Skip to content

Design, implementation and impact on patient safety of a mobile application for patients on antiretroviral therapy

Pdf

PDF Icon

European Statement

Patient Safety and Quality Assurance

Author(s)

Esther Chamorro de Vega, Carmen Rodriguez Gonzalez, Belen Mayo Canaleja, María Pilar Montero Anton, Sergio Herrera Bermejo, Rosa Romero Jimenez, Vicente Escudero Vilaplana, Roberto Collado Borrell, Ana Herranz Alonso, María Sanjurjo Sáez

Why was it done?

The profile of patients receiving antiretroviral therapy (ART) has changed. Patients are more active, autonomous and have greater information and communication needs.
Mobile health, especially apps, can help to healthcare professionals to optimize pharmacotherapeutic follow-up and provide patients greater autonomy facilitating communication with healthcare professionals and contributing to the humanization of their care.
Through this application we seek to achieve the following objectives:
– Allow patients to participate in their illness and/or treatment, promoting their compliance and safety and communication with the healthcare professional.
– Strengthen pharmacotherapeutic monitoring of patients receiving ART, avoiding visits to the emergency room and hospital consultations.
– Generate pioneering evidence on the impact of mobile applications on the pharmacotherapeutic monitoring of patients on ART.

What was done?

FarMCuida® is a mobile application designed for a closer and better pharmacotherapeutic monitorization of patients on antiretroviral therapy (ART). Through this app the patient can actively participate in his or her disease and treatment.

How was it done?

A multidisciplinary group was created to design and develop an app called FarMCuida® for patients on ART in a tertiary hospital. Once the app was designed and developed, we offered the app to patients starting or undergoing ART. Identification and inclusion of candidate patients was performed in the Pharmaceutical Care Consultation of the Pharmacy Service. The pharmacists responsible for the Infectious Diseases area performed real-time pharmacotherapeutic follow-up of the patients.
Records of adverse effect (AE) and Safety-related messages received (Adverse effects, interactions, drug administration) can be analyzed. All data can be exported from FarmCuida®. Informed consent is requested from all the patients included.

What has been achieved?

FarMCuida® was designed as a digital health mobile application that allows our patients to participate in their disease and/or treatment, promoting treatment safety, as well as making available a source of information and bidirectional communication, in real-time, between patients and healthcare professionals.
During a period of 13 months, a total of 152 patients were included in FarMCuida®. Seventy-two percent of the patients were diagnosed with HIV infection while 27.6% of them were included in the HIV pre-exposure prophylaxis programme.
In AE module, 58 adverse events (AEs) were registered. Twenty-two percent of the patients registered at least one AE.
Thirty-two percent of patients used the Messages module to communicate with healthcare professionals.
One hundred and twenty-six telematic consultations were carried out. Two hundred and five messages were exchanged between the patient and the pharmacist.
Forty-three percent of the consultations corresponded to doubts about interactions: 66.7% interactions with other drugs, 28.5% with herbal products and 4.8% with vitamin supplements. Three type D interactions and one type X interaction were identified.
In addition, 11% of the consultations corresponded to doubts about the administration of ART while 5.2% were related to adverse effects experienced by the patient.
At least three visits to the emergency department were avoided, resulting in health care and economic savings for the health system.

What next?

Based on the limited studies on the impact of mobile applications on the pharmacotherapeutic follow-up of patients, the results obtained will allow us to generate evidence in this regard. It is worth highlighting the flexibility of FarMCuida® design, being easily adaptable to different pathologies and hospital centres.

Improving difficult-to-manage medication usage: a pharmacist led education programme for hepatitis delta virus (HDV) patients

Pdf

PDF Icon

European Statement

Clinical Pharmacy Services

Author(s)

Sabrina Trivellato, Daniele Mengato, Francesca Venturini

Why was it done?

Bulevirtide, available in Italy since June 2023, is the sole approved drug for treating long-term HDV. It represents a precious clinical opportunity but its technical features make it a complex therapeutic regimen to handle. It is commercially available as a powder for injection that needs daily reconstitution before subcutaneous use, has strict storage requirements (+2/+8°C), and requires familiarity with needles and syringes. As home therapy, this is the responsibility of the patient, who will therefore need to be enrolled in a PEP to ensure compliance.

