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Aims: The management of patients treated with direct oral anticoagulants (DOACs) during hospitalization is a common challenge in clinical practice. Although bridging is generally not recommended, too often DOACs are switched to parenteral therapy with low molecular weight heparins. Our objectives were to update a local guideline for perioperative DOAC management and to develop a guideline for the anticoagulation management in non‐surgical patients regarding temporary DOAC discontinuation. Methods: We executed a two‐step modified Delphi study in a 1000‐bed university hospital in Belgium. The Delphi questionnaires were developed based on a literature review and a telephone survey of prescribers. Two expert panels were established: one dedicated to perioperative DOAC management and the other to DOAC management in non‐surgical patients. Both panels completed two rounds, commencing with an individual and online round, followed by a face‐to‐face group session. Results: After the two‐round Delphi process, the updated perioperative guideline on DOAC management included reasons for delaying the resumption of DOACs following surgery, such as oral intake not possible, the probability of re‐intervention within 3 days, and insufficient haemostasis (e.g. active clinically significant haematoma, haemorrhagic drains or wounds). Furthermore, a guideline for non‐surgical hospitalized patients was developed, outlining possible reasons for interrupting DOAC therapy. Both guidelines offer clear anticoagulation therapy strategies corresponding to the identified scenarios. Conclusions: We have updated and developed guidelines for DOAC management in surgical and non‐surgical patients during hospitalization, which aim to support prescribers and to enhance targeted prescription review by hospital pharmacists. [ABSTRACT FROM AUTHOR]

Aim: Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly preferred over vitamin K antagonists (VKAs) in atrial fibrillation (AF) management. However, differences in oral anticoagulant (OAC) prescribing according to patient's age, sex and physician's specialty may be present. Therefore, incident and prevalent use of OACs, NOACs and VKAs, stratified by age, sex and prescriber, and factors associated with the choice of OAC were investigated. Methods: Using two Belgian nationwide healthcare databases, AF patients ≥45 years old with ≥1 OAC prescription claim between 2013 and 2019 were identified. OAC use was investigated per half-year. Factors influencing NOAC vs. VKA initiation were identified by multivariable logistic regression. Results: Among 448 661 included OAC-treated AF patients, 297 818 were newly treated. Incident OAC use ranged from 45–49 to 42–44 users/10 000 persons between 2013 and 2019, whereas prevalent OAC use increased from 337 to 435 users/10 000 persons. Incident and prevalent NOAC use exceeded VKA use since 2013 and 2015, respectively, and NOACs represented 92% of incident and 81% of prevalent OAC users in 2019. Apixaban was the most frequently used NOAC since 2016. NOACs were significantly more prescribed by cardiologists and to older patients, whereas VKAs were more initiated in patients with cardiovascular, renal and hepatic comorbidities. Prevalent OAC use increased less in women than men (25.3% vs. 33.0% between 2013 and 2019) and female subjects had 5% significantly lower odds of NOAC vs. VKA initiation than men. Conclusion: Since 2013, prevalent anticoagulant use increased almost one third in Belgium, while incident use was stable. Potential (N)OAC underuse in women requires further exploration. [ABSTRACT FROM AUTHOR]

Concomitant use of nonsteroidal anti‐inflammatory drugs (NSAIDs) and antithrombotic agents is associated with increased risks of both bleeding and thromboembolism. In this prospective intervention study, community pharmacists screened for NSAID‐antithrombotic interactions and contacted the prescribing physician to discuss interaction management. We included 782 interactions; these were found in an older, polymedicated patient population (mean age: 68 y, median of 5 other drugs). Ibuprofen (in 43.0% of cases) and low‐dose aspirin (78.8%) were the most frequently involved NSAID and antithrombotic, respectively. Anticoagulants were involved in 16.1% of interaction cases. For 61% of cases, the interacting drugs were prescribed by the same physician. The pharmacist–physician discussion about how to manage the interaction mostly resulted in no change of pharmacotherapy (60.7%); the most frequent reason given by physicians was that the NSAID was for short‐term use only. In 39.3% of cases the discussion resulted in a pharmacotherapy change; replacing the NSAID by paracetamol was the most common change. [ABSTRACT FROM AUTHOR]

