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Craske ME, Hardeman W, Steel N, Twigg MJ. Components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review and narrative synthesis. BMJ Qual Saf 2024:bmjqs-2024-017283. [PMID: 39013596 DOI: 10.1136/bmjqs-2024-017283] [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: 02/28/2024] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Pharmacist-led medication reviews are an established intervention to support patients prescribed multiple medicines or with complex medication regimes. For this systematic review, a medication review was defined as 'a consultation between a pharmacist and a patient to review the patient's total medicines use with a view to improve patient health outcomes and minimise medicines-related problems'. It is not known how varying approaches to medication reviews lead to different outcomes. AIM To explore the common themes associated with positive outcomes from pharmacist-led medication reviews. METHOD Randomised controlled trials of pharmacist-led medication reviews in adults aged 18 years and over were included. The search terms used in MEDLINE, EMBASE and Web of Science databases were "medication review", "pharmacist", "randomised controlled trial" and their synonyms, time filter 2015 to September 2023. Studies published before 2015 were identified from a previous systematic review. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Descriptions of medication reviews' components, implementation and outcomes were narratively synthesised to draw out common themes. Results are presented in tables. RESULTS Sixty-eight papers describing 50 studies met the inclusion criteria. Common themes that emerged from synthesis include collaborative working which may help reduce medicines-related problems and the number of medicines prescribed; patient involvement in goal setting and action planning which may improve patients' ability to take medicines as prescribed and help them achieve their treatment goals; additional support and follow-up, which may lead to improved blood pressure, diabetes control, quality of life and a reduction of medicines-related problems. CONCLUSION This systematic review identified common themes and components, for example, goal setting, action planning, additional support and follow-up, that may influence outcomes of pharmacist-led medication reviews. Researchers, health professionals and commissioners could use these for a comprehensive evaluation of medication review implementation. PROSPERO REGISTRATION NUMBER CRD42020173907.
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Affiliation(s)
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norwich, UK
- Research Design and Development, NHS Norfolk and Waveney ICB, Norwich, UK
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2
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Solh Dost L, Gastaldi G, Schneider MP. Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes. BMC Health Serv Res 2024; 24:620. [PMID: 38741070 DOI: 10.1186/s12913-024-10784-9] [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: 06/28/2023] [Accepted: 02/26/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients' perspectives of their medications from hospital to two months after discharge. METHODS Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted. RESULTS Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence. CONCLUSIONS The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients' difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients' needs, increase their safety, and standardize physicians', pharmacists', and nurses' roles and responsibilities.
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Affiliation(s)
- Léa Solh Dost
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
| | - Giacomo Gastaldi
- Division of Endocrinology, Diabetes, Hypertension and Nutrition, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
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Wesselink EJ, van der Vegt M, Remmelzwaal S, Bossers SM, Franssen EJ, Swart EL, Boer C, de Leeuw MA. The impact of mental state altering medications on preventable falls after total hip or total knee arthroplasty: a systematic review and meta-analysis. Patient Saf Surg 2024; 18:6. [PMID: 38347630 PMCID: PMC10863089 DOI: 10.1186/s13037-023-00387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Joint replacement surgery of the lower extremities are common procedures in elderly persons who are at increased risk of postoperative falls. The use of mental state altering medications, such as opioids, antidepressants or benzodiazepines, can further contribute to impaired balance and risk of falls. The objective of the current systematic review was to evaluate the risk of the use of mental state altering medications on postoperative falls in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS A comprehensive search of Medline, Embase and Cochrane Controlled Trials Register was conducted from 1 October 1975 to 1 September 2021. The search was repeated in may 2023 and conducted from 1 October 1975 to 1 June 2023. Clinical trials that evaluated the risk of medication on postoperative THA and TKA falls were eligible for inclusion. Articles were evaluated independently by two researchers for risk of bias using the Newcastle-Ottawa Scale. A meta-analysis was performed to determine the potential effect of postoperative use of mental state altering medications on the risk of falls. Lastly, a qualitative synthesis was conducted for preoperative mental state altering medications use. RESULTS Seven cohort studies were included, of which five studies focussed on the postoperative use of mental state altering medications and two investigated the preoperative use. Meta-analysis was performed for the postoperative mental state altering medications use. The postoperative use of mental state altering medications was associated with fall incidents (OR: 1.81; 95% CI: 1.04; 3.17) (p < 0.01) after THA and TKA. The preoperative use of opioids > 6 months was associated with a higher risk of fall incidents, whereas a preoperative opioid prescription up to 3 months before a major arthroplasty had a similar risk as opioid-naïve patients. CONCLUSIONS The postoperative use of mental state altering medications increases the risk of postoperative falls after THA and TKA. Prior to surgery, orthopaedic surgeons and anaesthesiologists should be aware of the associated risks in order to prevent postoperative falls and associated injuries.
