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Falke C, Karapinar F, Bouvy M, Emmelot M, Belitser S, Boland B, O'Mahony D, Murphy KD, Haller M, Salari P, Schwenkglenks M, Rodondi N, Egberts T, Knol W. The association between medication use and health-related quality of life in multimorbid older patients with polypharmacy. Eur Geriatr Med 2024:10.1007/s41999-024-01036-4. [PMID: 39162972 DOI: 10.1007/s41999-024-01036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE To explore the association between medication use-related factors and health-related quality of life (HRQoL) in older hospitalised multimorbid patients with polypharmacy. METHODS This cross-sectional study used the intervention arm data of the OPERAM trial (hospitalised patients ≥ 70 years with polypharmacy). HRQoL was assessed using the visual analogue scale (EQ-VAS) and the EQ-5D index score of the EuroQol questionnaire (EQ-5D-5L). Lower or higher EQ-VAS/EQ-5D was based on the median of the study population. Medication use-related factors included hyperpolypharmacy (≥ 10 medications), anticholinergic and sedative burden, appropriateness of medication (STOPP/START criteria), high-risk medication for hospital (re)admission, medication complexity and adherence. Multivariable logistic regression analysis was used to assess the association between medication use-related factors and HRQoL. RESULTS A total of 955 patients were included (mean age 79 years, 46% female, median EQ-VAS of 60, median EQ-5D of 0.60). Opioids use was associated with lower EQ-5D and EQ-VAS (aOR EQ-5D: 2.10; 95% CI 1.34-3.32, EQ-VAS: 1.59; 1.11-2.30). Hyperpolypharmacy (aOR 1.37; 1.05-1.80), antibiotics (aOR 1.64; 1.01-2.68) and high medication complexity (aOR 1.53; 1.10-2.15) were associated with lower EQ-VAS. A high anticholinergic and sedative burden (aOR 1.73; 1.11-2.69), presence of multiple prescribing omissions (aOR 1.94; 1.19-3.17) and benzodiazepine use (aOR 2.01; 1.22-3.35) were associated with lower EQ-5D. Especially in hyperpolypharmacy patients, high anticholinergic and sedative burden and medication complexity were associated with a lower HRQoL. CONCLUSION Several medication use-related factors are significantly associated with a lower HRQoL in hospitalised older patients. Medication complexity is a novel factor, which should be considered when evaluating medication use of older patients with hyperpolypharmacy.
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Affiliation(s)
- Charlotte Falke
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Fatma Karapinar
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Clinical Pharmacy, CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Marcel Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Mariëlle Emmelot
- Geriatric Medicine Department and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Svetlana Belitser
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Benoit Boland
- Institute of Health and Society (IRSS), Université Catholique de Louvain (UCLouvain), Louvain, Belgium
- Geriatric Medicine, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
- Department of Geriatric and Stroke Medicine, Cork University Hospital, Cork, Ireland
| | - Kevin D Murphy
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Moa Haller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paola Salari
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse, 61, 4056, Basel, Switzerland
- Joint Research Centre (JRC), European Commission, Ispra, Italy
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse, 61, 4056, Basel, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Toine Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Wilma Knol
- Geriatric Medicine Department and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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Naga YS, Hamdy NA, Bassiouny AE, Selim M, ElHafeez SSA. Effect of medication therapy management services on medication-burden quality of life in hemodialysis patients. BMC Nephrol 2023; 24:277. [PMID: 37730586 PMCID: PMC10512485 DOI: 10.1186/s12882-023-03332-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Hemodialysis (HD) patients commonly receive polypharmacy leading to increased likelihood of drug related problems (DRPs) and poor quality of life. Medication Therapy Management (MTM) services discover and resolve DRPs and may specifically improve Medication-burden Quality of life (MBQoL) in HD patients. We aimed to assess the effect of MTM services on DRPs and MBQoL among HD patients. METHODS A prospective pre-post study was conducted on 104 patients in an HD unit in Alexandria, Egypt. MBQoL was assessed at baseline and after three months of MTM sessions, using the Arabic, validated version of the Patient Reported Outcomes Measure of Pharmaceutical Therapy (PROMPT) questionnaire. Cohen's d test and multiple linear regression were used to assess the effect size of MTM and the factors affecting MBQoL, respectively. DRPs, adverse events and adherence were also monitored. RESULTS MBQoL improved significantly after the implementation of MTM (Cohen's d=0.88, p < 0.01) with the largest effect size in the "medicine information and relation with healthcare providers" domain. DRPs decreased significantly after MTM implementation (11.97 ± 4.65 versus 7.63 ± 3.85 per patient, p<0.001). The mean adverse events per patient were also reduced (9.69 ± 4.12 versus 6.56 ± 3.77, p < 0.001). CONCLUSION Applying MTM services presents an opportunity to improve care for HD patients by improving MBQoL, decreasing DRPs and adverse events.
