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Real-time prescription monitoring: helping people at risk of harm.

ABSTRACT: Misuse of opioid analgesics and other psychoactive medicines is a serious and increasing problem in Australia Measures are being taken to try and prevent this progressing to a public health crisis like the opioid overdose epidemic seen in the USA: One measure is real-time prescription monitoring This provides real-time information about the patient’s supply of psychoactive medicines which have a high risk of being misused: Having identified a patient at risk many factors may delay appropriate management or result in the patient being discharged from care These factors include subconscious negative stereotyping a focus on preventing ‘doctor shoppers’ diverting psychoactive medicines and a fear of sanction by regulators: The Medical Board of Australia provides guidance about good practice Patients should be treated with respect free from bias and discrimination and without prejudicing care because of the belief that their behaviour has contributed to their problems:

SUBMITTER: Dobbin M

PROVIDER: S-EPMC7572195 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Real-time prescription monitoring: helping people at risk of harm.

Dobbin Malcolm M Liew David Fl DF

Australian prescriber 20201001 5

Misuse of opioid analgesics and other psychoactive medicines is a serious and increasing problem in Australia. Measures are being taken to try and prevent this progressing to a public health crisis like the opioid overdose epidemic seen in the USA One measure is real-time prescription monitoring. This provides real-time information about the patient’s supply of psychoactive medicines which have a high risk of being misused Having identified a patient at risk, many factors may delay appropriate ...[more]

PMID: 33093743

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Project description:As pharmacokinetics after burn trauma are difficult to predict, we conducted a 3-year prospective, monocentric, randomized, controlled trial to determine the extent of under- and overdosing of antibiotics and further evaluate the impact of systematic therapeutic drug monitoring (TDM) with same-day real-time dose adaptation to reach and maintain antibiotic concentrations within the therapeutic range. Forty-five consecutive burn patients treated with antibiotics were prospectively screened. Forty fulfilled the inclusion criteria; after one patient refused to participate and one withdrew consent, 19 were randomly assigned to an intervention group (patients with real-time antibiotic concentration determination and subsequent adaptations) and 19 were randomly assigned to a standard-of-care group (patients with antibiotic administration at the physician's discretion without real-time TDM). Seventy-three infection episodes were analyzed. Before the intervention, only 46/82 (56%) initial trough concentrations fell within the range. There was no difference between groups in the initial trough concentrations (adjusted hazard ratio = 1.39 [95% confidence interval {CI}, 0.81 to 2.39], P = 0.227) or the time to reach the target. However, thanks to real-time dose adjustments, the trough concentrations of the intervention group remained more within the predefined range (57/77 [74.0%] versus 48/85 [56.5%]; adjusted odd ratio [OR] = 2.34 [95% CI, 1.17 to 4.81], P = 0.018), more days were spent within the target range (193 days/297 days on antibiotics [65.0%] versus 171 days/311 days in antibiotics [55.0%]; adjusted OR = 1.64 [95% CI, 1.16 to 2.32], P = 0.005), and fewer results were below the target trough concentrations (25/118 [21.2%] versus 44/126 [34.9%]; adjusted OR = 0.47 [95% CI, 0.26 to 0.87], P = 0.015). No difference in infection outcomes was observed between the study groups. Systematic TDM with same-day real-time dose adaptation was effective in reaching and maintaining therapeutic antibiotic concentrations in infected burn patients, which prevented both over- and underdosing. A larger multicentric study is needed to further evaluate the impact of this strategy on infection outcomes and the emergence of antibiotic resistance during long-term burn treatment. (This study was registered with the ClinicalTrials.gov platform under registration no. NCT01965340 on 27 September 2013.).

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Real-time prescription monitoring: helping people at risk of harm.

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Real-time prescription monitoring: helping people at risk of harm.

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