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Affiliation(s)
- Elsbeth J Wesselink
- Department of Clinical Pharmacy, Zaans Medisch Centrum, Koningin Julianaplein 58, 1502 DV, Zaandam, The Netherlands.
- Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Anesthesiology, Boelelaan, Amsterdam, The Netherlands.
| | | | - Sharon Remmelzwaal
- Epidemiology & Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Boelelaan, Amsterdam, The Netherlands
| | - Sebastiaan M Bossers
- Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Anesthesiology, Boelelaan, Amsterdam, The Netherlands
| | - Eric J Franssen
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Eleonora L Swart
- Pharmacy and Clinical Pharmacology, Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Boelelaan, Amsterdam, The Netherlands
| | - Christa Boer
- Faculty of Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Boelelaan, Amsterdam, The Netherlands
| | - Marcel A de Leeuw
- Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Anesthesiology, Boelelaan, Amsterdam, The Netherlands
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Phimarn W, Saramunee K, Leelathanalerk A, Srimongkon P, Chanasopon S, Phumart P, Paktipat P, Babar ZUD. Economic evaluation of pharmacy services: a systematic review of the literature (2016-2020). Int J Clin Pharm 2023; 45:1326-1348. [PMID: 37233864 DOI: 10.1007/s11096-023-01590-0] [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: 10/17/2022] [Accepted: 04/01/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Economic evaluation is crucial for healthcare decision-makers to select effective interventions. An updated systematic review of the economic evaluation of pharmacy services is required in the current healthcare environment. AIM To conduct a systematic review of literature on economic evaluation of pharmacy services. METHOD Literature (2016-2020) was searched on PubMed, Web of Sciences, Scopus, ScienceDirect, and SpringerLink. An additional search was conducted in five health economic-related journals. The studies performed an economic analysis describing pharmacy services and settings. The reviewing checklist for economic evaluation was used for quality assessment. The incremental cost-effectiveness ratio and willingness-to-pay threshold were the main measures for cost-effective analysis (CEA) and cost-utility analysis (CUA), while cost-saving, cost-benefit-ratio (CBR), and net benefit were used for cost-minimization analysis (CMA) and cost-benefit analysis (CBA). RESULTS Forty-three articles were reviewed. The major practice settings were in the USA (n = 6), the UK (n = 6), Canada (n = 6), and the Netherlands (n = 6). Twelve studies had good quality according to the reviewing checklist. CUA was used most frequently (n = 15), followed by CBA (n = 12). Some inconsistent findings (n = 14) existed among the included studies. Most agreed (n = 29) that pharmacy services economically impact the healthcare system: hospital-based (n = 13), community pharmacy (n = 13), and primary care (n = 3). Pharmacy services were found to be cost-effectiveness or cost-saving among both developed (n = 32) and in developing countries (n = 11). CONCLUSION The increased use of economic evaluation of pharmacy services confirms the worth of pharmacy services in improving patients' health outcomes in all settings. Therefore, economic evaluation should be incorporated into developing innovative pharmacy services.
