Missed drug therapy alerts as a consequence of incomplete electronic patient records in dutch community pharmacies

Item does not contain fulltextBACKGROUND: Complete and up-to-date medical and pharmaceutical information in the electronic patient record (EPR) is a prerequisite for risk management in community pharmacy. OBJECTIVES: To analyze which information is missing in the EPR and which drug therapy alerts, therefore, fail to appear. METHODS: Pharmacy students selected patients who were dispensed a prescription drug and enlisted for >3 months in the participating pharmacies. Patients received a questionnaire in which they were asked to verify their medication history, and to provide additional patient information. For each enrolled patient, the students collected all relevant information from the EPR. Self-reported data from the patient were compared with data retrieved from the EPR. Missed information in the EPR was evaluated based on national professional guidelines. RESULTS: Questionnaires were received from 67% of the selected patients (442/660). Prescription drugs were missing in the EPR of 14% of the 442 patients, nonprescription drugs in 44%, diseases in 83%, and intolerabilities in 16%. In 38% of the patients (166/442), drug therapy alerts failed to appear because of missing information: drug-disease interactions in 34% of the patients, duplicate medications in 4%, drug-drug interactions (DDIs) in 4%, and drug intolerabilities in 2%. Among the (non-)prescription drugs missing, NSAIDs were most frequently responsible for the missed alerts. Diseases most frequently associated with missed alerts were gastroesophageal reflux disease, renal insufficiency, asthma/chronic obstructive pulmonary disease, and heart failure. CONCLUSIONS: Relevant patient information was frequently missing in the EPRs. The nonappearance of drug therapy alerts may have had clinical consequences for patients

Ineffectiveness and adverse events of nitrofurantoin in women with urinary tract infection and renal impairment in primary care

Item does not contain fulltextPURPOSE: To determine whether treatment with nitrofurantoin in women with urinary tract infection (UTI) and renal impairment in primary care is associated with a higher risk of ineffectiveness and/or serious adverse events than in women without renal impairment. METHODS: A cohort of 21,317 women treated with nitrofurantoin and a cohort of 7,926 women treated with trimethoprim, identified from the Pharmo Record Linkage System, were analysed. The primary outcome was ineffectiveness of treatment of nitrofurantoin defined as the start of a second antibacterial within 1 month after the start of nitrofurantoin. The secondary outcome was the occurrence of serious adverse events of nitrofurantoin leading to hospitalization within 90 days. A cohort of trimethoprim users was used to determine if the associations found for nitrofurantoin were mainly related to nitrofurantoin itself. The association between renal impairment and the risk of these outcomes was determined with Cox regression and expressed as hazard ratios (HRs). RESULTS: Overall, the incidence density for ineffectiveness was 5.4 per 1,000 person-days, and moderate renal impairment was not associated with ineffective treatment [HR 1.1, 95 % confidence interval (CI) 0.74-1.51]. The overall incidence density for adverse events was 0.02 per 1,000 person-days. In patients with renal impairment (<50 ml/min/1.73 m(2)) the risk of pulmonary adverse events leading to hospitalization was significantly increased (HR 4.1, 95 % CI 1.31-13.09) CONCLUSIONS: Nitrofurantoin treatment was not associated with a higher risk of ineffectiveness in women with UTI and moderate renal impairment (30-50 ml/min/1.73m(2)). However, we did find a significant association between renal impairment (<50 ml/min/1.73 m(2)) and pulmonary adverse events leading to hospitalization