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Haider I, Kosari S, Naunton M, Niyonsenga T, Koerner J, Peterson G, Davey R. Impact of on-site pharmacists in residential aged care facilities on the quality of medicines use: a cluster randomised controlled trial (PiRACF study). Sci Rep 2023; 13:15962. [PMID: 37749102 PMCID: PMC10519995 DOI: 10.1038/s41598-023-42894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
Residents of residential aged care facilities (RACFs) have a high prevalence of use of potentially inappropriate medications (PIMs) and resultant medicines-related harm. This study investigated the effect of an on-site pharmacist model on PIMs use and other medication outcomes for residents in RACFs. A multi-facility, non-blind, cluster randomised controlled trial, with randomisation at the facility level, was conducted. Fifteen facilities enrolled and participated in the study, 7 facilities (560 residents) were allocated to the intervention arm and 8 facilities (737 residents) were allocated to the control arm. Each facility in the intervention arm employed an on-site pharmacist for 12 months to perform medication management activities as part of an interdisciplinary care team. The primary outcome was the proportion of residents taking at least one PIM according to the 2019 Beers® Criteria. Using generalised linear mixed-effects models, accounting for confounders and clustering, there was a significant reduction in the proportion of residents prescribed at least one PIM (odds ratio 0.50, 95% confidence interval, 0.335-0.750; p = 0.001) in the intervention arm. There were also significant decreases in the Anticholinergic Cognitive Burden scale and chlorpromazine equivalent daily dose of antipsychotics. The on-site pharmacist intervention significantly improved the appropriateness of medicines use in RACFs.
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Affiliation(s)
- Ibrahim Haider
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Jane Koerner
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Gregory Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, 7005, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
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2
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Brennan S, Doan T, Osada H, Hashimoto Y. Validation of the Japanese version of the quality of life-Alzheimer's disease for nursing homes. Aging Ment Health 2023; 27:281-291. [PMID: 35585714 DOI: 10.1080/13607863.2022.2076209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study aims to validate the Japanese version of Quality of Life-Alzheimer's Disease for Nursing Homes (QOL-AD NH). This is the modified version of QOL-AD, initially developed for residents living with dementia in long-term care settings. METHODS Psychometric assessment was conducted in a sample of 101 residents and their professional care staff to obtain self-ratings and proxy-ratings of QOL, respectively. Residents' behavior was observed using Dementia Care Mapping (DCM) method, and their mood/engagement (ME) value was evaluated as a proxy measure of QOL. RESULTS Self-ratings were higher than proxy-ratings (t = 10.22, p<.001), with moderate correlation (r=.51, p<.001) and strong internal consistency (α=.87 for both). The exact agreement between the two groups was 38.23%. Convergent validity was confirmed with ME value and positive engagements of DCM. Exploratory factor analysis was performed for further validity testing. Three factors - self and life overall, social environment, and physical and psychological health, accounted for 85.9% of the total variance with Cronbach's α of .87, .73, .90, respectively. CONCLUSION Using a validated Japanese version of the QOL-AD NH may help assess the QOL of older residents living in long-term care settings to improve the continuum of care for dementia.
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Affiliation(s)
- Sumiyo Brennan
- Institute for Gerontology, J. F. Oberlin University, Tokyo, Japan
| | - Therese Doan
- School of Nursing, San Francisco State University, CA, USA
| | - Hisao Osada
- J. F. Oberlin University, Graduate School of International Advanced Studies MA&PhD Programs in Gerontology, Tokyo, Japan
| | - Yumiko Hashimoto
- Institute for Gerontology, J. F. Oberlin University, Tokyo, Japan
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3
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Aljeaidi MS, Haaksma ML, Tan ECK. Polypharmacy and trajectories of health-related quality of life in older adults: an Australian cohort study. Qual Life Res 2022; 31:2663-2671. [PMID: 35476171 PMCID: PMC9356923 DOI: 10.1007/s11136-022-03136-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/30/2022]
Abstract
Background Health-related quality of life (HRQoL) is an important outcome measure when considering medical treatment; however, the impact of polypharmacy on trajectories of HRQoL over time is unknown. This study aimed to investigate the association between polypharmacy status and trajectories of HRQoL in older adults. Methods A longitudinal cohort study of 2181 community-dwelling adults, 65 years and older, who participated in the 2013 to 2017 waves of the Household Income and Labour Dynamics in Australia (HILDA) Survey. Polypharmacy was defined as the regular use of ≥ 5 prescription medications. Polypharmacy status was categorised into no polypharmacy, in 2013 only (baseline only polypharmacy), in 2017 only (incident polypharmacy) or at both time points (persistent polypharmacy). HRQoL was assessed through the SF-36 questionnaire generating two summary scores: physical component summary (PCS) and mental component summary (MCS). Linear mixed-effects models stratified according to polypharmacy status and change in comorbidities were used to assess trajectories of HRQoL. Results Older adults with persistent polypharmacy had lowest scores for HRQoL measures from 2013 to 2017. After adjusting for all covariates, those with incident polypharmacy had the steepest annual decline in both the PCS and MCS: − 0.86 in PCS and − 0.76 in MCS for those with decreasing or stable comorbidities, and − 1.20 in PCS and − 0.75 in MCS for those with increasing comorbidities. Conclusions Polypharmacy was associated with poorer HRQoL, even after adjusting for confounders. Incident polypharmacy was found to be associated with a clinically important decline in HRQoL and this should be considered when prescribing additional medication to older adults. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03136-9.