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Affiliation(s)
- Wiraphol Phimarn
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Kritsanee Saramunee
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand.
| | - Areerut Leelathanalerk
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Pornchanok Srimongkon
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Suratchada Chanasopon
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Panumart Phumart
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Pawich Paktipat
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
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Tyler N, Hodkinson A, Planner C, Angelakis I, Keyworth C, Hall A, Jones PP, Wright OG, Keers R, Blakeman T, Panagioti M. Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes: A Systematic Review and Network Meta-Analysis. JAMA Netw Open 2023; 6:e2344825. [PMID: 38032642 PMCID: PMC10690480 DOI: 10.1001/jamanetworkopen.2023.44825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Importance Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. Objective To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community. Data Sources CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022. Study Selection Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified. Data Extraction and Synthesis At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Main Outcomes and Measures The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake. Results Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits. Conclusions and Relevance These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Ioannis Angelakis
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Institute of Population Health, Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | | | - Alex Hall
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | | | | | - Richard Keers
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
- Pharmacy Department, Pennine Care NHS Foundation Trust, Aston-Under-Lyne, United Kingdom
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Tom Blakeman
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
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Price E, Shirtcliffe A, Fisher T, Chadwick M, Marra CA. A systematic review of economic evaluations of pharmacist services. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:459-471. [PMID: 37543960 DOI: 10.1093/ijpp/riad052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Challenges to the provision of health care are occurring internationally and are expected to increase in the future, further increasing health spending. As pharmacist roles are evolving and expanding internationally to provide individualised pharmaceutical care it is important to assess the cost-effectiveness of these services. OBJECTIVES To systematically synthesise the international literature regarding published economic evaluations of pharmacy services to assess their cost-effectiveness and clinical outcomes. METHODS A systematic review of economic evaluations of pharmacy services was conducted in MEDLINE, EMBASE, PubMed, Scopus, Web of Science, CINAHL, IPA and online journals with search functions likely to publish economic evaluations of pharmacy services. Data were extracted regarding the interventions, the time horizon, the outcomes and the incremental cost-effectiveness ratio. Studies' quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) statement. RESULTS Seventy-five studies were included in the systematic review, including 67 cost-effectiveness analyses, 6 cost-benefit analyses and 2 cost-consequence analyses. Of these, 57 were either dominant or cost-effective using a willingness-to-pay threshold of NZ$46 645 per QALY. A further 11 studies' cost-effectiveness were unable to be evaluated. Interventions considered to be most cost-effective included pharmacist medication reviews, pharmacist adherence strategies and pharmacist management of type 2 diabetes mellitus, hypertension and warfarin/INR monitoring. The quality of reporting of studies differed with no studies reporting all 28 items of the CHEERS statement. CONCLUSIONS There is strong economic evidence to support investment in extended pharmacist services, particularly those focussed on long-term chronic health conditions.
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Affiliation(s)
- Emilia Price
- Division of Health Sciences, School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Andi Shirtcliffe
- Allied Health Office of the Chief Clinical Officers System Performance and Monitoring Ministry of Health, Wellington, New Zealand
| | - Thelma Fisher
- Centre for Pacific Health Information Services, University Library, University of Otago, Dunedin, New Zealand
| | - Martin Chadwick
- Office of the Chief Clinical Officers, Ministry of Health, Wellington, New Zealand
| | - Carlo A Marra
- Division of Health Sciences, School of Pharmacy, University of Otago, Dunedin, New Zealand
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D. Meid A, Wirbka L, Moecker R, Ruff C, Weissenborn M, E. Haefeli W, M. Seidling H. Mortality and Hospitalizations Among Patients Enrolled in an Interprofessional Medication Management Program. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:253-260. [PMID: 37070272 PMCID: PMC10366959 DOI: 10.3238/arztebl.m2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/25/2022] [Accepted: 01/13/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Measures for improving medication safety in outpatient care are often complex and involve medication reviews. Over the period 2016-2022 (with a preceeding one-year pilot phase), an interprofessional medication management program- the Medicines Initiative Saxony-Thuringia (Arzneimittelinitiative Sachsen-Thüringen, ARMIN)-was implemented in two German federal states. More than 5000 patients received a medication review by the end of 2019 by a team composed of physicians and pharmacists and were provided with joint, continuous care thereafter. METHODS In the framework of a retrospectively registered cohort study, the mortality and hospitalizations of this population (5033 patients) were studied using routine data from a statutory health insurer (observation period 2015-2019) and compared with those of a control group (10 039 patients) determined from the routine data by propensity score matching. Mortality was compared by survival analysis (Cox regression), and hospitalization rates were compared in terms of event probabilities within two years of enrollment in the medication management program. Robustness was tested in multiple sensitivity analyses. RESULTS Over the observation period, 9.3% of the ARMIN participants and 12.9% of persons in the control group died (hazard ratio of the adjusted Cox regression, 0.84; 95% confidence interval [0.76; 0.94], P = 0.001). In the first two years after inclusion, the ARMIN participants were hospitalized just as often as the persons in the control group (52.4% versus 53.4%; odds ratio from the adjusted model, 1.04 [0.96; 1.11], P = 0.347). The effects were consistent in sensitivity analyses. CONCLUSION In this retrospective cohort study, participation in the ARMIN program was associated with a lower risk of death. Exploratory analyses provide clues to the potential origin of this association.
