The risk of osteoporosis (a calcium-related bone disease) as a side effect of corticosteroids such as prednisolone depends on the degree to which these are used. Although this side effect can be countered with medication for bone decalcification, Michiel Duyvendak’s research has shown that this only actually occurs in 54 percent of cases. According to Duyvendak, who will be awarded a PhD by the University of Groningen on 8 October 2010, the situation could be improved by pharmacists and hospital pharmacists in particular.
Bone fractures are very prevalent – emergency treatment is required about 80,000 times a year. Many of the fractures are the result of osteoporosis, often due to medication, in particular corticosteroids such as prednisolone. Michiel Duyvendak considers this unnecessary: in many cases drug treatment could easily be modified to decrease the risks to patients.
An inventory of the motives family doctors and specialists had for not prescribing bisphosphonates –which counter bone decalcification – to patients revealed that doctors sometimes pass on responsibility for side effects to colleagues. Pharmacists adopting an active role could improve this situation. Duyvendak: ‘There are already very clear guidelines as to which patients should receive supplementary medication and which should not. The pharmacist is the one who can really see whether or not patients have received such medication and how many pills they have received.’
Duyvendak developed software enabling the pharmacist to calculate a patient’s average daily dose. Duyvendak: ‘People often use drugs differently than prescribed. Pharmacy records allow you to reconstruct corticosteroid use fairly accurately. So pharmacists are also the first to notice when people renew a prescription sooner or later than expected. Doctors and specialists often tend not to notice such patterns.’
If a patient uses more than a certain average amount a day, the pharmacist can inform the family doctor or specialist. An intervention study where pharmacists informed family doctors about risk patients showed that thirty percent were later started on bisphophonates, while the prednisolone prescription of ten percent of patients was either decreased or ended.
Surgical patients also often encounter problems in having information on their drug use conveyed properly. In 46% of cases there is a difference between the information the family doctor or pharmacist has on a patient’s drug use and what someone being admitted for surgery is actually using. Duyvendak: ‘There have been cases where there were nine different lists of medication for one patient. The lists were often contradictory as well. In cases like that, no-one has a clue – not even the patient – exactly what is being taken.’
By analysing patients’ drug use before they are admitted, the number of drug-related problems can be reduced from 3.6 to 1.5 per patient. ‘Patients visit the hospital for a preliminary interview before an operation. That’s when you could plan a meeting with a pharmacist’s assistant or perhaps even with a pharmacist.’ This would give the pharmacist a coordinating role in prescription, instead of the many specialists a patient sees before, during and after the operation.
‘Of course this means more work for the pharmacist,’ Duyvendak acknowledges. ‘However, a larger coordinating role for the pharmacist would bring down hospital costs. So this would make care safer, more efficient, and cheaper.’
Michiel Duyvendak (Oldenzaal, 1976) studied Pharmacy at the University of Groningen, supervised by Prof. J.R.B.J. Brouwers. His thesis is entitled Farmaceutische zorg door de ziekenhuisapotheker bij patiënten met botontkalking en die een orthopedische operatie ondergaan (Pharmaceutical care provided by hospital pharmacists to patients with osteoporosis undergoing orthopaedic operations). Duyvendak works as a hospital pharmacist at Antonius Hospital Sneek & Emmeloord.
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