BackgroundThe proper methods of storage of medicines are of great importance for the maintenance of their stability and therefore their efficacy and safety. Some factors that may affect the drug are: moisture, light, heat, air, time, bacteria and fungal growth.PurposeThe aim of the study is to research household storage habits of oral drugs dispensed by the outpatient hospital pharmacy service.Material and methodsProspective, observational study. All attendees to the outpatient pharmacy service during a period of 1 month were invited to voluntarily participate in the study. An anonymous survey was conducted including 17 items regarding sociodemographic data, knowledge about package insert conservation information content, conservation of original packaging and leaflet, place of home storage, presence of children at home, review of expiry dates and place where expired medication is discarded. Analysis of the influence of socio-demographic factors on wrong storage practices was performed by Chi-square test.ResultsOne hundred and eighty-five patients were included. Mean age (±SD) was 56 (±14.7) years. 49.7% patients did not have any studies and 50.3% had secondary or university studies. Sixty-two per cent of patients remembered to have been informed by the pharmacist about storage conditions and 53.1% knew that this information was included in the leaflet. Regarding the place of storage, 36.5% used the bedroom followed by the kitchen (33.7%), living room (36.5%) and bathroom (5.5%). Most of the patients admitted to retaining the original container (70.6%) or leaflet (68.8%). Drugs were generally stored in a closed place (79.8%), nevertheless 47% of patients admitted that it was accessible (26.5% lived with children). Some patients stored medicines inappropriately under cool conditions (9.2%) or near to a heat source (6.5%). Thirty-five per cent kept medicines that were no longer needed and 22% did not check the expiration date. 24.5% of patients threw out their medicines in the rubbish. A relationship between level of education and this behaviour was observed. The wrong practice was more frequent among patients with a high level of studies (p<0.01).ConclusionA significant proportion of patients presented an information gap regarding drug storage conditions. Several wrong storage practices were identified. There is room for improvement regarding these issues and the pharmacist’s role in patient education could be important.No conflict of interest

BackgroundThe objective of preoperative antibiotic prophylaxis (PAP) is to reduce the incidence of postoperative wound infection. In our centre, the pharmacy service is actively involved in the PAP antibiotic aseptic compounding in the centralised intravenous admixture unit. The PAP is prepared according to the approved infectious disease commission protocol that is reviewed by the pharmacist and applied for each patient the day before elective surgery. A systematic review of documented allergies has also been implemented since April 2015.PurposeTo evaluate the proportion of detected patients who required PAP with no notified antibiotic allergies in the preoperative patient list, the drugs implicated and pharmaceutical interventions.Material and methodsDescriptive, observational and retrospective study. According to the allergy detection programme, a pharmacist reviewed if the allergies had been notified by the surgeon in order to select appropriate alternative, if needed. Also, pharmacists checked previous patient medical records in order to detect documented allergies that were not notified. When detected, the pharmacist proposed an alternative antibiotic regimen.Data regarding the programme results and pharmacist interventions between April 2015 and September 2015 were analysed.Results1929 (33.7%) patients received PAP from 5724 elective surgeries. 64 patients who received PAP (3.3%) were allergic to antibiotics, had not been notified and required pharmaceutical interventions. 82.8% of unnotified allergies were to β-lactams, 4.7% to aminoglycosides, 6.3% to β-lactams and aminoglycosides, and 6.2% to others, including clavulanic acid intolerance. 57 (89.1%) of antibiotic prophylaxis prescriptions were changed due to an unnotified allergy. More frequent proposed alternative regimens were: intravenous vancomycin as an alternative to intravenous cefazolin (40.6%), moxifloxacin ophthalmic solution to intracameral cefuroxime (15.6%) and the combination of intravenous gentamicin and intravenous clindamycin to intravenous amoxicillin-clavulanate (12.5%).ConclusionA significant proportion of unreported allergies in the preoperative patient list, especially to β-lactams, were detected. Pharmaceutical interventions prevented the error and possible collateral damage. Allergies notification is an improvement approach to guarantee patient safety.No conflict of interest.

