Martina Teichert

Vitamin K Epoxide Reductase Complex Subunit 1 (VKORC1) Polymorphism and Aortic Calcification: The Rotterdam Study

Objective—Besides effects on hemostasis, vitamin K-dependent proteins play a role in bone mineralization and arterial calcification. We investigated the association between the VKORC1 1173C>T polymorphism and calcification of the aortic far wall in a large population-based cohort. Methods and Results—Aortic calcification was diagnosed by radiographic detection of calcified deposits in the abdominal aorta. In all cohort members for whom DNA was available, the C1173T SNP of VKORC1 (rs9934438) was determined. With multivariable logistic regression analysis the association between this polymorphism and the risk of aortic calcification was calculated, adjusted for potential confounders. The T allele frequency of the VKORC1 1173C>T polymorphism was 38.8%. 1185 (37.2%) persons were homozygous CC, 1529 (48,0%) were heterozygous CT and 473 (14.8%) were homozygous TT. Persons with at least one T-allele had a statistically significant 19% (95% CI 2 to 40%) risk increase of calcification of the aortic far wall compared to CC homozygous persons, adjusted for age and gender. Conclusion—The T-allele of the VKORC1 1173C>T polymorphism was associated with a significantly higher risk of aortic calcification in Whites.

Pharmacist-led intervention study to improve drug therapy in asthma and COPD patients

Background Pharmacists can play an important role in identifying and instructing pulmonary patients on their inhalation techniques in their patient contacts when dispensing inhalation medication. Pharmacy dispensing data can be used to identify inappropriate drug use in asthma and chronic obstructive pulmonary disease (COPD) patients. Recent studies found beneficial effects of pharmacy care services in improving drug adherence of pulmonary patients. However, large-scale and rigorous evaluations on pharmacist-led interventions in community care settings to enhance evidence-based drug treatment in patients with asthma and COPD seems to be lacking and results from studies on pharmacist-led interventions for pharmacotherapy improvements are inconsistent. This study evaluated the effectiveness of pharmacist-led interventions on suboptimal drug use patterns with asthma or COPD medication with substantial numbers of pharmacies and patients involved. Setting A prospective cohort study in a group of community pharmacies (intervention group) with a matched control group of Dutch community pharmacies was conducted between May 2011 and February 2012. Algorithms on 19 potential problems with asthma or COPD medication in a national dispensing database were used to signal patients to pharmacists of the intervention group (IG). Methods IG pharmacists selected patients for comprehensive care by a structured program. Changes in problems were measured during 10xa0months in selected and all users of asthma and COPD medication of IG pharmacies and in compared to a control pharmacies (CG) without the structured program. Primary outcome was reduction of oral high dosage corticosteroids or antibiotics (HDT). Secondary outcomes were changes in the persistence of 19 potential problems in the IG compared to CG. Results In the 107 IG pharmacies, 3,757 patients were selected for comprehensive care from totally 102,497 asthma or COPD patients and compared with 105,507 patients from 105 CG pharmacies. The mean number of HDT decreased in selected IG patients by an additional 0.54 (95xa0% CI 0.21–0.86) HDT treatments. From the problems with specific COPD and asthma medication, all problems decreased additionally to the CG within the total asthma or COPD population from the IG. Within the selected IG population the following problems decreased additionally for obsolete medication by 35xa0% (95xa0% CI 6–54xa0%), contra-indicated medication by 61xa0% (95xa0% CI 38–75xa0%) and lower use of powder inhalers in elderly patients by 29xa0% (95xa0% CI 13–42xa0%). Conclusion Community pharmacists actively providing comprehensive pharmacy care could improve effective treatment in asthma and COPD patients and thereby decrease the number of prescriptions for exacerbations for these patients.