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Affiliation(s)
- Muhamad S Aljeaidi
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Miriam L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Edwin C K Tan
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Pharmacy Building A15, Science Road, Camperdown, Sydney, NSW, 2006, Australia.
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Federman AD, O’Conor R, Wolf MS, Wisnivesky JP. Associations of Medication Regimen Complexity with COPD Medication Adherence and Control. Int J Chron Obstruct Pulmon Dis 2021; 16:2385-2392. [PMID: 34434045 PMCID: PMC8382307 DOI: 10.2147/copd.s310630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/04/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Medication adherence is often low among people with chronic obstructive pulmonary disease (COPD) and medication regimen complexity may be a contributing factor. In this study, we sought to examine the role of medication regimen complexity in COPD medication adherence among patients with multimorbidity. Methods We performed cross-sectional analysis of data on COPD patients in primary care and pulmonary practices in New York City and Chicago (n=400). Regimen complexity was represented by the medication regimen complexity index (MRCI) and simple medication count. Adherence was measured by self-report and inhaler dose counts. Disease control measures included the COPD severity score (COPDSS) and the Medical Research Council (MRC) severity index. Results Mean age of study participants was 69 years, 66% had MRC grades 4 or 5, and 45% had low medication adherence. MRCI scores did not differ significantly between those with and without adequate medication adherence. Patients with higher MRCI scores were more likely to have severe COPD (OR 5.00, 95% CI 1.46-17.1, p=0.01) and dyspnea grades 3 or 4 (OR 2.27, 95% CI 1.03-5.03, p=0.04). Significant associations of medication count with COPD severity were also observed. Discussion These findings demonstrate that among patients with COPD and comorbid hypertension and diabetes, higher medication regimen complexity is associated with worse COPD control but not with COPD medication adherence.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel O’Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Toida T, Toida R, Takahashi R, Uezono S, Komatsu H, Sato Y, Fujimoto S. Impact of polypharmacy on all-cause mortality and hospitalization in incident hemodialysis patients: a cohort study. Clin Exp Nephrol 2021; 25:1215-1223. [PMID: 34129133 DOI: 10.1007/s10157-021-02094-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Polypharmacy (PP) is common in end-stage chronic renal disease patients largely due to the presence of multiple comorbid conditions. Although PP is potentially harmful, its relationship with mortality and morbidity in hemodialysis patients currently remains unclear. METHODS Study design: cohort study. SETTING participants: one hundred and fifty-two initial hemodialysis patients (male, 88 patients; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at Nobeoka Prefectural Hospital and Chiyoda Hospital. PREDICTOR patients were divided into 2 groups according to PP (6 or more drug prescriptions or less) during admission and discharge for the initiation of hemodialysis. OUTCOMES all-cause mortality and hospitalization during the mean 2.8-year follow-up. MEASUREMENTS hazard ratios (HRs) were estimated using Cox's model for the relationships between PP and clinical outcomes and adjusted for potential confounders. The group with 5 or less drug prescriptions was set as a reference. RESULTS The number of prescribed drugs per patient averaged 7.4 at admission and 7.0 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During the follow-up, 20 patients died and 71 were hospitalized. PP at admission did not correlate with outcomes, whereas that at discharge correlated with all-cause hospitalization. CONCLUSIONS PP at discharge may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of outcomes or is simply a marker for an increased risk of outcomes.
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Affiliation(s)
- Tatsunori Toida
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki city, Miyazaki, 889-1692, Japan.
- Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka City, Miyazaki, Japan.
| | - Reiko Toida
- Chiyoda Hospital, Hyuga city, Miyazaki, Japan
| | - Risa Takahashi
- Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka City, Miyazaki, Japan
| | | | - Hiroyuki Komatsu
- Center for Medical Education and Career Development, Faculty of Medicine, University of Miyazaki, Miyazaki city, Miyazaki, Japan
| | - Yuji Sato
- Division of Nephrology, Department of Internal Medicine, National Health Insurance Takachiho Town Hospital, Takachiho, Miyazaki, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki city, Miyazaki, 889-1692, Japan
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McCloskey R, Keeping-Burke L, Donovan C, Cook J, Witherspoon R, Lignos N. Teaching strategies and activities to enhance students' clinical placement in residential aged care facilities: a scoping review. JBI Evid Synth 2021; 18:2302-2334. [PMID: 32813423 DOI: 10.11124/jbisrir-d-19-00334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The purpose of this scoping review was to examine teaching strategies and activities used in nursing students' clinical placement in residential aged care facilities. INTRODUCTION Population aging necessitates that nursing curricula ensure student interest and commitment to working with older adults. While searching for suitable clinical placements that provide students with opportunities to care for older adults, nursing programs have turned to residential aged care facilities. Studies show that carefully planned placement in these environments supports students' needs and offers rich learning possibilities. INCLUSION CRITERIA This review examined intentional teaching strategies and activities used during student placement in residential aged care facilities, and considered research and textual papers on the subject. The strategies and activities included those that took place prior to, during, or after the experience. METHODS The review included qualitative and quantitative research reports as well as text and opinion papers. Only research reports and papers published in English from 1992 to August 2019 were included. The databases searched were: CINAHL (EBSCO), MEDLINE (Ovid), Academic Search Premier (EBSCO), Embase (Elsevier), ERIC (EBSCO), ProQuest Dissertations and Theses, and Google (with advanced search strategies). Two independent reviewers screened citations for inclusion while a third reviewer resolved discrepancies. A table was developed for data extraction to record data relating to the review objective. Specific data extracted included the details on research design, geographical