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Schiek S, Hintzer K, Dahley C, Wernecke K, Feindt B, Baerwald C, Spiegl UJA, Bertsche T. Symptoms of older orthopedic and rheumatic patients : A telephone survey about symptoms, symptom communication, treatment and further support after hospital discharge. Z Gerontol Geriatr 2024; 57:50-58. [PMID: 36692537 PMCID: PMC10827833 DOI: 10.1007/s00391-022-02155-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/13/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND In older multimorbid orthopedic and rheumatic patients, data on symptoms besides pain or reduced mobility are rarely published. OBJECTIVE We investigated patients' perspectives on their symptoms after hospital discharge. MATERIAL AND METHODS Orthopedic and rheumatic patients aged over 70 years were asked via telephone interviews about (i) their symptoms, (ii) communication, (iii) treatment, and (iv) support. RESULTS (i) The 60 participants (35 women and 25 men) reported a median of 6 (min-max: 1-14) different symptoms, of which 86% (356 of 415) had existed before hospitalization, (ii) patients did not communicate 28% (117) of symptoms to either healthcare professionals, family or friends and (iii) 52 (87%) patients desired improvement. Of the 280 most impairing symptoms, 19% (52) were not treated at all. (iv) Almost all patients (59; 98%) considered it easy to obtain support. CONCLUSION Remarkably, many symptoms were not communicated or treated despite the patients having been hospitalized.
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Affiliation(s)
- Susanne Schiek
- Department of Clinical Pharmacy, Institute of Pharmacy, Leipzig University, Bruederstraße 32, 04103, Leipzig, Germany
- Drug Safety Center, University Hospital Leipzig and Leipzig University, Leipzig, Germany
| | - Katharina Hintzer
- Department of Clinical Pharmacy, Institute of Pharmacy, Leipzig University, Bruederstraße 32, 04103, Leipzig, Germany
- Drug Safety Center, University Hospital Leipzig and Leipzig University, Leipzig, Germany
| | - Carolin Dahley
- Department of Clinical Pharmacy, Institute of Pharmacy, Leipzig University, Bruederstraße 32, 04103, Leipzig, Germany
- Drug Safety Center, University Hospital Leipzig and Leipzig University, Leipzig, Germany
| | - Kathrin Wernecke
- Department of Clinical Pharmacy, Institute of Pharmacy, Leipzig University, Bruederstraße 32, 04103, Leipzig, Germany
- Drug Safety Center, University Hospital Leipzig and Leipzig University, Leipzig, Germany
| | - Birgit Feindt
- Central Patient Management, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Baerwald
- Department of Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich J A Spiegl
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Thilo Bertsche
- Department of Clinical Pharmacy, Institute of Pharmacy, Leipzig University, Bruederstraße 32, 04103, Leipzig, Germany.
- Drug Safety Center, University Hospital Leipzig and Leipzig University, Leipzig, Germany.
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2
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Vicente-Oliveros N, Gramage-Caro T, Corral de la Fuente E, Delgado-Silveira E, Álvarez-Díaz AM. Analysis of adverse drug events as a way to improve cancer patient care. Eur J Hosp Pharm 2023; 31:27-30. [PMID: 35332064 PMCID: PMC10800239 DOI: 10.1136/ejhpharm-2021-003199] [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: 12/28/2021] [Accepted: 03/08/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To define the signals that a new artificial intelligence (AI) system must emit to improve adverse drug events (ADEs) management in oral antineoplastic agents (OAA). METHODS A multidisciplinary group of experts in patient safety was set up to define what signals the new AI system must emit to improve ADEs management in OAAs. The baseline data for the new AI system were generated through an observational and ambispective study carried out in a university hospital. All patients who met the inclusion criteria were selected consecutively every working day for 6 months. The ADEs were collected by interview and by the review of health records. The ADEs were categorised according to how they could be detected: patient, analysis, examination. RESULTS The group defined what signals the AI system must emit to improve ADEs management in OAAs: a signal to educate the patient when the possible ADEs were categorised as patient, a signal as a reminder to request a blood test or a microbiological culture when the possible ADEs were categorised as analysis, and a signal as a reminder for the necessity of a clinical examination when the possible ADEs were categorised as examination. A total of 1652 ADEs were reported in the interviews (ADE-interview) with the pharmacist, and doctors noted 1989 ADEs in the health record (ADE-HR). The most frequent ADEs were identified in the patient category. CONCLUSION This study opens a new way for better management of ADEs and is the first step in the development of a future technology, which will improve the quality of life of patients.