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Affiliation(s)
- Yasmine Salah Naga
- Internal Medicine department, Nephrology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Noha Alaa Hamdy
- Clinical Pharmacy and Pharmacy Practice department, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Amany El Bassiouny
- Clinical pharmacist, Al Moassat University Hospital, Alexandria University, Alexandria, Egypt
| | - Mohamed Selim
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Samar Samy Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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3
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Al-Ebrahim SQ, Harrison J, Chen TF, Mohammed MA. Cross-cultural adaptation and psychometric properties of patient-reported outcome measures in Arabic speaking countries: A scoping review. Res Social Adm Pharm 2023; 19:989-1006. [PMID: 36941158 DOI: 10.1016/j.sapharm.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly recognized as an indicator of healthcare quality and safety. Over the past decades, there has been a growing interest in using PROMs in Arabic-speaking populations. However, there is a paucity of data regarding the quality of their cross-cultural adaptation (CCA) and measurement properties. OBJECTIVES To identify PROMs that have been developed, validated or cross-culturally adapted to Arabic and evaluate methodological qualities of CCA and measurement properties. METHODS MEDLINE, EMBASE, CINAHL, PsycINFO, IPA, and ISI Web of Science were searched using search terms 'PROMs', 'Arabic countries', 'CCA', and 'psychometric properties'. Measurement properties were evaluated using COSMIN quality criteria and CCA quality was assessed using the Oliveria rating method. RESULTS This review included 260 studies with 317 PROMs, focusing on psychometric testing (83.8%), CCA (75.8%), utilizing PROMs as outcome measures (13.4%), and developing PROMs (2.3%). Out of the 201 cross-culturally adapted PROMs, forward translation was the most frequently reported component of CCA (n = 178), followed by back translation (n = 174). Out of the 235 PROMs that reported measurement properties, internal consistency was the most frequently reported measurement property (n = 214), followed by reliability (n = 160) and hypotheses testing (n = 143). Other measurement properties were less reported, including responsiveness (n = 36), criterion validity (n = 22), measurement error (n = 12), and cross-cultural validity (n = 10). The strongest measurement property was hypotheses testing (n = 143), followed by reliability (n = 132). CONCLUSION There are several caveats regarding the quality of CCA and measurement properties of PROMs included in this review. Only 1 out of 317 Arabic PROMs met CCA and psychometric optimal quality criteria. Therefore, there is a need to improve the methodological quality of CCA and measurement properties of PROMs. This review provides valuable information for researchers and clinicians when choosing PROMs for practice and research. There were only 5 treatment-specific PROMs, indicating the necessity for more research focusing on development and CCA of such measures.
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Affiliation(s)
- Sundos Q Al-Ebrahim
- Pharmacy Department, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Jeff Harrison
- Pharmacy Department, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Timothy F Chen
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
| | - Mohammed A Mohammed
- Pharmacy Department, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
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Beerlage-Davids CJ, Ponjee GHM, Vanhommerig JW, Kuper IMJA, Karapinar-Çarkit F. Correlation between the number of patient-reported adverse events, adverse drug events, and quality of life in older patients: an observational study. Int J Clin Pharm 2022; 44:1434-1441. [PMID: 36243833 DOI: 10.1007/s11096-022-01481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies on medication therapy management services, e.g. medication reconciliation and medication review, do not show consistent improvements in patient's health-related quality of life. However, these services can reduce adverse drug events. AIM To evaluate the correlation between health-related quality of life and adverse events/adverse drug events reported by patients. METHOD Older patients (≥ 65 years) with polypharmacy (≥ 5 medicines) admitted to orthopaedic or surgical wards were included. Patients were contacted post-discharge to evaluate patient-reported adverse events, health-related quality of life using the EuroQol questionnaire and self-perceived health status on a 5-point Likert scale. The outcomes were the correlation between health-related quality of life and the number of adverse events/adverse drug events, and potential predictors for these events. Spearman correlation and Poisson regression were used for data analysis. RESULTS 102 patients were included. The correlation between health-related quality of life and adverse events was weak but significant (Spearman correlation coefficient: - 0.328, p = 0.001). No correlation was found for adverse drug events (- 0.064, p = 0.521). Self-perceived health status was a predictor for adverse events, not for adverse drug events. Health-related quality of life was neither a predictor for adverse events, nor for adverse drug events. CONCLUSION The correlation between the number of patient-reported adverse events, adverse drug events and health-related quality of life measured by the EuroQol was weak. There is a need for a questionnaire that includes the impact of medication use and is sensitive to outcomes that are affected by medication therapy management services.
