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Thomas A, Forsyth P, Griffiths C, Evans R, Pope C, Cudd T, Morgan J, Curran L, Hopley G, Davies B, Smout R, Samuel D, Thomas J, Smith P. Implementation and evaluation of pharmacist-led heart failure diagnostic and guideline directed medication therapies clinic. Int J Clin Pharm 2024:10.1007/s11096-024-01790-2. [PMID: 39190224 DOI: 10.1007/s11096-024-01790-2] [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: 06/27/2024] [Accepted: 08/07/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Timely diagnosis of heart failure (HF) and rapid optimisation of guideline-directed medication therapy (GDMT) improves patients qualities of life, reducing mortality and morbidity. Previous papers describe the role of pharmacists in medication optimisation, but not in the diagnosis of HF. AIM To describe the development, implementation, and evaluation of pharmacist-led heart failure clinics with respect to time from referral to diagnosis, time from diagnosis to first review with a specialist, and the proportion receiving optimal GDMT 180 days after diagnosis. SETTING Community outpatient clinics in rural west Wales, United Kingdom. DEVELOPMENT Two experienced non-medical prescribing pharmacists, one of whom had additional diagnostic qualifications in cardiology, delivered the clinic. IMPLEMENTATION Patients referred with suspected HF were risk-stratified to urgent (within 14 days of referral) or routine (within 42 days) review, based on natriuretic peptide levels. Patients attended the clinic for assessment, including physical examination, electrocardiogram, and echocardiogram. Those with HF with reduced ejection fraction were initiated on drug treatment and referred to the follow-up pharmacist-led GDMT clinic. EVALUATION A sample of 100 patients was evaluated (50 from pre-existing and 50 from new service). Median time from referral to diagnosis reduced from 61 days (IQR 47-115) to 16 days (IQR 10.5-27.5) for urgent and 19 days (IQR 11.5-33) for routine. Median time to first appointment following diagnosis reduced from 54 days (IQR 36-60.5) to 14 days (IQR 9.75-28.75) (p value < 0.0001), and proportion of patients achieving GDMT at 180 days following diagnosis improved from 24 to 86% (p value < 0.0001). CONCLUSION This pharmacist HF diagnostic clinic and medication optimisation clinic improved time to diagnosis, time to first specialist review, and proportion of patients' achieving GDMT optimisation in a rural healthcare setting.
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Affiliation(s)
- Angharad Thomas
- Lead Heart Failure Specialist Pharmacist, Cardiology, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, SA31 2AF, Wales.
| | - Paul Forsyth
- Lead Pharmacist Cardiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Ciara Griffiths
- Lead Admission Specialist Pharmacist, Pharmacy, Withybush Hospital, Hywel Dda University Health Board, Haverfordwest, SA61 2PZ, Wales
| | - Rhian Evans
- Principal Project Manager-Value Based Healthcare, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, SA31 2AF, Wales
| | - Christine Pope
- Advanced Clinical Physiologist, Prince Philip Hospital, Hywel Dda University Health Board, Llanelli, Wales
| | - Teleri Cudd
- Advanced Clinical Physiologist, Withybush Hospital, Hywel Dda University Health Board, Haverfordwest, Wales
| | - Jennifer Morgan
- Advanced Clinical Physiologist, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, Wales
| | - Laura Curran
- Health Care Support Worker, Community Heart Failure Specialist Team, Hywel Dda University Health Board, Milford Haven, Wales
| | - Gethin Hopley
- Health Care Support Worker, Community Heart Failure Specialist Team, Hywel Dda University Health Board, Carmarthen, Wales
| | - Bernadette Davies
- Health Care Support Worker, Community Heart Failure Specialist Team, Hywel Dda University Health Board, Llanelli, SA15 3YF, Wales
| | - Rachel Smout
- Service Support Manager, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, Wales
| | - Danielle Samuel
- Service Manager for Cardiology and Renal Medicine, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, Wales
| | - Julie Thomas
- Cardiology Nursing and Allied Healthcare Professional Clinical Lead, Cardiology, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, Wales
| | - Paul Smith
- Service Delivery Manager, Unscheduled Care, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, Wales
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Dinh TS, Hanf M, Klein AA, Brueckle MS, Rietschel L, Petermann J, Brosse F, Schulz-Rothe S, Klasing S, Muth C, Seidling H, Engler J, Mergenthal K, Voigt K, van den Akker M. Informational continuity of medication management in transitions of care: Qualitative interviews with stakeholders from the HYPERION-TransCare study. PLoS One 2024; 19:e0300047. [PMID: 38573912 PMCID: PMC10996284 DOI: 10.1371/journal.pone.0300047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The transition of patients between inpatient and outpatient care can lead to adverse events and medication-related problems due to medication and communication errors, such as medication discontinuation, the frequency of (re-)hospitalizations, and increased morbidity and mortality. Older patients with multimorbidity and polypharmacy are particularly at high risk during transitions of care. Previous research highlighted the need for interventions to improve transitions of care in order to support information continuity, coordination, and communication. The HYPERION-TransCare project aims to improve the continuity of medication management for older patients during transitions of care. METHODS AND FINDINGS Using a qualitative design, 32 expert interviews were conducted to explore the perspectives of key stakeholders, which included healthcare professionals, patients and one informal caregiver, on transitions of care. Interviews were conducted between October 2020 and January 2021, transcribed verbatim and analyzed using content analysis. We narratively summarized four main topics (stakeholders' tasks, challenges, ideas for solutions and best practice examples, and patient-related factors) and mapped them in a patient journey map. Lacking or incomplete information on patients' medication and health conditions, inappropriate communication and collaboration between healthcare providers within and across settings, and insufficient digital support limit the continuity of medication management. CONCLUSIONS The study confirms that medication management during transitions of care is a complex process that can be compromised by a variety of factors. Legal requirements and standardized processes are urgently needed to ensure adequate exchange of information and organization of medication management before, during and after hospital admissions. Despite the numerous barriers identified, the findings indicate that involved healthcare professionals from both the inpatient and outpatient care settings have a common understanding.
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Affiliation(s)
- Truc Sophia Dinh
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Maria Hanf
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Astrid-Alexandra Klein
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Maria-Sophie Brueckle
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Lisa Rietschel
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jenny Petermann
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Franziska Brosse
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Sylvia Schulz-Rothe
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Sophia Klasing
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Christiane Muth
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Department of General Practice and Family Medicine, Medical School Westphalia, Bielefeld University, Bielefeld, Germany
| | - Hanna Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Jennifer Engler
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
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Aksoy N, Ozturk N. A meta-analysis assessing the prevalence of drug-drug interactions among hospitalized patients. Pharmacoepidemiol Drug Saf 2023; 32:1319-1330. [PMID: 37705139 DOI: 10.1002/pds.5691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Drug-drug interactions (DDIs), particularly in hospitalized patients can result in adverse drug events and unfavorable health consequences. The aim of this meta-analysis is to provide up-to-date evidence on the prevalence of clinically evident adverse drug events due to DDIs in hospitalized patients. METHODS Data from Scopus, PubMed, Cochrane and Web of Science were extracted using these keywords (Drug interaction/drug-drug interactions, Hospital/ hospitals, Adverse drug event, Hospitalized patients, inpatient, Department, Hospital stay, Harm, Mortality, death). The studies that include Observational studies on hospitalized patients, reporting potential DDIs using an electronic database, and reporting the clinically observed adverse drug interactions (ADI) through symptoms, signs or Laboratory tests are included. Using Open meta-Software (version 12.11.14), the incidence of clinically evident DDIs among hospitalized patients was determined and shown in a forest plot. RESULTS Only 15 of the 8261 articles found through a literature search met the inclusion criteria and reported the desired outcome. The pooled prevalence of potential drug-drug interactions is 64.9% (CI 95% 0.618-0.736). While clinically evident DDIs have a pooled frequency of 17.17% (CI 95% 0.133-0.256). CONCLUSION The issue of DDIs remains a significant concern in hospitalized patients, with a notable rise in their prevalence. This meta-analysis encompassed a greater quantity of studies and demonstrated a heightened proportion of drug-drug interaction prevalence in comparison to the percentages reported in the previously published meta-analysis.
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Affiliation(s)
- Nilay Aksoy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Altınbaş University, İstanbul, Turkey
| | - Nur Ozturk
- Department of Clinical Pharmacy, Faculty of Pharmacy, Altınbaş University, İstanbul, Turkey
- Department of Clinical Pharmacy, Graduate School of Health Sciences, İstanbul Medipol University, İstanbul, Turkey
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Jasińska-Stroschein M, Waszyk-Nowaczyk M. Multidimensional Interventions on Supporting Disease Management for Hospitalized Patients with Heart Failure: The Role of Clinical and Community Pharmacists. J Clin Med 2023; 12:3037. [PMID: 37109373 PMCID: PMC10142526 DOI: 10.3390/jcm12083037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND existing trials on the role of clinical pharmacists in managing chronic disease patients have focused on variety of interventions, including preparing patients for the transition from hospital to home. However, little quantitative evidence is available regarding the effect of multidimensional interventions on supporting disease management for hospitalized patients with heart failure (HF). The present paper reviews the effects of inpatient, discharge and/or after-discharge interventions performed on hospitalized HF patients by multidisciplinary teams, including pharmacists. METHODS articles were identified through search engines in three electronic databases following the PRISMA Protocol. Randomized controlled trials (RCTs) or non-randomized intervention studies conducted in the period 1992-2022 were included. In all studies, baseline characteristics of patients as well as study end-points were described in relation to a control group i.e., usual care and a group of subjects that received care from a clinical and/or community pharmacist, as well as other health professionals (Intervention). Study outcomes included all-cause hospital 30-day re-admission or emergency room (ER) visits, all-cause hospitalization within >30 days after discharge, specific-cause hospitalization rates, medication adherence and mortality. The secondary outcomes included adverse events and quality of life. Quality assessment was carried out using RoB 2 Risk of Bias Tool. Publication bias across studies was determined using the funnel plot and Egger's regression test. RESULTS a total of 34 protocols were included in the review, while the data from 33 trials were included in further quantitative analyses. The heterogeneity between studies was high. Pharmacist-led interventions, usually performed within interprofessional care teams, reduced the rates of 30-day all-cause hospital re-admission (odds ratio, OR = 0.78; 95% CI 0.62-0.98; p = 0.03) and all-cause hospitalization >30 days after discharge (OR = 0.73; 95% CI 0.63-0.86; p = 0.0001). Subjects hospitalized primarily due to heart failure demonstrated reduced risk of hospital admission within longer periods, i.e., from 60 to 365 days after discharge (OR = 0.64; 95% CI 0.51-0.81; p = 0.0002). The rate of all-cause hospitalization was reduced by multidimensional interventions taken by pharmacists: reviews of medicine lists and/or their reconciliation at discharge (OR = 0.63; 95% CI 0.43-0.91; p = 0.014), as well as interventions that were based mainly on patient education and counseling (OR = 0.65; 95% CI 0.49-0.88; p = 0.0047). In conclusion, given that HF patients often have complex treatment regimens and multiple comorbid conditions, our findings highlight the need for greater involvement from skilled clinical and community pharmacists in disease management.
