken patiënten bij opname in het ziekenhuis niet altijd over een duidelijke lijst van hun geneesmiddelen te beschikken, of ontbreekt essentiële informatie over hun medicatie. Bij ontslag is er vaak onvoldoende informatie over het medicatieschema dat gevolgd moet worden, of is deze informatie moeilijk te interpreteren. Dit alles kan aanleiding geven tot onderbreking van de behandeling, tot dubbel gebruik van bepaalde geneesmiddelen of tot potentieel gevaarlijke interacties tussen geneesmiddelen. Deze knelpunten zijn niet nieuw. Ze werden eerder al gedocumenteerd in andere landen, maar werden nu voor België bevestigd. Wat wel opvalt, is dat zorgverleners uit de eerste lijn slechts beperkt op de hoogte blijken te zijn van de procedures en regelgeving in de ziekenhuizen, en omgekeerd. Bovendien zorgt dit verschil in regelgeving voor bijkomende problemen: zo worden artsen in de eerste lijn gestimuleerd om zo veel mogelijk generische geneesmiddelen voor te schrijven, terwijl artsen in de ziekenhuizen gebonden zijn aan de geneesmiddelenlijst van het ziekenhuis, wat frequent aanleiding geeft tot het veranderen van specialiteit (‘merk’) voor een bepaald geneesmiddel – een verandering die voor patiënten niet altijd duidelijk is. Een belangrijk sleutelelement in het verhogen van de patiëntveiligheid bij de overgang tussen ziekenhuis en thuis, is de beschikbaarheid van een volledig en up-to-date medicatieschema. Idealiter is dit medicatieschema elektronisch beschikbaar, en kan het, mits instemming van de patiënt, door elke zorgverlener geraadpleegd worden. Het delen van deze informatie moet zorgverleners toelaten om na te gaan of het toevoegen of veranderen van een bepaald geneesmiddel verantwoord is, om de patiënt correct te informeren over het medicatieschema of om andere zorgverleners te contacteren, en zo naadloze zorg te garanderen. Naast de huidige ontwikkelingen i.v.m. eHealth is er dringend nood aan de ontwikkeling van elektronische infrastructuur die toelaat om dergelijke essentiële patiëntengegevens te delen, niet alleen tussen zorgverleners binnen een bepaalde setting, maar ook over de grenzen van settings en organisaties heen. Daarnaast vergt het verhogen van de patiëntveiligheid verantwoordelijkheid en toewijding van alle betrokkenen, inclusief de patiënt. Uit een analyse van initiatieven in het buitenland blijkt alvast dat een gestandaardiseerde bevraging van de medicatie bij opname in het ziekenhuis heel wat problemen kan voorkomen. Ook in een aantal Belgische ziekenhuizen behoort dergelijke bevraging, bijvoorbeeld op de dienst spoedgevallen, ondertussen tot de standaardprocedures. Het bespreken van het medicatieschema met de patiënt blijkt het meest effectief te zijn wanneer het gebeurt aan het einde van het ziekenhuisverblijf én na een paar dagen thuis. Overigens richt deze informatie zich best niet alleen tot de patiënt, maar ook tot de zorgverleners uit de eerste lijn. De analyse van buitenlandse initiatieven leert verder dat de ontwikkeling van nationale richtlijnen waarin duidelijk staat aangegeven wat de te volgen procedures zijn bij opname en ontslag, en wat de verantwoordelijkheid is van de verschillende zorgverleners in dit proces, een belangrijke drijfveer te zijn voor het ontwikkelen van lokale procedures. Wij pleiten dan ook voor het opstellen van dergelijke richtlijnen voor België, en voor het creëren van een breed draagvlak, bijvoorbeeld via een sensibiliseringscampagne, om deze richtlijnen toe te passen in de praktijk. Het creëren van een veiliger overgang tussen ziekenhuis en thuis kan enkel gerealiseerd worden mits een pakket van maatregelen. Samenwerking tussen artsen, apothekers en verpleegkundigen uit de eerste en tweede lijn, en patiënten en hun mantelzorgers is hierbij essentieel. Het volledige rapport is beschikbaar via http://www.kce.fgov.be/index_nl.aspx?SGREF=14842&CREF=16673status: accepte

How to improve the continuity of pharmacotherapy at hospital admission and discharge

116-120The continuity of pharmacotherapy is of vital importance when patients move from one health care setting to another. Unfortunately, this continuity is not always guaranteed. The aim of this study is to propose solutions to enhance the continuity of pharmacotherapy at hospital admission and discharge. The study consists of a systematic review of the international literature and an analysis of seamless care initiatives in seven selected countries; a summary of Belgian data on problems as well as solutions with regard to continuity of care; a quantification of the extent of medication changes as a result of a hospital stay in Belgium; and a qualitative analysis of the perception of Belgian health care professionals (HCPs) on approaches to improve seamless care. The literature review yielded 15 papers of sufficient quality. However, this review did not generate definitive conclusions on the clinical impact and the cost-effectiveness of interventions aiming to enhance the continuity of pharmacotherapy. The most important initiatives that have been put in practice in foreign countries include the development and implementation of guidelines for HCPs; national information campaigns; education of HCPs; and the development of information technologies as to share patient and prescription data between settings of care. For Belgium, 66 seamless care initiatives were identified. The high number and variety of projects show the interest for this topic as well as the involvement of various HCPs from diverse settings in the development of solutions. Based on this research, and the solutions discussed in the focus groups, the following elements are proposed to enhance the continuity of pharmacotherapy: a national guideline governing the continuity of pharmacotherapy; a national campaign to sensitize HCPs and patients in this area; the availability of a comprehensive and up to date medication list for each patient; and electronic healthcare infrastructure that facilitates sharing of information