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Affiliation(s)
- Cathelijn J Beerlage-Davids
- Department of Internal Medicine, Section of Geriatric Medicine, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Godelieve H M Ponjee
- Department of Clinical Pharmacy, Amsterdam UMC Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG Hospital, Amsterdam, The Netherlands
| | - Ingeborg M J A Kuper
- Department of Internal Medicine, Section of Geriatric Medicine, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
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Brajković A, Bićanić LA, Strgačić M, Orehovački H, Ramalho-de-Oliveira D, Mucalo I. The Impact of Pharmacist-Led Medication Management Services on the Quality of Life and Adverse Drug Reaction Occurrence. PHARMACY 2022; 10:pharmacy10050102. [PMID: 36136835 PMCID: PMC9498323 DOI: 10.3390/pharmacy10050102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
The aim of this research was to assess the impact of comprehensive medication management (CMM) services on patients’ health-related quality of life (HRQoL) and frequency of adverse drug reactions (ADRs) in older patients with cardiovascular diseases (CVDs). A prospective, pre- and post-intervention study with a one-year follow-up was conducted at the Health Care Centre Zagreb—Centre (HCZC). The Euro-Quality of Life Questionnaire 5 Dimensions 5 Levels (EQ-5D-5L) was used to measure the HRQoL at baseline (initial visit at the HCZC) and 12 months following CMM services. The ADRs collected at the initial assessment of the CMM services and throughout follow-up consultations were analyzed according to the occurrence mechanism, seriousness, expectedness and distribution of the Preferred Term according to the System Organ Class. Following the CMM intervention, 65 patients reported significant improvement in dimensions “self-care” (p = 0.011) and “usual activities” (p = 0.003), whereas no significant change was found in the “mobility” (p = 0.203), “pain/discomfort” (p = 0.173) and “anxiety/depression” (p = 0.083) dimensions and the self-rated VAS scale (p = 0.781). A total of 596 suspected ADR reports were found, the majority at patients’ initial assessment (67.3%), with a mean ± SD of 9.2 ± 16.9 per patient. The CMM services significantly reduced the rate of suspected ADRs, namely 2.7 ± 1.7 ADRs per patient at the initial assessment vs. 1.0 ± 1.5 ADRs per patient at the last consultation (p < 0.001). The obtained results indicate that CMM services may improve patients’ HRQoL. Additionally, as CMM services diminished the proportion of ADRs following 1-year patient follow-up, they may serve as a viable solution for safety management.
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Affiliation(s)
- Andrea Brajković
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Lucija Ana Bićanić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Marija Strgačić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Djenane Ramalho-de-Oliveira
- Centre for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Iva Mucalo
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
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Jennings ELM, O’Mahony D, Gallagher PF. Medication-related quality of life (MRQoL) in ambulatory older adults with multi-morbidity and polypharmacy. Eur Geriatr Med 2022; 13:579-583. [PMID: 34676497 PMCID: PMC9151516 DOI: 10.1007/s41999-021-00573-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess medication-related quality-of-life (MRQoL) in multi-morbid older adults with polypharmacy and correlations with medications, frailty and health-related QoL. METHODS With a cross sectional study of multi-morbid geriatric medicine outpatients, we assessed MRQoL (MRQol-LSv1), frailty status, potentially inappropriate medications, Medication Adherence Rating Scale (MARS), health-related-QoL (Short-Form 12, SF12) and medication burden (Living with Medicines Questionnaire, LMQv2). RESULTS One-in-four (n = 59) of 234 outpatient attendees met inclusion criteria. Almost half (n = 106, 45%) were excluded due to cognition (MMSE < 26). Included participants (n = 27, mean age 80.2 years) experienced a median of 11 (IQR 9-13.5) co-morbidities and were prescribed a median of 10 (IQR 8-12.25) medications. Overall, MRQoL-LS.v.1 scores were low, suggesting good medication-related quality of life (median MRQoL-LS.v.1 score of 14, IQR 14-22). Correlations between MRQoL, number of daily medications, co-morbidity burden, LMQv2 score, SF12 scores and number of PIMs were non-significant. CONCLUSION MRQoL-LSv.1 is unsuitable for most patients attending geriatric ambulatory services.
