Background and objective: Discontinuity of care bears the risk of medication errors and poor clinical outcomes. Little is known about the continuity of care related to pharmacies. Therefore, we studied the prevalence and determinants of pharmacy shopping behaviour in the Netherlands.Methods: Beneficiaries from a Dutch pharmacy claims database who had visited two or more pharmacies in 2001 were indicated as ‘shoppers’ (n = 45 805). A random sample was taken from all the other beneficiaries who had received at least one prescription: ‘non-shoppers’ (n = 45 805). Shoppers were classified as light (all patients who visited more than one pharmacy at least once in 2001, except for patients defined as heavy or moderate shoppers), moderate (visited 3 or 4 pharmacies and had proportion of prescriptions elsewhere >10% and number of prescriptions elsewhere >10) or heavy (visited 5 or more pharmacies and had proportion of prescriptions elsewhere >10% and number of prescriptions elsewhere >10). Determinants of shopping behaviour were investigated as well as the association between any dispensing of Anatomical Therapeutic Chemical (ATC) classes of drugs and this behaviour.Results: 10·8% beneficiaries were identified as shoppers: 98·8%‘light shoppers’, 1·0%‘moderate shoppers’ and 0·2%‘heavy shoppers’. Female gender [odds ratio (OR)adj 1·2; 95% confidence interval (CI) 1·1–1·2], younger age (ORadj 1·7; 95%CI 1·7–1·8), the use of ≥3 drugs (ORadj 2·9; 95%CI 2·8–3·0) and visiting different kind of prescribers (ORadj 2·4; 95%CI 2·4–2·5) were associated with shopping behaviour. Shoppers more frequently received at least one prescription for systemic anti-infectives (51·7% vs. 30·8%; OR 2·4; 95%Cl 2·3–2·5) and for nervous system drugs (46·2% vs. 29·3%; OR 2.1; 95%Cl 2·0–2·1).Conclusions: Pharmacy shopping behaviour is limited in the Netherlands. However, it may put the patient at risk for unintentional problems, such as drug–drug interactions with anti-infectives. A small proportion of patients exhibit possibly intentional shopping behaviour with psychotropic drugs.
"We selected all patients who were dispensed ≥675 mg prednisone equivalents (≥67.5 defined daily dosages [DDDs] [7, 8]) without a concomitant bisphosphonate prescription within the 180 days before baseline and with at least one prescription for a glucocorticoid within the 90 days before baseline. In the Netherlands, the vast majority of the population obtains their medication from only one community pharmacy, enabling the collection of longitudinal medication histories . Medication records of patients were pseudonymised and were sent to the researchers. "
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine whether feedback by pharmacists to prescribers of patients eligible for glucocorticoid-induced osteoporosis prophylaxis would stimulate the prescribing of osteoporosis prophylaxis. The intervention did not significantly increase the prescribing of bisphosphonates in the total study population, but a significant increase was seen in men and in the elderly. However, the proportion of bisphosphonate-treated patients remained low.
The aim of this study was to determine whether feedback by pharmacists to prescribers of patients eligible for glucocorticoid-induced osteoporosis prophylaxis (GIOP) would stimulate the implementation of the Dutch GIOP guideline.
This randomised controlled trial included 695 patients who were dispensed ≥675 mg prednisone equivalents without a concomitant bisphosphonate prescription within 6 months before baseline. Pharmacists were asked to contact the physicians of GIOP-eligible patients in the intervention group to suggest osteoporosis prophylaxis. The primary endpoint was a bisphosphonate prescription. Secondary endpoints were a prescription of calcium supplements, vitamin D or any prophylactic osteoporosis drug (bisphosphonate, calcium supplements, vitamin D).
The group assigned to the intervention was slightly younger than the control group (68.7 ± 15.4 vs. 65.9 ± 16.9 years, p = 0.02) and used hydrocortisone more often (7.0 % vs. 3.1 %, p = 0.02). Within 6 months, the intervention did not significantly increase the prescribing of bisphosphonates (11.4 % after intervention vs. 8.0 % for controls; hazard ratio [HR] 1.47, 95 % confidence interval [CI] 0.91-2.39). However, subgroup analyses showed a significant increase for the primary endpoint in men (12.8 % vs. 5.1 %, HR 2.53, 95 % CI 1.11-5.74) and patients ≥70 years (13.4 % vs. 4.9 %, HR 2.88, 95 % CI 1.33-6.23). The prescribing of calcium and vitamin D was not significantly altered.
This study showed that active identification of patients eligible for GIOP by pharmacists did not significantly increase the prescribing of bisphosphonates in the total study population, but there was an increase in men and the elderly. However, the proportion of GIOP-treated patients remained low.
Osteoporosis International 11/2013; 25(1). DOI:10.1007/s00198-013-2562-8 · 4.17 Impact Factor
"The community pharmacy database includes all pharmacy dispensed healthcare products on the Dutch market prescribed by medical practitioners. Previous studies demonstrated that drug dispensing records in PHARMO RLS are virtually complete with regard to prescription drugs  . The overlapping PHARMO-ECR catchment area includes one million inhabitants. "
[Show abstract][Hide abstract] ABSTRACT: Results from preclinical and observational studies suggest that β-adrenoreceptor inhibition might influence disease progression of melanoma.
Patients ⩾18years with cutaneous melanoma (Breslow thickness >1mm) registered in the Eindhoven Cancer Registry between January 1, 1998 and December 31, 2010, who were also registered with PHARMO record linkage system (RLS), were eligible. Randomly selected patients using β-blockers from PHARMO record linkage system (RLS) matched on age and gender served as a control cohort. Adjusted time-dependent and time-fixed Cox proportional hazard models were employed to estimate the hazard ratio of all-cause mortality. Five-year relative survival rates for all-cause mortality were calculated to estimate disease specific survival.
203 of 709 eligible patients used β-blockers after melanoma diagnosis. The use of β-blockers was not associated with the risk of dying (adjusted hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.55-1.24). Neither duration of exposure nor β-blocker dosage showed significant influence on survival. Five-year relative survival for β-blocker users was lower than in non-users amongst melanoma patients (80.9% and 83.7%, respectively) but higher among the β-blocker control group compared to the general population (101.4%).
Our results do not show a statistically significant impact of β-blocker exposure on overall survival of melanoma patients, regardless of the timing, duration or dosage of β-blocker use.
European journal of cancer (Oxford, England: 1990) 08/2013; 49(18). DOI:10.1016/j.ejca.2013.07.141 · 5.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate, among new users of inhaled corticosteroids that did not persist treatment, knowledge of inhaled corticosteroids' actions and whether they were instructed on the use of their inhaler.
Fifteen community pharmacies in The Netherlands. Methods Patients were interviewed by telephone. Their general practitioners provided diagnostic information and automated dispensing records were retrieved.
Knowledge of patients about the actions of inhaled corticosteroids.
230 (80.1%) of 287 patients were willing to participate. The majority (79.1%) of 230 patients was not aware of the anti-inflammatory actions of inhaled corticosteroids. Most patients were instructed on the use of their inhaler, predominantly by their physician (53%) or pharmacy (35.2%).
Although most patients reported inhaler instruction by at least one health care provider, the majority was unaware of inhaled corticosteroids' actions. Physicians and pharmacists should reconsider the instructions they provide especially to patients who should continuously use inhaled corticosteroids.
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