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Affiliation(s)
| | - Magdalena Waszyk-Nowaczyk
- Pharmacy Practice Division, Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland
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TANER N, BERK B. A prospective study concerning the effect of pharmaceutical care services on patients with heart failure. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.895693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective: Heart failure (HF), caused by an abnormality in cardiac function, is the inability of heart tissue to pump blood or deliver sufficient oxygen, resulting in abnormal diastolic volume. Drug-Related Problems (DRPs) can cause significant but preventable morbidity and mortality once specific medication errors and their contributing factors are identified. The aim of this prospective study is to determine the effect of pharmaceutical care in patients with heart failure in a Turkish hospital.
Methods: A total of 160 patients with heart failure (80 patients in the control group, 80 patients in the intervention group) were examined at a university hospital. The results of the Pharmaceutical Care Survey were evaluated in accordance with the objective of the study. In addition, using the Pharmaceutical Care Network Europe (PCNE) classification system V8.01, the role and importance of the clinical pharmacist in identifying, preventing and resolving drug-related problems encountered during the treatment of two groups was assessed. The number and causes of potential DRPs were taken into scrutiny.
Results: Comparing the results of the Pharmaceutical Care Survey in both groups at the end of the 6th month, the study group shows a
significant improvement in the rates of “forgetting to take medication” (2.9%) and “experiencing any side effects from your drug” (4.5%). Compared to other problems, ineffectiveness of the drugs used in treatment was reported as the most common drug-related problem (n=23; 28.7%) in the study group (p
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Affiliation(s)
- Neda TANER
- İSTANBUL MEDİPOL ÜNİVERSİTESİ, ECZACILIK FAKÜLTESİ
| | - Barkın BERK
- İSTANBUL MEDİPOL ÜNİVERSİTESİ, ECZACILIK FAKÜLTESİ
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6
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Clinical pharmacist interventions in ambulatory psychogeriatric patients with excessive polypharmacy. Sci Rep 2022; 12:11387. [PMID: 35794225 PMCID: PMC9259566 DOI: 10.1038/s41598-022-15657-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
Psychogeriatric primary care patients are frequently treated with excessive polypharmacy (≥ 10 medications), leading to complications and increased costs. Such cases are rarely included in treatment guidelines and randomized controlled trials. This paper evaluates the impact of clinical pharmacist medication reviews on the quality of pharmacotherapy in primary care psychogeriatric patients with excessive polypharmacy. The retrospective observational multicentric pre-post study included patients (aged 65 or above) treated with at least one psychotropic and ten or more medications. Clinical pharmacists’ recommendations were retrieved from medication review forms for the period 2012–2014. The study outcome measures were the number of medications, potentially inappropriate medications in the elderly (PIMs), potential drug-drug interactions which should be avoided (pXDDIs), and adherence to treatment guidelines. The study included 246 patients receiving 3294 medications, of which 14.6% were psychotropics. The clinical pharmacists proposed 374 interventions in psychopharmacotherapy. The general practitioners accepted 45.2% of them (169). Accepting clinical pharmacist recommendations reduced the total number of medications by 7.5% from 13.4 to 12.4 per patient (p < 0.05), the total number of prescribed PIMs by 21.8% from 312 to 244 (p < 0.05), the number of pXDDIs by 54.9% from 71 to 31 (p < 0.05) and also improved treatment guidelines adherence for antidepressants and antipsychotics (p < 0.05). Clinical pharmacist interventions significantly improved the quality of psychopharmacotherapy by reducing the total number of medications, PIMs, and pXDDIs. Accepting clinical pharmacist interventions led to better treatment guidelines adherence.
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Alzahrani AA, Alwhaibi MM, Asiri YA, Kamal KM, Alhawassi TM. Description of pharmacists' reported interventions to prevent prescribing errors among in hospital inpatients: a cross sectional retrospective study. BMC Health Serv Res 2021; 21:432. [PMID: 33957900 PMCID: PMC8101218 DOI: 10.1186/s12913-021-06418-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/11/2020] [Indexed: 12/05/2022] Open
Abstract
Background Prescribing errors (PEs) are a common cause of morbidity and mortality, both in community practice and in hospitals. Pharmacists have an essential role in minimizing and preventing PEs, thus, there is a need to document the nature of pharmacists’ interventions to prevent PEs. The purpose of this study was to describe reported interventions conducted by pharmacists to prevent or minimize PEs in a tertiary care hospital. Methods A retrospective analysis of the electronic medical records data was conducted to identify pharmacists’ interventions related to reported PEs. The PE-related data was extracted for a period of six-month (April to September 2017) and comprised of patient demographics, medication-related information, and the different interventions conducted by the pharmacists. The study was carried in a tertiary care hospital in Riyadh region. The study was ethically reviewed and approved by the hospital IRB committee. Descriptive analyses were appropriately conducted using the IBM SPSS Statistics. Results A total of 2,564 pharmacists’ interventions related to PEs were recorded. These interventions were reported in 1,565 patients. Wrong dose (54.3 %) and unauthorized prescription (21.9 %) were the most commonly encountered PEs. Anti-infectives for systemic use (49.2 %) and alimentary tract and metabolism medications (18.2 %) were the most common classes involved with PEs. The most commonly reported pharmacists’ interventions were dose adjustments (44.0 %), restricted medication approvals (21.9 %), and therapeutic duplications (11 %). Conclusions In this study, PEs occurred commonly and pharmacists’ interventions were critical in preventing possible medication related harm to patients. Care coordination and prioritizing patient safety through quality improvement initiatives at all levels of the health care system can play a key role in this quality improvement drive. Future studies should evaluate the impact of pharmacists’ interventions on patient outcomes.
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Affiliation(s)
- Abdulhakim A Alzahrani
- College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia.,Pharmaceutical Care Department, King Fahad Hospital, Ministry of Health, Albaha, Saudi Arabia
| | - Monira M Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, PO Box 2457, Office (1A229), 11451, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yousif A Asiri
- College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia.,Department of Clinical Pharmacy, College of Pharmacy, King Saud University, PO Box 2457, Office (1A229), 11451, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M Kamal
- Division of Pharmaceutical, Social and Administrative Sciences, School of Pharmacy, Duquesne University, 600 Forbes Avenue, PA, 15282, Pittsburgh, USA
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, PO Box 2457, Office (1A229), 11451, Riyadh, Saudi Arabia. .,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. .,Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia.
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Arunmanakul P, Kengkla K, Chaiyasothi T, Phrommintikul A, Ruengorn C, Permsuwan U, Thakkinstian A, Page RL, Munger MA, Nathisuwan S, Chaiyakunapruk N. Effects of pharmacist interventions on heart failure outcomes: A systematic review and
meta‐analysis. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1442] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Poukwan Arunmanakul
- Department of Pharmaceutical Care, Faculty of Pharmacy Chiang Mai University Chiang Mai Thailand
| | - Kirati Kengkla
- School of Pharmaceutical Sciences University of Phayao Phayao Thailand
| | - Thanaputt Chaiyasothi
- Department of Clinical Pharmacy, Faculty of Pharmacy Srinakharinwirot University Nakhon Nayok Thailand
| | - Arintaya Phrommintikul
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine Chiang Mai University Chiang Mai Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy Chiang Mai University Chiang Mai Thailand
| | - Unchalee Permsuwan
- Department of Pharmaceutical Care, Faculty of Pharmacy Chiang Mai University Chiang Mai Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Robert L. Page
- Department of Clinical Pharmacy, School of Pharmacy University of Colorado Colorado USA
| | - Mark A. Munger
- Department of Pharmacotherapy, College of Pharmacy University of Utah Salt Lake City Utah USA
- Department of Internal Medicine, School of Medicine University of Utah Salt Lake City Utah USA
| | - Surakit Nathisuwan
- Department of Pharmacy, Faculty of Pharmacy Mahidol University Bangkok Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy University of Utah Salt Lake City Utah USA
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Lainscak M, Omersa D, Rosano G, Farkas J, Böhm M. Pharmacotherapy adherence in patients with heart failure: Easier said than done. Int J Cardiol 2021; 332:135-137. [PMID: 33785392 DOI: 10.1016/j.ijcard.2021.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia.
| | - Daniel Omersa
- Department of Research, General Hospital Murska Sobota, Murska Sobota, Slovenia; Department of Internal Medicine, General Hospital Jesenice, Jesenice, Slovenia
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Jerneja Farkas
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Research, General Hospital Murska Sobota, Murska Sobota, Slovenia; National Institute of Public Health, Ljubljana, Slovenia
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
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Tahmasebivand M, Barzegari H, Izadpanah M. Frequency of polypharmacy and drug interactions in inpatients in the emergency department, Southwest of Iran. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study aimed to evaluate the polypharmacy extent and the frequency and severity of drug interactions by evaluating inpatients in the emergency department. In this epidemiologicaldescriptive study, data were collected retrospectively by reviewing medical records of 92 hospitalized patients in the emergency department with a stay over 48 hours. Out of the study population, 54.3% and 45.7% were respectively male and female, with a mean age of 59.09. In terms of hospitalization, 27.2% and 16.3% were hospitalized due to heart problems and trauma, respectively and the mean length of hospitalization was 3.91 with a standard deviation of 2.57 days. The mean drug received was 8.48, with a standard deviation of 4.48. Of the patients, 81.5% received more than 5 drugs; in addition, the observed amounts of drug interactions of A, B, C, D, and X were 2.5%, 17%, 59.3%, 19.5%, and 1.9%, respectively. The drug interaction prevalence in inpatients in the emergency department was high. The presence of a pharmacist is necessary to identify drug interactions and reduce drug-therapy problems to provide quality services.