location, year of publication, description of the teaching strategy or activity. RESULTS Of the 84 research reports and papers that were eligible for full-text review, only 25 (30%) were included in the final set. Sixteen papers were research reports including a variety of qualitative, quantitative, and mixed method designs. The remaining nine were textual papers and included frameworks, descriptions, and evaluations of a teaching strategy or activity. Most research reports and papers identified more than one strategy and/or activity used concurrently. The use of care staff as student mentors and facility orientation for students were the two most common strategies and activities reported. CONCLUSION A range of teaching approaches during clinical placements in residential aged care facilities was revealed. These approaches targeted students, staff of aged care facilities, and nursing faculty. Collaborative efforts between aged care facilities and educational institutions allowed for the pooling of resources and the delivery of teaching approaches to students and the engagement of care staff. Many of the approaches were co-designed by educational programs and residential aged care facilities. The number of approaches that used more than one teaching strategy and/or activity reflects an appreciation for the importance of student placements and the complexities of aged care facilities. A lack of longitudinal or evaluative research highlights a gap in the literature. There is a need for further work to understand and evaluate the long-term effects and benefits of teaching strategies and activities used to enhance students' clinical placements in resident aged care facilities.
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Affiliation(s)
- Rose McCloskey
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada.,The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
| | - Lisa Keeping-Burke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada.,The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
| | | | - Jessica Cook
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Richelle Witherspoon
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada.,Information Services, University of New Brunswick, Fredericton, NB, Canada
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Mohammed MA, Moles RJ, Chen TF. Factors Associated with Medication-Related Burden Quality of Life (MRB-QoL) in Community-Dwelling Adults with Long-Term Conditions: An Exploratory Study. PATIENT-RELATED OUTCOME MEASURES 2021; 12:55-63. [PMID: 33688289 PMCID: PMC7936687 DOI: 10.2147/prom.s245534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022]
Abstract
Background The Medication-Related Burden Quality of Life (MRB-QoL) tool has been developed to measure the burden of medications on functioning and wellbeing from a patient perspective. However, predictors of MRB-QoL were not reported in greater detail in the validation study. This study aimed to explore factors associated with MRB-QoL to see whether there is any new information that calls for further research. Methods Analysis of data from the MRB-QoL validation study was undertaken. Outcome variables were domains of the MRB-QoL (Routine and Regimen Complexity, Psychological Burden, Functional and Role Limitation, Therapeutic Relationship, and Social Burden). Explanatory variables were patient age; disease-related factors; and medication-related factors, such as number of medications, complexity of medication regimen (measured by the Medication Regimen Complexity Index [MRCI]), and exposure to medications with anticholinergic and sedative effects (measured by the Drug Burden Index [DBI]). Linear regression analyses were used to identify factors associated with the MRB-QoL. Results The study included 367 participants (52.1% male), with a median age of 64 years. In multivariable regression analyses, an increase in the DBI was significantly associated with poorer Psychological wellbeing (β=−0.15, p<0.001) and Functional and Role Limitation (β=−1.79, p<0.001). Living with three or more medical conditions was significantly associated with poorer Psychological wellbeing (β=−0.21, p<0.001). Age was significantly associated with all domains of the MRB-QoL (β=0.28 to 0.55). Polypharmacy and MRCI were not associated with any of the MRB-QoL domains. Conclusion In this sample of community-dwelling adults with multiple medications, the DBI was independently associated with the Psychological Burden and Functional and Role Limitation domains of the MRB-QoL. This study provides preliminary evidence on factors affecting medication-related quality of life outcomes from a patient perspective. Future longitudinal studies, along with further psychometric testing of the MRB-QoL measure, are warranted to better understand predictors of MRB-QoL.
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Affiliation(s)
| | - Rebekah J Moles
- The University of Sydney, School of Pharmacy, Sydney, NSW, Australia
| | - Timothy F Chen
- The University of Sydney, School of Pharmacy, Sydney, NSW, Australia
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Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med 2021; 12:443-452. [PMID: 33694123 PMCID: PMC8149355 DOI: 10.1007/s41999-021-00479-3] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In the absence of an accepted agreement on the definition of polypharmacy, data on its prevalence in various studies are not easily comparable. Besides, the evidence on the potential adverse clinical outcomes related to polypharmacy is limited though polypharmacy has been linked to numerous adverse clinical outcomes. This narrative review aims to find and summarize recent publications on definitions, epidemiology and clinical consequences of polypharmacy. METHODS The MEDLINE database was used to identify recent publications on the definition, prevalence and clinical consequences of polypharmacy using their respective common terms and their variations. Systematic reviews and original studies published between 2015 and 2020 were included. RESULTS One hundred and forty-three definitions of polypharmacy and associated terms were found. Most of them are numerical definitions. Its prevalence ranges from 4% among community-dwelling older people to over 96.5% in hospitalized patients. In addition, numerous adverse clinical outcomes were associated with polypharmacy. CONCLUSION The term polypharmacy is imprecise, and its definition is yet subject to an ongoing debate. The clinically oriented definitions of polypharmacy found in this review such as appropriate or necessary polypharmacy are more useful and relevant. Regardless of the definition, polypharmacy is highly prevalent in older adults, particularly in nursing home residents and hospitalized patients. Approaches to increase the appropriateness of polypharmacy can improve clinical outcomes in older adults.
