Veerle Foulon

Patient adherence to oral anticancer drugs: an emerging issue in modern oncology.

Abstract The steady increase in the use of oral anticancer drugs in modern oncology has created a paradigm shift, challenging traditional attitudes towards cancer care and requiring new concepts of organization of oncology services. Important issues are the prolonged treatment period, management of toxicity, treatment adherence, reimbursement conditions and patient and family education. Although most patients generally prefer oral therapy over intravenous treatment for reasons of convenience, the daily use of oral anticancer drugs can be a challenging commitment for many patients. Reports on adherence and persistence among patients with cancer show that adherence ranges from 16% to 100%, depending on the type of therapy and the measurement/definition of adherence. Apart from demographic, disease and therapy related factors, the determinants that mostly influence (non-)adherence are the satisfaction with care activities performed at the initiation of the drug treatment, and the perceived necessity of treatment. Therefore, patient education addressing these issues is considered the cornerstone of successful oral anticancer treatment. Studies examining the role of different health care providers in the pharmacotherapeutic care of patients with cancer, treated with oral anti-cancer drugs, support the need for a multidisciplinary approach to achieve a maximum benefit for the individual patient and consequently for the whole health system. Limiting adverse events and developing appropriate supportive care are only some aspects that need to be considered in this.

Guidelines recommendations on care of adult patients receiving home parenteral nutrition: a systematic review of global practices.

BACKGROUND & AIMSnBecause home parenteral nutrition (HPN) in adult patients can give rise to a variety of complications, good guidance is necessary. To achieve this, clarity and consistency in guidelines are essential. The aim of this review is to identify and compare evidence-based guidelines, and to compile a list of main recommendations, according to their evidence-based grade.nnnMETHODSnWe searched Medline and the international guideline database for HPN guidelines, performed a content analysis of retrieved guidelines, and evaluated their quality. We then compiled a comparative table of guideline recommendations along with their assigned level of evidence.nnnSUMMARY OF RESULTSnSix systematically developed evidence-based guidelines and one expert opinion-based standard for home care were retrieved. Of these guidelines, two were exclusively devoted to HPN. Although the guidelines generally covered the same topics, most did not provide information on intravenous medication, bone metabolic disease, and indications in patients with malignant disease. Moreover, we found grading discrepancies among various guidelines, as identical recommendations were often labeled with different grades.nnnCONCLUSIONnOur comparison of guidelines and standards for HPN revealed substantial differences among recommendations. Identification of these discrepancies and omissions should facilitate the development of more comprehensive and better justified guidelines in the future.

Development of quality of care interventions for adult patients on home parenteral nutrition (HPN) with a benign underlying disease using a two-round Delphi approach

BACKGROUND & AIMSnHPN patients with benign diseases deserve professional care as they have to deal with complex techniques and risk potentially dangerous complications. The aim was to highlight main outcome quality indicators and to develop a set of key interventions to direct multidisciplinary teams in providing qualitative care.nnnMETHODSnA two-round Delphi approach was used to build consensus on the most important outcome indicators and on 59 interventions identified in existing guidelines on HPN. Comments and interventions newly identified in the first round were co-evaluated in the second round.nnnRESULTSn29 experts from 9 countries completed the two-round Delphi approach. The outcome indicators rated as the most important are 1) incidence of catheter-related infections, 2) incidence of readmission and quality of life (shared second place) and 3) incidence of dehydration. Sixty eight of a total of 89 interventions were considered as important for the quality of care, of which 46 are based on published guidelines and 22 were newly suggested by the Delphi panel.nnnCONCLUSIONSnUsing a two-round Delphi approach, consensus was reached for the majority of interventions concerning HPN patients with benign diseases. This set of 68 interventions could be of use as a starting point for quality-improvement programs.

Development of a transfer document for the community pharmacist at hospital discharge

s PCNE working conference 2017. Bled, Slovenia. 1–3 February 2017 Pharm.Care@BLED Build Lead Engage – Disseminate

Exploring the relationship between fall risk-increasing drugs and fall-related fractures

BackgroundHospital admissions due to fall-related fractures are a major problem in the aging population. Several risk factors have been identified, including drug use. Most studies often retrieved prescription-only drugs from national databases. These are associated with some limitations as they do not always reliably reproduce the complete patient’s active drug list.ObjectiveTo evaluate the association between the number of FRIDs intake identified by a standardised medication reconciliation process and a fall-related fracture leading to a hospital admission in older adults.SettingThe first cohort has been recruited from one traumatology ward of a tertiary teaching hospital in Belgium and the second cohort has been recruited from 11 community pharmacies in Belgium.MethodA prospective study with two individually matched cohorts was performed. Adult patients (≥75xa0years) admitted with an injury due to a fall were included in the first cohort (faller group). The second cohort consisted of patients who did not suffer from a fall within the last 6xa0months (non-faller group). Matching was performed for age, gender, place of residence and use of a walking aid. In both groups, clinical pharmacists and undergraduate pharmacy students obtained the medication history, using a standardised approach. A list of drugs considered to increase the risk of falling was created. It included cardiovascular drugs and drugs acting on the nervous system. A linear mixed model was used to compare the number of fall risk-increasing drugs between fallers and non-fallers.Main outcome measureThe number of fall risk-increasing drugs in a faller versus a non-faller group.ResultsSixty-one patients were matched with 121 non-fallers. Patients received on average 3.1xa0±xa02.1 and 3.2xa0±xa01.8 fall risk-increasing drugs in the faller and in the non-faller group, respectively. The mean number of fall risk-increasing drugs was comparable in both groups (pxa0=xa00.844), even after adjusting for alcohol consumption, fear of falling, vision and foot problems (pxa0=xa00.721).ConclusionIn a sample of hospitalised patients admitted for a fall-related injury, no significant difference in the number of fall risk-increasing drugs versus that of an outpatient group of non-fallers was found.

Pharmaceutical Care and the Role of the Patient

In order to effectively implement the gold standard for healthcare practice, person-centered care, communication between the patient and the pharmacist is required. As patients form a heterogeneous group with different needs depending on the disease stage they are in, coping strategies and health beliefs, an accurate understanding of the patient’s own motivations, priorities and preferences is critical. Based on the evidence discussed in the current chapter, we strongly believe that drug information embedded in pharmaceutical care contributes more to therapy adherence and patients’ quality of life if this information is adjusted to patients’ needs. Therefore, the role of the patient in pharmaceutical care is to express his/her needs - and it is the role of the pharmacist to explore those needs and to help patients to articulate them. Consequently, the pharmacists should provide tailored information responsive to patients’ needs.