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Audurier Y, Chapet N, Renaudin P, Bons C, Mathieu B, Theret S, de Barry G, Jalabert A, Breuker C, Leclercq F, Pasquie JL, Agullo A, Roubille F, Castet-Nicolas A. Collaboration between cardiologist and clinical pharmacist on prescription quality: What is the potential clinical impact for cardiology patients? Int J Clin Pract 2020; 74:e13531. [PMID: 32459398 DOI: 10.1111/ijcp.13531] [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: 12/15/2019] [Revised: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the effect of pharmacists' interventions (PI) on the potential clinical impact of medication errors, including the lack of therapeutic optimisation of patients with cardiologic diseases, such as heart failure and acute coronary syndrome). METHODS This was an observational, prospective study conducted in the cardiology department of a French university hospital centre for a duration of 9 months. All prescriptions were analysed and PI were registered for clinical rating by pharmacists and cardiologist. RESULTS A total of 532 PI cases were recorded in 339 patients, with a mean of 1.57 (±1.04) PI. The PI acceptance rate was 98.1%. "Dose adjustment" and "introduction therapy" were the most common interventions and represented 38.0% and 32.9%, respectively, of all PI. Statins were the most frequently involved drugs (18.1%), followed by ACE (Angiotensin Converting Enzyme) inhibitors (10.9%) and antiplatelet agents (9.3%). Moreover, 13.8% of PI potentially avoided a severe or very severe clinical impact (n = 71) and 38.6% had a significant impact altering the quality of life (n = 198). There was no significant difference between the average score performed by the clinical pharmacist included in the cardiology team and the one obtained by the cardiologist (P = .797). In contrast, a significant difference was observed for the average score established by the pharmacist localised in central pharmacy versus the rating of the cardiologist (P < .001). CONCLUSIONS The collaboration between clinical pharmacists and cardiologists in the medical units seems to be beneficial to the quality of prescriptions, including the implementation of recommendations. The good rate of PI acceptance and the similar rating with the cardiologist show that there is a change in perspective of the pharmacist, being closer to the clinical reality.
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Affiliation(s)
- Yohan Audurier
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
| | - Nicolas Chapet
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Pierre Renaudin
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
- Faculty of Medicine Timone, Center for Studies and Research on Health Services and Quality of Life, University of Aix-Marseille, EA 3279, Marseille, France
| | - Carole Bons
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Betty Mathieu
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Sarah Theret
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Gaëlle de Barry
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Cyril Breuker
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Florence Leclercq
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
- Cardiology Department, University Hospital, Montpellier, France
| | - Jean-Luc Pasquie
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
- Cardiology Department, University Hospital, Montpellier, France
| | - Audrey Agullo
- Cardiology Department, University Hospital, Montpellier, France
| | - François Roubille
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
- Cardiology Department, University Hospital, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
- Cancer Research Institute of Montpellier (IRCM), INSERM U1194, ICM, Montpellier, France
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The impact of an in-department pharmacist on the prevention of drug iatrogenesis in a rheumatology department. Clin Rheumatol 2020; 40:359-368. [PMID: 32519050 DOI: 10.1007/s10067-020-05138-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/17/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION/OBJECTIVES The primary objective was to evaluate the impact of an in-department pharmacist on the prevention of drug iatrogenesis in a rheumatology department. Secondary objectives were to determine (i) if medication history discrepancies were detected more frequently in the elderly or not, and (ii) if the mean number of treatments at admission had an impact on the number of medication history discrepancies. METHODS Implementation of a clinical-pharmacy program based on medication reconciliation and medication review of prescription for all patients admitted to a rheumatology department between January and June 2017. The analytical approach was mainly descriptive and data were expressed as mean ± standard deviation (i.e., number of treatments at admission, number of medication reconciliations) and as proportions (i.e., acceptance rate, impact). Chi-squared tests and Student's test were performed to determine if there was a significant difference in outcomes. RESULTS Three hundred twelve patients were included in the study, 517 medication history discrepancies in 243 (77.8%) patients and 196 pharmaceutical interventions in 133 (42.6%) patients. A significant difference was found in the number of medication history discrepancies and pharmaceutical interventions between the two age groups and in the mean number of treatments at admission between patients with or without medication history discrepancies. 15.4% of study patients had major medication history discrepancies and major pharmaceutical interventions. All patients and practitioners reported the usefulness of an in-department pharmacist. CONCLUSION This program was found effective in terms of safety and improvement in the continuity of care. Key Points • This clinical-pharmacy program with an in-department pharmacist had a positive impact on the prevention of drug iatrogenesis in one rheumatology department. • 15.4% (n = 48) of study patients had major medication history discrepancies and major pharmaceutical interventions. • All practitioners and patients were satisfied with this clinical-pharmacy program.
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Kasper B, Erdel A, Tabaka C, Edgar B. Analysis of Pharmacist Interventions Used to Resolve Safety Target of Polypharmacy (STOP) Drug Interactions. Fed Pract 2020; 37:268-275. [PMID: 32669779 PMCID: PMC7357888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Statin drug interactions commonly increase the risk of muscle-related toxicities. The medical literature supports consultative pharmacist interventions to resolve drug interactions, but studies demonstrating autonomous pharmacist interventions are lacking. OBJECTIVE To evaluate the complementary impact of using pharmacist-led protocols and pharmacists with prescriptive authority to resolve statin drug interactions. METHODS Pharmacist-led protocols were developed to address gemfibrozil-statin and niacin-statin interactions. Pharmacists discontinued gemfibrozil and niacin by protocol or referred patients to the Patient Aligned Care Team (PACT) Pharmacy Clinic for individualized management. After all drug interactions were addressed, a retrospective quality improvement analysis was conducted. The primary outcome was to evaluate the impact of gemfibrozil and niacin discontinuation by protocol on patients' triglyceride (TG) laboratory results. The coprimary endpoints were the change in TGs and the percentage of patients with TGs ≥ 500 mg/dL, following pharmacist discontinuation by protocol. Secondary outcomes included the time required to resolve the interactions and a description of the PACT Clinical Pharmacy Specialists' (CPS) pharmacologic interventions. RESULTS The gemfibrozil and niacin protocols addressed 397 drug interactions. Seventy-six patients underwent gemfibrozil discontinuation by protocol and had TG laboratory results available. TG levels decreased or increased by < 100 mg/dL for 62 patients (82%), and 1 patient (1.3%) experienced TG elevation above the threshold of 500 mg/dL. Thirty-six patients had niacin discontinued by protocol and available laboratory results. The TG levels decreased or increased by < 100 mg/dL for 33 patients (91.7%), and no patients had TG levels increase above the threshold of 500 mg/dL. The mean time required to resolve both gemfibrozil and niacin drug interactions was 15.5 minutes per patient. A total of 129 patients were referred to the PACT Pharmacy Clinic to manage gemfibrozil and niacin drug interactions. TG laboratory results were available for 80 gemfibrozil patients (74.8%) and 16 niacin patients (72.7%). The PACT CPS made 171 pharmacologic interventions to address drug interactions and the median of 2 encounters per patient. CONCLUSIONS This single-site quality improvement analysis supports the complementary use of protocols and pharmacists with prescriptive authority to resolve statin drug interactions. These data support expanded roles for pharmacists, across settings, to mitigate select drug interactions.