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Affiliation(s)
| | | | - Elena Corral de la Fuente
- Early Phase Clinical Drug Development in Oncology, South Texas Accelerated Research Therapeutics (START). Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain
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3
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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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4
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Scott S, Atkins B, Martin-Kerry JM, Pritchard M, Alldred DP, Clark AB, Colles A, Hammond A, Murphy K, Keevil VL, Kellar I, Patel M, Sims E, Taylor J, Turner D, Witham M, Wright D, Bhattacharya D. CompreHensive geriAtRician-led MEdication Review (CHARMER): protocol for a feasibility study of a hospital deprescribing behaviour change intervention. BMJ Open 2023; 13:e075795. [PMID: 37541754 PMCID: PMC10407388 DOI: 10.1136/bmjopen-2023-075795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Over 50% of older adults are prescribed a medicine where the risk of harm outweighs the chances of benefit. During a hospital admission, older adults and carers expect medicines to be reviewed for appropriateness and any inappropriate medicines proactively deprescribed. While the principle of proactive deprescribing is an expectation of good prescribing practice, it is yet to become routine. The CompreHensive geriAtRician-led MEdication Review (CHARMER) study aims to develop and test a five-component behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe inappropriate medicines with older adults in hospital. This study aims to test the feasibility and acceptability of study processes and CHARMER implementation. METHODS AND ANALYSIS A two-arm purposive allocation feasibility study is being undertaken at four acute hospitals in England, UK (three intervention and one control). The target sample is 400 patients across all hospitals. Primary outcome measures are: (1) participant recruitment rate and (2) participant attrition rate. Secondary outcome measures are: (1) hospital readmission rate; (2) mortality rate and (3) quality of life. Quantitative data will be checked for completeness and quality, and practitioner and patient demographics descriptively analysed. We will undertake a rapid qualitative analysis on observations, interviews and study meeting minutes data. A subsequent thematic analysis will be undertaken with codes mapped to the Theoretical Domains Framework and Normalisation Process Theory. Triangulation of qualitative and quantitative data will be undertaken. ETHICS AND DISSEMINATION Ethics approval was obtained from Wales Research Ethics Committee 1 (IRAS ID 312494) and study approval from the Health Research Authority (22/WA/0087). Informed consent will be sought from all hospital staff involved in data collection activities and for patients involved in enhanced data collection activities. The findings of this study will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION ISRCTN11899506.
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Affiliation(s)
- Sion Scott
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | - Bethany Atkins
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Megan Pritchard
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Antony Colles
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amber Hammond
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Katherine Murphy
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | - Victoria L Keevil
- Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Martyn Patel
- Norwich Medical School, University of East Anglia, Norwich, UK
- Older People's Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Erika Sims
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Miles Witham
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
- AGE Research Group, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - David Wright
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
- School of Pharmacy, University of Bergen, Bergen, Norway
| | - Debi Bhattacharya
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
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5
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Atmaja DS, Yulistiani, Suharjono, Zairina E. Detection tools for prediction and identification of adverse drug reactions in older patients: a systematic review and meta-analysis. Sci Rep 2022; 12:13189. [PMID: 35915219 PMCID: PMC9341414 DOI: 10.1038/s41598-022-17410-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Tools to accurately predict and detect adverse drug reactions (ADR) in elderly patients have not been developed. We aimed to identify and evaluate reports on tools that predict and detect ADR in elderly patients (≥ 60 years). In this review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Databases were searched until January 2022 using key terms “elderly,” “adverse drug reaction,” and “detection instruments.” Eighteen studies met the inclusion criteria, and they examined assorted interventions: STOPP/START version 1/2 (n = 10), Beers Criteria 2012 or 2015 (n = 4), Systematic Tool to Reduce Inappropriate Prescribing (STRIP) (n = 2), Tool to Reduce Inappropriate Medications (TRIM) (n = 1), Medication Risk Score (MERIS) (n = 1), Computerized alert systems (n = 1), and Norwegian General Practice-Nursing Home criteria (n = 1). The interventions affected the number of potential prescription omissions (OR, 0.50 [0.37–0.69]; p < 0.0001; four studies). No apparent reduction in the number of drug interactions within 2 months (OR, 0.84 [0.70–1.02]; p = 0.08; two studies) and mortality (OR, 0.92 [0.76–1.12]; p = 0.41; three studies) was observed. In conclusion, there is no definitive and validated assessment tool for detecting and predicting ADR in elderly patients. Thus, more research on refining existing tools or developing new ones is warranted.