Aim: Direct oral anticoagulants (DOACs) are increasingly used compared to vitamin K antagonists (VKAs). Guidelines advocate a structured multidisciplinary approach in the management of patients treated with DOACs. The aim of this study was to assess the views and experiences of physicians and pharmacists regarding DOAC use in clinical practice. Methods: An online questionnaire was sent to both primary (general practitioners [GPs], community pharmacists) and secondary healthcare professionals (cardiologists, residents in internal medicine and hospital pharmacists) between March and July 2020. The questionnaire covered four topics: (i) current practice, (ii) prescribing behaviour (only for physicians), (iii) self‐perceived knowledge about DOACs and (iv) views and opinions about DOACs versus VKAs. Results: In total, 110 physicians and 111 pharmacists completed the survey. Healthcare professionals in secondary care had more experience with DOACs and felt more confident with higher self‐perceived knowledge about DOACs compared to their colleagues in primary care. Healthcare professionals' self‐perceived knowledge was more or less complementary, for example physicians felt less confident in managing drug–drug interactions (DDIs) where pharmacists reported being more confident in this topic. Physicians reported uncertainties on the potential impact of risk factors – such as older age, lower body weight and DDIs – on appropriate DOAC dosing. Conclusion: Complementarity in physicians' and pharmacists' self‐perceived knowledge levels of DOACs may facilitate and necessitate future multidisciplinary collaboration initiatives for the management and follow‐up of DOAC patients. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The Ghent Older People's Prescriptions community Pharmacy Screening (GheOP3S)‐tool was recently developed as an explicit screening tool to detect drug‐related problems (DRPs) and to help in performing medication reviews. In this study, we aimed (a) to describe the characteristics of the detected DRPs and the subsequent pharmacists' recommendations with their acceptance and implementation rate resulting from a pharmacist‐led medication review using the GheOP3S‐tool and (b) to assess the potential impact of the intervention. Method: Prospective observational study in community‐dwelling older patients (70 years or older, using five or more medications). Community pharmacists performed medication reviews resulting in the documentation of "GheOP3S‐related DRPs" and "other DRPs" with corresponding pharmacists' recommendations. Acceptance was recorded during face‐to‐face pharmacist‐general practitioner (GP) meetings. Implementation was assessed after a 3‐month follow‐up by consulting the electronic pharmacy record, the patient, and/or GP. The potential impact on the number of medications, the number of "GheOP3S‐related DRPs", the anticholinergic and sedative burden quantified by the Drug Burden Index (DBI), and medication costs was assessed by a pre‐post comparison of the patients' medication lists. Results: Twenty‐one pharmacists detected 470 DRPs with a median (IQR) of 6 (4‐8) per patient in 75 patients (about half "GheOP3S‐related DRPs" and half "other DRPs"). Most prevalent recommendations were stopping (22.9%) and substituting (18.9%) medication. Overall acceptance was 66.9%. At follow‐up, 42.9% of all recommendations were implemented. The number of GheOP3S‐criteria (P <.001) and the DBI scores (P =.033) significantly differed from baseline. This was not the case for the number of chronic medications and medication costs. Conclusions: This study demonstrates a relatively high acceptance of pharmacists' recommendations, although implementation could be improved. Pharmacist‐led medication reviews with multidisciplinary meetings using the GheOP3S‐tool can have a potential impact on the number of DRPs and the anticholinergic and sedative burden of patients. [ABSTRACT FROM AUTHOR]

