Med Adherence – Difference between prescribed and dosing histories [Article]

Annual Review of Pharmacology and Toxicology (2012 Feb 10;52:275-301. Epub 2011 Sep 19) – No big surprise here, but check out the graphs (posted below), especially the second one where you can see the effect poor compliance/adherence has on therapeutic concentration. Crazy.


Satisfactory adherence to aptly prescribed medications is essential for good outcomes of patient care and reliable evaluation of competing modes of drug treatment. The measure of satisfactory adherence is a dosing history that includes timely initiation of dosing plus punctual and persistent execution of the dosing regimen throughout the specified duration of treatment. Standardized terminology for initiation, execution, and persistence of drug dosing is essential for clarity of communication and scientific progress. Electronic methods for compiling drug dosing histories are now the recognized standard for quantifying adherence, the parameters of which support model-based, continuous projections of drug actions and concentrations in plasma that are confirmable by intermittent, direct measurements at single time points. The frequency of inadequate adherence is usually underestimated by pre-electronic methods and thus is clinically unrecognized as a frequent cause of failed treatment or underestimated effectiveness. Intermittent lapses in dosing are potential sources of toxicity through hazardous rebound effects or recurrent first-dose effects.

Continue reading Med Adherence – Difference between prescribed and dosing histories [Article]

Surprise! Pharma says their “digital resources” are good for consumers


Reliance on pharma-sponsored digital resources among online U.S. adults is significant. The research found “51% of online U.S. adults (ages 18+) use pharma-sponsored digital resources, such as condition and treatment information, disease management tools, doctor discussion guides, or mobile apps or websites.” This validates that the interactive information and tools produced by biopharma are being utilized and appreciated.

Use of these materials results in action: a conversation about a prescription drug. The study learned “43% of consumers using pharma-sponsored digital resources have discussed prescription drugs with a doctor, nurse, or pharmacist as a result.” This data point supports the business objective behind providing these interactive resources: generating a conversation with a healthcare professional. Note that the study was fielded online among 6,634 U.S. adults, ages 18+ during Q4 2011.

For comparison, Prevention Magazine’s Direct to Consumer Study 2011 found that as a result of seeing an advertisement – not necessarily online – 77% of survey respondents talked to a doctor and 23% asked for a prescription.

How scary is this! Getting consumers to talk about their medication with their physician is a good thing; talking with their pharmacist even better. However, many times this type of advertising (“digital resource”) results in consumers asking about something completely inappropriate. Which, as we all know, can lead to  a physician prescribing an unnecessary medication, using something that they’re not familiar with or prescribing something they wouldn’t consider first line.

All you have to do is look at the top 5 “patient and caregiver groups to agree that pharma should be involved in online health consumer communities” to understand why this is such a bad idea.

1. ADD/ADHD Caregivers
2. Bipolar Disorder Caregivers
3. Epilepsy Caregivers
4. Cystic Fibrosis Patients
5. Rheumatoid Arthritis Patients

Yikes! Choosing drug therapy is quite a bit different than picking out a book on Amazon and it should be treated that way.

Look at the Transformer Prime with keyboard dock

Nice little review of the Transformer Prime (TFP) hardware at GigaOM. Make sure to check the game play at around 7:55 in the video. The reviewer plugs an Xbox 360 controller into the USB slot on the keyboard dock and uses it to play Shadow Run. How cool is that. 

I really think the hybrid design of the TFP is ideal for many situations, especially for those people that truly want to carry a single device. As much as I like tablets I find that I still need a keyboard for any significant data entry chores, whether it be with a spreadsheet, word processor, etc.

I would really like to see tablet PC manufacturers like Lenovo and Samsung do something similar, i.e. a keyboard dock that increases battery life and folds into a laptop style portfolio with the tablet docked. My dream machine would be a Samsung Series 7 Slate with a laptop dock similar to the TFP. It doesn’t appear that Samsung is interested in such a docking solution, but I’m hopeful that a third party will take the hint and do it anyway.

Digital edition of U.S. Pharmacist off to a bad start

I received the announcement below in my email just a short time ago. So being the good little pharmacist that I am, I headed on over to the U.S. Pharmacist website to check it out. Imagine my surprise when I clicked on the digital issue link and was greeted with a “Service Unavailable” message (bottom image). Bummer. Hopefully they’ll get it up and running shortly.

Update: Looks like they got it working within 5 minutes of me posting this. It’s a nice format. Check it out for yourself here.

Continue reading Digital edition of U.S. Pharmacist off to a bad start

Impact of Anti-infective Drug Shortages [Article]

Clinical Infectious Disease (online January 19):


Anti-infective shortages pose significant logistical and clinical challenges to hospitals and may be considered a public health emergency. Anti-infectives often represent irreplaceable life-saving treatments. Furthermore, few new agents are available to treat increasingly prevalent multidrug-resistant pathogens. Frequent anti-infective shortages have substantially altered patient care and may lead to inferior patient outcomes. Because many of the shortages stem from problems with manufacturing and distribution, federal legislation has been introduced but not yet enacted to provide oversight for the adequate supply of critical medications. At the local level, hospitals should develop strategies to anticipate the impact and extent of shortages, to identify therapeutic alternatives, and to mitigate potential adverse outcomes. Here we describe the scope of recent anti-infective shortages in the United States and explore the reasons for inadequate drug supply.

