To Assess the Success of Computerized Order Sets and Pharmacy Education Modules in Improving Antiretroviral Prescribing

Mehta, Dhara; Kohn, Bella; Blumenfeld, Michael; Horowitz, Harold W.

doi:10.1177/0897190017729599

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…Factors affecting a children's ART compliance include (i) the caregiver, (ii) the child himself, (iii) the prescribed medication or treatment, (iv) socio-economic status, and (v) the provision of services [51][52][53][54][55]. The degree to which patients are compliant with their treatment regimen is an essential determinant of clinical success [56,57].…”

Section: Adherence To Art In Childrenmentioning

confidence: 99%

Strategies towards Empowering Nurses on the Rational Use of Antiretrovirals in Children Initiated and Managed on Therapy in Rural Primary Healthcare Clinics of South Africa

Mabila¹,

Demana²,

Mothiba³

2023

Rural Health - Investment, Research and Implications

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HIV has affected the health and welfare of children and undermined the success of child survival in some countries. The introduction of antiretroviral therapy (ART) in managing HIV is one great public health success story. ART has commanded increased survival for people living with HIV (PLHIV). Barriers to achieving ART outcomes in children have been simplifying the prescribing process for non-paediatricians, such as medical doctors and nurses familiar with prescribing ART for adults but involved in treating children, particularly at the primary health care level. And the lack of appropriate antiretroviral formulations for children. The calculation of individualised doses for liquid oral ARVs for children at each clinic visit is considered complicated and time-consuming. ART failure among children seems to be an under-recognised issue, and adherence to treatment guidelines is reported to be a challenge among nurses caring for children and PLWHIV. Rational medicine use is essential to ensure the success of pharmacologic interventions. The attainment of ART goals depends on the effective use ARVs as recommended in guidelines. It is pivotal that nurses be empowered with strategies aimed at promoting the rational use of antiretrovirals.

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Section: Adherence To Art In Childrenmentioning

confidence: 99%

Strategies towards Empowering Nurses on the Rational Use of Antiretrovirals in Children Initiated and Managed on Therapy in Rural Primary Healthcare Clinics of South Africa

Mabila¹,

Demana²,

Mothiba³

2023

Rural Health - Investment, Research and Implications

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“…Antiretroviral-stewardship programmes are required to reduce the risk of medication-related errors and reduce treatment adverse effects in order to enhance patient safety (Koren et al 2020 ; Meintjes et al 2017 ). Furthermore, a focus on ARV stewardship can prevent virological resistance and optimise cost (Mehta et al 2018 ). Numerous factors can be considered when it comes to ARV stewardship, such as adherence promotion, assessment of appropriateness of the current ART regimen and dosage, elimination of serious side effects and clinical significant drug–drug interactions (DDIs) while assessing cost effectiveness of treatment (Hsu et al 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral stewardship in a Tertiary Academic Hospital: The need for a clinical pharmacist

Bronkhorst¹,

Hattingh²,

Poka³

2023

Health SA Gesondheid

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Background South Africa has the highest prevalence of people living with HIV globally. Although antiretroviral therapy provides solutions, evidence of antiretroviral resistance emerged, requiring the application of antiretroviral-stewardship programmes to curb medication-related problems. Aim Identify and describe antiretroviral-stewardship pharmacist interventions in an active antiretroviral-stewardship programme. Setting HIV-positive adults admitted to medical wards at a tertiary academic hospital in South Africa. Methods A descriptive quantitative study was performed, utilising an antiretroviral-stewardship assessment tool to determine antiretroviral-related recommendations in the treatment of HIV-positive adults. The study employed purposive sampling. Treatment charts were evaluated to identify antiretroviral-stewardship recommendations. The number of recommendations highlighted the need for a clinical pharmacist in an active antiretroviral-stewardship programme. Descriptive data analysis with Pearson correlations was employed to display the data. Results Medication-related problems were identified in 100% of study patients ( n = 41), with an average of 2.46 interventions per patient. One-hundred-and-one medication-related problems were identified by using the antiretroviral-stewardship assessment tool. The identified problems included a lack of viral load testing (41, 100%), lack of CD4 count monitoring (15; 36.6%) and lack of prophylactic treatment against opportunistic infections (10; 24.4%). Medication-related problems included the presence of clinically significant drug–drug interactions and serious side effects, CD4 count decline despite being on antiretroviral therapy, unnecessary treatment interruptions including risk for IRIS, inappropriate antiretroviral therapy regimen, non-adherence and absence of treating tuberculosis as co-morbidity. Conclusion Present study demonstrates the need of an active antiretroviral-stewardship programme’s benefits. The possible role of the clinical pharmacist as active participant and leader in this programme is highlighted. Contribution Highlight the role of clinical pharmacists in antiretroviral stewardship.

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“…One main impetus for order sets comes from the need to improve user adherence for computerbased physician order entry systems, by decreasing the time physicians need to type orders. Using order sets decreases the time spent on prescribing (Mehta et al, 2018). It is worth mentioning that a similar concept of treatment algorithm (TA) came into prevalence in the U.S. medical care system (DiGioia and Rubash, 1991;Green et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Effects of Pharmacist-Led Clinical Pathway/Order Sets on Cancer Patients: A Systematic Review

Tan

Chen

et al. 2021

Front. Pharmacol.

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Background: Pharmacist-led clinical pathways/order sets (PLCOs) were first applied for designated diseases and surgical operations, such as cancer. They were not used in pharmacotherapy until recently. After screening a large number of publications, we found that PLCOs were rarely accessible.Objective: To evaluate the effects and the changes of relevant medical outcomes of PLCOs.Methods: Articles from PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang database, and China Biology Medicine disc (CBM) were systematically retrieved. Clinical research comparing cancer patients’ clinical effects with or without clinical pathway/order sets was performed. Two reviewers performed quality assessment, and the data were abstracted independently. A narrative synthesis of the extracted data was performed due to heterogeneity.Results: Nine studies were identified, including six uncontrolled before–after studies and three case-series studies. The scopes of PLCOs of included research can be divided into two types, one focusing on chemotherapy agents and the other on the managements of chemotherapy-induced complications. The PLCOs shortened hospital length of stay, decreased initial antibiotic time intervals in patients with febrile neutropenia, reduced medication error incidence, and increased physicians’ adherence rate to clinical pathway/order sets. Moreover, three articles included economic effects showing positive savings on medication costs through PLCOs.Conclusion: PLCOs can have beneficial effects on medication effectiveness, safety, and economic outcomes. Nevertheless, clinical pathway/order sets need to be further optimized and expanded to other clinical areas.

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To Assess the Success of Computerized Order Sets and Pharmacy Education Modules in Improving Antiretroviral Prescribing

Abstract: Enhanced antiretroviral order sets and pharmacy education modules improved ART prescription by reducing the overall number of antiretroviral interventions required per quarter. This modality was effective in improving prescribing of ART and reducing the need for pharmacist interventions.

Cited by 5 publications

References 13 publications

Strategies towards Empowering Nurses on the Rational Use of Antiretrovirals in Children Initiated and Managed on Therapy in Rural Primary Healthcare Clinics of South Africa

Strategies towards Empowering Nurses on the Rational Use of Antiretrovirals in Children Initiated and Managed on Therapy in Rural Primary Healthcare Clinics of South Africa

Antiretroviral stewardship in a Tertiary Academic Hospital: The need for a clinical pharmacist

Effects of Pharmacist-Led Clinical Pathway/Order Sets on Cancer Patients: A Systematic Review

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