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BackgroundSeveral firstline disease modifying therapies (DMTs) have shown significant benefit in preventing relapses and slowing disease progression among multiple sclerosis (MS) patients. Lower adherence may be associated with lower efficacy and thus with a higher risk of relapse. Adherence to DMTs was also associated with a lower likelihood of hospitalisation and relapse, and lower medical costs.PurposeThe objective of this study was to analyse adherence to parenteral firstline treatments in MS patients and related factors.Material and methodsThis was an observational, retrospective, longitudinal study. All MS adult patients starting firstline treatment with intramuscular(IM) interferon(IFN)-beta-1-a, subcutaneous(SC) IFN-beta 1-a, SC IFN-beta 1-b and glatiramer acetate from 1 September 2005 to 31 August 2015 were included. Data were collected from the pharmacy department electronic records. DMT adherence was measured using the medication possession ratio (MPR) calculated as the number of days of any DMT medication over the study period (MPR had a maximum value of 100%). Patients with MPR ≥90% were classified as adherent. Patient characteristics compared between adherent and non-adherent patients included demographics (age, gender), treatment and route of administration. Categorical variables were compared using the χ2 or Fisher’s exact tests; continuous variables were compared using the non-parametric Wilcoxon rank sum test. One way analysis of variance (ANOVA) was performed to explore treatment influence. A logistic regression model was used to estimate the risk adjusted rate of non-adherence. A p value ≤0.05 was considered to indicate a statistically significant difference.Results176 patients were included, 67.6% women and 32.4% men. Mean age (±SD) was 36.27±11 years. Treatment distribution: 36.4% SC IFN-beta 1-a, 10.2% SC IFN-beta 1-b, 39.2% IM IFN-beta-1-a, 14.2% glatiramer acetate. 84.1% of patients were adherent. Mean (±SD) adherence was 93.6%±16.5%. In univariate analysis no difference was observed regarding gender (OR 1.2, 95% CI 0.5–2.8; p=0.85) and route of administration (OR 0.7, 95% CI 0.3–1.6; p=0.533). Adherent patients were older (mean age difference=2.2 years, 95% CI 9.4–0.6; p=0.04). No difference was observed between treatments in ANOVA analysis (p=0.52). In multivariate analysis, age was the only associated variable (OR 1.05, 95% CI 1.01–1.10; p=0.02).ConclusionFirstline adherence was high among MS treated patients although nearly one sixth of patients were non-adherent. Younger patients were more likely to be non-adherent.No conflict of interest

BackgroundParenteral firstline treatments for multiple sclerosis (MS) include disease modifying therapies (DMTs): intramuscular (IM) interferon (IFN) beta-1-a, subcutaneous (SC) IFN-beta 1-a, SC IFN-beta 1-b glatiramer acetate. Long term persistence for chronic diseases is difficult for patients to achieve, and low persistence has been related to increased mortality and morbidity as well as higher costs in medical care.PurposeThe aim of this study was to analyse firstline parenteral treatment persistence in patients with MS according to the administration route.Material and methodsThis was an observational, retrospective, longitudinal study. All MS adult patients starting firstline treatment with IM IFN-beta-1-a, SC IFN-beta 1-a, SC IFN-beta 1-b and glatiramer acetate from 1 September 2005 to 31 August 2015 were included. Data were collected from the pharmacy department electronic record (Farmatools). Persistence was calculated as duration of time from initiation to discontinuation of therapy and as a dichotomous variable at the first and second year of therapy. Discontinuation was defined as a gap in treatment exposure of at least 90 days. For analysis of persistence, a survival analysis with Kaplan–Meier estimator was used. The log rank test was used to compare survival times between administration routes. The influence of covariables (age, gender, treatment, compliance) was tested according to a Cox regression model. Persistence at first and second year was compared using a χ2 test. Statistical analysis were performed using SPSS.Results176 patients were included, 67.6% women and 32.4% men. Mean age (±SD) was 36.27±11 years. Treatment distribution: 36.4% SC IFN-beta 1-a, 10.2% SC IFN-beta 1-b, 39.2% IM IFN-beta-1-a, 14.2% glatiramer acetate. Mean compliance was 93.6%±16.5%. Mean overall persistence was 2043 (95% CI 1827–2260; p=0.217). Mean persistence times were 2007 days (95% CI 1580–2927) for the IM route and 2302 days (95% CI 1799–2805) for the SC route(p=0.751). 81.2% versus 75.7% (p=0.506) of patients were persistent in the first year for the IM and SC routes, respectively, and 68.2% versus 31.8% for the second year. Cox model showed no influence of age, gender, treatment or compliance.ConclusionThere were no differences regarding persistence between IM or SC firstline therapies in MS patients.No conflict of interest