J.-F. Bussières

Recensement et analyse des preuves sur le rôle et sur les retombées de l’activité pharmaceutique : développement d’un outil sur Internet

BACKGROUNDnConsidering the increase in healthcare expenses, stakeholders need to make choices, including healthcare program funding, and professional activities to prioritise.nnnPURPOSEnThe main objective was to list evidences about the role and impact of pharmacists.nnnMETHODSnThemes were chosen according to three dimensions of the pharmacist profession: (1) activities, (2) healthcare programs and (3) disorders. A literature search was conducted for each theme. A bibliographic data sheet was completed for each article. An analytic data sheet, consisting of descriptive and impact outcomes, was also completed for the most relevant articles. For each theme, a synthesis was elaborated. The website Impact Pharmacie (http://impactpharmacie.org) was developed.nnnRESULTSnA total of 70 synthesis were written. A total of 1442 articles were included with a bibliographic data sheet, and 914 with an analytic data sheet. Six hundred and fifty articles had positive outcomes on the role of the pharmacist, representing 803 different positive outcome markers. Pharmacists had positive outcomes on morbidity (n=212), adherence (n=92), costs (n=36), adverse effects (n=26), drug errors (n=31) and mortality (n=13).nnnCONCLUSIONnThis descriptive study presents the review of the evidence on the role and the impact of pharmacists activities, which led to the Impact Pharmacie website. This francophone website can contribute to support clinical pharmacy development, and to a better use of pharmacists in healthcare.

6ER-031 Roles and impacts of the pharmacist from 1990 to the present: literature review and research perspective

Background There are an increasing number of publications concerning the roles and impacts of pharmacists. Decision makers, clinicians and patients need evidence to support an appropriate allocation of funds to better use the expertise of pharmacists. Purpose To provide a profile of the roles and impacts of the pharmacist in the literature. Material and methods Review of literature. Articles in English and French related to the roles and the impacts of the pharmacist were selected, according a reproducible search strategy from 1990 to September 2017 in Pubmed and Pubmed Central. The following variables were extracted: author, country, study plan, pharmaceutical activities, patient care programmes, diseases, outcomes (e.g. mortality, morbidity, costs, adverse events, medication errors, compliance, satisfaction, other) and a quality score. Outcome results were categorised as positive, neutral or negative. Only descriptive statistics were performed. Results On 20 September, 2017, a total of 2323 articles were included on 100 themes (e.g. 41 pharmaceutical activities, 30 diseases and 29 patient care programmes). Studies were conducted in the United States (46.6%), multiple countries (8.2%), Canada (7.8%), France (6.2%), the United Kingdom (5.3%), Australia (3.6%) and other countries (19.3%). Studies were either cross-sectional (47%), retrospective (33%), prospective (18%) or uncategorised (12%). Outcomes included morbidity (22%), medication errors (11.7%), satisfaction (7.3%), adherence (6%), costs (5.6%), adverse reactions (3.7%), mortality (1.3%) and others (42.4%). Included studies reported 6784 descriptive indicators and 5108 outcome indicators (60% were positive, 39% neutral and 1% negative). The quality score of articles (n=1,697) were either excellent (8.8%), acceptable (34.2%) or with methodological limitations (57%). Conclusion This review of the literature confirms the extensive presence of pharmacists in numerous patient care programmes, treating different diseases and performing a variety of pharmaceutical activities. Most outcomes related to pharmaceutical activities were positive. However, a significant proportion of published studies had methodological limitations. Pharmacists need to be more exposed to evidence about their roles and their impact, both in community and hospital settings. Furthermore, increasing funding for evaluative research must be supported by external stakeholders in different countries to better understand the impact of pharmacists’ activities. No conflict of interest

PS-098 Reorganisation of medication circuit in the operating and delivery room

Background Pharmacy practice is highly regulated and the medication circuit is complex in healthcare settings. Required organisational practices of the national accreditation authority also provide a normative framework. Purpose To describe the reorganisation of the medication circuit in the operating (OR) and delivery (DR) room. Material and methods A prospective descriptive study was conducted in OR and DR in a 500 bed teaching hospital. Following a review of literature, an Ishikawa diagram was developed to identify failure modes. Thereafter, a semi-structured direct observation in OR and DR was done to identify key issues. Corrective measures were discussed and adopted by consensus with a multidisciplinary group, including pharmacists, anaesthesiologists, nurses and respiratory therapists. Results 10 failure modes associated with the medication circuit and 18 key issues were identified. A total of 30 corrective measures were proposed. While all inpatient care areas have designated pharmacists to provide decentralised pharmaceutical care in the hospital, the OR and DR have none. Pharmacists were identified to share such coverage within their current intensive care and surgical care daily duties. Automated dispensing cabinets were implemented to better control drug dispensing and stock replenishing for each room. A safe anaesthesia box system was chosen and the drug content standardised with a detailed record sheet, improving the management and the documentation of prepared and administered doses, including residual quantities at the end of a shift. The system was pre-tested and improved before implementation. A radio-identification based system was also developed to manage RFID labels and anaesthesia box replenishing steps within the central pharmacy. A monitoring system was chosen to monitor cold chain of drugs stored in refrigerators. Expiration dates were reviewed according to current standards to minimise risks of contamination. Drug utilisation reviews were identified for drug targets to offer feedback to drug prescribers. Conclusion OR and DR are often less supported by pharmacy to insure an optimal medication circuit. With a view to ensuring continuous improvement of quality of patient care, audits should be performed to measure the impact of corrective actions implemented. References and/or acknowledgements Thanks to pharmacists and medical and paramedical staffs for their collaboration. No conflict of interest

