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BACKGROUND:Clinicians often encounter information about drug-drug interactions (DDIs) during clinical practice. This information is found within product information (hardcopy and electronic) and various electronic systems. Prescribers may receive medication-related communications in practice that are distributed by facsimile (fax), mail, or telephone from pharmacies and pharmacy benefit managers (PBMs). The purpose of this study was to determine if near-real time fax alerts for potential drug-drug interactions (PDDIs) would influence prescribing.METHODS:A prospective study, in cooperation with a pharmacy benefit manager (PBM), was conducted targeting 18 clinically important PDDIs. Fax alerts included an individualized letter to the prescriber with a list of the interacting drugs, PDDI evidence summaries with citations, and recommended clinical management strategies. Among the 18 PDDIs, 13 PDDIs could be assessed for prescription therapy changes using pharmacy claims data. A prospective cohort design was used to evaluate changes in prescription dispensing 90-days following a PDDI fax alert.RESULTS:A total of 8,075 fax alerts were sent to prescribers and there were 4,712 alerts for the 13 PDDIs that could be assessed for change using pharmacy claims data. There were 2,019 patients (interventions) for which fax alerts were sent to their prescribers who were matched with a control group consisting of patients with the same PDDIs but for whom no fax alert was sent. Overall, this study found 154 (7.6%) of patients in the fax alert group compared to 132 (6.5%) in the control group had changes in therapy (p=0.177).CONCLUSIONS:This fax alert intervention program observed no statistically significant differences in prescribing with a fax alert compared to the control group. If PBMs chose to send individualized, evidence-based information to clinicians regarding drug-drug interactions, this study suggests it may not be an effective intervention to mitigate harm.

published_or_final_version / abstract / Sociology / Master / Master of Philosophy

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Research in the field of drug dependence and recovery emphasises the need for more understanding of the concept of recovery from dependent drug use. This study explored the ways in which dependent drug users recover from drug dependency in a Christian faith-based agency in Lagos, Nigeria. The strategy employed was a qualitative research design using a case study approach. Instruments for data collection were qualitative interviews and observation methods; agency records were also accessed for background information purposes. Three stages of the recovery process were explored: motivation for recovery, disengagement from drugs and maintenance of recovery. In each of these stages, psychological, socio-environmental and spiritual elements were identified as significant factors in the recovery process. The offer of treatment from a Christian faith-based agency seemed to be the most important factor in motivating informants to engage in treatment in the first place. At the disengagement stage, psychological and socio-environmental issues came to the fore, with a personal commitment to change and support from significant others including peers becoming important. Spiritual factors played a significant part at this time, however, including teaching and Bible reviews and prayers. Maintenance of recovery was found to be facilitated by psychological strategies such as positive self-talk and avoidance of triggers of drug dependency; by socio-environmental factors including supportive relationships; and by spiritual elements, which centred on the adoption of a Christian lifestyle. The findings conclude that although recovery from drug dependence is achieved through various routes, the most significant factor for the informants in this study was the spiritual intervention received.

Class of 2009 Abstract / OBJECTIVES: To assess the performance of drug-drug interaction (DDI) software programs utilized in community and hospital pharmacies located in urban and rural settings. METHODS: A fictitious patient profile with 18 drugs and a penicillin allergy was entered into pharmacy computer systems throughout Arizona. Researchers recorded the software systems’ responses to 20 targeted combinations, 14 of which should have produced an alert and 6 that were not true interactions. The number of true positive, true negative, false positive and false negative responses was determined for each system. These data were subsequently used to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) overall and at each site. RESULTS: There were 35 participating pharmacies that used a total of 18 different software programs. The overall sensitivity was 0.8, and ranged from 0.21 to 1 between sites. Computer software failed to detect important interactions 20% of the time. The specificity ranged from 0.83 to 1; PPV ranged from 0.89 to 1; and NPV ranged from to 0.35 to 1. Nine sites, using five different software programs returned perfect results. However, some of those programs produced different results at other sites. CONCLUSIONS: This study shows that improvements are needed in software programs to help pharmacists accurately identify DDIs which could prevent potential adverse drug events. Many clinically important interactions remain undetected by software programs, and users should be mindful of current limitations in technology.