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Affiliation(s)
- Barbara Kasper
- is a Clinical Assistant Professor; and and were Students at the time this article was written; all at the University of Missouri-Kansas City School of Pharmacy. and Barbara Kasper are Clinical Pharmacy Specialists at the Harry S. Truman Memorial Veterans' Hospital in Columbia, Missouri
| | - Angela Erdel
- is a Clinical Assistant Professor; and and were Students at the time this article was written; all at the University of Missouri-Kansas City School of Pharmacy. and Barbara Kasper are Clinical Pharmacy Specialists at the Harry S. Truman Memorial Veterans' Hospital in Columbia, Missouri
| | - Caitlynn Tabaka
- is a Clinical Assistant Professor; and and were Students at the time this article was written; all at the University of Missouri-Kansas City School of Pharmacy. and Barbara Kasper are Clinical Pharmacy Specialists at the Harry S. Truman Memorial Veterans' Hospital in Columbia, Missouri
| | - Borden Edgar
- is a Clinical Assistant Professor; and and were Students at the time this article was written; all at the University of Missouri-Kansas City School of Pharmacy. and Barbara Kasper are Clinical Pharmacy Specialists at the Harry S. Truman Memorial Veterans' Hospital in Columbia, Missouri
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Abstract
BACKGROUND Hospital admissions in older adults are frequently drug related and avoidable. Clinical pharmacy interventions during hospital stay might reduce drug-related harm and reduce hospital visits. Moreover, several recent positive clinical pharmacy investigations incorporated a transitional care component to further improve medication use after discharge. It is currently unclear what the strength of evidence is and what the exact components should be of such clinical pharmacy interventions in older adults. OBJECTIVE An evidence-based review was performed to determine the status of the evidence and also to explore whether a clinical pharmacy intervention incorporating transitional care was associated with reduced hospital visits after discharge. METHODS Prospective controlled investigations were included if they contained a clinical pharmacy intervention that was initiated before discharge in older inpatients. Relevant quasi-experimental and randomized controlled trials were searched in MEDLINE. First, an evidence-based review was performed, including a description of the study design, characteristics, and outcomes. Major components of successful clinical pharmacy interventions were described and potential implications for clinical practice and research were determined. Second, the Fisher's exact test was used to explore the association between transitional care and reduced hospital visits. Third, based on these findings, a medication review proposal was developed to improve medication use in older adults. RESULTS Thirty-five studies were included, with 26 randomized controlled trials. Median patient follow-up after discharge was 90 days (interquartile range 37-180 days) and investigators enrolled a median of 210 (interquartile range 110-498) study participants. On average, patients were aged 77.5 years (interquartile range 73-82.2 years). Nine randomized controlled trials had sufficient power to detect a reduction in hospital visits after discharge; this was reduced in three randomized controlled trials. Post-discharge follow-up was not associated with reduced post-discharge hospital visits (20 randomized controlled trials: follow-up vs. no follow-up: 6/11 vs. 1/9, p = 0.070). There was a significant reduction in post-discharge hospital visits in patients aged 75 years or older (12 randomized controlled trials: follow-up vs. no follow-up: 5/7 vs. 0/5, p = 0.028). A medication review proposal was developed, consisting of six steps. CONCLUSIONS Three powered randomized controlled trials were identified that found a significant association between a pharmacist-led intervention in older adults and a reduction in post-discharge hospital visits. In clinical practice, an intervention consisting of medication reconciliation, review, counseling, and post-discharge follow-up should be provided to such high-risk inpatients. Regarding research priorities, large, multi-center randomized controlled trials should be performed to generate more evidence on the impact of clinical pharmacy interventions on the patient trajectory and economic outcomes.
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Haq I, Ismail M, Khan F, Khan Q, Ali Z, Noor S. Prevalence, predictors and outcomes of potential drug-drug interactions in left ventricular failure: considerable factors for quality use of medicines. BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902020000218326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Pantoja T, Grimshaw JM, Colomer N, Castañon C, Leniz Martelli J. Manually-generated reminders delivered on paper: effects on professional practice and patient outcomes. Cochrane Database Syst Rev 2019; 12:CD001174. [PMID: 31858588 PMCID: PMC6923326 DOI: 10.1002/14651858.cd001174.pub4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Health professionals sometimes do not use the best evidence to treat their patients, in part due to unconscious acts of omission and information overload. Reminders help clinicians overcome these problems by prompting them to recall information that they already know, or by presenting information in a different and more accessible format. Manually-generated reminders delivered on paper are defined as information given to the health professional with each patient or encounter, provided on paper, in which no computer is involved in the production or delivery of the reminder. Manually-generated reminders delivered on paper are relatively cheap interventions, and are especially relevant in settings where electronic clinical records are not widely available and affordable. This review is one of three Cochrane Reviews focused on the effectiveness of reminders in health care. OBJECTIVES 1. To determine the effectiveness of manually-generated reminders delivered on paper in changing professional practice and improving patient outcomes. 2. To explore whether a number of potential effect modifiers influence the effectiveness of manually-generated reminders delivered on paper. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers on 5 December 2018. We searched grey literature, screened individual journals, conference proceedings and relevant systematic reviews, and reviewed reference lists and cited references of included studies. SELECTION CRITERIA We included randomised and non-randomised trials assessing the impact of manually-generated reminders delivered on paper as a single intervention (compared with usual care) or added to one or more co-interventions as a multicomponent intervention (compared with the co-intervention(s) without the reminder component) on professional practice or patients' outcomes. We also included randomised and non-randomised trials comparing manually-generated reminders with other quality improvement (QI) interventions. DATA COLLECTION AND ANALYSIS Two review authors screened studies for eligibility and abstracted data independently. We extracted the primary outcome as defined by the authors or calculated the median effect size across all reported outcomes in each study. We then calculated the median percentage improvement and interquartile range across the included studies that reported improvement related outcomes, and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We identified 63 studies (41 cluster-randomised trials, 18 individual randomised trials, and four non-randomised trials) that met all inclusion criteria. Fifty-seven studies reported usable data (64 comparisons). The studies were mainly located in North America (42 studies) and the UK (eight studies). Fifty-four studies took place in outpatient/ambulatory settings. The clinical areas most commonly targeted were cardiovascular disease management (11 studies), cancer screening (10 studies) and preventive care (10 studies), and most studies had physicians as their target population (57 studies). General management of a clinical condition (17 studies), test-ordering (14 studies) and prescription (10 studies) were the behaviours more commonly targeted by the intervention. Forty-eight studies reported changes in professional practice measured as dichotomous process adherence outcomes (e.g. compliance with guidelines recommendations), 16 reported those changes measured as continuous process-of-care outcomes (e.g. number of days with catheters), eight reported dichotomous patient outcomes (e.g. mortality rates) and five reported continuous patient outcomes (e.g. mean systolic blood pressure). Manually-generated reminders delivered on paper probably improve professional practice measured as dichotomous process adherence outcomes) compared with usual care (median improvement 8.45% (IQR 2.54% to 20.58%); 39 comparisons, 40,346 participants; moderate certainty of evidence) and may make little or no difference to continuous process-of-care outcomes (8 comparisons, 3263 participants; low certainty of evidence). Adding manually-generated paper reminders to one or more QI co-interventions may slightly improve professional practice measured as dichotomous process adherence outcomes (median improvement 4.24% (IQR -1.09% to 5.50%); 12 comparisons, 25,359 participants; low certainty of evidence) and probably slightly improve professional practice measured as continuous outcomes (median improvement 0.28 (IQR 0.04 to 0.51); 2 comparisons, 12,372 participants; moderate certainty of evidence). Compared with other QI interventions, manually-generated reminders may slightly decrease professional practice measured as process adherence outcomes (median decrease 7.9% (IQR -0.7% to 11%); 14 comparisons, 21,274 participants; low certainty of evidence). We are uncertain whether manually-generated reminders delivered on paper, compared with usual care or with other QI intervention, lead to better or worse patient outcomes (dichotomous or continuous), as the certainty of the evidence is very low (10 studies, 13 comparisons). Reminders added to other QI interventions may make little or no difference to patient outcomes (dichotomous or continuous) compared with the QI alone (2 studies, 2 comparisons). Regarding resource use, studies reported additional costs per additional point of effectiveness gained, but because of the different currencies and years used the relevance of those figures is uncertain. None of the included studies reported outcomes related to harms or adverse effects. AUTHORS' CONCLUSIONS Manually-generated reminders delivered on paper as a single intervention probably lead to small to moderate increases in outcomes related to adherence to clinical recommendations, and they could be used as a single QI intervention. It is uncertain whether reminders should be added to other QI intervention already in place in the health system, although the effects may be positive. If other QI interventions, such as patient or computerised reminders, are available, they should be preferred over manually-generated reminders, but under close evaluation in order to decrease uncertainty about their potential effect.
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Affiliation(s)
- Tomas Pantoja
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Jeremy M Grimshaw
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramThe Ottawa Hospital ‐ General Campus501 Smyth Road, Box 711OttawaONCanadaK1H 8L6
| | - Nathalie Colomer
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Carla Castañon
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Javiera Leniz Martelli
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
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Georgiev KD, Hvarchanova N, Georgieva M, Kanazirev B. The role of the clinical pharmacist in the prevention of potential drug interactions in geriatric heart failure patients. Int J Clin Pharm 2019; 41:1555-1561. [PMID: 31595450 DOI: 10.1007/s11096-019-00918-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
Background The treatment of heart failure patients is very complex and includes lifestyle modification as well as different pharmacological therapies. Polypharmacy is very common in such patients and they are at increased risk of potential drug-drug interactions and associated effects such as poor adherence, compliance and adverse events. Objective The aim of the present study is to investigate retrospectively the prescribed pharmacotherapy of the hospital discharged heart failure patients for possible drug interactions. Settings Clinic for Cardiology of the "Saint Marina" University Hospital in Varna, Bulgaria. Method Lexicomp® Drug interaction software was used for screening potential drug-drug interactions. Logistic regression was applied to determine the odds ratio for the association between the age and number of drugs taken and the number of potential drug-drug interactions. Main outcome measure Incidence and type of pDDIs in geriatric heart failure patients. Results A retrospective study was conducted by reviewing the medical records of 248 selected heart failure patients for the prescribed medicines for a 1-year period (January 2015-December 2015). The total number of potential drug-drug interactions was 1532, or approximately 6.28 (± 4.72 SD) per one person. The range of prescribed drugs was between three and fourteen, 92% of them have been taking more than five medicines, an average of 7.12 (± 2.07 SD) per patient. The average age was 72.35 (± 10.16 SD). The results have shown stronger association between the number of drugs taken (more than 7) and the occurrence of potential drug-drug interactions (more than 10)-37.84 (95% CI 9.012-158.896, P ≤ 0.001). No statistically significant differences were found between age and occurrence of potential drug-drug interactions (more than 10)-1.008 (95% CI 0.441-2.308, P = 0.848). Conclusion The incidence of drug-drug interactions in heart failure patients is high. The clinical pharmacist, as a part of the multidisciplinary team, could reduce medication-related problems, such as drug interactions, and to optimize drug therapy by checking the treatment prescribed at the discharge of these patients.