Aims Few well-designed randomized controlled trials have been conducted regarding the impact of community pharmacist interventions on pharmacotherapeutic monitoring of patients with chronic obstructive pulmonary disease ( COPD). We assessed the effectiveness of a pharmaceutical care programme for patients with COPD. Methods The pharmaceutical care for patients with COPD ( PHARMACOP) trial is a single-blind 3 month randomized controlled trial, conducted in 170 community pharmacies in Belgium, enrolling patients prescribed daily COPD medication, aged ≥50 years and with a smoking history of ≥10 pack-years. A computer-generated randomization sequence allocated patients to an intervention group ( n = 371), receiving protocol-defined pharmacist care, or a control group ( n = 363), receiving usual pharmacist care (1:1 ratio, stratified by centre). Interventions focusing on inhalation technique and adherence to maintenance therapy were carried out at start of the trial and at 1 month follow-up. Primary outcomes were inhalation technique and medication adherence. Secondary outcomes were exacerbation rate, dyspnoea, COPD-specific and generic health status and smoking behaviour. Results From December 2010 to April 2011, 734 patients were enrolled. Forty-two patients (5.7%) were lost to follow-up. At the end of the trial, inhalation score [mean estimated difference (Δ),13.5%; 95% confidence interval ( CI), 10.8-16.1; P < 0.0001] and medication adherence (Δ, 8.51%; 95% CI, 4.63-12.4; P < 0.0001) were significantly higher in the intervention group compared with the control group. In the intervention group, a significantly lower hospitalization rate was observed (9 vs. 35; rate ratio, 0.28; 95% CI, 0.12-0.64; P = 0.003). No other significant between-group differences were observed. Conclusions Pragmatic pharmacist care programmes improve the pharmacotherapeutic regimen in patients with COPD and could reduce hospitalization rates. [ABSTRACT FROM AUTHOR]

Organizational aspects of the medication management process ( MMP) have been investigated in hospital and nursing home settings. However, the amount of literature on medication management in residential care facilities ( RCF) for individuals with ID is limited to two studies from the Netherlands, focusing only on drug administration errors. To assess the organization of the MMP in Belgian RCFs for people with ID, the authors undertook a cross-sectional observational study in 34 Belgian RCFs for people with ID. Structured interviews were performed using a questionnaire: the first part (for the RCF directors) addressed administrative and policy issues. The second (for unit employees) and third parts (for medical office employees) addressed practical aspects of the MMP. The fourth part (for physicians) focused on the physician's role in the MMP, on the therapeutic drug formulary, and on communication with staff and delivering pharmacist. Standard operating procedures concerning the MMP were not available in 32% of the RCFs. About one-quarter of the RCFs did not have a medication error reporting system, and most RCFs did not systematically (i.e., at least annually) review their MMP for failures. Only two participating RCFs were equipped with an electronic prescribing system. The role of the pharmacist was mainly limited to delivery of medication. Medication was mostly administered by nonmedically qualified staff (e.g., educators). Most frequently cited problems by the interviewees were problems in the medication preparation and administration stage. Most frequently cited possible improvement actions were education/sensitization of staff and improved communication among all stakeholders. The authors note that as this study revealed operational inadequacies, problem areas can be identified and targeted quality improvement actions can be undertaken. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • In tube-fed patients with severe neurodevelopmental problems, omeprazole for the treatment of gastro-oesophageal reflux disease often needs to be administered through the feeding tube. • In daily practice, various procedures are used to administer the commercially available, enteric-coated omeprazole formulations through a feeding tube. • No bioavailability data are available to support a rational choice between the available administration procedures. WHAT THIS STUDY ADDS • This study demonstrates a substantial interindividual variability in omeprazole pharmacokinetics after administration through the gastrostomy tube in patients with severe neurodevelopmental problems. • In most patients, plasma concentration-time profiles seem more favourable with a suspension formulation than with a MUPS® formulation. • Consequently, there is no apparent advantage in choosing a MUPS® formulation over the more easily administered suspension formulation. AIMS Omeprazole is often administered through a gastrostomy tube as either (i) a Multiple Unit Pellet System (MUPS®) tablet disintegrated in water (MUPS® formulation), or (ii) a suspension in 8.4% sodium bicarbonate (suspension formulation). This bioavailability study evaluates this practice in tube-fed patients with severe neurodevelopmental problems. METHODS Nonblinded, two-phase cross-over trial. RESULTS In seven of 10 patients, bioavailability was higher for the suspension formulation than for the MUPS® formulation. Median (90% confidence interval) area under the plasma concentration-time curve ratio (MUPS® over suspension) was 0.5 (0.06-2.37). CONCLUSIONS In this population, omeprazole MUPS® formulation has no apparent advantage over the more easily administered suspension formulation. [ABSTRACT FROM AUTHOR]

A response by Els Mehuys, Koen Boussery, and Koen Paemeleire to a letter to the editor about their article on cross-sectional descriptive observational study on self-medication of regular headache in the naturalistic setting of the community pharmacy.