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Böhm DTMM, Berghuis K, Said M, Kerskes MCHM, Deenen MJ, Bastiaans DET. Identification of Medication-Related Risks in Bariatric Surgery Patients by Performing Structured Medication Reviews. Obes Surg 2023; 33:3932-3937. [PMID: 37882989 DOI: 10.1007/s11695-023-06889-5] [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: 03/24/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE More medication-related issues are seen with the growing demand for bariatric surgery, because of possible altered pharmacokinetics after surgery. Collaboration with a pharmacist could improve the short- and long-term safety and efficacy of pharmacotherapy in patients undergoing bariatric surgery. The aim of this study was to evaluate the impact of a structured medication review to identify medication-related risks before bariatric surgery. MATERIALS AND METHODS The impact on pharmacy-led interventions of introducing a structured medication review was evaluated in a historically controlled study. In the retrospective part, we evaluated patient characteristics, medication use, and number of pre-surgery consultations with a pharmacist before the introduction of medication reviews. A flowchart was developed to detect the use of medicines with risks associated with bariatric surgery. In the prospective part, we evaluated pharmacy-led interventions after the introduction of structured medication reviews using the flowchart. Outcome effectiveness was measured through the number of pre-surgery pharmacy-led interventions. RESULTS Before using the flowchart for screening on risk medicines, 40 (2.6%) pharmacy-led interventions were identified in 1536 patients. In the prospective group, 195 patients were included and 88 (45%) interventions were identified (p < 0.001). CONCLUSION A structured medication review before bariatric surgery significantly increased the number of pharmacy-led interventions in bariatric surgery patients. This procedure will shift interventions to pre-surgery instead of post-surgery, contributing to the optimization of pharmacotherapy at an early stage.
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Affiliation(s)
- Doortje T M M Böhm
- Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Kim Berghuis
- Obesity Center, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Mohammed Said
- Obesity Center, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Marieke C H M Kerskes
- Department of Clinical Pharmacy, Catharina Ziekenhuis, Michelangelolaan 2, 5623, EJ, Eindhoven, The Netherlands
| | - Maarten J Deenen
- Department of Clinical Pharmacy, Catharina Ziekenhuis, Michelangelolaan 2, 5623, EJ, Eindhoven, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Diane E T Bastiaans
- Department of Clinical Pharmacy, Catharina Ziekenhuis, Michelangelolaan 2, 5623, EJ, Eindhoven, The Netherlands.
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Influence of Bariatric Surgery on Levetiracetam Clinical Effectiveness: Case Series. Obes Surg 2022; 32:2795-2796. [PMID: 35687253 DOI: 10.1007/s11695-022-06135-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
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Han A, Nguyen NY, Hung N, Kamalay S. Efficacy of a Bariatric Surgery Clinic-Based Pharmacist. Obes Surg 2022; 32:2618-2624. [PMID: 35349045 PMCID: PMC9273558 DOI: 10.1007/s11695-022-06022-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the impact of a bariatric clinic-based pharmacist on inpatient length of stay, medication errors, and patient experience. Materials and Methods This was a retrospective cohort study comparing patients who received a pre-operative pharmacist consultation to historical cases without pre-operative pharmacist consultation prior to admission for bariatric surgery. A patient experience survey was administered post-operatively to the intervention group. The primary outcome was hospital length of stay (LOS). Secondary outcomes included corrected medication errors on reconciliation, pharmacist interventions, adverse drug event (ADE) prevention, and patient satisfaction. Results With 68 patients in the intervention group and 67 patients in the control group, the majority were female (76%) and received either laparoscopic Roux-en-Y gastric bypass (53%) or sleeve gastrectomy (47%). The median LOS in the intervention group was 55.5 h, which did not significantly differ from the median 57.9 h in the control group (p = 0.56). The clinic-based pharmacist made an average of 13 interventions per patient. Surveys were distributed to 73 patients with a 60% response rate. High overall satisfaction with the pre-operative pharmacist consultation was reported by 97% of patients. Conclusion Although hospital LOS did not significantly differ between groups, pre-operative pharmacist consultation prevented potential ADEs, and provided strong patient satisfaction. Having pharmacists as part of a multidisciplinary approach to bariatric surgery patient care can prevent medication-related adverse events and improve patient satisfaction. Graphic Abstract ![]()