What was done?

A Patient Education Programme (PEP) was implemented to support patients diagnosed with hepatitis delta virus (HDV) being compliant to a complex therapeutic chronic regimen.

How was it done?

In July 2023, a specific pharmacist-led PEP (named “EXPLAIN”) was defined. It consists of two phases: education & training; follow-up & assistance. After clinical examination, patients were received by pharmacists and introduced to the therapy thanks to a simulation kit. Posology, storage conditions and special warnings were described and the drug together with the administration kit was delivered. During the follow-up phase the pharmacist was focused on proofing medication adherence, discussing with the patient about any problems or ADRs and drug refilling. Quality of Life (QoL, measured through EuroQoL5) was adopted as an effectiveness outcome. Evaluation feedback on the service was requested as well.

What has been achieved?

Up to September 2023, 15 patients, with a mean QoL starting score of 72,5/100±15, are assisted by the EXPLAIN program. 12 of them already accessed the follow-up phase. A single episode of medium gravity ADR was reported, but it did not affect therapy continuation. Globally, an excellent reported medication adherence (98.5% of doses taken) was registered and the educational support of the pharmacist was considered to be “essential on positively approaching the medication”.

What next?

QoL, adherence and feedback on the received service have to be proofed after 6, 9 and 12 months as well, together with a regular viral load detection to confirm referred compliance. Although the EXPLAIN program has just started, it represents a promising PEP model to be adopted in the case of complex therapies, where continuity is crucial to ensure effectiveness and safety.

Empowering home hospitalisation with comprehensive pharmaceutical care: a model programme for medication management and patient monitoring

Pdf

PDF Icon

European Statement

Clinical Pharmacy Services

Author(s)

Beatriz Somoza-Fernández, Vicente Escudero-Vilaplana, Cristina Ortega-Navarro, Ana de Lorenzo-Pinto, Ana Herranz-Alonso, María Sanjurjo-Sáez

Why was it done?

HH units have experienced an extraordinary period of growth over the past few years and are already considered the preferred option of care model for most patients. However, its full potential is actually limited by some challenges both demanding and ripe with opportunities for pharmacy engagement, such as patient clinical complexity (usually elderly and chronic patients at greater risk of poor adherence and suffering from medication errors) and lack of medical staff physically available for monitoring patients’ evolution.

What was done?

We developed and implemented a comprehensive pharmaceutical care programme in a home hospitalisation (HH) unit.

How was it done?

The project was conceived by a multidisciplinary team (physicians, pharmacists, and nurses) that conducted a literature review and developed a new home medication management standardised operating procedure. The team worked in the design of a HH pharmaceutical care guideline and the implementation of an e-health care tool for remote patient monitoring.

What has been achieved?

1. HH pharmaceutical care guideline: it included the directions for the following measures: (1) a comprehensive pharmaceutical assessment and medication reconciliation, (2) standardised recommendations for optimising acute and chronic treatments at home, (3) daily interviews with patients or caregivers to explain medication changes, and (4) follow-up calls 7 days after discharge in order to assess medication adherence.
2. HH monitoring app: this new tool ensures pharmacotherapeutic monitoring by setting medication schedules and intake notifications. The platform includes a patient recording for vital signs, side effects, medication intake, and health status (functional status and quality of life). The system enables online access for pharmacists and physicians in real-time and continuous two-way communication.

What next?

Since our programme is easily applicable to any HH unit, we are working on implementing it in other hospitals in our country, in order to overcome HH medication management complexity nationally. We aim to conduct a multicentre study to evaluate its external validity in terms of increasing medication errors detected and optimising hospital resources.

Development of My Medication Plan involving Patient Representatives as Co-designers

Pdf

PDF Icon

European Statement

Clinical Pharmacy Services

Why was it done?

Despite numerous attempts to improve medication information, patients express a need for more information about their drug treatment after discharge from hospital. A consequence of missing information could be unintentional non-adherence or adverse drug events. In Denmark, the electronic Shared Medication Record (SMR) lists the patients’ current drug treatment, but further relevant patient requested information is needed to support patients.