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Affiliation(s)
- Kaloyan D Georgiev
- Department of Pharmaceutical Technologies, Faculty of Pharmacy, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria.
| | - Nadezhda Hvarchanova
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Marieta Georgieva
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Branimir Kanazirev
- Department of Internal Medicine, UMHAT "St. Marina", Faculty of Medicine, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
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Ritchie A, Seubert L, Clifford R, Perry D, Bond C. Do randomised controlled trials relevant to pharmacy meet best practice standards for quality conduct and reporting? A systematic review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:220-232. [PMID: 31573121 DOI: 10.1111/ijpp.12578] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Evidence-based pharmacy practice requires a dependable evidence base. Randomised controlled trials (RCTs) are the gold standard of high-quality primary research, and tools exist to assist researchers in conducting and reporting high-quality RCTs. This review aimed to explore whether RCTs relevant to pharmacy are conducted and reported in line with Cochrane risk of bias and CONSORT standards, respectively. METHODS A MEDLINE search identified potential papers. After screening of titles, abstracts and full texts, the 50 most recent papers were reviewed and assessment of bias according to Cochrane domains and compliance with CONSORT checklist items was recorded. Each domain of the Cochrane tool and CONSORT checklist item and each article were given a percentage score, reported as median and interquartile range (IQR). Correlation between quality of conduct, quality of reporting, continent of origin, and journal impact factor was conducted using the R2 statistic. The median domain score for risk of bias by paper according to the Cochrane risk of bias tool was 53.0% (IQR 38.5-68.5), while the median compliance score by paper for the CONSORT checklist was 64.0% (IQR 36.0-94.0%). KEY FINDINGS The median Cochrane domain and median CONSORT item completion scores, respectively, were 50.0% (IQR 33.3-66.7%) and 59.5% (IQR 52.0-70.3%). The highest risk of bias was associated with allocation concealment and blinding, and the least well-reported items were randomisation details, sequence generation and allocation concealment. A positive relationship between conduct and reporting of RCTs was found (R2 = 0.75), while no correlation was found between quality of conduct or quality of reporting and journal impact factor, correlation coefficients (R2 = 0.06 and R2 = 0.05, respectively). SUMMARY This review identified that issues related to randomisation and blinding are often inadequately conducted or not comprehensively reported by researchers conducting pharmacy relevant RCTs, providing useful information for education and future research.
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Affiliation(s)
- Alison Ritchie
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Liza Seubert
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Danae Perry
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Effectiveness of the Pharmacist-Involved Multidisciplinary Management of Heart Failure to Improve Hospitalizations and Mortality Rates in 4630 Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Card Fail 2019; 25:744-756. [DOI: 10.1016/j.cardfail.2019.07.455] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 07/03/2019] [Accepted: 07/12/2019] [Indexed: 12/28/2022]
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AlHabeeb W, Al-Ayoubi F, AlGhalayini K, Al Ghofaili F, Al Hebaishi Y, Al-Jazairi A, Al-Mallah MH, AlMasood A, Al Qaseer M, Al-Saif S, Chaudhary A, Elasfar A, Tash A, Arafa M, Hassan W. Saudi Heart Association (SHA) guidelines for the management of heart failure. J Saudi Heart Assoc 2019; 31:204-253. [PMID: 31371908 PMCID: PMC6660461 DOI: 10.1016/j.jsha.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is the leading cause of morbidity and mortality worldwide and negatively impacts quality of life, healthcare costs, and longevity. Although data on HF in the Arab population are scarce, recently developed regional registries are a step forward to evaluating the quality of current patient care and providing an overview of the clinical picture. Despite the burden of HF in Saudi Arabia, there are currently no standardized protocols or guidelines for the management of patients with acute or chronic heart failure. Therefore, the Heart Failure Expert Committee, comprising 13 local specialists representing both public and private sectors, has developed guidelines to address the needs and challenges for the diagnosis and treatment of HF in Saudi Arabia. The ultimate aim of these guidelines is to assist healthcare professionals in delivering optimal care and standardized clinical practice across Saudi Arabia.
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Affiliation(s)
- Waleed AlHabeeb
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
- Corresponding author at: Cardiac Sciences Department, King Saud University, P.O. Box 7805, Riyadh 11472, Saudi Arabia.
| | - Fakhr Al-Ayoubi
- King Fahad Cardiac Center, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Kamal AlGhalayini
- King Abdulaziz University Hospital, Jeddah, Saudi ArabiaSaudi Arabia
| | - Fahad Al Ghofaili
- King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi ArabiaSaudi Arabia
| | | | - Abdulrazaq Al-Jazairi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mouaz H. Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi ArabiaSaudi Arabia
| | - Ali AlMasood
- Riyadh Care Hospital, Riyadh, Saudi ArabiaSaudi Arabia
| | - Maryam Al Qaseer
- King Fahad Specialist Hospital, Dammam, Saudi ArabiaSaudi Arabia
| | - Shukri Al-Saif
- Saud Al-Babtain Cardiac Center, Dammam, Saudi ArabiaSaudi Arabia
| | - Ammar Chaudhary
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi ArabiaSaudi Arabia
| | - Abdelfatah Elasfar
- Madina Cardiac Center, AlMadina AlMonaoarah, Saudi ArabiaSaudi Arabia
- Cardiology Department, Tanta University, EgyptEgypt
| | - Adel Tash
- Ministry of Health, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mohamed Arafa
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Walid Hassan
- International Medical Center, Jeddah, Saudi ArabiaSaudi Arabia
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Mussina AZ, Smagulova GA, Veklenko GV, Tleumagambetova BB, Seitmaganbetova NA, Zhaubatyrova AA, Zhamaliyeva LM. Effect of an educational intervention on the number potential drug-drug interactions. Saudi Pharm J 2019; 27:717-723. [PMID: 31297027 PMCID: PMC6598212 DOI: 10.1016/j.jsps.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background The objective of this study was to evaluate effect of an Educational intervention on the number Potential Drug-Drug Interactions in the Emergency Hospital. Methods The prevalence and structure of Major Drug-Drug Interactions at Emergency care Hospitals of Aktobe, Uralsk, Atyrau cities (Kazakhstan) were studied (pharmacoepidemiological, cross-sectional study). Educational interventions were developed and implemented to improve pharmacotherapy in the Cardiology Department of the Aktobe Emergency Hospital, followed by an assessment of their effect. Results The effect of educational interventions was revealed, which led to a significant decrease in the indicators of drug interactions of the Major Drug-Drug Interactions by 18.2% (OR: 0.45; 95% CI, 0.25-to-0.82) in the cardiological patients of the Emergency Care Hospital of Aktobe city compared to the Regional Cardiology Center of Uralsk. Conclusion The implementation of educational pharmacotherapy programs decreased the number of clinically significant drug interactions in the Cardiology Department of Emergency Hospitals.
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Affiliation(s)
- Aigul Z Mussina
- Department of Propedeutics of Internal Diseases and Clinical Pharmacology, West Kazakhstan Marat Ospanov State Medical University, Abulhair Khan Avenue, 21-1-30, Aktobe 030020, Kazakhstan
| | - Gaziza A Smagulova
- Department of Propedeutics of Internal Diseases and Clinical Pharmacology, West Kazakhstan Marat Ospanov State Medical University, Alia Moldagulova Avenue, 47-84, Aktobe 030000, Kazakhstan
| | - Galina V Veklenko
- Department of Propedeutics of Internal Diseases and Clinical Pharmacology, West Kazakhstan Marat Ospanov State Medical University, Eset Batyr Street, 109-1-8, Aktobe 030000, Kazakhstan
| | - Bibigul B Tleumagambetova
- Department of Propedeutics of Internal Diseases and Clinical Pharmacology, West Kazakhstan Marat Ospanov State Medical University, Almaty District, Residential Massif Kargaly, 2 Mikroroyon, 16v - 230, Aktobe 030000, Kazakhstan
| | - Nazgul A Seitmaganbetova
- Department of Propedeutics of Internal Diseases and Clinical Pharmacology, West Kazakhstan Marat Ospanov State Medical University, 131g Bokenbay Batyr Street - 126, Aktobe 030000, Kazakhstan
| | - Aigul A Zhaubatyrova
- Department of Propedeutics of Internal Diseases and Clinical Pharmacology, West Kazakhstan Marat Ospanov State Medical University, Novatorov lane 1, Aktobe 030012, Kazakhstan
| | - Lazzat M Zhamaliyeva
- Center for Family Medicine and Primary Care Research, West Kazakhstan Marat Ospanov State Medical University, Alia Moldagulova Avenue, 11B - 120, Aktobe 030019, Kazakhstan
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Schulz M, Griese-Mammen N, Anker SD, Koehler F, Ihle P, Ruckes C, Schumacher PM, Trenk D, Böhm M, Laufs U. Pharmacy-based interdisciplinary intervention for patients with chronic heart failure: results of the PHARM-CHF randomized controlled trial. Eur J Heart Fail 2019; 21:1012-1021. [PMID: 31129917 DOI: 10.1002/ejhf.1503] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/08/2019] [Accepted: 05/12/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Medication non-adherence is frequent and is associated with high morbidity and mortality in patients with chronic heart failure (CHF). We investigated whether an interdisciplinary intervention improves adherence in elderly CHF patients. METHODS AND RESULTS The study population (mean age 74 years, 62% male, mean left ventricular ejection fraction 47%, 52% in New York Heart Association class III) consisted of 110 patients randomized into the pharmacy care and 127 into the usual care group. The median follow-up was 2.0 years (interquartile range 1.2-2.7). The pharmacy care group received a medication review followed by regular dose dispensing and counselling. Control patients received usual care. The primary endpoint was medication adherence as proportion of days covered (PDC) within 365 days for three classes of heart failure medications (beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and mineralocorticoid receptor antagonists). The main secondary outcome was the proportion of adherent patients (PDC ≥ 80%). The primary safety endpoint was days lost due to unplanned cardiovascular hospitalizations (blindly adjudicated) or death. Pharmacy care compared with usual care resulted in an absolute increase in mean adherence to three heart failure medications for 365 days [adjusted difference 5.7%, 95% confidence interval (CI) 1.6-9.8, P = 0.007]. The proportion of patients classified as adherent increased (odds ratio 2.9, 95% CI 1.4-5.9, P = 0.005). Pharmacy care improved quality of life after 2 years (adjusted difference in Minnesota Living with Heart Failure Questionnaire scores -7.8 points (-14.5 to -1.1; P = 0.02), compared to usual care. Pharmacy care did not affect the safety endpoints of hospitalizations or deaths. CONCLUSION Pharmacy care safely improved adherence to heart failure medications and quality of life.