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Affiliation(s)
- Dewi Susanti Atmaja
- Doctoral Program of Pharmaceutical Science, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Department of Pharmacy, Faculty of Health, Universitas Sari Mulia, Banjarmasin, Indonesia
| | - Yulistiani
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Arlangga, Jalan Dokter Ir. Haji Soekarno, Mulyorejo, Surabaya, 60115, Jawa Timur, Indonesia
| | - Suharjono
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Arlangga, Jalan Dokter Ir. Haji Soekarno, Mulyorejo, Surabaya, 60115, Jawa Timur, Indonesia
| | - Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Arlangga, Jalan Dokter Ir. Haji Soekarno, Mulyorejo, Surabaya, 60115, Jawa Timur, Indonesia. .,Innovative Pharmacy Practice and Integrated Outcome Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia. .,Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia.
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6
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Lim R, Ellett LK, Roughead EE, Cheah PY, Masnoon N. Patient-Reported Questionnaires to Identify Adverse Drug Reactions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211877. [PMID: 34831635 PMCID: PMC8624083 DOI: 10.3390/ijerph182211877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022]
Abstract
Background: This systematic review aims to summarise available patient-reported questionnaires to detect adverse drug reactions (ADRs) that can be utilised by healthcare professionals in clinical practice and to summarise the psychometric properties (validity, reliability, and responsiveness) of the questionnaires. Methods: A systematic literature search was conducted using Medline, Pubmed, Embase, and Emcare databases to screen for articles published between January 2000 and July 2020. Data items regarding validity, reliability, and responsiveness were extracted independently by two authors. The methodological quality was assessed using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) checklist. Results: A total of 1563 unique article titles were identified after removing duplicates. Following shortlisting of relevant articles, 19 patient-reported ADR questionnaires were identified. Questionnaires most commonly focused on mental health medications (42.1%, n = 8), followed by general questionnaires applicable to any medication (21.1%, n = 4). Many questionnaires did not report assessing the validity and reliability of the measurement tool. For example, only 11 questionnaires (58%) mentioned assessing content validity, in addition to criterion or construct testing. Conclusion: This systematic review summarised the available patient-reported questionnaires that can be used in research and clinical practice to identify ADRs. Results of this systematic review highlight the need for more robust validity and reliability testing when developing patient-reported ADR questionnaires.
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Affiliation(s)
- Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (L.K.E.); (E.E.R.)
- Correspondence:
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (L.K.E.); (E.E.R.)
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (L.K.E.); (E.E.R.)
