BackgroundOver the past decades, opioid prescriptions have increased in the Netherlands. The Dutch general practitioners’ guideline on pain was recently updated and now aims to reduce opioid... Show moreBackgroundOver the past decades, opioid prescriptions have increased in the Netherlands. The Dutch general practitioners’ guideline on pain was recently updated and now aims to reduce opioid prescriptions and high-risk opioid use for non-cancer pain. The guideline, however, lacks practical measures for implementation.ObjectiveThis study aims to determine practical components for a tool that should assist Dutch primary care prescribers and implements the recently updated guideline to reduce opioid prescriptions and high-risk use.MethodsA modified Delphi approach was used. The practical components for the tool were identified based on systematic reviews, qualitative studies, and Dutch primary care guidelines. Suggested components were divided into Part A, containing components designed to reduce opioid initiation and stimulate short-term use, and Part B, containing components designed to reduce opioid use among patients on long-term opioid treatment. During three rounds, a multidisciplinary panel of 21 experts assessed the content, usability, and feasibility of these components by adding, deleting, and adapting components until consensus was reached on the outlines of an opioid reduction tool.ResultsThe resulting Part A consisted of six components, namely education, opioid decision tree, risk assessment, agreements on dosage and duration of use, guidance and follow-up, and interdisciplinary collaboration. The resulting Part B consisted of five components, namely education, patient identification, risk assessment, motivation, and tapering.ConclusionsIn this pragmatic Delphi study, components for an opioid reduction tool for Dutch primary care-givers are identified. These components need further development, and the final tool should be tested in an implementation study. Show less
Levens, A.D.; Haan, M.C. den; Jukema, J.W.; Heringa, M.; Hout, W.B. van den; Moes, D.J.A.R.; Swen, J.J. 2023
Tailoring antiplatelet therapy based on CYP2C19 pharmacogenetic (PGx) testing can improve cardiovascular outcomes and potentially reduce healthcare costs in patients on a P2Y(12)-inhibitor regime... Show moreTailoring antiplatelet therapy based on CYP2C19 pharmacogenetic (PGx) testing can improve cardiovascular outcomes and potentially reduce healthcare costs in patients on a P2Y(12)-inhibitor regime with prasugrel or ticagrelor. However, ubiquitous adoption-particularly in an outpatient setting-remains limited. We conducted a proof-of-concept study to evaluate the feasibility of CYP2C19-guided de-escalation of prasugrel/ticagrelor to clopidogrel through point-of-care (POC) PGx testing in the community pharmacy. Multiple feasibility outcomes were assessed. Overall, 144 patients underwent CYP2C19 PGx testing in 27 community pharmacies. Successful test results were obtained in 142 patients (98.6%). De-escalation to clopidogrel occurred in 19 patients (20%) out of 95 (67%) eligible for therapy de-escalation, which was mainly due to PGx testing not being included in cardiology guidelines. Out of the 119 patients (84%) and 14 pharmacists (100%) surveyed, 109 patients (92%) found the community pharmacy a suitable location for PGx testing, and the majority of pharmacists (86%) thought it has added value. Net costs due to PGx testing were estimated at euro43 per patient, which could be reduced by earlier testing and could turn into savings if de-escalation would double to 40%. Although the observed de-escalation rate was low, POC CYP2C19-guided de-escalation to clopidogrel appears feasible in a community pharmacy setting. Show less
Kruijtbosch, M.; Koerkamp, E. Jansen-Groot; Thiel, G. van; Numans, M.; Heringa, M.; Bouvy, M. 2023
Patiënt, 49-jarige man, komt in de apotheek met een recept voor oxycodon retard 20 mg 2 dd 1. Het middel is door de orthopedisch chirurg voorgeschreven voor twee weken. De patiënt is een bekende in... Show morePatiënt, 49-jarige man, komt in de apotheek met een recept voor oxycodon retard 20 mg 2 dd 1. Het middel is door de orthopedisch chirurg voorgeschreven voor twee weken. De patiënt is een bekende in de apotheek; hij komt er wekelijks zijn medicatie ophalen. Hij gebruikt quetiapine 450 mg per dag vanwege een bipolaire stoornis. Daarnaast krijgt hij sinds 9 maanden fentanylpleisters, voorgeschreven door de huisarts vanwege artrose van de knie. Show less
Background Proton pump inhibitor (PPI) indications are limited to gastrointestinal disorders and ulcer prophylaxis. However, PPIs are among the most frequently prescribed drugs. Aim To evaluate the... Show moreBackground Proton pump inhibitor (PPI) indications are limited to gastrointestinal disorders and ulcer prophylaxis. However, PPIs are among the most frequently prescribed drugs. Aim To evaluate the appropriateness of PPI prescriptions and identify predictive factors for inappropriate PPI use. Design and setting Observational study using a Dutch primary care database with all new PPI prescriptions between 2016 and 2018. Method Individual patient data and details on PPI use were collected. The appropriateness of initiation and continuation of PPI prescriptions was evaluated using the applicable guidelines. Results In total, 148 926 patients (aged & GE;18 years) from 27 general practices were evaluated. A total of 23 601 (16%) patients started PPI therapy (mean age 57 [SD 17] years, 59% female). Valid PPI indications at initiation were seen in 10 466 PPI users (44%). Predictors for inappropriately initiated PPI use were older age (odds ratio [OR] 1.03, 95% confidence interval [CI] = 1.03 to 1.03), and use of non- selective non-steroidal anti-inflammatory drugs (OR 5.15, 95% CI = 4.70 to 5.65), adenosine diphosphate receptor inhibitors (OR 5.07, 95% CI = 3.46 to 7.41), COX-2 inhibitors (also known as coxibs) (OR 3.93, 95% CI = 2.92 to 5.28), and low-dose aspirin (OR 3.83, 95% CI = 3.07 to 4.77). Despite an initial valid indication, PPI use was inaccurately continued in 32% of patients on short-course therapy for dyspepsia and in 11% of patients on ulcer prophylaxis. Conclusion More than half of PPI users in primary care were found to have an inappropriate indication, with unnecessary ulcer prophylaxis related to drug use being one of the leading causes. Future initiatives to reduce PPI use for unnecessary ulcer prophylaxis and timely deprescription if PPI is no longer indicated, are needed. Show less