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Affiliation(s)
- Martin Schulz
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.,Drug Commission of German Pharmacists (AMK), Berlin, Germany.,Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Nina Griese-Mammen
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism; Department of Cardiology (CVK), Berlin-Brandenburg Centre for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Friedrich Koehler
- Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Ihle
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Centre Mainz, Mainz, Germany
| | - Pia M Schumacher
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Dietmar Trenk
- Department of Clinical Pharmacology, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Michael Böhm
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, University Hospital of Saarland, Saarland University, Homburg, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Hospital, Leipzig University, Leipzig, Germany
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23
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Bress AP, King JB. Optimizing Medical Therapy in Chronic Worsening HFrEF: A Long Way to Go. J Am Coll Cardiol 2019; 73:945-947. [PMID: 30819363 PMCID: PMC6642611 DOI: 10.1016/j.jacc.2018.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Adam P Bress
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah.
| | - Jordan B King
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
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24
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Stuhec M, Gorenc K, Zelko E. Evaluation of a collaborative care approach between general practitioners and clinical pharmacists in primary care community settings in elderly patients on polypharmacy in Slovenia: a cohort retrospective study reveals positive evidence for implementation. BMC Health Serv Res 2019; 19:118. [PMID: 30760276 PMCID: PMC6375190 DOI: 10.1186/s12913-019-3942-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The population of developed countries is aging, leading to an increase in the use of medication in daily practice, which can lead to serious treatment costs and irrational polypharmacy. A collaborative care approach, such as providing medication review service provided by a clinical pharmacist (CP), is a possible way to reduce drug-related problems and irrational polypharmacy. The aim of this study was to determinate whether a CP's medication review service can improve the quality of drug prescribing in elderly patients treated with polypharmacy in primary care. METHODS In a retrospective observational medical chart review study, patients aged 65 years or more in the period 2012-2014 who received 10 or more medications concomitantly and who were screened by a CP were included. Data on pharmacotherapy and CPs' interventions were obtained from the patients' medical records (non-electronic chart review). Potential drug-drug interactions (pDDIs) were determined with Lexicomp Online™ 3.0.2. Only potential X-type DDIs (pXDDIs) were included. Potentially inappropriate medications in the elderly (PIMs) were identified using the PRICUS list. RESULTS Ninety-one patients were included. The CPs suggested 625 interventions, of which 304 (48.6%) were accepted by the general practitioners (GPs). After adopting the CPs' interventions, the number of total medications decreased by 11.2% (p < 0.05) and the number of pXDDIs decreased by 42% (p < 0.05). The number of clinically important pXDDIs decreased by 50% (3 cases). The number of prescribed PIMs decreased by 20% (p = 0.069). The acceptance of CP's recommendations reduced the number of pXDDIs (p < 0.05) and improved the adherence to heart failure treatment guidelines. CONCLUSIONS A collaborative care approach offering a CP medication review service significantly improved the quality of pharmacotherapy by reducing the total number of medications and pXDDIs. The results support the implementation of this service in the Slovenian healthcare system.
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Affiliation(s)
- Matej Stuhec
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ptujska cesta 33, SI-2270 Ormoz, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, SI-1000 Ljubljana, Slovenia
- Faculty of medicine Maribor, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia
| | - Katja Gorenc
- Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, SI-1000 Ljubljana, Slovenia
| | - Erika Zelko
- Faculty of medicine Maribor, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia
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25
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Dias BM, dos Santos FS, Reis AMM. Potential drug interactions in drug therapy prescribed for older adults at hospital discharge: cross-sectional study. SAO PAULO MED J 2019; 137:369-378. [PMID: 31691770 PMCID: PMC9744019 DOI: 10.1590/1516-3180.2019.013405072019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/05/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Older adults with a range of comorbidities are often prescribed multiple medications, which favors drug interactions. OBJECTIVES To establish the frequency of potential drug interactions in prescriptions at hospital discharge among older adults and to identify the associated factors. DESIGN AND SETTING Cross-sectional study conducted in a public hospital. METHODS An initial face-to-face interview, data collection from the electronic medical records (covering sociodemographic, clinical, functional and drug therapy-related variables) and telephone follow-up after discharge were conducted to confirm the medication prescribed at discharge. Drug interactions were identified through the Micromedex DrugReax software, along with interactions that should be avoided among the elderly, as per the 2015 American Geriatric Society/Beers criteria. Multivariable logistic regression was performed. RESULTS Potential for drug interactions was identified in the discharge drug therapy of 67.8% of the 255 older adults evaluated (n = 172), and 54.5% (n = 145) of the drug interactions were major. Among the drug interactions that should be avoided among older adults, those that increase the risk of falls were the most frequent. The drug interactions thus identified were independently associated with polypharmacy (odds ratio, OR = 12.62; 95% confidence interval, CI 6.25-25.50; P = 0.00), diabetes mellitus (OR = 2.16; 95% CI 1.05-4.44; P = 0.04), hypothyroidism (OR = 7.29; 95% CI 2.03-26.10; P = 0.00), chronic kidney disease (OR = 3.41; 95% CI 1.09-10.64; P = 0.03) and hospitalization in geriatric units (OR = 0.45; 95% CI 0.22-0.89; P = 0.02). CONCLUSION The frequency of potential drug interactions in drug therapy prescribed at discharge for these older adults was high. Polypharmacy, diabetes mellitus, hypothyroidism and chronic kidney disease were positively associated with occurrences of drug interactions, while hospitalization in geriatric units showed an inverse association.
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Affiliation(s)
- Bianca Menezes Dias
- Pharmacist, School of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | | | - Adriano Max Moreira Reis
- PhD. Associate Professor, Department of Pharmaceutical Products, School of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
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26
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de Barra M, Scott CL, Scott NW, Johnston M, de Bruin M, Nkansah N, Bond CM, Matheson CI, Rackow P, Williams AJ, Watson MC. Pharmacist services for non-hospitalised patients. Cochrane Database Syst Rev 2018; 9:CD013102. [PMID: 30178872 PMCID: PMC6513292 DOI: 10.1002/14651858.cd013102] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND This review focuses on non-dispensing services from pharmacists, i.e. pharmacists in community, primary or ambulatory-care settings, to non-hospitalised patients, and is an update of a previously-published Cochrane Review. OBJECTIVES To examine the effect of pharmacists' non-dispensing services on non-hospitalised patient outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases and two trial registers in March 2015, together with reference checking and contact with study authors to identify additional studies. We included non-English language publications. We ran top-up searches in January 2018 and have added potentially eligible studies to 'Studies awaiting classification'. SELECTION CRITERIA Randomised trials of pharmacist services compared with the delivery of usual care or equivalent/similar services with the same objective delivered by other health professionals. DATA COLLECTION AND ANALYSIS We used standard methodological procedures of Cochrane and the Effective Practice and Organisation of Care Group. Two review authors independently checked studies for inclusion, extracted data and assessed risks of bias. We evaluated the overall certainty of evidence using GRADE. MAIN RESULTS We included 116 trials comprising 111 trials (39,729 participants) comparing pharmacist interventions with usual care and five trials (2122 participants) comparing pharmacist services with services from other healthcare professionals. Of the 116 trials, 76 were included in meta-analyses. The 40 remaining trials were not included in the meta-analyses because they each reported unique outcome measures which could not be combined. Most trials targeted chronic conditions and were conducted in a range of settings, mostly community pharmacies and hospital outpatient clinics, and were mainly but not exclusively conducted in high-income countries. Most trials had a low risk of reporting bias and about 25%-30% were at high risk of bias for performance, detection, and attrition. Selection bias was unclear for about half of the included studies.Compared with usual care, we are uncertain whether pharmacist services reduce the percentage of patients outside the glycated haemoglobin target range (5 trials, N = 558, odds ratio (OR) 0.29, 95% confidence interval (CI) 0.04 to 2.22; very low-certainty evidence). Pharmacist services may reduce the percentage of patients whose blood pressure is outside the target range (18 trials, N = 4107, OR 0.40, 95% CI 0.29 to 0.55; low-certainty evidence) and probably lead to little or no difference in hospital attendance or admissions (14 trials, N = 3631, OR 0.85, 95% CI 0.65 to 1.11; moderate-certainty evidence). Pharmacist services may make little or no difference to adverse drug effects (3 trials, N = 590, OR 1.65, 95% CI 0.84 to 3.24) and may slightly improve physical functioning (7 trials, N = 1329, mean difference (MD) 5.84, 95% CI 1.21 to 10.48; low-certainty evidence). Pharmacist services may make little or no difference to mortality (9 trials, N = 1980, OR 0.79, 95% CI 0.56 to 1.12, low-certaintly evidence).Of the five studies that compared services delivered by pharmacists with other health professionals, no studies evaluated the impact of the intervention on the percentage of patients outside blood pressure or glycated haemoglobin target range, hospital attendance and admission, adverse drug effects, or physical functioning. AUTHORS' CONCLUSIONS The results demonstrate that pharmacist services have varying effects on patient outcomes compared with usual care. We found no studies comparing services delivered by pharmacists with other healthcare professionals that evaluated the impact of the intervention on the six main outcome measures. The results need to be interpreted cautiously because there was major heterogeneity in study populations, types of interventions delivered and reported outcomes.There was considerable heterogeneity within many of the meta-analyses, as well as considerable variation in the risks of bias.