| | - Phaik Yeong Cheah
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK;
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7FZ, UK
| | - Nashwa Masnoon
- Laboratory of Ageing and Pharmacology, Kolling Institute, University of Sydney, St Leonards, NSW 2064, Australia;
- Department of Pharmacy, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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7
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Kosse LJ, Weits G, Vonkeman HE, Tas SW, Hoentjen F, Van Doorn MB, Spuls PI, D'Haens GR, Nurmohamed MT, van Puijenbroek EP, Van Den Bemt BJ, Jessurun NT. Patients' perspectives on a drug safety monitoring system for immune-mediated inflammatory diseases based on patient-reported outcomes. Expert Opin Drug Saf 2021; 20:1565-1572. [PMID: 34348543 DOI: 10.1080/14740338.2021.1963436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) on adverse drug reactions (ADRs) are increasingly used in cohort event monitoring (CEM) to obtain a better understanding of patients' real-world experience with drugs. Despite the leading role for patients, little is known about their perspectives on CEM systems. RESEARCH DESIGN AND METHODS In a cross-sectional open survey following the rationale of the Technology Acceptance Model, we aimed to obtain insight in patients' perspectives on the perceived usefulness, ease of use and attitude toward using a PRO-based drug safety monitoring system for ADRs attributed to biologics. RESULTS Patients considered structural reporting of ADRs in web-based questionnaires as useful and not burdensome. It was preferred to link the questionnaire frequency to regular hospital consultations or the biologic administration schedule. Various respondents were interested in sharing questionnaires with their medical specialist (49.0%) or pharmacist (34.2%), and suggested to minimize the questionnaire frequency in case of an unaltered situation or absence of ADRs. CONCLUSIONS Patients' perspectives should be considered in the setup of PRO-based CEM studies, as this contributes to data quality and patient centeredness. Since incorporation of patients' perspectives in CEM studies is indispensable, a delicate balance should be found between user-friendliness and study aims.
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Affiliation(s)
- Leanne J Kosse
- Netherlands Pharmacovigilance Centre Lareb, 's-hertogenbosch, The Netherlands
| | - Gerda Weits
- Netherlands Pharmacovigilance Centre Lareb, 's-hertogenbosch, The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Sander W Tas
- Department of Rheumatology & Clinical Immunology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Infection & Immunity Institute and Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology, Radboudumc, Nijmegen, The Netherlands
| | | | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Department of Rheumatology, Reade and Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, The Netherlands
| | - Eugène P van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 's-hertogenbosch, The Netherlands.,University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Pharmacoeconomics, Groningen, The Netherlands
| | - Bart Jf Van Den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboudumc, Nijmegen, The Netherlands
| | - Naomi T Jessurun
- Netherlands Pharmacovigilance Centre Lareb, 's-hertogenbosch, The Netherlands
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8
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Ponjee GHM, van de Meerendonk HWPC, Janssen MJA, Karapinar-Çarkit F. The effect of an inpatient geriatric stewardship on drug-related problems reported by patients after discharge. Int J Clin Pharm 2020; 43:191-202. [PMID: 32909222 DOI: 10.1007/s11096-020-01133-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Background Drug-related problems after discharge are common among older adults with polypharmacy. Medication review during hospitalization has been proposed as one solution. Inpatient medication review is often based on clinical records only. An obstacle is the lack of insight into the outpatient history. Therefore, a geriatric stewardship was designed and involved an inpatient medication review by a hospital pharmacist and geriatrician based on (I) clinical records to draft initial recommendations, (II) consultations with primary care providers (general practitioner and community pharmacist) to discuss the hospital-based recommendations, (III) patient interviews to assess their needs, and (IV) a multidisciplinary evaluation of all previous steps to draft final recommendations. Objective To assess the effect of the geriatric stewardship on drug-related problems reported by patients after discharge. Setting General teaching hospital. Methods An implementation study (pre-post design) was performed. Orthopaedic and surgical patients (≥ 65 years) with polypharmacy and a frailty risk factor were included. The pre-group received usual care, the post-group received the geriatric stewardship intervention. Two weeks post-discharge, patient-reported drug-related problems were assessed using a validated questionnaire. Drug-related problems were classified into drug-related complaints, practical problems, and questions about medication. Outcomes The outcomes were the number and type of drug-related problems per patient (primary) and the number of initial recommendations that were altered due to primary care provider and patient input (secondary). Results In total, 127 patients were analysed (usual care n = 74, intervention n = 53). Intervention patients reported fewer drug-related problems compared to usual care: 2.8 versus 3.3 per patient (Adjusted relative risk 0.83, 95% confidence interval 0.66-1.05). This difference resulted from a halving in drug-related complaints (p < 0.05), for example pain, drowsiness, nausea or constipation. Nearly 30% of the initial recommendations based on the clinical records were discarded or modified after primary care provider consultations and patient interviews. Conclusion The geriatric stewardship did not significantly reduce drug-related problems, but it significantly halved drug-related complaints. One-in-three initial recommendations were altered due to primary care provider and patient input. Inpatient medication reviews should not be based on clinical records only; they require transmural collaboration and patient participation to ensure continuity of patient care.