A survey of pharmacists’ knowledge and views of biosimilars in Quebec and France

OBJECTIVEnThe objective of this study was to survey pharmacists knowledge and views of biosimilars in Quebec and France.nnnMETHODSnAn online and anonymous survey was conducted. The survey was divided into two parts including: (1) ten multiple choice questions on main characteristics that distinguish biosimilars from generic drugs; (2) fifteen statements on biosimilars key issues (interchangeability, immunogenicity risk management…). Pharmacists were asked to indicate their level of agreement to these statements using a 5-item Likert scale. A descriptive statistical analysis of the results was performed.nnnRESULTSnA total of 229 pharmacists answered the survey (141 in Quebec and 88 in France). Pharmacists know the main differences between generic drugs and biosimilars. Viewpoints of pharmacists on biosimilars key issues are alike: nomenclature of biosimilars is essential to avoid confusions with the reference drug; the creation of a list of biosimilar and interchangeable biologic drugs is necessary; responsibilities for immunogenicity risk management should be shared between pharmacists and physicians. However, viewpoints vary regarding the patient informed consent for biologic drugs substitution.nnnCONCLUSIONnKnowledge and views of pharmacists about biosimilars in Quebec and in France are alike. Pharmacists should be knowledgeable about the particularities and key issues of biosimilars because they will play a key role for their introduction in clinical practice. They should be aware of the evolution of the legal framework of biosimilars to ensure their safe and optimal use.

Étude pilote du niveau d’accord à des énoncés sur l’éthique pharmaceutique d’étudiants en pharmacie et pharmaciens hospitaliers québécois

OBJECTIVEnThe main objective was to assess the position of Quebec pharmaceutical community about pharmaceutical ethics statements. The second objective was to compare the level of agreement of pharmacy students and hospitals pharmacists.nnnMETHODnSurvey conducted one day given in 2012xa0and 2013xa0for students in 2013xa0and from 29/08/2014xa0to 02/09/2014xa0for pharmacists. A questionnaire of eight themes and 43xa0statements was developed: training and education (5xa0questions), clinical research (7) advertising and marketing (5) evaluation (5) dispensing medication (4), pharmaceutical care (9) economic aspect (6) and code of ethics (2). A Likert scale with four choices was used to measure the level of agreement. The primary outcome was the difference between the level of agreement of pharmacy students and hospital pharmacists. The Chi2xa0test was used.nnnRESULTSnA total of 347xa0students and 398xa0pharmacists responded to the survey. There was a statistically significant difference regarding the level of agreement with 28xa0statements on 43. The differences focused on eight themes of the questionnaire, or training and education (3/5xa0significantly different questions), clinical research (2/7), advertising and marketing (2/5), Evaluation (4/5) dispensing medication (4/4), pharmaceutical care (5/9), economic aspect (6/6) and ethics (2/2).nnnCONCLUSIONnThis study shows that there is a difference between pharmacists and pharmacy students about pharmaceutical ethics statements.

Mieux s’approprier les données relatives aux rôles et retombées de l’activité pharmaceutique : étude quantitative et qualitative auprès de quatre groupes d’experts

OBJECTIVESnThe use of scientific data about the roles and the impact of pharmacists is suboptimal. The objective is to evaluate the opinion and attitude of expert pharmacists on the measurement of indicators for the pharmaceuticals activities, sharing and appropriation of scientific knowledge and the place of the website Impact Pharmacie.nnnMETHODSnThis is a descriptive cross-sectional study. Four expert groups were interviewed (hematology-oncology, intensive care, emergency and infectious diseases). To achieve the objective, a preliminary evaluation followed by a semi-structured interview by teleconference was organized for each group.nnnRESULTSnTwenty pharmacists were invited and 18xa0participated in the survey and 19xa0in interviews. Ten out of 18xa0and 2xa0out of 18xa0were collecting descriptive and impact indicators respectively. The use of these indicators by pharmacists was limited. Pharmacists had difficulties determining precise indicators measuring their impact but the majority would choose indicators related to medication errors or adverse drug event monitoring. The keywords mentioned by panelists about the usefulness of the site were to guide, to help prioritize, to think, to (re) structure the activity and time saving. To optimize website use, participants targeted journal club visioconferences, targeted activities in professional meetings and through various organizations.nnnCONCLUSIONnExperts pharmacists recognized the importance of monitoring their practice and a better use of the current available data may ensure the provision of consistent pharmaceutical services. They recognized the need to better educate pharmacists about using and disseminating data about the role and the impact of pharmacists including the website Impact Pharmacy.