Class of 2007 Abstract / Objectives: The purpose of this study was to determine if there is a difference between both graduating medical and pharmacy students in their capabilities to appropriately recognize drug-drug interactions that have led or can lead to serious toxicological consequences in humans. The hypothesis of this study was that there would be no difference between the ability of medical and pharmacy students to recognize potential drug-drug interactions. Methods: A two-page questionnaire was giving during the last semester before both the medical and pharmacy students graduate. The first page requested information about demographics, such as: gender, age, current educational program, previous education in healthcare, other degrees held, and average hours worked in healthcare per week for the past year. The second page contained 22 questions on potential drug-drug interactions. Also, there will be some questions that do not contain any drug-drug interactions. The students had four choices, in which they could answer. The choices were (1) The two drugs should not be used together (contraindicated), (2) The two drugs may be used safely together with monitoring, (3) The two drugs may be used safely together without monitoring, and (4) Not sure if the drugs can be used together. Results: Of the 168 questionnaires distributed, 51 were completed and returned. Forty-seven pharmacy students responded, while only 4 medical students responded. Pharmacy students correctly identified 38.4% + 11.7% of the interactions. The minimum correct responses was 13.6% and the maximum was 68.2% Pharmacy students without a bachelor of science (BS) performed slightly better than the students having a BS with a mean score of 40.0% + 3.0% and 37.1% + 9.0%, respectively. There was no significant difference between the groups (p = 0.42). Males had a mean score of 39.1% + 8.2%, while females had a mean score of 38.1% + 13.1%. There was no significant difference between the groups (p = 0.78). Also, there was no significant difference between the student’s age or how many hours they worked per week regarding the percent of correct responses.

PRΕLIMINARY ANALYSIS OF DRUG ADHERENCE OF PATIENTS WITH ULCERATIVE COLITIS Author: Konstantina Tsianou Tutor: Prof. Jiri Vlcek Department of Social and Clinical Pharmacy, Faculty of Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis: To investigate the role of the beliefs of patients suffering with Ulcerative Colitis about medicines according to age group (group 1: age between 20-45 years old versus group 2: age between 46-65 years old). The study employs the Belief about Medicine Questionnaire to measure the adherence of patients with Ulcerative Colitis in Greece. Method: This study was conducted using the Greek version of the BMQ that has been translated from English into Greek language by a professional bilingual translator and then translated back into English by a native English speaker in a previous study. Results: Our study is resulted to the lowest accepting belief group ratio (12.8%) along with the highest results for ambivalent and indifferent belief group ratios (31.2% and 40%, respectively). Conclusion: The Greek version of the Beliefs about Medicines Questionnaire presented satisfactory psychometric/measurement properties indicating its reliability for use in patients with IBD who receive care in an outpatient hospital clinic. The BMQ is a useful tool...

A dissertation submitted to the Faculty of Health Science, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in medicine. Johannesburg 2014 / Introduction: The presence of pain during sleep causes patients with chronic daily pain, such as in Rheumatoid and Osteoarthritis, to experience insomnia, fragmented sleep and an increased number of night-time awakenings. This poor sleep results in an increased sensitivity to pain during the day. The effect of improving sleep on pain, sleep and mood after taking Zolpidem MR was the aim of this study. Methods: 11 patients from Chris Hani Baragwanath Hospital in Soweto South Africa who reported insomnia and daily pain spent 4 weeks in this crossover design, double blinded, placebo controlled study. Week 1- baseline, week 2 and 4 were Intervention weeks – either placebo or Zolpidem MR, week 3 was a Washout week. Data collected included actigraphy, McGill Pain Questionnaire, PSQI, BDI, physical activity questionnaire and daily sleep and pain diaries containing VAS scales for sleep and pain. Results: No significant changes were found in the pain or physical activity levels in any of the patients. Sleep quality, as measured by an isolated PSQI question, was improved by Zolpidem MR (p=0.0075). PSQI was decreased in the final week of the study compared to baseline (8.7 vs. 11.3, p=0.0106) and BDI was lower in week 4 than baseline (7.7 vs. 15.85, p=0.0003), BDI was also lower in week 4 compared to week 2 (7.7 vs. 12.8, p<0.05). However the changes in PSQI and BDI were a result of the order of the weeks, with patients interacting with the researcher and were not due to either Zolpidem MR or placebo. Anecdotal reports include feeling more energised and capable of living life. Conclusion: This study has shown that human interaction is an important component of treatment for insomnia and chronic pain as there is a positive effect on sleep disruption and depression.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Pharmaceutical Affairs Johannesburg, 2003 / Tshwane is one of three metropolitan municipalities in Gauteng Province and a cross border district with North West Province. Tshwane has a complex Drug Supply Management system. Gauteng Provincial Authority (GPA), North West Provincial Authority (NWPA) and City of Tshwane Metropolitan Municipality (CTMM) play significant roles. This has resulted in duplication of duties and inefficient use of resources. The aim of the study was to describe the current Drug Supply Management System in Tshwane, identify any weaknesses plus the factors responsible for the observed weaknesses and formulate recommendations for improvement. / IT2018