Interventions pharmaceutiques émises par les pharmaciens sur les médicaments psychotropes - 02/10/15
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Résumé |
La SFPC et son groupe « standardisation et valorisation des activités de pharmacie clinique » étudient les interventions pharmaceutiques (IP) émises lors de l’analyse des prescriptions. Cette étude explore les problèmes médicamenteux et les IP relatifs aux médicaments psychotropes enregistrés sur le site Act-IP® entre septembre 2006 et février 2009. Quatre mille six cent vingt IP émises dans 57 établissements de santé concernent un médicament psychotrope. Sept problèmes médicamenteux engendrent plus de 69 % des interventions (par ordre de fréquence) : posologie supra-thérapeutique, interaction médicamenteuse, plan de prise non optimale, effet indésirable, non conformité au livret thérapeutique, redondance pharmacologique, mauvais choix de galénique. Les 2 types d’interventions les plus fréquents sont l’adaptation de posologie et les arrêts de traitement. Certaines problématiques ne sont pas identifiées ou ne trouvent pas un écho suffisamment favorable car le taux d’acceptation globale par les médecins est de 57 %. Ce retour d’information peut permettre aux médecins d’identifier des situations à risque. Pour évoluer, médecins et pharmaciens doivent se concerter et dialoguer. Ceci pourrait déboucher sur un thésaurus décrivant situations cliniques et IP basé sur les recommandations et la vision pratique des prescripteurs.
Le texte complet de cet article est disponible en PDF.Summary |
Introduction |
The French Society of Clinical Pharmacy (SFPC) through the special interest group “standardization and optimization of clinical pharmacy activities” stated that the study of pharmacists’ interventions (PIs) conducted during prescription analysis was a priority. The SFPC developed an internet website named Act-IP® (fr/) where French speaking pharmacists were able to document PIs using a normalized codification. The objective of this study was to analyze medication-related problems linked to psychotropic drugs in hospital and to investigate PIs performed during prescription analysis.
Materials and methods |
This is a multicenter, retrospective, observational study using PIs involving psychotropic medications recorded between September 2006 and February 2009 on the Act-IP® website.
Results |
Four thousand six hundred and twenty PIs recorded by 165 pharmacists in 57 hospitals were related to psychotropic drugs. Patients concerned by these drug-related problems were 64years old on average. Seven categories of medication-related problems represented more than 69% of PIs (1.1-Non Conformity of the drug choice compared to the formulary; 4.1 Supratherapeutic dose; 5.3 Therapeutic redundancy; 6.2 Drug interaction (all levels of severity); 7.0 Adverse drug reaction; 8.3 Inappropriate drug form; 8.5 Inappropriate timing of administration). The PIs related to 9.2 Patient's non compliance, 2.0 Untreated indication and 3.2 Length of the treatment too short were infrequent (less than 1%). The most common type of intervention was the dose adjustment. Almost 45% of these PIs involved Zopiclone or Zolpidem prescription in elderly patients. Seven hundred and nine drug interactions were identified by pharmacists. The most common type of drug interaction considered the risk of cardiac arrhythmias due to antipsychotic medications. One hundred and thirty-three PIs concerned adverse drug reaction. The most frequent adverse drug reactions were a fall (36 PIs), hemorrhage/bleeding (32 PIs), drowsiness (12 PIs) and extrapyramidal syndrome (12 PIs). Antidepressant drugs were the greatest pharmacological class concerning adverse drug reaction. The overall acceptance rate was 57%. Eight hundred and seventy-four PIs (19%) were refused and 1111 (24%) were non-assessable.
Discussion |
PIs avoids drug-related problems, such as the polyprescription of benzodiazepine or supratherapeutic dose. However, few PIs concern compliance to therapy or polyprescription of antipsychotic drugs. These two categories of medication-related problems are known to be an issue in mental health therapy. The lack of guidelines describing mental health pathology (such as the HAS guideline) is an obstacle for performing evidence-based PIs. The lack of information describing the context of the prescription is a limitation of this study. In order to improve their practice, pharmacists have to focus more on the context in which patients are evolving, and to take into account its entire situation based on Anglo-Saxon approaches. A second way is to identify clinical settings where PIs are useful and to describe PIs needed. Doctors and pharmacists should get together and talk about these clinical situations and PIs, because some may be misunderstood or disapproved by prescribers. This collaboration could take the form of a thesaurus combining clinical situation and PIs.
Conclusion |
It appears important for pharmacists to show their daily involvement in the quality of medical care. This feedback on medication problems encountered and PIs proposed should help prescribers to identify clinical situations at risk. Nevertheless, this study also suggests that progress is possible. Dialogue must allow pharmacists and physicians to delete misunderstandings about their practices.
Le texte complet de cet article est disponible en PDF.Mots clés : Intervention pharmaceutique, Psychotropes, Problèmes médicamenteux, Pharmacie clinique, Iatrogénie
Keywords : Pharmacists’ intervention, Psychotropic drug, Drug-related problems, Clinical pharmacy
Plan
Vol 41 - N° 4
P. 339-345 - septembre 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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