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Affiliation(s)
- Farhad Pazan
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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9
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Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study. Sci Rep 2020; 10:18964. [PMID: 33144598 PMCID: PMC7609640 DOI: 10.1038/s41598-020-75888-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
Polypharmacy is a growing and major public health issue, particularly in the geriatric population. This study aimed to examine the association between polypharmacy and the risk of hospitalization and mortality. We included 3,007,620 elderly individuals aged ≥ 65 years who had at least one routinely-prescribed medication but had no prior hospitalization within a year. The primary exposures of interest were number of daily prescribed medications (1–2, 3–4, 5–6, 7–8, 9–10, and ≥ 11) and presence of polypharmacy (≥ 5 prescription drugs per day). The corresponding comparators were the lowest number of medications (1–2) and absence of polypharmacy. The study outcomes were hospitalization and all-cause death. The median age of participants was 72 years and 39.5% were men. Approximately, 46.6% of participants experienced polypharmacy. Over a median follow-up of 5.0 years, 2,028,062 (67.4%) hospitalizations and 459,076 (15.3%) all-cause deaths were observed. An incrementally higher number of daily prescribed medications was found to be associated with increasingly higher risk for hospitalization and mortality. These associations were consistent across subgroups of age, sex, residential area, and comorbidities. Furthermore, polypharmacy was associated with greater risk of hospitalization and death: adjusted HRs (95% CIs) were 1.18 (1.18–1.19) and 1.25 (1.24–1.25) in the overall and 1.16 (1.16–1.17) and 1.25 (1.24–1.25) in the matched cohorts, respectively. Hence, polypharmacy was associated with a higher risk of hospitalization and all-cause death among elderly individuals.
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10
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McCloskey R, Keeping-Burke L, Donovan C, Witherspoon R, Cook J, Lignos N. Teaching strategies and activities used for students' clinical placement in residential aged care facilities: a scoping review protocol. JBI Evid Synth 2020; 18:1043-1050. [PMID: 32813357 DOI: 10.11124/jbisrir-d-19-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to examine and map current knowledge of teaching strategies and activities used with nursing students during clinical placements in residential aged care facilities. INTRODUCTION Residential aged care facilities provide opportunities for nursing students to develop skills and interest in caring for older adults. Studies that address students' clinical placements in these settings highlight the benefits of and concerns with their experiences. Insight into the state of knowledge regarding teaching strategies used in residential aged care facilities could benefit nursing education programs and help to ensure student learning is maximized. INCLUSION CRITERIA This scoping review will consider research and narrative reports on teaching activities and strategies used by nursing faculty and residential aged care facility staff in teaching nursing students. The concepts of interest include planned and intentional activities and strategies used to facilitate student learning and student clinical experiences. A clinical experience is defined as when a student enters a residential aged care facility and is assigned an individual or individuals to care for. METHODS This scoping review will aim to locate published and unpublished literature employing a three-step search strategy. Only papers published in English from 1992 onward will be included. Data extracted from eligible papers will include details on the participants, context, strategy, activity and outcomes. Extracted data will be reported in a tabular form and presented narratively to address the review objective.
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Affiliation(s)
- Rose McCloskey
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada.,The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence
| | - Lisa Keeping-Burke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada.,The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence
| | | | - Richelle Witherspoon
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence.,Information Services, University of New Brunswick, Fredericton, Canada
| | - Jessica Cook
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
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Simplicidad del régimen de medicación y supervivencia en pacientes pluripatológicos. Med Clin (Barc) 2020; 154:248-253. [DOI: 10.1016/j.medcli.2019.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 11/17/2022]
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Sevilla-Sanchez D, Molist-Brunet N, González-Bueno J, Solà-Bonada N, Amblàs-Novellas J, Espaulella-Panicot J, Codina-Jane C. Medication regimen complexity on hospital admission in patients with advanced chronic conditions in need of palliative care. Eur J Hosp Pharm 2019; 26:262-267. [PMID: 31656613 DOI: 10.1136/ejhpharm-2017-001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/05/2018] [Accepted: 03/27/2018] [Indexed: 11/03/2022] Open
Abstract
Objectives To evaluate characteristics of the medication complexity, risk factors associated with high medication complexity and their clinical consequences in patients with advanced chronic conditions. Methods A 10-month cross-sectional study was performed in an acute-hospital care Geriatric Unit. Patients with advanced chronic conditions were identified by the NECPAL test. Medication complexity was established using the Medication Regimen Complexity Index (MRCI) tool. Demographic, pharmacological and clinical patient data were collected with the objective of determining risk factors related to high medication complexity. Measured clinical outcomes were hospital length of stay, destination on hospital discharge, in-hospital mortality and 2-year survival. Results Two hundred and thirty-five patients (mean age 86.8, SD 5.37; 65.5% female) were recruited. MRCI's mean score was 38 points (SD 16.54, rank: 2.00-98.50), with 57.9% of patients with high medication complexity (MRCI >35 points).