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Affiliation(s)
- Mícheál de Barra
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Claire L Scott
- NHS Education for ScotlandScottish Dental Clinical Effectiveness ProgrammeDundee Dental Education CentreSmall's WyndDundeeUKDD1 4HN
| | - Neil W Scott
- University of AberdeenMedical Statistics TeamPolwarth BuildingForesterhillAberdeenScotlandUKAB 25 2 ZD
| | - Marie Johnston
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Marijn de Bruin
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Nancy Nkansah
- University of CaliforniaClinical Pharmacy155 North Fresno Street, Suite 224San FranciscoCaliforniaUSA93701
| | - Christine M Bond
- University of AberdeenDivision of Applied Health SciencesPolwarth BuildingForesterhillAberdeenUKAB25 2ZD
| | | | - Pamela Rackow
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - A. Jess Williams
- Nottingham Trent UniversitySchool of PsychologyNottinghamEnglandUK
| | - Margaret C Watson
- University of BathDepartment of Pharmacy and Pharmacology5w 3.33Claverton DownBathUKBA2 7AY
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27
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Forsyth P, Warren A, Thomson C, Bateman J, Greenwood E, Williams H, Khatib R, Hadland R, McGlynn S, Khan N, Duggan C, Beezer J. A competency framework for clinical pharmacists and heart failure. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:424-435. [PMID: 30028562 DOI: 10.1111/ijpp.12465] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 06/01/2018] [Indexed: 01/28/2023]
Abstract
Abstract
Objectives
Heart failure is an escalating ‘pandemic’ with malignant outcomes. Clinical pharmacist heart failure services have been developing for the past two decades. However, little clarity is available on the additional advanced knowledge, skills and experience needed for pharmacists to practice safely and competently. We aimed to provide an expert consensus on the minimum competencies necessary for clinical pharmacists to deliver appropriate care to patients with heart failure.
Methods
There were four methodological parts; (1) establishing a project group from experts in the field; (2) review of the literature, including existing pharmacy competency frameworks in other specialities and previous heart failure curricula from other professions; (3) consensus building, including developing, reviewing and adapting the contents of the framework; and (4) write-up and dissemination to widen the impact of the project.
Key findings
The final framework defines minimum competencies relevant to heart failure for four different potential levels of specialism: all pharmacists regardless of role (Stage 1); all patient-facing clinical pharmacists (Stage 2); clinical pharmacists with specific planned roles in the care of heart failure patients (Stage 3); and regionally/nationally/internationally recognised expert pharmacists with a direct specialism in heart failure (Stage 4).
Conclusions
The framework delivers the vital first step needed to help standardise care, give pharmacists a blueprint for career progression and continuing professional development and bring clarity to the role of the pharmacist. Future collaboration between professional bodies and training providers is needed to develop structured programmes to align with the framework and facilitate training and resultant accreditation.
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Affiliation(s)
- Paul Forsyth
- West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Alison Warren
- Brighton and Sussex University Hospitals NHS Trust, Brighton and Hove Clinical Commissioning Group, Brighton, UK
| | | | | | | | - Helen Williams
- NHS Southwark Clinical Commissioning Group and Medicines Use and Safety Team, Specialist Pharmacy Services, London, UK
| | - Rani Khatib
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rocco Hadland
- Wrexham Maelor Hospital, NHS Betsi Cadwaladr University Health Board, Bangor, UK
| | - Steve McGlynn
- Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Nazish Khan
- NHS Royal Wolverhampton Hospital, Wolverhampton, UK
| | | | - Janine Beezer
- City Hospitals Sunderland Foundation Trust, Sunderland, UK
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28
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Laufs U, Griese-Mammen N, Krueger K, Wachter A, Anker SD, Koehler F, Rettig-Ewen V, Botermann L, Strauch D, Trenk D, Böhm M, Schulz M. PHARMacy-based interdisciplinary program for patients with Chronic Heart Failure (PHARM-CHF): rationale and design of a randomized controlled trial, and results of the pilot study. Eur J Heart Fail 2018; 20:1350-1359. [PMID: 29846031 DOI: 10.1002/ejhf.1213] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/25/2018] [Accepted: 04/11/2018] [Indexed: 12/28/2022] Open
Abstract
We report the rationale and design of a community PHARMacy-based prospective randomized controlled interdisciplinary study for ambulatory patients with Chronic Heart Failure (PHARM-CHF) and results of its pilot study. The pilot study randomized 50 patients to a pharmacy-based intervention or usual care for 12 months. It demonstrated the feasibility of the design and showed reduced systolic blood pressure in the intervention group as indicator for improved medication adherence. The main study will randomize patients ≥60 years on stable pharmacotherapy including at least one diuretic and a history of heart failure hospitalization within 12 months. The intervention group will receive a medication review at baseline followed by regular dose dispensing of the medication, counselling regarding medication use and symptoms of heart failure. The control patients are unknown to the pharmacy and receive usual care. The primary efficacy endpoint is medication adherence, pre-specified as a significant difference of the proportion of days covered between the intervention and control group within 365 days following randomization using pharmacy claims data for three CHF medications (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists). The primary composite safety endpoint is days lost due to blindly adjudicated unplanned cardiovascular hospitalizations or death. Overall, 248 patients shall be randomized. The minimum follow-up is 12 months with an expected mean of 24 months. Based on the feasibility demonstrated in the pilot study, the randomized PHARM-CHF trial will test whether an interdisciplinary pharmacy-based intervention can safely improve medication adherence and will estimate the potential impact on clinical endpoints. ClinicalTrials.gov Identifier: NCT01692119.
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Affiliation(s)
- Ulrich Laufs
- Department of Cardiology, University Hospital, Leipzig University, Germany
| | - Nina Griese-Mammen
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Katrin Krueger
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Angelika Wachter
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Centre, University of the Saarland, Homburg/Saar, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism; Department of Cardiology (CVK); and Berlin-Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Friedrich Koehler
- Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology, Charité Universitätsmedizin Berlin, Germany
| | | | - Lea Botermann
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Dorothea Strauch
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Dietmar Trenk
- Department of Clinical Pharmacology, University Heart Centre Freiburg-Bad Krozingen, Germany
| | - Michael Böhm
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Centre, University of the Saarland, Homburg/Saar, Germany
| | - Martin Schulz
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.,Drug Commission of German Pharmacists (AMK), Berlin, Germany
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29
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Cheng JW. Current perspectives on the role of the pharmacist in heart failure management. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2018; 7:1-11. [PMID: 29594034 PMCID: PMC5863893 DOI: 10.2147/iprp.s137882] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pharmacists play an important role within a multidisciplinary health care team in the care of patients with heart failure (HF). It has been evaluated and documented that pharmacists providing medication reconciliation especially during transition of care, educating patients on their medications, and providing collaborative medication management lead to positive changes in the patient outcomes, including but not limited to decreasing in hospitalizations and read-missions. It is foreseeable that pharmacist roles will continue to expand as new treatment and innovative care are developed for HF patients. I reviewed published role of pharmacists in the care of HF patients. MEDLINE and Current Content database (both from 1966 – December 31, 2017) were utilized to identify peer-reviewed clinical trials, descriptive studies, and review articles published in English using the following search terms: pharmacists, clinical pharmacy, HF, and cardiomyopathy. Citations from available articles were also reviewed for additional references. Preliminary search revealed 31 studies and 55 reviews. They were further reviewed by title and abstract as well as full text to remove irrelevant articles. At the end, 24 of these clinical trials and systematic reviews are described in the following text and Table 1 summarizes 16 pertinent clinical trials. Some roles that are currently being explored include medication management in patients with mechanical circulatory support for end-stage HF, where pharmacokinetics and pharmacodynamics of medications can change, medication management in ambulatory intravenous diuretic clinics, and comprehensive medication management in patients’ home settings. Pharmacists should continue to explore and prospectively evaluate their role in the care of this patient population, including documenting their interventions, and impact to economic and patient outcomes.
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Affiliation(s)
- Judy Wm Cheng
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Brigham and Women's Hospital, Boston, MA, USA
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30
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Pharmacist-led intervention in the multidisciplinary team approach optimizes heart failure medication. Heart Vessels 2017; 33:615-622. [PMID: 29204682 DOI: 10.1007/s00380-017-1099-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 12/01/2017] [Indexed: 12/28/2022]
Abstract
We evaluated the impact of pharmacist-led heart failure (HF) drug recommendations during hospitalization for hospitalized patients with HF. Hospitalized patients with HF were retrospectively reviewed. Patients were hospitalized before (n = 208, non-intervention group) or after (n = 170, intervention group) the launch of the HF multidisciplinary team (HFMDT) approach with pharmacist-led HF medication optimization. There were no significant group differences in patient background characteristics at admission. Patients with HF with reduced ejection fraction who were not on beta blockers or angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACE-I/ARB) at admission were significantly more likely to be on beta blockers at the time of discharge in the intervention group (73.3 vs 96.3%, P = 0.027) compared to those in non-intervention group; however, the change in ACE-I/ARB prescriptions was not significant (53.3 vs 63.3%, P = 0.601). The proportion of patients on any drug with recommendations against its use in patients with HF did not change from admission to discharge in the non-intervention group (21.2 vs. 20.2%, P = 0.855), but was significantly reduced in the intervention group (22.9 vs. 12.9%, P = 0.005). There were no group differences in the in-hospital all-cause mortality (non-intervention, 3.4%; intervention, 2.4%; P = 0.761) or length of hospital stay (median: non-intervention, 13 days; intervention, 14 days; P = 0.508). Pharmacist-led HF drug recommendations during hospitalization as part of a HFMDT approach for hospitalized patients with HF can increase beta blocker prescriptions and decrease non-preferred drug prescriptions.