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Affiliation(s)
- Godelieve H M Ponjee
- Department of Clinical Pharmacy, OLVG Hospital, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, Amsterdam UMC-AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Henk W P C van de Meerendonk
- Section of Geriatric Medicine, Department of Internal Medicine, OLVG Hospital, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands
| | - Marjo J A Janssen
- Department of Clinical Pharmacy, OLVG Hospital, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands.
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9
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Gordijn R, Teichert M, Nicolai MPJ, Elzevier HW, Guchelaar HJ. Adverse drug reactions on sexual functioning: a systematic overview. Drug Discov Today 2019; 24:890-897. [PMID: 30690197 DOI: 10.1016/j.drudis.2019.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/12/2018] [Accepted: 01/17/2019] [Indexed: 12/22/2022]
Abstract
Adverse drug reactions (ADRs) that diminish sexual functioning can seriously affect a person's quality of life and can also affect drug adherence. However, no comprehensive overview on the subject is available and a lack of knowledge among healthcare professionals might be present. This systematic review of Summary of Products Characteristics identified 346 drugs registered with at least one sexual ADR. The drug class 'nervous system' (N) was represented most frequently with 105 drugs, followed by 'cardiovascular system' (C) with 89 drugs. For 16 drugs an incidence rate for sexual ADR of >10% was reported and for 98 drugs there was an incidence rate >1%. Because sexual ADRs occur in frequently used drugs, they should be considered in clinical practice to optimize drug treatment.
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Affiliation(s)
- Rineke Gordijn
- Leiden University Medical Center, Department of Clinical Pharmacy & Toxicology, Leiden, The Netherlands.
| | - Martina Teichert
- Leiden University Medical Center, Department of Clinical Pharmacy & Toxicology, Leiden, The Netherlands
| | | | - Henk W Elzevier
- Leiden University Medical Center, Department of Urology and Medical Decision Making, The Netherlands
| | - Henk-Jan Guchelaar
- Leiden University Medical Center, Department of Clinical Pharmacy & Toxicology, Leiden, The Netherlands
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10
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Jordan S, Logan PA, Panes G, Vaismoradi M, Hughes D. Adverse Drug Reactions, Power, Harm Reduction, Regulation and the ADRe Profiles. PHARMACY 2018; 6:E102. [PMID: 30231573 PMCID: PMC6165166 DOI: 10.3390/pharmacy6030102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 12/15/2022] Open
Abstract
The power and influence of healthcare systems comes largely from the ability to prescribe efficacious medicine. However, medicine can sometimes cause harm rather than bring benefits. Systematically checking patients for the adverse effects of medicines, as listed in manufacturers' literature, would protect patients from iatrogenic harm, but this is rarely undertaken. We argue for the benefits of this approach using the example of the prescription of antipsychotics to older adults. Prescribing antipsychotics to control challenging behaviours associated with dementia is a controversial matter, and regulatory intervention is under discussion. Improved regulatory systems could protect against iatrogenic harm, such as over-sedation, falls, tremor, or drug-induced Parkinsonism. However, measuring the impact and outcomes of regulatory interventions has proved difficult, not least because there are rarely systematic records of all adverse effects of medicines. We indicate how regulatory initiatives to reduce antipsychotic prescribing can be supported by systematic monitoring and documentation of patients' signs and symptoms of putative adverse drug reactions. Monitoring documentation then provides the rationale and support for professionals' responses to identified problems. Longitudinal monitoring records would improve understanding of the impact and outcomes of adverse drug reactions (ADRs) on health and wellbeing, and the many costs of ADRs.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK.
| | - Patricia A Logan
- Faculty of Science, Charles Sturt University, Bathurst Campus, NSW 2795, Australia.
| | - Gerwyn Panes
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK.
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway.
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK.