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Affiliation(s)
- Daniel Sevilla-Sanchez
- Pharmacy Department, Hospital Universitari de Vic - Consorci Hospitalari de Vic; Hospital de la Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic - Universitat Central de Catalunya, Vic, Catalonia, Spain
| | - Núria Molist-Brunet
- Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic - Universitat Central de Catalunya, Vic, Catalonia, Spain.,Acute Geriatric Unit, Hospital de la Santa Creu de Vic, Vic, Spain
| | - Javier González-Bueno
- Pharmacy Department, Hospital Universitari de Vic - Consorci Hospitalari de Vic; Hospital de la Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic - Universitat Central de Catalunya, Vic, Catalonia, Spain
| | - Núria Solà-Bonada
- Pharmacy Department, Hospital Universitari de Vic - Consorci Hospitalari de Vic; Hospital de la Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic - Universitat Central de Catalunya, Vic, Catalonia, Spain
| | - Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic - Universitat Central de Catalunya, Vic, Catalonia, Spain.,Acute Geriatric Unit, Hospital de la Santa Creu de Vic, Vic, Spain.,Geriatric and Palliative Care Territorial Unit, Hospital de la Santa Creu de Vic, Consorci Hospitalari de Vic, Vic, Spain.,Palliative Care Chair, Universitat de Vic - Universitat Central de Catalunya, Vic, Spain
| | - Joan Espaulella-Panicot
- Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic - Universitat Central de Catalunya, Vic, Catalonia, Spain.,Acute Geriatric Unit, Hospital de la Santa Creu de Vic, Vic, Spain.,Geriatric and Palliative Care Territorial Unit, Hospital de la Santa Creu de Vic, Consorci Hospitalari de Vic, Vic, Spain
| | - Carles Codina-Jane
- Pharmacy Department, Hospital Universitari de Vic - Consorci Hospitalari de Vic; Hospital de la Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic - Universitat Central de Catalunya, Vic, Catalonia, Spain.,Pharmacy Department, Hospital Clinic de Barcelona, Barcelona, Spain
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13
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Chen EY, Bell JS, Ilomaki J, Keen C, Corlis M, Hogan M, Van Emden J, Hilmer SN, Sluggett JK. Medication Regimen Complexity In 8 Australian Residential Aged Care Facilities: Impact Of Age, Length Of Stay, Comorbidity, Frailty, And Dependence In Activities Of Daily Living. Clin Interv Aging 2019; 14:1783-1795. [PMID: 31695348 PMCID: PMC6815218 DOI: 10.2147/cia.s216705] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
Objective To explore variation in medication regimen complexity in residential aged care facilities (RACFs) according to resident age, length of stay, comorbidity, dementia severity, frailty, and dependence in activities of daily living (ADLs), and compare number of daily administration times and Medication Regimen Complexity Index (MRCI) as measures of regimen complexity. Methods This study was a cross-sectional analysis of baseline data from the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial. The SIMPLER study recruited 242 residents with at least one medication charted for regular administration from 8 RACFs in South Australia. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Dementia severity was assessed using the Dementia Severity Rating Scale. Frailty was assessed using the FRAIL-NH scale. Dependence in ADLs was assessed using the Katz ADL scale. Results The median age of participants was 87 years (interquartile range 81–92). Over one-third of participants (n=86, 36%) had 5 or more daily medication administration times. The number of daily administration times and MRCI scores were positively correlated with resident length of stay (rs=0.19; 0.27), FRAIL-NH score (rs=0.23; 0.34) and dependence in ADLs (rs=−0.21; −0.33) (all p<0.01). MRCI was weakly negatively correlated with CCI score (rs=−0.16; p=0.013). Neither number of daily administration times nor MRCI score were correlated with age or dementia severity. In multivariate analysis, frailty was associated with number of daily administration times (OR: 1.13, 95% CI: 1.03–1.24) and MRCI score (OR: 1.26, 95% CI: 1.13–1.41). Dementia severity was inversely associated with both multiple medication administration times (OR: 0.97, 95% CI: 0.94–0.99) and high MRCI score (OR: 0.95, 95% CI: 0.92–0.98). Conclusion Residents with longer lengths of stay, more dependent in ADLs and most frail had the most complex medication regimens and, therefore, may benefit from targeted strategies to reduce medication regimen complexity.
