Magalie Baudrant

La sécurisation du circuit du médicament dans les établissements de santé : données actuelles et expérience du centre hospitalier universitaire de Grenoble☆

Drug supply chain safety has become a priority for public health which implies a collective process. This process associates all health professionals including the pharmacist who plays a major role. The objective of this present paper is to describe the several approaches proven effective in the reduction of drug-related problem in hospital, illustrated by the Grenoble University Hospital experience. The pharmacist gets involved first in the general strategy of hospital drug supply chain, second by his direct implication in clinical activities. The general strategy of drug supply chain combines risk management, coordination of the Pharmacy and Therapeutics Committee, selection and purchase of drugs and organisation of drug supply chain. Computer management of drug supply chain is a major evolution. Nominative drug delivering has to be a prior objective and its implementation modalities have to be defined: centralized or decentralized in wards, manual or automated. Also, new technologies allow the automation of overall drug distribution from central pharmacy and the implementation of automated drug dispensing systems into wards. The development of centralised drug preparation allows a safe compounding of high risk drugs, like cytotoxic drugs. The pharmacist should develop his clinical activities with patients and other health care professionals in order to optimise clinical decisions (medication review, drug order analysis) and patients follow-up (therapeutic monitoring, patient education, discharge consultation).

Comment évaluer l'adhésion médicamenteuse ? Le point sur les méthodes

INTRODUCTIONnIdentifying the difficulties of the patient towards following his medication regimen remains complex for the healthcare provider. This can be explained by the multidimensional character of medication adherence and, actually, the evaluation of this phenomenon. The objective of this work was to review the various methods to measure medication adherence.nnnMETHODSnWe performed a search on PubMed completed by a manual one.nnnRESULTSnTwo types of measure are described. The direct methods are based on the measurement of the level of medicine or metabolite in blood or urine, measurement of biologic markers in blood or measurement of physiologic or clinical markers. The indirect methods are represented by the analysis of the administrative databases (prescription, rate of prescription refills); pill counts; electronic medication monitors; the self-reported measures by the patient or his close relations (questionnaires, diaries, interviews); the opinion of the healthcare provider.nnnDISCUSSIONnNone of these tools supplants the others, each having limits either of feasibility, or reliability. In the end, it is the crossing of the information stemming from these various equipments that allows an idea on the adherence behavior of the patient and especially, dimensions on which he is most in trouble.nnnCONCLUSIONnThe identification of these difficulties can allow the healthcare provider to develop behavioral and organizational skills tailored to the patient follow-up.

Educating diabetic children: integrating representations by children aged 7 to 11 and their parents

ObjectiveA patient living with a chronic disease develops illness-related knowledge, representations, and specific behaviour leading to attitudes. Our objective was to assess the interaction between representations from diabetic children 7 to 11 years of age and their parents, on the disease and its treatment, in order to improve the therapeutic education process.MethodA qualitative approach was developed. Semi-structured interviews and free association technique were used on 10 children 7 to 11 years of age and 10 parents, in the Toulouse Hospital, France. Qualitative and quantitative (Alceste® software) discourse analysis relating to representations was performed (distribution, frequency, and meaning of word sequences were compared).ResultsChildren seemed to cope naturally with their environment in order to manage their disease. Their attitudes were neutral and their behaviour pragmatic. The parents representations were more conceptual and negative. They expressed their fear of the disease, their difficulty to endorse the responsibilities and overcome everyday constraints.ConclusionThe educator must adapt his language level to integrate the childs universe and facilitate assimilation of knowledge. The therapeutic education process for diabetic children should integrate a specific support and training for parents. These results have influenced our choice of a strategy involving continuous group education focusing parents.

Why Do Patients with Chronic Inflammatory Rheumatic Diseases Discontinue Their Biologics? An Assessment of Patients' Adherence Using a Self-report Questionnaire.

Objective. Concerns have been raised about nonadherence behavior among patients with chronic inflammatory rheumatic diseases (CIRD) receiving biologics. This nonadherence may be caused by various factors. The main objective was to explain why patients discontinue their biologics of their own accord. Methods. A quantitative and descriptive study was performed using a self-report questionnaire that was sent through the Internet to members of different patient associations. Sociodemographic data, medical and therapeutic history, management of biologic administration, previous experiences, and patients’ beliefs and perceptions about treatment efficacy and side effects were studied to explain self-discontinuation (SD). Results. A total of 581 patients answered the questionnaire between June 16, 2012, and July 4, 2012, including patients with ankylosing spondylitis (351/581, 60.4%), rheumatoid arthritis (196/581, 33.7%), psoriatic arthritis (30/581, 5.2%), and other CIRD (4/581, 0.7%). More than 1000 different biologics were described by the 581 patients, with a median of 2 lines per patient. Eighty-six patients discontinued their biologics of their own accord (14.8%). In a multivariate analysis, factors that were significantly related to SD were low level of pain, more than 1 line of biologics tried, self-administration of biologics, negative beliefs about the treatment, and a lack of medical and social support. Conclusion. Five predictive factors of this SD were identified, which should be assessed in routine with patients with CIRD receiving biologic treatment: pain, treatment history, self-administration of injections, negative beliefs about treatment, and a lack of perceived medical and social support.