What was done?

A booklet called My Medication Plan was developed as a tool to assist patients in managing their medication treatment. The Design Thinking Framework was applied as a model for involving patient representatives in the development as co-designers.

How was it done?

Three patient representatives from Hospital Sønderjylland participated during two group sessions with the purpose of generating ideas and designs for the My Medication Plan. Brainstorming was applied as an idea generating technique, since it is easy to use and effective in generating ideas in a short time. The ideas from the first session were used as inspiration for six prototypes of the booklet, which were presented and discussed at the second session. The final edition of the My Medication Plan was prepared based on this input.

What has been achieved?

The patient representatives stressed a need for specific instructions about the drugs’ application, boxes to note over-the-counter medication, dietary supplements and herbal remedies, as well as appointments with healthcare professionals to be a part of My Medication Plan. Additionally, free-text space for notes and questions about medication was requested. A non-electronic tool was specifically preferred because patients would have something to look at and write in meanwhile discussion medication changes and appointments. Furthermore, it could also provide relatives the opportunity to seek information about agreements made. According to the patient representatives, the final tool should include a print of the SMR and predefined pages including a glossary of medical terms. The developed tool, My Medication Plan, contains the requested information in an interchangeable design with a print of the SMR and the predefined papers added into plastic sleeves.

What next?

After developing the My Medication Plan, the next step is to use and test the effect of using the tool in relation to a sector transition intervention conducted as a randomised controlled trial.

Pharmaceutical care for human immunodeficiency virus pre-exposure prophylaxis users

Pdf

PDF Icon

European Statement

Clinical Pharmacy Services

Author(s)

NURIA FERNANDEZ PIÑEIRO, CRISTINA GONZALEZ PEREZ, LIDIA YBAÑEZ GARCIA, NATALIA SANCHEZ-OCAÑA MARTÍN, JOSE MANUEL MARTINEZ SESMERO

Why was it done?

In our area all care for PrEP users was centralised in a specialised centre. Here, a multidisciplinary team made up of doctors, nurses and pharmacists integrated in a patient-centred care model. PrEP users are a potentially vulnerable population. Health education and motivation are provided in the PhC consultations to raise awareness about the use of medication and adherence to treatment, which are key to avoiding HIV infection. The use of sex-related drugs is a growing health problem in this population and has been associated with increased HIV transmission risk.

What was done?

Development and implementation of a monographic pharmaceutical care (PhC) consultation for human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) users.

How was it done?

On 20 January 2020, the PhC consultation was launched in a monographic STI care centre linked to a tertiary hospital.
– On the same day as the first medical appointment, the user attends a PhC appointment. In this unit the user receives the necessary information to properly take the medication. Possible interactions are reviewed, not only with medications, but also with natural medicine, sports supplements and drugs. All doubts are resolved and the medication is dispensed.
– Every 3 months medical follow-up is carried out and, in the PhC consultation, where not only possible adverse effects are reviewed, but also adherence and related problems are specially monitored. To increase the quality of care, active communication between all health personnel was ensured.

What has been achieved?

Until 30 September 2022, 3,460 initial visits and 13,349 follow-up visits have been made (411 of them through telepharmacy during the lockdown as a result of the global pandemic by SARS-CoV-2). From the users, 98.98% were men who have sex with men (MSM), 0.80% transgender women, 0.04% transgender men and 0.18% were women. 70.3% used sex-related drugs (Chemsex), with the most used substances being Popper (37.1%), mephedrone (28.2%) and gamma hydroxybutyrate (GHB) (24.6%).

What next?

In our experience, the role of hospital pharmacists as a reference health personnel for HIV-PrEP users has become clear, not only as an expert in medication. Given the prevalence of drug use in this population makes the health education that we hospital pharmacists can provide especially important.

Drone delivery of prescription medicines: contact-free, direct-to-consumer shipment reduces risk of Covid-19 infection for vulnerable populations

European Statement

Patient Safety and Quality Assurance

Author(s)

Jon Michaeli, Bryan Li

Why was it done?