Unfortunately the abstract doesn’t say much and a subscription is required to read the full article [grrr!]. The authors of the article basically evaluate the shortage of anti-infective agents over a multi-year period (2005-2010) and conclude that “anti-infective drug shortages continue to pose significant problems for clinicians and are a rapidly evolving public health emergency.” In addition they call for further research “regarding the clinical impact of drug shortages on patient outcomes”. How would one perform such a study?

Drug shortages have received a lot of attention lately. Shortages are certainly nothing new, but they seem to have become a bigger issue lately as the sheer number of unavailable medications is staggering. Areas like oncology and infectious disease are particularly hard hit as the number of treatment options in these specialties are limited to start with.

While there is no doubt that the shortages have impacted healthcare, I tend to agree with the authors of a commentary piece on the article that conclude that " it is difficult to systematically measure the resulting clinical problem or draw quantitative conclusions about differences in outcomes." Sounds overly simplified, but it’s true.

For more information on drug shortages make sure to visit the ASHP Drug Shortages Resource Center. Over 200 drugs and counting…

Yo, wouldn’t a high-tech laminar air flow hood be cool

We have so much technology around these days. I mean we have real-time patient monitoring, near field communication, telemedicine, smartphones, music and video in the cloud, and so on ad infinitum. So why is it that hospital pharmacies use the same old horizontal hoods that they’ve always used?

Continue reading Yo, wouldn’t a high-tech laminar air flow hood be cool

Domain expertise in healthcare can go a long way

mobilehealthnews: “[John] Sculley said [while speaking at the Digital Health Summit, CES 2012] that some companies have put too much emphasis on style over substance.

“The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services,””

I think these comments ring true for many of us that realize the disconnect between the people designing and building products for healthcare, and those actually using them. I can attest to the fact that it exists in many aspects of pharmacy automation and technology where things have a way of being forced down your throat. It becomes a game of which product is the “least bad”. It’s called settling for something, and it never really makes anyone happy. That’s why we’ve seen so many homegrown systems in pharmacies over the years.

There once was time when terrible usability at least meant great functionality. Unfortunately many companies have chosen to improve the usability at the expense of the functionality, which ultimately leads to a crappy product. I’ve experienced this many times during my career, especially with pharmacy information systems where improved UI’s have often resulted in poor performance, more mouse clicks and frustration.

Do the industry a favor and ask the end users what they need, instead of giving them what you think they want.

Contact lenses loaded with anesthetic medication

When I think of technological advances these are the things that come to mind.

medGadget “…researchers at University of Florida are reporting that they developed a way to load topical anesthetics into contact lenses to provide extended delivery of pain relief in a uniform fashion.  And since many of the patients that undergo eye procedures have been wearing contacts prior, they’re already used to putting them on. From the study abstract in Langmuir:

Here we focus on creating dispersion of highly hydrophobic vitamin E aggregates in the lenses as barriers for drug diffusion for increasing the release durations. This approach has been shown previously to be successful in extending the release durations for some common hydrophilic ophthalmic drugs. The topical anesthetic drugs considered here (lidocaine, bupivacaine, and tetracaine) are hydrophilic at physiologic pH due to the charge, and so these cannot partition into the vitamin E barriers. However, these surface active drug molecules adsorb on the surface of the vitamin E barriers and diffuse along the surface, leading to only a small decrease in the effective diffusivity compared to non-surface-active hydrophilic drugs. The drug adsorption can be described by the Langmuir isotherm, and measurements of surface coverage of the drugs on the vitamin E provide an estimate of the available surface area of vitamin E, which can then be utilized to estimate the size of the aggregates. A diffusion controlled transport model that includes surface diffusion along the vitamin E aggregates and diffusion in the gel fit the transport data well. In conclusion, the vitamin E loaded silicone contact lens can provide continuous anesthetics release for about 1–7 days, depending on the method of drug loading in the lenses, and thus could be very useful for postoperative pain control after corneal surgery such as the photorefractive keratectomy (PRK) procedure for vision correction.

Cool, simply cool.

Check out the image and rest of the article “Transport of Topical Anesthetics in Vitamin E Loaded Silicone Hydrogel Contact Lenses” at the Langmuir site.

VGo telepresence robot has Verizon LTE

Engadget: “the VGo ‘bot — a chest-high roving device that has a display and camera built-in and allows patients and others to interact with a remote operator — is at CES this year to show off its inclusion of Verizon LTE, instead of the WiFi-only model we’ve seen in times past.” – So? So this means you’re no longer confined to locations with Wi-Fi. It means you can have telepresence (telemedicine, telepharmacy) anywhere. Need a specialist’s opinion in the middle of nowhere? Ok, just fire up the VGo robot with Verizon LTE.

For those of you that haven’t experience “4G” you’re missing out. It’s quite snappy. I frequently use my Galaxy Nexus to watch movies on Netflix while waiting for my daughter at Volleyball practice. No lag. No buffering. Just a smooth movie watching experience.


If I were to buy a tablet today…

imageI’m always on the lookout for a new tablet, and never more so then I am at this moment. My trusty Lenovo X201T is getting old. At more than a year, it’s downright ancient in computer technology years. It’s a dilemma to be sure.

Fortunately for me there’s no shortage of tablets on the market: Windows OS, Android OS, iOS. Crud, based on reports from CES 2012 I’ll have a much bigger selection within another 6 months or so.

Continue reading If I were to buy a tablet today…