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Affiliation(s)
- Emma L. M. Jennings
- Department of Medicine (Geriatric Medicine), University College Cork, Wilton, T12 DC4A Cork Ireland
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork Ireland
| | - Denis O’Mahony
- Department of Medicine (Geriatric Medicine), University College Cork, Wilton, T12 DC4A Cork Ireland
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork Ireland
| | - Paul F. Gallagher
- Department of Medicine (Geriatric Medicine), University College Cork, Wilton, T12 DC4A Cork Ireland
- Department of Medicine (Geriatric Medicine), Bon Secours Hospital, Cork, Ireland
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The Effect of Electroacupuncture Treatment with Different Intensities for Functional Diarrhea: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2564979. [PMID: 35027932 PMCID: PMC8752238 DOI: 10.1155/2022/2564979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/11/2021] [Indexed: 12/15/2022]
Abstract
Background Electroacupuncture (EA) may have a role in the treatment of diarrhea symptoms. However, the efficacy and safety of EA with different current intensities in improving gastrointestinal function, psychology, and quality of life (QOL) of functional diarrhea (FD) remain unknown. Objective To investigate the efficacy and safety of EA with different current intensities in improving gastrointestinal function, psychology, and QOL for FD patients. Methods 73 FD patients were randomly divided into three groups: low current intensity group (LI) of EA, high current intensity group (HI) of EA, and loperamide control group (LC). Four weeks of treatment were provided in the three groups. The primary outcome was the proportion of normal defecation. Additional outcomes included the change from baseline for the weekly spontaneous bowel movements (SBMs) and the change from baseline for the mean Bristol Stool Form Scale (BSFS). QOL was assessed by the 36-item short-form health survey (SF-36). Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess the psychology state. Results Low current intensity of EA significantly improved the proportion of normal defecation during treatment and follow-up period (P < 0.01). EA significantly improves the mean BSFS scores and weekly SBMs, and this efficacy is equivalent to loperamide (P < 0.05). The SF-36 scores of general health in LI and HI groups and vitality and mental health in LI group were significantly increased compared to baseline (P < 0.05). Low current intensity of EA can significantly improve SAS and SDS scores (P < 0.05). Conclusions EA significantly improved stool consistency and weekly SBMs in FD patients. Compared with loperamide, low current intensity of EA may have a better sustainable effect in restoring normal defecation in patients with FD, and it can also effectively improve QOL, anxiety, and depression. However, larger sample sizes are needed to determine safety and efficacy. Trial registration number: NCT01274793.
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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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Schulz M, Griese-Mammen N, Schumacher PM, Anker SD, Koehler F, Ruckes C, Rettig-Ewen V, Wachter R, Trenk D, Böhm M, Laufs U. The impact of pharmacist/physician care on quality of life in elderly heart failure patients: results of the PHARM-CHF randomized controlled trial. ESC Heart Fail 2020; 7:3310-3319. [PMID: 32700409 PMCID: PMC7754956 DOI: 10.1002/ehf2.12904] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/10/2020] [Accepted: 07/13/2020] [Indexed: 01/12/2023] Open
Abstract
Aims Patients with heart failure (HF) have impaired quality of life (QoL). The randomized controlled trial PHARM‐CHF investigated whether an interdisciplinary intervention consisting of regular contacts with the community pharmacy and weekly dosing aids improves medication adherence in patients with HF. It is unknown how an intervention involving frequent structured pharmacy visits affects QoL. Our aim was to explore adherence to the intervention and effects on QoL. Methods and results Among 237 patients, n = 110 were randomized to pharmacy care and n = 127 to usual care. The pharmacy care group received a medication review followed by (bi‐)weekly dose dispensing and counselling. The median follow‐up was 2.0 years [inter‐quartile range (IQR) 1.2–2.7]. Median interval between pharmacy visits was 8.4 days (IQR 8.0–10.3) and the visits lasted in median 14 min (IQR 10–15). Median adherence to the intervention was 96% (IQR 84–100). QoL at 365 days was predefined as a main secondary and at 730 days as another secondary endpoint in PHARM‐CHF. QoL was measured by the Minnesota Living with Heart Failure Questionnaire; and for 111 patients (n = 47 in the pharmacy care group and n = 64 in the usual care group), data were available at baseline, and after 365 and 730 days (mean age 74 years; 41% female). Improvement in QoL was numerically higher in the pharmacy care group after 365 days and was significantly better after 730 days (difference in total scores −7.7 points [−14.5 to −1.0]; P = 0.026) compared to the usual care group. In all subgroups examined, this treatment effect was preserved. Improvements in the physical and emotional dimensions were numerically higher in the pharmacy care group after 365 days and were significantly better after 730 days: −4.0 points [−6.9 to −1.2]; P = 0.006, and −1.9 points [−3.7 to −0.1]; P = 0.039, respectively. Conclusions A pharmacy‐based interdisciplinary intervention was well received by the patients and suggests clinically important improvements in QoL.
