This article's calculations demonstrate that OC itself is responsible for the analgesic effect. Although OM and noroxymorphone have much higher µ-receptor affinity than the parent drug, the metabolite concentrations at the site of action are very low. This suggests that there is a minimal analgesic effect from these metabolites.

Background:The aim of this pilot study was to evaluate patients’ self-reported attitudes towards medication-related factors known to impair adherence and to assess their prevalence in ambulatory care as an essential prerequisite to improve patient adherence.Methods:We conducted a face-to-face interview with 110 primary care patients maintained on at least one drug. For each drug, the patient was asked to specify medication-related factors of interest, ie, dosage form, dosage interval, required relationship with food intake, and the planned time of day for intake, and to rate the individual relevance of each prevalent parameter on a three-point Likert scale (discriminating between prefer, neutral, and dislike).Results:Tablets with a once-daily dosage frequency were the most preferred dosage form, with a high prevalence in the ambulatory setting. Drug intake in the morning and evening were most preferred, and drug intake at noon was least preferred, but also had a low prevalence in contrast with drug intake independent of meals that was most preferred. Interestingly, only one quarter (26.4%) of all the patients were able to indicate clear preferences or dislikes.Conclusion:When patients are asked to specify their preferences for relevant medication regimen characteristics, they clearly indicated regimens that have been associated with better adherence in earlier studies. Therefore, our results suggest that adaptation of drug regimens to individual preferences might be a promising strategy to improve adherence. Because the German health care system may differ from other systems in relevant aspects, our findings should be confirmed by evaluation of patient preferences in other health care systems. Once generalizability of the study results is shown, these findings could be a promising basis upon which to promote patient adherence right from the beginning of drug therapy.

Almost one-fifth of all regimen complexity characteristics relevant for patient adherence were avoidable by simple modifications of the medication scheme, stressing the need for targeted interventions.

AIMSThe aim of this work is to understand the process of drug administration and identify points in the workflow that resulted in interventions by clinical information systems in order to improve patient safety. METHODSTo identify a generic way to structure the drug administration process we performed peer-group discussions and supplemented these discussions with a literature search for studies reporting errors in drug administration and strategies for their prevention. RESULTSWe concluded that the drug administration process might consist of up to 11 sub-steps, which can be grouped into the four sub-processes of preparation, personalization, application and follow-up. Errors in drug handling and administration are diverse and frequent and in many cases not caused by the patient him/herself, but by family members or nurses. Accordingly, different prevention strategies have been set in place with relatively few approaches involving e-health technology. CONCLUSIONSA generic structuring of the administration process and particular error-prone sub-steps may facilitate the allocation of prevention strategies and help to identify research gaps. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Similar to prescription errors also drug administration errors contribute to a large fraction of preventable medication errors and adverse drug events.• Drug administration can be exceedingly complex with regard to dose form, route of administration, number of co-medications, and setting and accordingly, error rates may vary. WHAT THIS STUDY ADDS• The drug-specific drug administration process can be generically structured for distinct dosage forms to allow identification of particularly error prone steps and allocated prevention strategies.• Potential research gaps in error epidemiology and prevention are highlighted. from 2003-2006 [5]). More than 50% of adults administer drugs daily [6]. This fact, however, does not automatically make drug administration a safe and straightforward process and, indeed, drug administration errors are frequent and in the inpatient setting, roughly 30% of errors resulting in adverse drug events (ADE) happen during drug administration [7]. Comparably susceptible to errors is the prescription process [7]. Whereas for the prescribing process electronic prescription platforms with enhanced clinical decision support tools were implemented as promising error prevention strategy [8], similar and theory-driven approaches are only scarcely available for the administration process [9], even though introduction of electronic support in the drug administration process has shown to reduce error rates [10].Drug treatment is a rather complex and demanding task ( Figure 1) and depending on the setting and co-medication a great number of different errors may occur. The aim of this study was to structure the drug administration process (process 5 in Figure 1) in a way that allowed the allocation of current knowledge on frequent sources of errors as well as successful methods to prevent such errors with a particular emphas...

AIMSWe aimed to develop a generic knowledge base with drug administration recommendations which allows the generation of a dynamic and comprehensive medication plan and to evaluate its comprehensibility and potential benefit in a qualitative pilot study with patients and physicians. METHODSBased on a literature search and previously published medication plans, a prototype was developed and iteratively refined through qualitative evaluation (interviews with patients and focus group discussions with physicians). To develop the recommendations for safe administration of specific drugs we screened the summary of product characteristics (SmPC) of different exemplary brands, allocated the generated advice to groups with brands potentially requiring the same advice, and reviewed these allocations regarding applicability and appropriateness of the recommendations. RESULTSFor the recommendations, 411 SmPCs of 140 different active ingredients including all available galenic formulations, routes of administrations except infusions, and administration devices were screened. Finally, 515 distinct administration recommendations were included in the database. In 926 different generic groups, 29 879 allocations of brands to general advice, food advice, indications, step-by-step instructions, or combinations thereof were made. Thereby, 27 216 of the preselected allocations (91.1%) were confirmed as appropriate. In total, one third of the German drug market was labelled with information. CONCLUSIONSGeneric grouping of brands according to their active ingredient and other drug characteristics and allocation of standardized administration recommendations is feasible for a large drug market and can be integrated in a medication plan. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Patients require information on how to administer drugs to prevent administration errors effectively, especially after hospital discharge.• Standardization and categorization of written instructions improves knowledge, recall and satisfaction of patients.