Browsing by discipline "Social Pharmacy"
Now showing items 61-66 of 66
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(2014)Long-term use of benzodiazepines is not recommended in the aged. Elimination of these drugs is delayed in the aged, which can prolong drug action and expose users to adverse effects. Long-term benzodiazepine use is associated with many adverse effects, including cognitive impairment and falls. However, there are only few published studies dealing with associations between benzodiazepine concentration and clinical outcomes in the aged in long-term use. The aim of this study was to explore association of residual concentration of temazepam, oxazepam and zopiclone with age, gender, kidney function, drug dose and clinical outcomes, such as self-perceived health and functional abilities in aged patients. The data were collected in Pori City Hospital in July 2004. The patients were between 60-98 years of age (median 81) and the majority (79%) of them were women. Residual drug concentrations were analysed from serum from patients using temazepam (n=14), oxazepam (n=11) or zopiclone (n=28) regularly. Residual oxazepam concentration correlated positively with evening dose (p<0.001) and daily dose (p=0.003). Also oxazepam concentration was higher (p=0.017) in patients who took the last dose later (21:00-02:45) compared to patients with earlier dosing time (15:35-19:00). There was no such association between temazepam or zopiclone and dose or dosing time. This might be explained by the fact that there was more dispersion in the dose and dosing time of oxazepam compared to temazepam and zopiclone. There were no other associations between drug concentrations and demographic variables studied. Concerning associations with clinical outcomes, zopiclone concentration tended to be higher in patients who often felt themselves tired during daytime (p=0.087). Surprisingly, residual serum concentration of oxazepam seemed to be higher in patients who were able to walk and manage their shopping independently. Apart from these findings, residual concentration of temazepam, oxazepam and zopiclone associated poorly with clinical outcomes. These findings do not support routine monitoring of residual benzodiazepine concentrations in aged patients.
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(2016)Atypical antipsychotics (AAPs) can be used to treat severe behavioural symptoms of dementia when certain conditions are fulfilled. They are not considered as primary treatment for these symptoms due to their possible serious side effects that are found to be more common in elderly dementia patients. Package leaflets (PLs) are one of the most important sources of medicine information for elderly patients. Evidence-based medicines information is the prerequisite for decision-making and success of pharmacotherapy. The aim of this study was to evaluate the usability and informational content of atypical antipsychotic PLs from the perspective of the elderly. Additionally, the content of medicines information for the elderly found in PLs was compared to similar medicines information targeted to health care professionals (HCPs). Medication Information Design Assessment Scale (MIDAS) was used to evaluate the usability of the most commonly used AAPs (olanzapine, quetiapine and risperidone) among the elderly in Finland. To evaluate the informational content of the PLs and summaries of product characteristics (SmPCs) all the references for the elderly were identified using certain keywords. The informational content concerning elderly from the PLs was compared to information targeted to HCPs in Beer's criteria, Current Care Guideline for memory disorders, Database of medication for the elderly, Martindale and SmPCs. The usability of the PLs in this study was found to be insufficient. The mean MIDAS-credit was 6,4 (n=61; range 5,0-8,0), the maximum credit being 13. Sufficient line spacing and limiting the length of line were among the poorly represented features in the PLs in this study. The occurrence of sufficient font-size varied. Good contrast, headings, usage of upper and lower case in text and bullet points were among the well-represented features. All the PLs included in the content-analysis (n=106) contained at least three references to the elderly. The way the information was presented and how well it stood out from the leaflet varied. The SmPCs contained useful information targeted to elderly that was not found in corresponding PLs. Actions need to be taken to improve the usability and content of product specific medicines information from the perspective of the elderly. Medicine authorities and the pharmaceutical industry have the authority to make these improvements possible. Scientific data and concrete tools are needed to facilitate the change.
