Interventi del farmacista clinico per il miglioramento della gestione della terapia immunosoppressiva in una popolazione pediatrica: Formazione, aderenza, farmacovigilanza

Aim. To value and improve the adherence to the immunosuppressive therapy in a pediatric population and the pharmacovigilance activity. Materials and methods. From January 2013 to October 2014, the pharmacist has developed an education program for 147 pediatric patients in the management of their home therapy. The methods used to evaluate the adherence were three: the measuring of trough blood concentration of immunosuppressive drugs, a questionnaire and the prescription refill rate. Our secondary goal was to create a family collaboration sensitizing patients and their parents to inform the physician or the pharmacist of any adverse drug reactions. Results. During the education phase, the pharmacist answered patient/family's questions about therapy doubts and curiosities. In the trough blood level monitoring of immunosuppressive drugs, 9% of the patients had an average hematic concentration of immunosuppressive drug out of the expected range. Questionnaires showed that: 12.2% of the patients missed a dose of immunosuppressant drug in the previous month, 2% 2 doses and 1.3% 3 doses. 8.8% of the patients diverged once for about 2 hours the scheduled time in the previous month and 3.4% 2-3 times. 21% of the children/parents said they did not know the correct way of drugs intake in relation to meals. After the training, 45 children/parents followed pharmacist tips more. According the analysis of the prescription refill rate, 10.8% of the patients were late in withdrawing their medications. Through the combination of the three methods, 17.7% of the patients were non-adherent. We identified and reported 15 suspected ADR, of which 4 were serious. Conclusion. Children adherence is widely determined by the ability and role of their parents to manage home therapy. On the contrary, teenagers often want to manage their home therapy by themselves. Pharmacist has to talk to the patient to evaluate adherence obstacles and collaborate with the patient in order to overcome them. Parents can have an active role in reporting ADRs to the pharmacist.