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Affiliation(s)
- Esa Yh Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Jenni Ilomaki
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Claire Keen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.,Helping Hand Aged Care, North Adelaide, SA, Australia
| | | | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.,Helping Hand Aged Care, North Adelaide, SA, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.,Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
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14
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Schenker Y, Park SY, Jeong K, Pruskowski J, Kavalieratos D, Resick J, Abernethy A, Kutner JS. Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness. J Gen Intern Med 2019; 34:559-566. [PMID: 30719645 PMCID: PMC6445911 DOI: 10.1007/s11606-019-04837-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/13/2018] [Accepted: 12/19/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Polypharmacy may be particularly burdensome near the end of life, as patients "accumulate" medications to treat and prevent multiple diseases. OBJECTIVE To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month-1 year). DESIGN Secondary analysis of baseline data from a trial of statin discontinuation. PARTICIPANTS Adults with advanced, life-limiting illness. MAIN MEASURES Polypharmacy was assessed by summing the number of non-statin medications taken regularly or as needed. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (range 0-90; higher scores indicating greater symptom burden) and QOL was assessed using the McGill QOL Questionnaire (range 0-10; higher scores indicating better QOL). Linear regression models assessed associations between polypharmacy, symptom burden, and QOL. KEY RESULTS Among 372 participants, 47% were age 75 or older and 35% were enrolled in hospice. The mean symptom score was 27.0 (standard deviation (SD) 16.1) and the mean QOL score was 7.0 (SD 1.3). The average number of non-statin medications was 11.6 (SD 5.0); one-third of participants took ≥ 14 medications. In adjusted models, higher polypharmacy was associated with higher symptom burden (coefficient 0.81; p < .001) and lower QOL (coefficient - .06; p = .001). Adjusting for symptom burden weakened the association between polypharmacy and QOL (coefficient - .03; p = .045) without a significant interaction, suggesting that worse quality of life associated with polypharmacy may be related to medication-associated symptoms. CONCLUSIONS Among adults with advanced illness, taking more medications is associated with higher symptom burden and lower QOL. Attention to medication-related symptoms and shared decision-making regarding deprescribing are warranted in this setting. NIH TRIAL REGISTRY NUMBER ClinicalTrials.gov Identifier for Parent Study - NCT01415934.
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Affiliation(s)
- Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA.
| | - Seo Young Park
- Center for Research on Healthcare Data Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kwonho Jeong
- Center for Research on Healthcare Data Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer Pruskowski
- Department of Pharmacy and Therapeutics, UPMC Palliative and Supportive Institute, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Dio Kavalieratos
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA
| | - Judith Resick
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA
| | | | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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15
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Tegegn HG, Erku DA, Sebsibe G, Gizaw B, Seifu D, Tigabe M, Belachew SA, Ayele AA. Medication-related quality of life among Ethiopian elderly patients with polypharmacy: A cross-sectional study in an Ethiopia university hospital. PLoS One 2019; 14:e0214191. [PMID: 30921379 PMCID: PMC6438590 DOI: 10.1371/journal.pone.0214191] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 03/09/2019] [Indexed: 11/18/2022] Open
Abstract
Polypharmacy among older patients has been associated with a decline in their quality of life. We aimed to assess the medication-related quality of life (MRQOL) among older patients with polypharmacy at Gondar University Hospital, Gondar, Ethiopia. A prospective cross-sectional study was carried out among 150 elder patients who had visited the internal medicine ward and ambulatory ward of Gondar referral hospital from March 25 to May 15, 2017, using a validated scale, Medication-Related Quality of Life Scale version 1.0 (MRQoLS-v1.0). A total of 150 older patients with polypharmacy participated in the study with a mean age of 70.06±5.12, andtwo-thirds of the participants (67.3%) were female. The overall prevalence of poor quality of life due to polypharmacy in the current study was found to be three fourth (75.3%) of the participants. Regarding the severity of impairment in MRQoL, Univariate analysis revealed that frequency of hospital visits (COR = 1.34, 95% CI, 1.02–1.77) and medication number (COR = 1.94, 95% CI, 1.33, 2.8) had a statistically significant positive association with the likelihood of having a severe impairment.The multivariate analysis also showed that one unit increase in the number of hospital visits (AOR = 1.45, 95% CI, 1.040–2.024) and medications greater than 5 (AOR = 1.91, 95% CI, 1.29, 2.84) increases 1.45 and 1.91 times the likely hood of posing severe impairment of MRQoL, respectively. As far as poor MRQoL quality of life is concerned, multivariate analysis did not show any significant association between the poor MRQoL;and Sociodemographic and clinical data of patients. The poor QoL associated with medication was very high in this study. Deprescribing should be sought by the health care providers to optimize drug therapy and minimize the polypharmacy related poor quality of life.
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Affiliation(s)
- Henok Getachew Tegegn
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
- * E-mail:
| | - Daniel Asfaw Erku
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | - Girum Sebsibe
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | - Biruktawit Gizaw
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | - Dawit Seifu
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | - Masho Tigabe
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | | | - Asnakew Achaw Ayele
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
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16
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Balodiya S, Kamath A. Evaluation of Hospital Discharge Prescriptions in the Elderly and Younger Adults Using the Medication Regimen Complexity Index. Curr Drug Saf 2018; 14:116-121. [PMID: 30523768 DOI: 10.2174/1574886314666181207105118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/20/2018] [Accepted: 12/03/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Advances in the clinical management of diseases have been accompanied by increasing complexity of treatment regimens. The complexity of medication regimen is of concern for patients as well as doctors as it may adversely affect patient compliance and treatment outcomes. It may result in medication errors, increased utilization of health resources owing to a reduction in treatment effectiveness, and increased risk of therapeutic failure. OBJECTIVE This study aimed to assess the complexity of medication regimen prescribed to patients on hospital discharge using the medication regimen complexity index (MRCI). METHODS A cross-sectional, descriptive study was conducted. Hospital discharge prescriptions written for patients discharged from the General Medicine wards of a tertiary care teaching hospital in South India were scored for their complexity using MRCI. The correlation of age and gender with the MRCI scores was also assessed. Patients ≥60 years of age were considered elderly. RESULTS The median MRCI score for 563 prescriptions studied was 14 (Interquartile range, 9-21). Elderly patients received a significantly more complex medication regimen compared with younger patients (p < 0.001) at the time of hospital discharge. Gender variation was seen with higher MRCI scores in females, but this was not statistically significant in the elderly group. CONCLUSION MRCI scores are significantly high in elderly patients at the time of hospital discharge. Although a strong correlation is seen between the number of medications and the MRCI score, the latter helps to distinguish regimen complexity between prescriptions with the same number of medications.