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Affiliation(s)
- Andreas D. Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
| | - Lucas Wirbka
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
| | - Robert Moecker
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
| | - Carmen Ruff
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
| | - Marina Weissenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
| | - Hanna M. Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
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8
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Oonk NGM, Dorresteijn LDA, van den Berg AD, van der Palen J, Movig KLL, Nijmeijer HW, van Kesteren ME, Koffijberg H. Cost-utility analysis of a structured medication review compared to usual care in Parkinson's disease. Eur J Clin Pharmacol 2023; 79:289-297. [PMID: 36562830 DOI: 10.1007/s00228-022-03438-4] [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: 10/10/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE For controlling symptoms in Parkinson's disease (PD) together with treating additional comorbidities, patients often face complex medication regimens, with suboptimal adherence, drug-related problems, and diminished therapy efficacy as a common consequence. A medication review could potentially tackle these issues, among others by optimizing drug treatment. Even if no change in clinical outcomes is observed, this intervention might decrease health care costs by reducing drug-related problems and hospital admissions. This study aimed to gain more insight in the health benefits and costs of a structured medication review (SMR) in PD. METHODS A cost-utility analysis was performed, based on a multicenter randomized controlled trial with 202 PD patients with polypharmacy. The intervention group received an SMR, whereas the control group received usual care. The intervention effect after 6 months of follow-up was presented as incremental quality-adjusted life years (QALY) using the EQ-5D-5L questionnaire. Costs were based on real-world data. Missing data was imputed using multiple imputation techniques. Bootstrapping was used to estimate the uncertainty in all health and economic outcomes. RESULTS The QALY gain in the intervention group compared to the control group was - 0.011 (95% CI - 0.043; 0.020). Incremental costs were €433 (95% CI - 873; 1687). When adapting a willingness-to-pay threshold of €20,000/QALY and €80,000/QALY, the probability of SMRs being cost-effective was 18% and 30%, respectively. CONCLUSION A community pharmacist-led SMR in PD patients in the current setting shows no apparent benefit and is not cost-effective after 6 months, compared to usual care. TRIAL REGISTRATION Netherlands Trial Register, NL4360. Registered 17 March 2014.
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Affiliation(s)
- N G M Oonk
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands.
| | - L D A Dorresteijn
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - A D van den Berg
- Department of Science and Technology, University of Twente, Enschede, the Netherlands
| | - J van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands.,Section Cognition, Data and Education, University of Twente, Enschede, the Netherlands
| | - K L L Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands
| | - H W Nijmeijer
- Department of Neurology, Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - M E van Kesteren
- Department of Neurology, Isala Klinieken, Zwolle, the Netherlands
| | - H Koffijberg
- Technical Medical Centre, Section Health Technology and Services Research, University of Twente, Enschede, the Netherlands
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9
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Sultan R, van den Beukel TO, Reumerman MO, Daelmans HEM, Springer H, Grijmans E, Muller M, Richir MC, van Agtmael MA, Tichelaar J. An Interprofessional Student-Run Medication Review Program: The Clinical STOPP/START-Based Outcomes of a Controlled Clinical Trial in a Geriatric Outpatient Clinic. Clin Pharmacol Ther 2022; 111:931-938. [PMID: 34729774 PMCID: PMC9299053 DOI: 10.1002/cpt.2475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022]
Abstract
As the population ages, more people will have comorbid disorders and polypharmacy. Medication should be reviewed regularly in order to avoid adverse drug reactions and medication-related hospital visits, but this is often not done. As part of our student-run clinic project, we investigated whether an interprofessional student-run medication review program (ISP) added to standard care at a geriatric outpatient clinic leads to better prescribing. In this controlled clinical trial, patients visiting a memory outpatient clinic were allocated to standard care (control group) or standard care plus the ISP team (intervention group). The medications of all patients were reviewed by a review panel ("gold standard"), resident, and in the intervention arm also by an ISP team consisting of a group of students from the medicine and pharmacy faculties and students from the higher education school of nursing for advanced nursing practice. For both groups, the number of STOPP/START-based medication changes mentioned in general practitioner (GP) correspondence and the implementation of these changes about 6 weeks after the outpatient visit were investigated. The data of 216 patients were analyzed (control group = 100, intervention group = 116). More recommendations for STOPP/START-based medication changes were made in the GP correspondence in the intervention group than in the control group (43% vs. 24%, P = < 0.001). After 6 weeks, a significantly higher proportion of these changes were implemented in the intervention group (19% vs. 9%, P = 0.001). The ISP team, in addition to standard care, is an effective intervention for optimizing pharmacotherapy and medication safety in a geriatric outpatient clinic.