The novel delivery method provides an on-demand option for senior citizens at higher risk of serious Covid-19 infections to receive health essentials while maintaining social distancing. The program launched before Covid-19 vaccines were publicly available, and was sustained during a period of especially intense Covid-19 spread in the US from Nov 2020 – Jan 2021.

What was done?

In early May 2020, Matternet, CVS, and UPS launched direct-to-consumer drone delivery of prescription medicines and other health goods to The Villages, the United States’s largest retirement community with more than 135,000 residents. The operations have expanded in scope since and are ongoing

How was it done?

The drone flights were conducted by Matternet’s M2V9 UAV platform and drew upon the companies’ experience operating other US healthcare drone networks. Deliveries are dispatched from CVS store 8381 and flown to New Covenant United Methodist Church, with final delivery to front porches via golf cart. This is an important milestone on the journey to drone delivery to individual homes at scale.

What has been achieved?

Matternet and UPS have completed 2,500+ deliveries to date. The partnership has expanded operations to Elan Buena Vista, another retirement community nearby. The program’s success helped pave the way for other healthcare drone programs, including a new route at Wake Forest Baptist where Matternet and UPS are transporting Pfizer-BioNTech Covid-19 vaccines (first ever in the US).

What next?

Full automation achieved via Matternet’s proprietary drone port, the “Station,” will permit pharmaceutical drone delivery at scale and accelerate the roll-out of city-wide networks that give pharmacists more flexibility around where and how patients receive medicines. These networks will support and accelerate the shift to tele-health and “hospital at home” as well as just-in-time inventory management, with significant potential to reduce medical waste through stock centralization. First commercial deployment of the Station occurred in Lugano, Switzerland in September 2021. The same month, Matternet announced a partnership with the Abu Dhabi Department of Health and the UAE’s General Civil Aviation Authority to launch a city-wide medical network serving 40+ locations by 2023. Similar systems are planned for Europe, in cities such as Zurich, Berlin and Athens.

PANDEMIC CRISIS COVID 19: THE DRUGS HOME DELIVERY AS A TOOL FOR ADHERENCE AND COMPLIANCE

European Statement

Clinical Pharmacy Services

Author(s)

BARBARA RE, MARTA DEL VECCHIO, CLAUDIA LAURIA PANTANO, ELIROSA MINNITI , VITO LADISA

Why was it done?

The covid-19 pandemic and the lockdown made it difficult and very often not possible to access hospital pharmacies for dispensing of drugs for cancer treatment

What was done?

Drugs homedelivery has been implemented for fragile patients and at risk both oncological and hemato-oncological, all over the italian territory

How was it done?

Through the telemedicine program, in agreement with the oncologist, patients unable to reach the pathology doctor’s office are contacted and the project explained to them. If the patient accepts the delivery at home, paths with specialized couriers have been activated, in compliance with the GDPR, which ensure the delivery of medicines within 48 hours. Upon delivery The Pharmacist contacts the patient to ensure that they have been received the medicines and reinforces how you take the drug and the potential side effects that need to be reported to doctor and / or pharmacist

What has been achieved?

In the period from March to September 2020, 501 deliveries were made, of which 301 in the regional territory and 200 in the national territory. 423 patients were contacted, A Customer Satisfaction was activated to which 90% of patients with a high degree of acceptance of the service responded

What next?

The Homedelivery service has shown that integrating telemedicine, with the collaboration oncologist and pharmacist, allows, when possible, to avoid fragile patients having to go to the hospital every month to collect the drug needed for their treatment. Furthermore, the role of the pharmacist will be increasingly central in the home clinical management of this patient population to assure Adherence and Compliance even in at Home setting.

×

EAHP Forum

All the EAHP team is working on providing a Forum that can help connect all the members in Conversations and Groups to talk about important matters for the European Hospital Pharmacist.

The Forum will be accessible for all the EAHP members, you don’t have to create a new account to browse and participate.

Conversations and groups

The Conversations will be moderated by our team to provide documents and relevant topics for the community.

The Groups will connect all members that share a category. Members who work on the same assocation, on the same hospital, that have the same role, etc.

Stay tuned for the realase of the forum. Soon on EAHP.