No abstract

Background Therapeutic drug monitoring (TDM) is currently planned and ordered by doctors at an outer metropolitan hospital. Previous audits looking at clozapine and low-molecular weight heparin (LMWH) TDM found that sample timing was

BackgroundProprotein inhibitors convertase subtilisin/kexin9 (i-PCSK9) are new drugs for hypercholesterolaemia used in monotherapy or in combination with statins, which have numerous interactions. It may be useful to study the efficacy of I-PCSK9 as a single therapy.PurposeTo compare the efficacy of i-PCSK9 alirocumab and evolocumab in monotherapy versus bitherapy with statins, in order to define the clinical benefit of deprescribing statins in these patients.Material and methodsA retrospective observational study was conducted in our centre from March 2016 to March 2017. Patients treated with I-PCSK9 with/without combining it with statins were included. Low-density lipoprotein cholesterol (LDL-C) levels were measured before starting the treatment and at weeks 8 and 24. Data were available from medical histories. Adherence was calculated indirectly by consulting the dispensing of statins at the pharmacy office in the application for external prescription of our Autonomous Community.ResultsDuring the study period, 42 patients, 25 males and 17 females, were treated with i-PCSK9 in our centre. Sixteen started i-PCSK9 as a single treatment because of their intolerance to statins. Among the 26 patients who continued their treatment with statins, 58% (15/26) had a treatment adherence of 90%. Forty-two per cent (11/26) of these patients dropped out from treatment with statins before week 8. In the subgroup of patients in treatment with i-PCSK9 in monotherapy (because of lack of adherence or intolerance to statins) the lowering of LDL-C at week 8 (n=10) was compared to patients treated with bitherapy (n=9) (all other patients were excluded because they had not completed 8 weeks of treatment or because of lack of data).An average reduction in LDL-C from a baseline of 57% (95% CI: 40 to 74) and 80% (95% CI: 40 to 74) was obtained respectively.ConclusionA high rate of patients who start i–PCSK9 therapy do not continue statin treatment.In our study, the reduction in LDL–C with i–PCSK9 as a single agent is similar to the results of the LONG TERM trial (60%) in which only patients with biotherapy were included.Regarding the results obtained and the added complexity of using statins, it seems reasonable to research the efficacy of i–PCSK9 in monotherapy.No conflict of interest

BackgroundDrug therapy represents a major portion of healthcare spending. Drug utilisation research contributes to optimise drug policies in a rational drug use context.PurposeTo analyse PQI results in our centre and to identify new strategies in order to reinforce its compliance.Material and methodsDescriptive study based on the information arising from the PQI results from November 2015 to October 2016 compared to the previous two years. PQI is a tool proposed by our healthcare service (HCS) in order to establish a qualitative and quantitative assessment of drug prescribing. The index includes 14 items for specific improvement objectives for different therapeutic areas, and they are weighted according to their importance in global pharmaceutical spending (optimal 10 points, minimum 5). Data on defined daily dose (DDD) and prescriptions (number, cost, medical department) were retrieved from the Microstretegy® assistance application.ResultsFrom November 2013 to October 2014, our centre scored 6.71 (HCS average 4.83), from November 2014 to October 2015, 4.72 (4.83) and from November 2015 to October 2016 2.54 (2.37). Due to the evident decline,an in-depth analysis it was imperative to reverse this trend. Analysis showed an imbalance when data were broken down by medical department. Most of the medical departments achieved a minimum score of 5 points at PQI, but they did not reach minimum score for those items with higher impact in their pharmaceutical consumption. Comparing the data between November 2014 to October 2015 and November 2015 to October 2016, we observed poorer results for the following items (therapeutic group (treatment of choice)): second-line antihyperglycaemic therapies (glicazide,glipizide,glimepiride); insulin treatment (intermediate and biphasic); lipid lowering medication (simvastatin); high-blood pressure medication (angiotensin-converting-enzyme inhibitor ±tiazides and angiotensin-II-receptor-antagonists losartan ±tiazides); and antidepressants (selective serotonin reuptake inhibitors). Endocrinology, cardiology and mental health medical departments were responsible for the low scores in those items. Consequently, a programme was designed and implemented to ensure the achievement of the PQI objectives: medical departments will have to comply with only 3/14 items from the PQI, and those who represent ≥80% overall DDD consumption in their department. Scores are now regularly reviewed in order to identify possible deviations and take the actions necessary to correct them. First results are reported as positive (August 2017, 2.88), particularly in the cardiology department.ConclusionAnalysis of PQI results is essential to adapt the specific improvement objectives to the medical units, in order to grant a sustainable high-quality public health system.No conflict of interest

There is an urgent need to strengthen continuous training and to set up better coordination of care between community and hospital health professionals.