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(2017)Hepatitis C virus disease is transmitted through blood. Chronic hepatitis C causes liver damages such as liver fibrosis, liver cirrhosis, and hepatocellular carcinoma. It is estimated that there are approximately 20 000 - 30 000 patients infected with hepatitis C virus in Finland. For many years pegylated interferon and ribavirin has been standard of care. However standard of care causes side effects and an adequate treatment response can't be achieved with it. There have been effective direct-acting antivirals available on market which are directed against structural proteins and enzymes of the virus from 2014 onward. These second generation direct-acting antivirals are effective, safe and well tolerated. The only disadvantage is the high price of these medicines which restricts them for severe liver damage patients. More information about cost-effectiveness of second generation direct-acting antivirals is needed to support the decision making. The aim of this master thesis is to describe current care, guidelines, and costs of hepatitis C in Finland. Thesis also describes the principles of economic evaluation and systematic literature review. The purpose of the thesis is to assess cost-effectiveness of second generation direct-acting antivirals versus standard of care in treating of hepatitis C by means of systematic literature review and evaluate the quality of cost-effectiveness analyses. Previously published studies were used to analyze the cost-effectiveness of second generation direct-acting antivirals. In total of 435 references were found through systematic literature search. In addition, two studies were found from the bibliographies of already included studies. Altogether 26 studies were included in the systematic review of which 25 were original studies and one was previously published systematic literature review. The most relevant data of the studies was gathered and analyzed. The quality of the studies was assessed by using three checklists. It is difficult to make conclusions about cost-effectiveness of second generation direct-acting antivirals based on previously published reviews because only one review was found through systematic literature search. The incremental cost-effectiveness ratio (ICER) of second generation direct-acting antivirals varied between dominance and 1 135 655 € /QALY compared to standard of care. When compared to another second generation direct-acting antiviral, ICER of second generation direct-acting antivirals varied between dominance and 65 281 € /QALY. It was also analyzed how stage of liver damage affects the incremental costeffectiveness of second generation direct-acting antivirals. The ICER of second generation direct-acting antivirals was between 299 € - 85 195 € /QALY when treating patients with cirrhosis. When treating non-cirrhotic patients, the ICER of second generation direct-acting antivirals was between 2182 € - 177 679 € /QALY.The connection between funder of the study and the ICER of second generation direct-acting antivirals was also analyzed. The ICER was 1717 € - 86 056 € /QALY in studies funded by pharmaceutical company. The ICER was 299 € - 1 135 655 € /QALY in studies funded by other party. Based on the results of the thesis second generation direct-acting antivirals might be cost-effective compared to current standard of care in treating hepatitis C. The cost-effectiveness ratio of second generation direct-acting antivirals is lower in cirrhotic patients than in non-cirrhotic patients. The incremental cost-effectiveness ratio is lower when pharmaceutical company funds a study. The quality of the cost-effectiveness analyses included in the thesis varied greatly which makes it difficult to draw conclusions and interpretate the results. This study has several strengths. First, literature search was conducted systematically and transparently. Second, quality of the reviewed studies included was assessed by care. Finally, reporting of the results is transparent and repeatable. The study has also some limitations. Selection of the reviewed studies, data extraction and quality assessment of the studies was conducted by one person which may increase the possibility of human error.
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(2012)Inflammatory bowel diseases are among the fastest growing chronic disease of young people in Europe and they are increasing in Western countries for unknown reasons. Illness often occurs at a young age and the symptoms persist generally throughout life, Crohn's disease and ulcerative colitis are the most common diseases in this category. Inflammatory bowel diseases often cause persistent symptoms and require treatment usually for life, affect the quality of life and the ability to go to work. Conventional treatment usually consists of anti-inflammatory and immunosuppressive drug therapy or surgical intervention. In difficult cases, the biologic drug treatment is used. New biological drug products (TNF-blockers) have improved, in particular in Crohn's disease, a response to treatment. The aim of this study is to provide information about the effectiveness and the costs of the biological treatment in inflammatory bowel diseases. The main results presented are the changes of the quality of life during the observation period measured with the generic and disease-specific HRQoL instruments. The results are also reported on the matter of costs for quality-adjusted life-years gained during the follow-up period. The study consists of FinnIBDQ (inflammatory Bowel Disease Questionnaire) survey (n=2831) and the follow-up survey of the patients who used biologic drug products (n=189). Patients were selected into the follow-up if they reported using the biologic drugs to treat the illness. FinnIBDQ-survey was conducted in 2006/2008 and follow-up questionnaire in 2011. As a generic HRQoL instrument was the 15D-instrument used which is a standardized measure of the health related quality of life. 15D-instrument produces a single index number between 0-1. IBDQ is a disease-specific HRQoL instrument, which consists of 32 questions. The total number of points varies between 32 and 224 from the worst to the best. Patients' medical history, symptoms, medication and health care use were studied in their own partition on the questionnaire. Biological drug therapy group belonged at the baseline (n=148) improved the quality of life (p=0.004) during the follow-up. A disease-specific HRQoL instrument (IBDQ) shows the quality of life has changed in parallel (p=0.003)with the 15D-instrument. Dimensions, where progress was achieved (p<0.05) were the elimination, the usual activities, discomfort and symptoms, as well as vitality and sexual activity. In the research group (n=51), the average cost per patient per QALYs gained during the follow-up period proved to be very high, at over 5 million euro's. During this time, the patient gained an average of 0,01 quality adjusted additional years of life. The evidence of the long-term impact of the biologic drug treatment on the patient's quality of life is still scarce. In most of the research concerned with the benefits of biological treatment, the effectiveness data is derived from the pharmaceutical manufacturers' short-term clinical efficacy studies, or taken from any other quality of life studies.