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Affiliation(s)
- Martin Schulz
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.,Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Nina Griese-Mammen
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Pia M Schumacher
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Friedrich Koehler
- Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials, University Medical Centre Mainz, Mainz, Germany
| | | | - Rolf Wachter
- Department of Cardiology, University Hospital, Leipzig University, Leipzig, Germany
| | - Dietmar Trenk
- Department of Clinical Pharmacology, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Michael Böhm
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Hospital, Leipzig University, Leipzig, Germany
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Lech LVJ, Jónsdóttir ED, Niclasen J, Treldal C, Graabæk T, Almarsdóttir AB. Translation and psychometric validation of a Danish version of the medication-related quality of life scale. Int J Clin Pharm 2020; 42:667-676. [PMID: 32026349 DOI: 10.1007/s11096-020-00979-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/22/2020] [Indexed: 11/29/2022]
Abstract
Background Generic and disease specific health-related quality of life scales have been found to be non-responsive to changes in medications in polypharmacy patients. The Taiwanese medication-related quality of life (MRQoL) scale aims to measure the effect of medication use on patients' quality of life. Objective To evaluate the psychometric properties of the Danish translation of MRQoL in a population of patients with polypharmacy. Setting Polypharmacy patients waiting for services at a community pharmacy or hospital in Denmark. Method The original MRQoL included 14 items. It was forward-translated into Danish and backward-translated into Chinese according to a modified translation protocol proposed by Sousa and Rojjanasrirrat et al. The translation was pre-tested, adjusted, and administered to polypharmacy patients. The factor structure was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency reliability was evaluated, and criterion validity assessed using the beliefs about medicines questionnaire (BMQ) and SF-12v2. Known-group validity was carried out on age, number of medicines and setting. Main outcome measure Validity of the Danish version of the MRQoL-scale. Results 164 patients completed the questionnaire. EFA of all 14 items resulted in a two-factor structure, accounting for 72.8% of the total variance. The two factors were named "Energy/Concentration" (7 items) and "Feelings/Social" (7 items). Items correlating over 0.80 were removed leaving 11 items (Model 1). This model was further reduced to 8 items (Model 2) based on Cronbach's alpha. CFA confirmed the two-factor structure of both models. Model 2 fitted data without having to define covariations between error terms. Both factors showed high internal consistency reliability (Cronbachs' alpha 0.901-0.932). Ceiling effects were detected for both factors. Criterion validity was demonstrated via its significant correlations with SF-12vs2 subscales (Spearman's rho 0.340-0.353) and BMQ Concern (Spearman's rho - 0.451 to - 0.347). There was a statistically significant difference in relation to total scores of the MRQoL for age and number of drugs taken, indicating known-group validity. Conclusion The Danish translation of the MRQoL instrument showed measurement properties indicating a well-defined two-factor structure with high internal reliability, concurrent criterion validity, and known group validity. However, challenges remain with ceiling effects and efforts should be put into further development of the instrument.
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Affiliation(s)
- Laura Victoria Jedig Lech
- The Social and Clinical Pharmacy Research Group, Department of Pharmacy, University of Copenhagen, Universitetsparken 2, Copenhagen, Denmark.
| | - Elín Dröfn Jónsdóttir
- Faculty of Pharmaceutical Sciences, University of Iceland, Hagi, Hofsvallagata 53, 107, Reykjavík, Iceland
| | - Janni Niclasen
- Frederikshøj Skole og dagbehandling, Primulavej 2, Vanløse, Denmark
- Steno Diabetes Center Copenhagen, Capital Region of Denmark, Niels Steensens Vej 6, Gentofte, Denmark
| | - Charlotte Treldal
- Clinical Research Center, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Hvidovre, Denmark
- Capital Region Pharmacy, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Hvidovre, Denmark
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, Copenhagen, Denmark
| | - Trine Graabæk
- The Social and Clinical Pharmacy Research Group, Department of Pharmacy, University of Copenhagen, Universitetsparken 2, Copenhagen, Denmark
- The Research Unit, Hospital Pharmacy Funen, Odense University Hospital, Solfaldsvej 38, Odense C, Denmark
| | - Anna Birna Almarsdóttir
- The Social and Clinical Pharmacy Research Group, Department of Pharmacy, University of Copenhagen, Universitetsparken 2, Copenhagen, Denmark
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Does Deprescribing Improve Quality of Life? A Systematic Review of the Literature. Drugs Aging 2019; 36:1097-1110. [DOI: 10.1007/s40266-019-00717-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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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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