Recently, the effectiveness of shared decision-making (SDM) for adherence, such as improvement of patients’ motivation for treatment and reduction in missing a dose, has been reported. The purpose of this study was to analyze the result of SDM-based continuous pharmacist intervention in outpatients with HIV. The single-center retrospective study was conducted at Niigata University Medical and Dental Hospital, which was the AIDS treatment center hospital in the Kanto region. We collected information from electronic medical records and performed analysis of 49 outpatients who regularly visit the hospital and are undergoing ART.
Pharmacists worked with the patients and their physicians to select medications that were optimal in terms of efficacy, avoiding DDIs, and patient tolerability. Adverse events were the most common reason for a change of prescription, followed by reducing the burden of taking medication and DDIs. The prescription changes succeeded in optimization of ART regimens in accordance with guidelines and psychotropic medications (significant reduction in the number of tablets and types of medication), which resulted in contribution to hospital income by incentive medical fees due to the avoidance of polypharmacy. The findings indicate that continuous SDM-based pharmacist interventions in outpatients with HIV were effective for not only optimization of the ART regimen and improvement of polypharmacy but also economic benefits.
Recently, the role of pharmacists has been expanding to include providing direct care to patients. To facilitate this expansion, one option is that non-pharmacists perform some drug-related tasks under the supervision of a pharmacist. Therefore, at our hospital we adopted Personal Digital Assistance (PDA), which is based on the electronic recording of drug preparation steps, and an audit support system, which is based on the weight of a drug. This study aimed to evaluate the efficacy of the PDA and audit support system in avoiding drug preparation errors and reducing the number of dispensing incidents among pharmacists and non-pharmacists. We categorized these events into 3 groups: drug preparation errors prevented by PDA (PDA_NG), drug preparation errors prevented by pharmacist audit (PreDEs), and dispensing incidents (DIs). The results showed that the rate of PDA_NG was significantly higher among pharmacists than non-pharmacists (P < 0.01). When a PDA was used in drug preparation, PreDEs were not significantly different between pharmacists and non-pharmacists (P = 0.69). The types of PDA_NG were dispensing the wrong dosage form and dispensing the wrong drug. Ten DIs occurred when the audit support system was not used, but none occurred when it was used. Drug counting errors accounted for 70％ of the DIs. The use of a PDA in drug preparation by non-pharmacists was associated with a decrease in the number of drug preparation errors. In this study, we clearly demonstrated that a PDA helps to prevent errors in drug preparation by non-pharmacists.
Enzalutamide, a potent androgen-receptor inhibitor, is known to induce drug-metabolizing enzymes including cytochrome P450 (CYP) 3A4, 2C9, and 2C19. The antihypertensive effects of calcium channel blockers (CCB) and angiotensin receptor blockers (ARB), which are substrates of CYPs, may be attenuated due to the CYP-inducing effects of enzalutamide. To examine the effect of enzalutamide on the antihypertensive role of CCBs and ARBs, we performed a retrospective investigation evaluating blood pressure in enzalutamide-treated prostate cancer patients taking or not taking CCBs or ARBs. The change in systolic blood pressure was calculated at the start of enzalutamide (day 0) and 4 ± 1 weeks later (day 28). The effect of the covariates on the change in blood pressure was analyzed using linear regression analysis. Univariate linear regression analysis showed that taking CCB and ARB were associated with increased blood pressure, but multiple regression analysis that simultaneously incorporated age, BMI, and dose of enzalutamide showed that only CCB was significantly associated. An interaction effect between CCB and dose of enzalutamide on systolic blood pressure change was also observed. A dose-dependent increase in blood pressure was observed with enzalutamide in the patients taking CCB. These results indicate that enzalutamide may cause a marked increase in blood pressure in patients being treated with CCB due to the dose-dependent CYP3A4 induction effect leading to a decrease in blood levels of CCB by enzalutamide.
Glucocorticoid-induced osteoporosis (GIO) is a serious side effect of long-term glucocorticoid (GC) administration. However, sufficient high compliance rate data for the guidelines on the management and treatment of GIO in Japan is unavailable. Additionally, GC is prescribed at many medical departments involved in outpatient care. Community pharmacists might intervene to support more appropriate pharmacotherapy to avoid GIO. This study examines the actual state and characteristics of pharmacotherapy for GIO prevention. We investigated 136 patients from the Gifu Pharmaceutical University pharmacy that received GC treatment continuously for over three months. We obtained the age, GC dosage, and combined medications data retrospectively from the electronic drug system and assessed the fracture risk factor using a scoring system. One hundred and two patients were recommended for prophylactic pharmacotherapy based on the guidelines on the management and treatment of GIO. Nineteen patients (18.6％) did not receive this therapy. Thus, community pharmacists should consider proposing prescriptions using the guidelines and help support GIO prevention.