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(2014)The aim of this Master's Thesis was to assess experiences of access to medications and follow up services. The aspects studied were: access to medications from the public's perspective, also in relation to availability of follow-up services and support for self-management in long-term medications, and difficulty to buy necessary medicines due to economic reasons. The respondents were also asked to identify needs for developing new customer-oriented services for follow up of treatments. The data were collected during December 2013 and January 2014 by an email survey to those registered in the loyal customer program of University Pharmacy. The data were analyzed by using the statistical programme SPSS. Responses to open-ended questions were analyzed (a preliminary analysis). Respondents' age, gender, area of residency and financial situation were used as background variables. 606 responses were received (84% women, 16% men). The mean age of the respondents was 53.5 years and 91% had at least one disease or symptom diagnosed by a doctor. Almost all (93%) used some medicine or vitamin product. Eleven percent of the respondents reported that they had not been able to purchase a medicine they needed due to poor personal financial situation. A majority (85%) of the respondents perceived their health status as good. The average number of visits at the doctor during a one year period was 5.5. About 22 % of the respondents reported that they were not able to get an appointment when they needed it. About half of the respondents had regular health controls by a doctor. The respondents indicated a wish that getting the appointment regularly should be easier and that there should be time to have a holistic discussion on one's care. About half had a personal doctor and 42% had a medication card. The most common ways to self-monitor one's care were by observing general health status, measuring blood pressure and weight. Almost two-thirds (63%) discussed the monitoring results with their doctor. Many respondents reported in the open comments that they did not have instructions for self-monitoring and there was no healthcare provider to share the results with. The respondents wanted have more information concerning the reasons to use medicines, and the benefits of a long-term medicine use. They also wanted to know more about adverse effects and interactions, as well as about non-pharmacological treatment options. The prescriptions were most commonly renewed at the doctor's office (47%).The respondents also expressed a wish to have more options to contact their healthcare providers, e.g., though electronic services (online doctor, email counselling). There are limitations in the Finnish health care system from the medication management's perspective. Aspects needing improvement include access to regular controls and follow-up services, having more options to contact healthcare providers, also through electronic services, having better access to information on diseases and medication, and finally, improve caring for people's health concerns in a holistic way.
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(2017)Ankylosing spondylitis is an inflammatory rheumatoid disease, that is typically diagnosed in young adults. The symptoms include inflammatory back pain, rigidity in the lumbar and thoracic spines, and peripheral inflammations. The incidence of ankylosing spondylitis among northern European population ranges from 0.2 to 0.5%. The mortality rate of people with ankylosing spondylitis is about 50% higher than in the average population. First-line treatment for ankylosing spondylitis includes physiotherapy and NSAIDs. TNF inhibitors are used for patients whose symptoms cannot be controlled with first-line treatment. In Finland, there are five TNF inhibitors indicated for ankylosing spondylitis on the market: infliximab, etanercept, adalimumab, golimumab, and sertolizumab pegol. In 2015, the average medication cost for a patient entitled to reimbursement for TNF inhibitors in Finland was over 12 000 €. The cost-effectiveness of TNF inhibitors in the treatment of ankylosing spondylitis compared to conventional care has been extensively studied, but there is less data on the differences between TNF inhibitors. In this thesis, previously published literature on the cost-effectiveness of TNF inhibitors in the treatment of ankylosing spondylitis was reviewed, and a patient-specific simulation model based on data from the National Register for Biologic Treatment in Finland was conducted. The aim of the simulation was to compare the cost-effectiveness of TNF inhibitors (infliximab, etanercept, adalimumab and golimumab) in the treatment of ankylosing spondylitis as the patient's first biological treatment compared to other TNF inhibitors. The simulation was conducted on a lifetime time horizon and incorporated direct health care and medication costs in 2015 euros. As conclusions of the model, all other TNF inhibitors were found dominant over etanercept. The greatest effectiveness was achieved with golimumab, while the costs were lowest with infliximab. The incremental cost-effectiveness ratio of golimumab compared to infliximab was 63 840 €/QALY. In sensitivity analyzes, the model was found to be very sensitive to TNF inhitors' prices. In addition, sensitivity was also observed for the discount rate and time horizon used.
Now showing items 61-66 of 66