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Affiliation(s)
- Althea Han
- Department of Pharmaceutical Sciences, University of California San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA. .,Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, 513 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Nicole Yvonne Nguyen
- Department of Pharmaceutical Sciences, University of California San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, 513 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Nancy Hung
- Department of Pharmaceutical Sciences, University of California San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, 513 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Salem Kamalay
- Department of Pharmaceutical Sciences, University of California San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, 513 Parnassus Ave, San Francisco, CA, 94143, USA
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Clements JN, Albanese NP, D'Souza JJ, Misher A, Reece S(M, Trujillo J, Whitley HP. Clinical review and role of clinical pharmacists in obesity management: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Jennifer N. Clements
- Diabetes Transition Spartanburg Regional Healthcare System Spartanburg South Carolina USA
| | - Nicole P. Albanese
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences Buffalo New York USA
| | - Jennifer J. D'Souza
- Midwestern University Chicago College of Pharmacy Downers Grove Illinois USA
| | - Anne Misher
- Patient Health Support Pharmacist Caromont Health Gastonia North Carolina USA
| | | | - Jennifer Trujillo
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado USA
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Graham YNH, Earl-Sinha C, Parkin L, Callejas-Diaz L, Fox A, Tierney C, Mahawar K, Hayes C. Evaluating a potential role for community pharmacists in post-bariatric patient nutritional support. Clin Obes 2020; 10:e12364. [PMID: 32351027 DOI: 10.1111/cob.12364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022]
Abstract
Physiological changes to the body from bariatric surgery necessitate lifelong vitamin and mineral supplementation to prevent potential nutritional deficiencies. Presently, there is no consensus on appropriate long-term follow-up in community settings for people who have undergone bariatric surgery. Current UK guidelines recommend annual monitoring of nutritional status, but little else. Semi-structured interviews were carried out with members of a high volume bariatric surgical unit and community pharmacists working in a variety of settings and locations. Data were collected between June and August 2018 and analysed using a thematic analytic framework. Twenty-five participants were recruited. Bariatric staff (n = 9) reported negligible interaction with community pharmacists but felt establishing communication and developing a potential pathway to collaborate, would provide additional support and potentially improved levels of patient compliance. Community pharmacists (n = 16) reported poor knowledge of bariatric surgery, indicating they were unable to routinely identify people who had bariatric surgery, but understood issues with absorption of vitamins. There is evident potential to involve community pharmacists in post-bariatric patient care pathways. Pharmacists possess knowledge of absorption and metabolism of supplements which could be used to actively support people who have had bariatric surgery in their changed physiological status. Education ought to focus on the functional impact of bariatric surgical procedures and interventions and the consequent nutritional recommendations required. Communication between bariatric units and community pharmacies is needed to construct a clear and formalized infrastructure of support, with remuneration for pharmacy specialist expertise agreed to ensure both financial viability and sustainability.
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Affiliation(s)
- Yitka N H Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Bariatric Surgical Unit, Directorate of Surgery, Sunderland Royal Hospital, Sunderland, UK
- Faculdad de Psicologia, Universidad Anahuac Mexico, Mexico
| | - Charlotte Earl-Sinha
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Lindsay Parkin
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Directorate of Pharmacy, Sunderland Royal Hospital, Sunderland, UK
| | | | - Ann Fox
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Sunderland Clinical Commissioning Group, Pemberton House, Sunderland, UK
| | - Callum Tierney
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Bariatric Surgical Unit, Directorate of Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Catherine Hayes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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