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Affiliation(s)
- Rowan Sultan
- Department of Internal Medicine section PharmacotherapyAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - Tessa O. van den Beukel
- Department of Internal Medicine section PharmacotherapyAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - Michael O. Reumerman
- Department of Internal Medicine section PharmacotherapyAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - Hester E. M. Daelmans
- Skills Training DepartmentFaculty of MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | | - Majon Muller
- Department of Internal Medicine section Geriatric MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Milan C. Richir
- Department of Internal Medicine section PharmacotherapyAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - Michiel A. van Agtmael
- Department of Internal Medicine section PharmacotherapyAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine section PharmacotherapyAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
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10
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Laberge M, Sirois C, Lunghi C, Gaudreault M, Nakamura Y, Bolduc C, Laroche ML. Economic Evaluations of Interventions to Optimize Medication Use in Older Adults with Polypharmacy and Multimorbidity: A Systematic Review. Clin Interv Aging 2021; 16:767-779. [PMID: 33981140 PMCID: PMC8108125 DOI: 10.2147/cia.s304074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To conduct a systematic review of the economic impact of interventions intended at optimizing medication use in older adults with multimorbidity and polypharmacy. Methods We searched Ovid-Medline, Embase, CINAHL, Ageline, Cochrane, and Web of Science, for articles published between 2004 and 2020 that studied older adults with multimorbidity and polypharmacy. The intervention studied had to be aimed at optimizing medication use and present results on costs. Results Out of 3,871 studies identified by the search strategy, eleven studies were included. The interventions involved different provider types, with a majority described as a multidisciplinary team involving a pharmacist and a general practitioner, in the decision-making process. Interventions were generally associated with a reduction in medication expenditure. The benefits of the intervention in terms of clinical outcomes remain limited. Five studies were cost-benefit analyses, which had a net benefit that was either null or positive. Cost-utility and cost-effectiveness analyses resulted in incremental cost-effectiveness ratios that were generally within the willingness-to-pay thresholds of the countries in which the studies were conducted. However, the quality of the studies was generally low. Omission of key cost elements of economic evaluations, including intervention cost and payer perspective, limited interpretability. Conclusion Interventions to optimize medication use may provide benefits that outweigh their implementation costs, but the evidence remains limited. There is a need to identify and address barriers to the scaling-up of such interventions, starting with the current incentive structures for pharmacists, physicians, and patients.