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Affiliation(s)
- Sujit Balodiya
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwin Kamath
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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17
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Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf 2018; 17:1185-1196. [PMID: 30540223 DOI: 10.1080/14740338.2018.1546841] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Polypharmacy, the use of multiple medications by one individual, is increasingly common among older adults. Caring for the growing number of older people with complex drug regimens and multimorbidity presents an important challenge in the coming years. AREAS COVERED This article reviews the international trends in the prevalence of polypharmacy, summarizes the results from previous reviews on polypharmacy and negative health outcomes, and updates a previous review on the clinical consequences of polypharmacy by focusing on studies published after 2013. This narrative review, which is based on a literature search in MEDLINE and EMBASE from January 1990 to June 2018, was undertaken to identify relevant articles. Search terms included variations of polypharmacy and multiple medications. EXPERT OPINION The prevalence of polypharmacy is increasing worldwide. More than half of the older population is exposed to polypharmacy in some settings. Polypharmacy is associated with a broad range of clinical consequences. However, methods to assess the dangers of polypharmacy should be refined. In our opinion, the issue of 'confounding by multimorbidity' has been underestimated and should be better accounted for in future studies. Moreover, researchers should develop more clinically relevant definitions of polypharmacy, including measures of inappropriate or problematic polypharmacy.
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Affiliation(s)
- Jonas W Wastesson
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden
| | - Lucas Morin
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden
| | - Edwin C K Tan
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden.,b Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , Australia
| | - Kristina Johnell
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden
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18
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Complejidad del régimen de medicación en pacientes pluripatológicos. Rev Clin Esp 2018; 218:342-350. [DOI: 10.1016/j.rce.2018.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/23/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022]
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19
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Complexity of the medication regimen for polypathological patients. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Mohammed MA, Moles RJ, Hilmer SN, Kouladjian O'Donnel L, Chen TF. Development and validation of an instrument for measuring the burden of medicine on functioning and well-being: the Medication-Related Burden Quality of Life (MRB-QoL) tool. BMJ Open 2018; 8:e018880. [PMID: 29330175 PMCID: PMC5781060 DOI: 10.1136/bmjopen-2017-018880] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Medication-related burden (MRB) is a negative experience with medicine, which may impact on psychological, social, physical and financial well-being of an individual. This study describes the development and initial validation of an instrument specifically designed to measure MRB on functioning and well-being-the Medication-Related Burden Quality of Life (MRB-QoL) tool. METHODS An initial pool of 76-items for MRB-QoL was generated. The link to MRB-QoL survey was sent to a sample of consumers living with at least one chronic medical condition and taking ≥3 prescription medicines on a regular basis. Exploratory factor analysis (EFA) was used to determine the underlining factor structure. Internal consistency (Cronbach's α) and construct validity were examined. The latter was examined through correlation with Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI) and Charlson's Comorbidity Index (CCI). RESULTS 367 consumers completed the survey (51.2% male). EFA resulted in a 31-item, five-factor solution explaining 72% of the total variance. The five subscales were labelled as 'Routine and Regimen Complexity' (11 items), 'Psychological Burden' (six items), 'Functional and Role Limitation' (seven items), 'Therapeutic Relationship' (three items) and 'Social Burden' (four items). All subscales showed good internal consistency (Cronbach's α 0.87 to 0.95). Discriminant validity of MRB-QoL was demonstrated via its correlations with MRCI (Spearman's r -0.16 to 0.08), DBI (r 0.12 to 0.28) and CCI (r -0.23 to -0.15). Correlation between DBI and 'Functional and Role Limitation' subscale (r 0.36) indicated some evidence of convergent validity. Patients with polypharmacy, multiple morbidity and DBI >0 had higher median scores of MRB-QoL providing evidence for known group validity. CONCLUSIONS The MRB-QoL V.1 has good construct validity and internal consistency. The MRB-QoL may be a useful humanistic measure for evaluating the impact of pharmaceutical care interventions on patients' quality of life. Future research is warranted to further examine additional psychometric properties of MRB-QoL V.1 and its utility in patient care.