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31
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Khalil V, Danninger M, Wang W, Khalil H. An audit of adherence to heart failure guidelines in an Australian hospital: A pharmacist perspective. J Eval Clin Pract 2017; 23:1195-1202. [PMID: 28512920 DOI: 10.1111/jep.12760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/26/2017] [Accepted: 03/28/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The Australian National Heart Foundation Guidelines have been developed to guide clinicians on how to best manage chronic heart failure (CHF) patients according to the current best available evidence. The primary aim of this study is to evaluate the proportion of patients prescribed evidence-based therapy (EBT) for CHF on discharge at this Australian metropolitan hospital and factors affecting its prescribing. The secondary aims are to examine the proportion of patients prescribed EBT on discharge on cardiac wards compared to medical wards and to explore the role of the pharmacist in the management of these patients. METHOD A retrospective audit of patients' medical notes who were admitted consecutively for CHF management was conducted over 6 months to examine their management. RESULTS The results showed at discharge, a total of 52% of patients were discharged on angiotensin converting enzyme inhibitors/angiotensin receptor blockers, 49% were discharged on β-blockers, 15% were on Aldosterone receptor antagonists, 90% were discharged on diuretics, and 29% were discharged on Digoxin. The main determinants of prescribing EBT on discharge were the presence of prescribing contraindications and patients' comorbidities. Patients discharged from cardiac wards were more likely to be prescribed EBT than if discharged on medical wards. Furthermore, in the subset of the cohort who was reviewed by a pharmacist during admission, a higher percentage of patients were discharged on EBT compared with those who did not have a pharmaceutical input. CONCLUSION This study highlighted existing gaps between the National CHF Guidelines and clinical prescribing practice in this hospital. Patients who were discharged from cardiac wards were more likely to be prescribed medications concordant with the guidelines, and there is further opportunity for pharmacists to assist in closing gaps in prescribing practice by the promotion of adherence to these guidelines.
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Affiliation(s)
- Viviane Khalil
- Pharmacy Department, Frankston Hospital, Frankston, Australia.,Monash University, Parkville, Melbourne, Australia
| | - Melanie Danninger
- Faculty of Natural sciences, Karl-Franzens University Graz, Graz, Austria
| | - Wei Wang
- Peninsula Clinical School, Faculty of Medicine, Nursing and health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Hanan Khalil
- Faculty of Medicine, Nursing and Health Sciences, Monash Rural Health, Monash University, Clayton, Melbourne, Victoria, Australia
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32
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Khalil V, Chin K, Tran M, Furtula D. The impact of pharmacists' input to reduce serotonin syndrome drug interactions in an Australian hospital. INT J EVID-BASED HEA 2017; 14:123-9. [PMID: 27552535 DOI: 10.1097/xeb.0000000000000091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Drug interactions contribute significantly to adverse-related events and hospital admissions. Example of common drug interactions includes combinations of medications that induces serotonin syndrome. Pharmacists are well placed in the multidisciplinary team to alert prescribers of these drug interactions and offer an alternative management. OBJECTIVE The objective is to evaluate the effectiveness of pharmacists' input in preventing patients being discharged on clinically relevant drug interactions that have the potential to cause serotonin syndrome in an Australian hospital. METHOD A retrospective cross-sectional audit of patients' case notes who were prescribed a combination of drugs likely to induce serotonin syndrome on admission were examined over a 3-month period. A predefined list of serotonin syndrome-inducing drugs of severity 1 and 2 was used to search for patients on these drug combinations on admission. The severities of the drug combinations were classified as per the Monthly Index of Medical Specialties drug interactions guide. Subsequent pharmacists' interventions were recorded on discharge to observe any change in prescribing practice. Descriptive statistics were used to analyze the data. P values were obtained using the Student's t-test and Fisher's exact tests. RESULTS A total of 144 patients over 3 months were identified to have been prescribed a combination of drugs with a potential to cause serotonin syndrome during admission. Of these patients, 79 and 21% were prescribed combination of serotonergic drugs that were classified as severity 1 and 2, respectively, according to Monthly Index of Medical Specialties. A total of 56% (n = 81) of the audited patients were discharged with no serotonin syndrome-inducing drug combinations and 44% (n = 63) were discharged on serotonin syndrome-inducing drug combinations of severity 1 or 2. Pharmacist input has led to a significant reduction (relative risk reduction 44%; P < 0.0001) in the total number of patients who were discharged on severity 1 and 2 serotonin syndrome-inducing drug combinations. There were 87 patients (60%) who had a pharmacist input during admission. In this subset of the cohort, 36% (n = 31) of patients were discharged on serotonin syndrome-inducing drug combinations (combined both severity 1 and 2) compared with 56% (n = 32) in those who did not get a pharmacist input, P = 0.017. In addition, 64% (n = 56) of patients in this group were discharged on no serotonin syndrome-inducing drug combinations compared with 44% (n = 25) in the nonpharmacist group, P = 0.017. CONCLUSION The audit highlights the pharmacists' role in significantly reducing clinically relevant drug interaction in patients prescribed serotonin syndrome-inducing drug combination in a single-center Australian hospital on discharge.
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Potential drug-drug interactions in pediatric patients admitted to intensive care unit of Khyber Teaching Hospital, Peshawar, Pakistan: A cross-sectional study. J Crit Care 2017; 40:243-250. [PMID: 28458171 DOI: 10.1016/j.jcrc.2017.04.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/11/2017] [Accepted: 04/20/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE To investigate frequencies, levels, clinical relevance and predictors of potential drug-drug interactions (pDDIs) in pediatric intensive care unit (PICU). METHODS Case notes of 411 patients were reviewed for pDDIs through Micromedex. Frequencies, levels and clinical relevance of pDDIs were reported. Logistic regression was applied to calculate the odds-ratios for predictors of pDDIs. RESULTS We recorded pDDIs in 59.4% patients. Major-pDDIs were found in 34.5% patients. Total 990 pDDIs were identified, of which, 37.8% were of moderate-severity and 30.6% of major-severity. Patient's case notes of top-ten pDDIs showed presence of signs/symptoms such as fever, jaundice, vomiting, anorexia, tachycardia, drowsiness, & lethargy; and abnormalities in labs such as total leukocytes count, blood urea nitrogen, alanine aminotransferase, & potassium-level. Odds of exposure to major-pDDIs were significantly higher in patients aged 6-12years (p=0.008); hospital stay of ≥7days (p=0.05); and ≥11 prescribed medicines (p<0.001). CONCLUSION Substantial numbers of patients in PICU are exposed to pDDIs. Major-pDDIs are of particular concern. Timely identification of pDDIs, preferably with computerized source, is crucial point for their management. Monitoring of clinically relevant parameters and identification of various predictors are needed to minimize or prevent the associated negative consequences of pDDIs.
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Wongpakaran R, Suansanae T, Tan-Khum T, Kraivichian C, Ongarjsakulman R, Suthisisang C. Impact of providing psychiatry specialty pharmacist intervention on reducing drug-related problems among children with autism spectrum disorder related to disruptive behavioural symptoms: A prospective randomized open-label study. J Clin Pharm Ther 2017; 42:329-336. [PMID: 28317138 DOI: 10.1111/jcpt.12518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/25/2017] [Accepted: 02/16/2017] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient's function and quality of life. Due to the complicated neurobiological aetiology of autism spectrum disorder (ASD), a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population. We evaluate the impact of providing specialty psychiatry (PS) pharmacist intervention in identifying and resolving drug-related problems (DRPs) among children with ASD associated with disruptive behaviours. METHODS An eight-week-long, prospective, randomized open-label study was conducted. Children between 2.5 and 12 years of age with ASD and showing disruptive behaviours were included. They were randomly assigned to an intervention or a control group. Patients in the intervention group received pharmacist interventions delivered by a PS pharmacist, while those in control group were cared by a hospital pharmacist. The primary outcome was the number of patients who resolved of at least one DRP by the end of the study. The secondary outcome was to compare the mean Aberrant Behavior Checklist-Irritability (ABC-I) scores between the two groups. RESULTS Twenty-five patients were randomly assigned to either an intervention or control group. At week 8, the total number of patients who resolved of at least one DRP was 13 (52%) in the intervention group and 4 (16%) in the control group, respectively (P=.016). Improper drug selection, medication non-adherence and subtherapeutic dosage were the most common DRPs. Mean ABC-I scores improved in the intervention group more than in the control group (9.8±5.6 vs 17.7±7.9; P<.001). WHAT IS NEW AND CONCLUSION To the best of our knowledge, this is the first study which demonstrated that PS pharmacist intervention is an effective strategy to resolve DRPs in patient with ASD. The reduction in common DRPs mostly resulted from the PS pharmacist interventions, including selection of antipsychotic agent, adjustment of dosage based on ABC-I scores and provision of individualized drug counselling. Reducing DRPs led to the improvement of any disruptive behaviour. In addition, multidisciplinary team should develop drug therapy protocols to promote the role of pharmacists in this setting.
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Affiliation(s)
- R Wongpakaran
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - T Suansanae
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - T Tan-Khum
- Yuwaprasart Waithayopathum Child Psychiatric Hospital, Samutprakarn, Thailand
| | - C Kraivichian
- Yuwaprasart Waithayopathum Child Psychiatric Hospital, Samutprakarn, Thailand
| | - R Ongarjsakulman
- Yuwaprasart Waithayopathum Child Psychiatric Hospital, Samutprakarn, Thailand
| | - C Suthisisang
- Department of Pharmacology, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
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Parajuli DR, Franzon J, McKinnon RA, Shakib S, Clark RA. Role of the Pharmacist for Improving Self-care and Outcomes in Heart Failure. Curr Heart Fail Rep 2017; 14:78-86. [DOI: 10.1007/s11897-017-0323-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lainscak M, Coats AJ. The PARADIGM of ARNI's: Assessing reasons for non-implementation in heart failure. Int J Cardiol 2016; 212:187-9. [DOI: 10.1016/j.ijcard.2016.02.130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
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