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Affiliation(s)
- Maude Laberge
- Department of Operations & Decision Systems, Faculty of Administration, Université Laval, Quebec City, Quebec, Canada.,Vitam, Centre de recherche en santé durable-Université Laval, Quebec, Canada.,Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Caroline Sirois
- Vitam, Centre de recherche en santé durable-Université Laval, Quebec, Canada.,Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada.,Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada.,Institut National de santé publique du Québec, Quebec City, Quebec, Canada
| | - Carlotta Lunghi
- Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada.,Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Myriam Gaudreault
- Faculty of Administration, Université Laval, Quebec City, Quebec, Canada
| | - Yumiko Nakamura
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carolann Bolduc
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
| | - Marie-Laure Laroche
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur les médicaments, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, Limoges, France.,Laboratoire Vie-Santé, Faculté de Médecine, Université de Limoges, Limoges, France
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11
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Dautzenberg L, Bretagne L, Koek HL, Tsokani S, Zevgiti S, Rodondi N, Scholten RJPM, Rutjes AW, Di Nisio M, Raijmann RCMA, Emmelot-Vonk M, Jennings ELM, Dalleur O, Mavridis D, Knol W. Medication review interventions to reduce hospital readmissions in older people. J Am Geriatr Soc 2021; 69:1646-1658. [PMID: 33576506 PMCID: PMC8247962 DOI: 10.1111/jgs.17041] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective To assess the efficacy of medication review as an isolated intervention and with several co‐interventions for preventing hospital readmissions in older adults. Methods Ovid MEDLINE, Embase, The Cochrane Central Register of Controlled Trials and CINAHL were searched for randomized controlled trials evaluating the effectiveness of medication review interventions with or without co‐interventions to prevent hospital readmissions in hospitalized or recently discharged adults aged ≥65, until September 13, 2019. Included outcomes were “at least one all‐cause hospital readmission within 30 days and at any time after discharge from the index admission.” Results Twenty‐five studies met the inclusion criteria. Of these, 11 studies (7,318 participants) contributed to the network meta‐analysis (NMA) on all‐cause hospital readmission within 30 days. Medication review in combination with (a) medication reconciliation and patient education (risk ratio (RR) 0.45; 95% confidence interval (CI) 0.26–0.80) and (b) medication reconciliation, patient education, professional education and transitional care (RR 0.64; 95% CI 0.49–0.84) were associated with a lower risk of all‐cause hospital readmission compared to usual care. Medication review in isolation did not significantly influence hospital readmissions (RR 1.06; 95% CI 0.45–2.51). The NMA on all‐cause hospital readmission at any time included 24 studies (11,677 participants). Medication review combined with medication reconciliation, patient education, professional education and transitional care resulted in a reduction of hospital readmissions (RR 0.82; 95% CI 0.74–0.91) compared to usual care. The quality of the studies included in this systematic review raised some concerns, mainly regarding allocation concealment, blinding and contamination. Conclusion Medication review in combination with medication reconciliation, patient education, professional education and transitional care, was associated with a lower risk of hospital readmissions compared to usual care. An effect of medication review without co‐interventions was not demonstrated. Trials of higher quality are needed in this field.
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Affiliation(s)
- Lauren Dautzenberg
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisa Bretagne
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Huiberdina L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Stella Zevgiti
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Rob J P M Scholten
- Cochrane Netherlands/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne W Rutjes
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti, Italy
| | - Renee C M A Raijmann
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marielle Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emma L M Jennings
- School of Medicine, University College Cork, National University of Ireland, Cork, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Olivia Dalleur
- Louvain Drug Research Institute (LDRI), Clinical Pharmacy Research Group, Université catholique de Louvain-UCLouvain, Brussels, Belgium.,Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain-UCLouvain, Brussels, Belgium
| | - Dimitris Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.,Sorbonne Paris Cité, Faculté de Médecine, Paris Descartes University, Paris, France
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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12
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Luetsch K, Rowett D, Twigg MJ. A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why? BMJ Qual Saf 2020; 30:bmjqs-2020-011418. [PMID: 33127835 PMCID: PMC8070649 DOI: 10.1136/bmjqs-2020-011418] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/13/2020] [Accepted: 10/03/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Medication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes. OBJECTIVE A realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital. METHODS The realist synthesis was performed in accordance with Realist And MEta-narrative Evidence Syntheses: Evolving Standards reporting standards. An initial programme theory informed a systematic literature search of databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms. RESULTS The synthesis identified 9 contexts in which 10 mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care postdischarge. For a medication review to take place these include trust patients have in healthcare professionals, their healthcare priorities postdischarge, capacity to participate, perceptions of benefit and effort, and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients. CONCLUSIONS Medication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, programmes promote coordination and collaboration between healthcare professionals and establish trust, and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform postdischarge medication review service models.
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Affiliation(s)
- Karen Luetsch
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Debra Rowett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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