Rôles et retombées des pharmaciens dans la gestion des dispositifs médicaux en établissement de santé : une revue de littérature

OBJECTIVESnIdentify the training profile and the published evidences about the roles and the impacts of hospital pharmacists in medical devices.nnnMETHODSnA literature review was conducted using Google, Google Scholar and Pubmed for 1990-2016 associated with a manual search conducted in three non-indexed pharmaceutical journals for 2000-2016.nnnRESULTSnThe analysis of training programs available did not allow us to identify a specific training profile. A total of 72 articles related to the roles and the impacts of the pharmacist were identified, 52 of which came from non-indexed journals. Those articles did not deal specifically about the roles and the impacts of pharmacist; however, articles were analyses for three spheres including the referencing of medical devices (n=36), the evaluation (n=19) and the distribution system (n=13).nnnCONCLUSIONSnFrench pharmacists have many theoretical and practical training opportunities. There are a few articles describing precisely the roles and the impacts of hospital pharmacists in medical device. It appears urgent to better document this activity in professional and indexed literature.

Publications presenting negative impacts of pharmacists

OBJECTIVESnThe main objective was to evaluate the rate of publications with at least one indicator of the negative impact of clinical pharmaceutics activity.nnnMETHODSnThis is a descriptive and retrospective literature review. A literature search was conducted using Pubmed. Articles published between 2009-2014 that described the role and impacts of pharmacists were included. We calculated the rate of publication containing at least one negative indicator. We collected the indicators with negative results.nnnRESULTSnA total of 203 articles were included. Nine articles (4%) that had at least one indicator of negative impact were identified. A total of 66% (6/9) were conducted in the United States. The study designs of the articles included were a meta-analysis (n=1), a systematic review (n=1), randomized studies (n=2), pre-post studies (n=3), a cohort study (n=1) and a survey (n=1). Nine indicators of negative impact were identified.nnnCONCLUSIONnThere were nine publications with at least one negative indicator of the impact of clinical pharmacy activity. While there are a large number of studies about the positive impact of clinical pharmacy activities; the publication of negative results should be encouraged.

Évaluation de la perception des professionnels de santé vis-à-vis du bilan comparatif des médicaments au CHU Sainte-Justine

OBJECTIVESnOur main objective is to assess nurses and doctors perception about medication reconciliation.nnnMETHODSnThis is a descriptive and cross-sectional study. We have created three surveys, one for each health worker (nurses, doctors, resident, pharmacists). Each survey consists of single or multi-choice closed questions. A four-point Likert scale was used to collect the perception. Descriptive statistics have been calculated.nnnRESULTSnA total of 114xa0nurses, 98xa0doctors and residents and 26xa0pharmacists from all care services, replied to the survey. The majority of doctors (58%), pharmacists (60%) and nurses (52%) recognized the relevance and utility of medication reconciliation in healthcare safety. However, few healthcare professionals (6% of doctors, 13% of nurses et 46% of pharmacists) know that medication reconciliation is a required organizational practice. Only 25% of doctors always consult the best possible medication history after a patient admission while the majority do not use it because of unreliability issues. So, there have been some major changes to optimize medication reconciliation process in our hospital.nnnCONCLUSIONnThis study shows a increasing interest to medication reconciliation by healthcare professionals. However, the use of medication reconciliation remains marginal.

Article originalÉtude pilote permettant de calculer le ratio d’effets indésirables médicamenteux par 10 000 doses définies journalières et 10 000 jours de traitement d’anti-infectieux en 2012–2013Pilot study evaluating the ratio of adverse drug reactions related to antimicrobials over their consumption in 2012–2013

OBJECTIVESnAs part of our antimicrobials stewardship program, we were interested in the use of antimicrobials and prevalence of adverse drug reactions associated with the use of these drugs.nnnMETHODSnThe retrospective and descriptive study was conducted over a one year-period between April 1st 2012 and March 31st 2013 in a mother-child Hospital. We determined the ratio: number of adverse drug reactions over 10,000 defined daily dose or 10,000days of therapy. We identified the ratios higher than average for which the confidence interval did not cross the calculated average. The severity of the adverse drug reactions was codified using the Common Terminology Criteria for Adverse Events.nnnRESULTSnWe found 570 adverse drug reactions including 100 (17.5%) adverse drug reactions related to antimicrobials during the financial year 2012-2013. It represented 96 patients. Thus, five antimicrobials, for which the confidence interval does not cross the calculated average value, may be targeted in risk management because they have a higher ratio than average: piperacillin (290 [113-722]), valganciclovir (244 [43-1260]), ceftriaxone (114 [56-234]), acyclovir (76 [26-220]) and liposomal amphotericin B (72 [20-258]).nnnCONCLUSIONnIn a mother-child university hospital, we calculated a ratios of 19 [15-23] and 13 [10-15], it allows us targeting some antimicrobials in our approach to prevention and management of adverse drug reactions.