Background Non-vitamin K antagonist oral anticoagulants (NOACs) are prescribed to patients with atrial fibrillation (AF) to reduce the risk of stroke. Prescribing the correct dose warrants careful consideration of the prevailing dose criteria that differ per NOAC. Electronic systems are useful to intercept prescriptions that are incorrect based on simple ‘primary’ criteria, for example dosing frequency and drug-drug interactions with concomitant medication. However, these systems do not take into account patient characteristics such as age, renal function or weight, which are crucial elements to determine the NOAC dose. Methods Our goal was to determine the appropriateness of all prescriptions, as compared with the product labelling approved by the European Medicines Agency, to address common pitfalls in prescribing NOACs. AF patients with a first NOAC prescription between January 2012 and December 2016 were identified from our electronic hospital information system (Martini Hospital, Groningen, the Netherlands). Results The study included 3,231 AF patients who had started on an NOAC; 10.7% received an inappropriate dose and the appropriateness of the prescription could not be determined in 14.1%. Underdosing and overdosing occurred in 5.4% and 4.5% of all prescriptions, respectively. A reduced-dose NOAC was a predictor for incorrect prescribing (odds ratio: 2.70, 95% confidence interval: 2.13–3.41). Patient factors were identified that predicted incorrect prescriptions for dabigatran and apixaban. Conclusion An incorrect prescription occurred more often in the reduced-dose NOAC group. Clinical parameters such as renal function are often unknown whilst these are essential to determine the right NOAC and dose. Electronic supplementary material The online version of this article (10.1007/s12471-019-1267-9) contains supplementary material, which is available to authorized users.

IntroductionDrug confusion is thought to be the most common type of dispensing error. Several strategies can be implemented to reduce the risk of medication errors. One of these are alerts in the pharmacy information system.ObjectiveTo evaluate the experiences of pharmacists and pharmacy technicians with alerts for drug name and strength confusion.MethodsIn May 2017, a cross-sectional survey of pharmacists and pharmacy technicians was performed in community pharmacies in the Netherlands using an online questionnaire.ResultsOf the 269 respondents, 86% (n = 230) had noticed the alert for drug name confusion, and 26% (n = 67) for drug strength confusion. Of those 230, 9% (n = 20) had experienced that the alert had prevented dispensing the wrong drug. For drug strength confusion, this proportion was 12% (n = 8). Respondents preferred to have an alert for drug name and strength confusion in the pharmacy information system. ‘Alert fatigue’ was an important issue, so alerts should only be introduced for frequent confusions or confusions with serious consequences.ConclusionPharmacists and pharmacy technicians were positive about having alerts for drug confusions in their pharmacy information system and experienced that alerts contributed to the prevention of dispensing errors. To prevent alert fatigue, it was considered important not to include all possible confusions as a new alert: the potential contribution to the prevention of drug confusion should be weighed against the risk of alert fatigue.

1.04-1.68), >12 to 18 (HR 1.17, 95% CI 1.10-1.83), and >18 (HR 1.21, 95% CI 1.26-2.03) month intervals had elevated risk for CVD (p for trend <0.001). In total strokes, the risk-increasing effect of CVD with longer lipid testing interval is stronger than MI or CHD and this positive association was preserved among subgroups according to drug adherence and outpatient department visits. CONCLUSIONS: Lipid testing intervals of more than 6 months may lead to increased risk of CVD among newly diagnosed dyslipidemia patients. Newly diagnosed dyslipidemia patients should be encouraged to check lipid profile at 6 months interval in order to reducing risk for CVD. OBJECTIVES:To assess the value of implementation of pharmaceutical care (PC) for cardiovascular diseases in low-middle-income countries (LMICs). METHODS: This is a health care use and policy study based on health care management, which has evaluated the value of implementation (VOI) of PC from a societal and Brazilian Public Health System (BPHS) perspective. During 2009, a PC program enlisted 104 patients covered by the BPHS. Direct medical and non-medical costs and social costs were considered. Markov modeling projected over 10-years systemic arterial hypertension complications (ischemic heart disease, stroke, peripheral arterial disease, heart failure, chronic kidney disease). The treatment effect was calculated by comparing PC and conventional care and discount rates of 5% and 3% were applied to costs/outcomes, respectively. In a cash flow model, the net present value based on the return on investment (ROI) over 10 years was calculated, which represented a quantitative measure of the pharmaceutical care (PC) acceptance effect, and was converted into a net health benefit (NHB). The systematizing of the epidemiological and NHB impact provided the calculation and sensitivity analysis of VOI according to the variation for 10,000 Monte Carlo's iterations of 38 inputs from the expected value of PC implementation. RESULTS: The ROI was USD $1,712,710 (95%CI 1,146,000-2,216,000), which represented a cost-benefit ratio of 30.03 (95%CI, 26.74e34.28). The social variables presented an important impact on NHB, they were able to change the ROI from USD $1,283,206 to USD $1,962,401. Lambda was estimated as the largest limit of willingness to pay for QALY, usually in LMICs; in Brazil it is three times the GDP, USD $28,000. Thus, the calculated NHB was 2.8 per patient (95%CI 2.67 -3.04) and NHB ROI¼5.41%. CONCLUSIONS: The impact of implementation was higher than implementation of net beneficial technology, which presents a great opportunity cost for PC.