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Affiliation(s)
- Mohammed A Mohammed
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah J Moles
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Department of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Kolling Institute of Medical Research, Sydney, New South Wales, Australia
- Cognitive Decline Partnership Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Kouladjian O'Donnel
- Department of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Kolling Institute of Medical Research, Sydney, New South Wales, Australia
- Cognitive Decline Partnership Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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21
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Negewo NA, Gibson PG, Wark PA, Simpson JL, McDonald VM. Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2929-2942. [PMID: 29062230 PMCID: PMC5638593 DOI: 10.2147/copd.s136256] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD patients are often prescribed multiple medications for their respiratory disease and comorbidities. This can lead to complex medication regimens resulting in poor adherence, medication errors, and drug–drug interactions. The relationship between clinical outcomes and medication burden beyond medication count in COPD is largely unknown. Objectives The aim of this study was to explore the relationships of medication burden in COPD with clinical outcomes, comorbidities, and multidimensional indices. Methods In a cross-sectional study, COPD patients (n=222) were assessed for demographic information, comorbidities, medication use, and clinical outcomes. Complexity of medication regimens was quantified using the validated medication regimen complexity index (MRCI). Results Participants (58.6% males) had a mean (SD) age of 69.1 (8.3) years with a postbronchodilator forced expiratory volume in 1 second % predicted of 56.5 (20.4) and a median of five comorbidities. The median (q1, q3) total MRCI score was 24 (18.5, 31). COPD-specific medication regimens were more complex than those of non-COPD medications (median MRCI: 14.5 versus 9, respectively; P<0.0001). Complex dosage formulations contributed the most to higher MRCI scores of COPD-specific medications while dosing frequency primarily drove the complexity associated with non-COPD medications. Participants in Global Initiative for Chronic Obstructive Lung Disease quadrant D had the highest median MRCI score for COPD medications (15.5) compared to those in quadrants A (13.5; P=0.0001) and B (12.5; P<0.0001). Increased complexity of COPD-specific treatments showed significant but weak correlations with lower lung function and 6-minute walk distance, higher St George’s Respiratory Questionnaire and COPD assessment test scores, and higher number of prior year COPD exacerbations and hospitalizations. Comorbid cardiovascular, gastrointestinal, or metabolic diseases individually contributed to higher total MRCI scores and/or medication counts for all medications. Charlson Comorbidity Index and COPD-specific comorbidity test showed the highest degree of correlation with total MRCI score (ρ=0.289 and ρ=0.326; P<0.0001, respectively). Conclusion In COPD patients, complex medication regimens are associated with disease severity and specific class of comorbidities.
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Affiliation(s)
- Netsanet A Negewo
- Priority Research Centre for Healthy Lungs.,Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs.,Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle
| | - Peter Ab Wark
- Priority Research Centre for Healthy Lungs.,Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs.,Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan
| | - Vanessa M McDonald
- Priority Research Centre for Healthy Lungs.,Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle.,School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
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22
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Cobretti MR, Page RL, Linnebur SA, Deininger KM, Ambardekar AV, Lindenfeld J, Aquilante CL. Medication regimen complexity in ambulatory older adults with heart failure. Clin Interv Aging 2017; 12:679-686. [PMID: 28442898 PMCID: PMC5396835 DOI: 10.2147/cia.s130832] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Heart failure prevalence is increasing in older adults, and polypharmacy is a major problem in this population. We compared medication regimen complexity using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool in "young-old" (60-74 years) versus "old-old" (75-89 years) patients with heart failure. We also compared pMRCI between patients with ischemic cardiomyopathy (ISCM) versus nonischemic cardiomyopathy (NISCM). PATIENTS AND METHODS Medication lists were retrospectively abstracted from the electronic medical records of ambulatory patients aged 60-89 years with heart failure. Medications were categorized into three types - heart failure prescription medications, other prescription medications, and over-the-counter (OTC) medications - and scored using the pMRCI tool. RESULTS The study evaluated 145 patients (n=80 young-old, n=65 old-old, n=85 ISCM, n=60 NISCM, mean age 73±7 years, 64% men, 81% Caucasian). Mean total pMRCI scores (32.1±14.4, range 3-84) and total medication counts (13.3±4.8, range 2-30) were high for the entire cohort, of which 72% of patients were taking eleven or more total medications. Total and subtype pMRCI scores and medication counts did not differ significantly between the young-old and old-old groups, with the exception of OTC medication pMRCI score (6.2±4 young-old versus 7.8±5.8 old-old, P=0.04). With regard to heart failure etiology, total pMRCI scores and medication counts were significantly higher in patients with ISCM versus NISCM (pMRCI score 34.5±15.2 versus 28.8±12.7, P=0.009; medication count 14.1±4.9 versus 12.2±4.5, P=0.008), which was largely driven by other prescription medications. CONCLUSION Medication regimen complexity is high in older adults with heart failure, and differs based on heart failure etiology. Additional work is needed to address polypharmacy and to determine if medication regimen complexity influences adherence and clinical outcomes in this population.
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Affiliation(s)
| | - Robert L Page
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO
| | - Sunny A Linnebur
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO
| | | | - Amrut V Ambardekar
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplant Program, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
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23
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Wimmer BC, Cross AJ, Jokanovic N, Wiese MD, George J, Johnell K, Diug B, Bell JS. Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review. J Am Geriatr Soc 2016; 65:747-753. [PMID: 27991653 DOI: 10.1111/jgs.14682] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To systematically review clinical outcomes associated with medication regimen complexity in older people. DESIGN Systematic review of EMBASE, MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. SETTING Hospitals, home, and long-term care. PARTICIPANTS English-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants' overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. MEASUREMENTS Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. RESULTS Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff. CONCLUSION Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization.
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Affiliation(s)
- Barbara C Wimmer
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Natali Jokanovic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael D Wiese
- Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kristina Johnell
- Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Basia Diug
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Medication management policy, practice and research in Australian residential aged care: Current and future directions. Pharmacol Res 2016; 116:20-28. [PMID: 27965033 DOI: 10.1016/j.phrs.2016.12.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 01/30/2023]
Abstract
Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting.
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