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Verdoorn S, Kwint HF, Blom J, Gussekloo J, Bouvy ML. DREAMeR: Drug use Reconsidered in the Elderly using goal Attainment scales during Medication Review; study protocol of a randomised controlled trial. BMC Geriatr 2018; 18:190. [PMID: 30143003 PMCID: PMC6109293 DOI: 10.1186/s12877-018-0877-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/13/2018] [Indexed: 11/23/2022] Open
Abstract
Background Clinical medication reviews (CMR) are increasingly performed in older patients with polypharmacy. Studies have shown positive effects of CMR on process- and intermediate outcomes, like drug-related problems (DRPs). Little effect has been shown on clinical outcomes, like hospital admissions or health-related quality of life (HR-QoL). In particular, HR-QoL is related to the individual health-related goals and complaints of patients. The aim of this study is to investigate the effects of a CMR focused on personal goals on HR-QoL and health-related complaints in older patients with polypharmacy. Methods A randomised controlled trial will be performed in 35 Dutch community pharmacies aiming to include 630 patients aged 70 years and older using seven or more chronic drugs. Patients will be randomly assigned to control or intervention group by block-randomisation per pharmacy. Patients in the intervention group receive a CMR focused on patients’ preferences, personal goals and health-related complaints. With every goal a goal attainment scale (GAS) will be proposed. Primary outcome measures are HR-QoL, measured with the EQ-5D-5L and EQ-VAS and the number of health-related complaints per patient measured with a written questionnaire, during a follow-up period of six months. Secondary outcomes are healthcare utilisation, number and type of drug changes, number and type of health-related goals, scores on GAS and number and type of DRPs and interventions. Discussion This study is expected to add evidence on the effects of a CMR on HR-QoL and health-related complaints in older patients with polypharmacy. New in this study is the use of personal goals measured with GAS and health-related complaints as patient-related outcome measures. Trial registration Netherlands Trial Register; NTR5713.
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Affiliation(s)
- Sanne Verdoorn
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. .,SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands.
| | - Henk-Frans Kwint
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | - Jeanet Blom
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Internal Medicine, section Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
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12
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Schoenmakers TWA, Wensing M, De Smet PAGM, Teichert M. Patient-reported common symptoms as an assessment of interventions in medication reviews: a randomised, controlled trial. Int J Clin Pharm 2017; 40:126-134. [PMID: 29209863 PMCID: PMC5840243 DOI: 10.1007/s11096-017-0575-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/30/2017] [Indexed: 12/28/2022]
Abstract
Background A 'Patient-Reported Outcome Measure, Inquiry into Side Effects' (PROMISE) instrument was developed for patients to report common symptoms in clinical medication reviews. Objective To determine changes in patient-reported drug-associated symptoms collected by PROMISE before and after community pharmacist-led clinical medication reviews compared with usual care. Setting Community pharmacies in the Netherlands. Methods Patients were randomised into an intervention group (IG) and a control group (CG). PROMISE was used to collect symptoms experienced during the previous month, and any suspected drug-associated symptoms from both groups at baseline and at follow-up after 3 months. IG patients received a one-time clinical medication review, while CG patients received usual care. Main outcome measure Mean number of drug-associated symptoms at follow-up. Results Measurements were completed by 78 IG and 67 CG patients from 15 community pharmacies. Mean numbers of drug-associated symptoms per patient at follow-up were 4.0 in the IG and 5.0 in the CG, with an incident rate ratio between the groups of 0.90 (95% CI 0.62-1.33). Mean numbers of drug-associated symptoms per patient reported at follow-up and persisting since baseline were 2.1 in the IG and 2.6 in the CG, with an incident rate ratio of 0.85 (95% CI 0.43-1.42). The lowest percentages of persisting drug-associated symptoms detected in the IG were 'palpitations' and 'stomach pain, dyspepsia' while in the CG they were 'stomach pain, dyspepsia' and 'trembling, shivering'. Conclusion PROMISE provided meaningful information on drug-associated symptoms in clinical medication reviews, however the number of drug-associated symptoms was not reduced by performing clinical medication reviews compared with usual care.
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Affiliation(s)
- Tim W A Schoenmakers
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Zorgapotheek Nederland BV, Utrecht, The Netherlands.
| | - Michel Wensing
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter A G M De Smet
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Clinical Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martina Teichert
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
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