Effectiveness of interventions by community pharmacists to reduce risk of gastrointestinal side effects in nonselective nonsteroidal anti-inflammatory drug users

Upper gastrointestinal (UGI) complications in elderly users of nonselective nonsteroidal anti‐inflammatory drugs (ns‐NSAIDs) without concomitant use of gastroprotective agents (GPAs) were a leading cause of potentially avoidable drug‐related hospital admissions in the Netherlands. We aimed to determine the effectiveness of community pharmacists interventions to improve safety in ns‐NSAID use in patients at UGI risk.

Implementation of medication reviews in community pharmacies and their effect on potentially inappropriate drug use in elderly patients

Background In 2008 recommendations were launched to prevent medication-related hospital admissions in the Netherlands. Elderly patients using several drugs on a chronic basis were among the target group. Pharmacy-led medication reviews (MRs) were identified as having potential for improving patient safety. Objective This observational study evaluated the implementation success rate of performing all five steps of a complete MR for patients and changes in the presence of nine issues of potentially inappropriate medication (PIM) use. This change was compared between patients with a complete MR (intervention group, IG) and a reference group (RG) who attended the same pharmacy; all patients were eligible for MR, but only selected patients formed the IG. Setting Dutch community pharmacy. Method After appropriate training, the rate of IG with complete MRs was measured by pharmacists registering the various MR steps in the MR tool. Patients were eligible for a MR if aged ≥65xa0years with ≥5 drugs being used chronically. Main outcome measures The success rate of implementing MRs with five steps completed; the presence of nine PIMs for both study groups. Results In pharmacies with specifically trained pharmacists, 63xa0% of selected patients received a complete MR. This was 12xa0% higher than in pharmacies without trained pharmacists. PIMs reported at study start declined in the IG and at study end had decreased by an average of 19xa0% (with a range between 34 and 100xa0% per PIM); this decrease did not significantly differ from the RG. Conclusion Additional efforts are needed to improve the implementation of pharmacist-led MRs in order to realize its full potential in general practice, and for a substantial decrease of PIMs to occur in susceptible patients. These efforts should focus on training courses and additional support using computerized systems to share information with GPs and to register MR activities, together with sufficient financial reimbursement.

Decline in prolonged hormone replacement therapy in women aged 45 years or more, and impact of a centralised database tool

Objective Evaluation of discontinuation in prolonged use of menopausal and post‐menopausal hormone replacement therapy (HRT) in The Netherlands after the publication of the Million Women Study in The Lancet of August 9, 2003. Furthermore estimation of the contribution of a centralised database tool on this decline, supplying community pharmacists with their patients on prolonged HRT therapy.

Potential Medication Triggers Of Deteriorated Renal Function Among Patients With Type 2 Diabetes: Using Real World Data

(SR) was conducted using MEDLINE and EMBASE (1996-2017). Key terms included a combination of neurogenic bladder, treatment patterns and epidemiological study. The inclusion criteria for studies were: 1) published in English; 2) conducted in human subjects; 4) reporting the treatment patterns/use in NGB (any neurogenic condition listed in the EAU guidelines); 5) conducted in a real world setting. Articles were reviewed for inclusion by an independent reviewer (AJ) and 10% were cross examined by a second independent reviewer (FF). A narrative synthesis of results was conducted and percentage of treatment use was reported in ranges. Results: A total of eight studies met the inclusion criteria. Study designs, setting, and patient groups were notably heterogeneous and all data was collected before 2008. This SR found that the most commonly used management method amongst NGB patients was reflex voiding (RV) methods and catheterisation (CIC and IndUC). Data and commentary from three studies show that a notable amount of patients switched treatments. The most popular oral pharmacotherapies were alpha-blockers and antimuscarinics used for neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). One study which focused on spina bifida reported that the majority of patients underwent surgery. ConClusions: With passing time, clinicians have moved away from techniques associated with higher rates of complications and mortality. This has meant that in recent years, the survival chances of patients with NGB have increased. This suggests that current treatment patterns will be different from what was uncovered in this review. Epidemiological studies using electronic healthcare records (EHRs) are necessary to advance our understanding in how NGB patients are managed in current practice, and how well patterns relate to practice guidelines.