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Torres-Novellas B, Rius P, Figueiredo-Escribá C, Mariño EL, Modamio P. Drug-Related Problems Detected in Complex Chronic Patients by Community Pharmacists of Catalonia: Perception of the Person-Centred Approach Necessity. Healthcare (Basel) 2024; 12:240. [PMID: 38255127 PMCID: PMC10815887 DOI: 10.3390/healthcare12020240] [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: 12/02/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Community pharmacies are healthcare settings in which pharmacists are in an ideal position to carry out pharmaceutical care. The aim of this study was to analyse the number, type and groups of drugs that caused drug-related problems (DRPs) detected in complex chronic patients who are outpatients, the interventions and actions of community pharmacists and their impact on patient medication adherence. The study was designed as a secondary analysis of a multicentre study in the field of primary healthcare and community pharmacies in Catalonia (Spain). The patients who took part were divided into two groups by the primary care physician depending on whether or not they were considered likely to receive their medication through a monitored dosage system (MDS) based on pre-established criteria. Patients underwent 12 months of follow-up by community pharmacists. The prevalence of DRPs among the studied complex chronic patients was high (n = 689). The most identified DRP was nonadherence (31.20%). In the MDS group, results showed a statistically significant increase of 21% in the number of adherent patients with respect to the baseline visit (p-value = 0.0008). Community pharmacists can have an important role in addressing DRPs and optimizing the safety and effectiveness of medications for these patients and in involving them in their own health conditions.
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Affiliation(s)
- Berta Torres-Novellas
- Catalan Council of Pharmacists’ Associations (CCFC), 08009 Barcelona, Spain
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain
| | - Pilar Rius
- Catalan Council of Pharmacists’ Associations (CCFC), 08009 Barcelona, Spain
| | - Carlos Figueiredo-Escribá
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain
| | - Eduardo L. Mariño
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain
| | - Pilar Modamio
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain
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Thielemans L, Chin K, Hegarty A, Schiff R. Carer involvement in medication adherence: carer views and experiences of facilitating medication adherence using pharmacy-filled multi-compartment medication compliance aids and other methods of adherence support-a questionnaire survey. Age Ageing 2023; 52:afad169. [PMID: 37930740 PMCID: PMC10627250 DOI: 10.1093/ageing/afad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/21/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Unpaid carers are an increasing proportion of the UK population. One of the many ways in which they help those they care for is assisting with medication adherence. Many older adults have medicines dispensed in pharmacy-filled multi-compartment medication compliance aids (pMCAs). However, evidence suggests that pMCAs may increase medication-related harm, and little is known about the interaction between the user, medication adherence systems and the carer. AIM To explore the views of carers supporting older adults to manage their medications with and without a pMCA. METHOD A researcher-administered questionnaire survey of carers supporting older adults to manage their medicines with or without a pMCA. Participants were recruited from inpatient wards, outpatient clinics and community services in central London. Responses were analysed by two independent researchers to identify overarching themes. RESULTS Eighty-eight unpaid carers were interviewed and responses were categorised according to the medication adherence method used; 47 supported a user with a pMCA and 41 supported without a pMCA. The main themes were: Time, Responsibility and Mistakes, Waste and Sustainability, and Polypharmacy, with sub-themes of design of multi-compartment medication compliance aids, organisation and reassurance. CONCLUSION Supporting medication adherence puts considerable burden on carers regardless of whether a self- or pharmacy-filled medication compliance aid is used or not. Prescribers could alleviate this burden through regular medication review by considering the prescribing frequency and duration and medication rationalisation. Redesign of both pMCAs and systems surrounding their use could also help reduce carer's burden and environmental burden.
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Affiliation(s)
- Lieze Thielemans
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH, United Kingdom
| | - Katherine Chin
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH, United Kingdom
| | - Alice Hegarty
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH, United Kingdom
| | - Rebekah Schiff
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH, United Kingdom
- King’s College London, London, WC2R 2LS, United Kingdom
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Alqenae FA, Steinke D, Belither H, Robertson P, Bartlett J, Wilkinson J, Williams SD, Brad L, Jeffries M, Ashcroft DM, Keers RN. A Multi-method Exploratory Evaluation of a Service Designed to Improve Medication Safety for Patients with Monitored Dosage Systems Following Hospital Discharge. Drug Saf 2023; 46:1021-1037. [PMID: 37819463 PMCID: PMC10584716 DOI: 10.1007/s40264-023-01342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Medication safety problems are common post-hospital discharge, and an important global healthcare improvement target. The Transfers of Care Around Medicines (TCAM) service was launched by a National Health Service Trust in the North-West of England, initially focusing on patients with new or existing Monitored Dosage Systems (MDS). The TCAM service is designed to enable the prompt transfer of medication information, with referrals made by hospitals at discharge to a named community pharmacy. This study aimed to explore the utilisation and impact of the TCAM service on medication safety. METHODS The evaluation included a descriptive analysis of 3033 anonymised patient referrals to 71 community pharmacies over a 1-year period alongside an assessment of the impact of the TCAM service on unintentional medication discrepancies and adverse drug events using a retrospective before-and-after study design. Impact data were collected across 18 general practices by 16 trained clinical pharmacists. RESULTS Most patient referrals (70%, 2126/3033) were marked as 'completed' by community pharmacies, with 15% of completed referrals delayed beyond 30 days. Screening of 411 patient records by clinical pharmacists yielded no statistically significant difference in unintentional medication discrepancies or adverse drug event rates following TCAM implementation using a multivariable regression analysis (unintentional medication discrepancies adjusted odds ratio = 0.79 [95% confidence interval 0.44-1.44, p = 0.46]; and adverse drug events adjusted odds ratio = 1.19 [95% confidence interval 0.57-2.45, p = 0.63]), although there remained considerable uncertainty. CONCLUSIONS The TCAM service facilitated a number of community pharmacy services offered to patients with monitored dosage systems; but the impact of the intervention on unintentional medication discrepancies and adverse drug event rates post-hospital discharge for this patient group was uncertain. The results of this exploratory study can inform the ongoing implementation of the TCAM service at hospital discharge and highlight the need to understand service implementation in different contexts, which may influence its impact on medication safety.
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Affiliation(s)
- Fatema A Alqenae
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Douglas Steinke
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Hilary Belither
- Pharmacy Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, UK
| | | | - Jennifer Bartlett
- Pharmacy Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, UK
| | - Jack Wilkinson
- Centre for Biostatistics, Division of Population Health, Health Service Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Steven D Williams
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Westbourne Medical Centre, Bournemouth, UK
| | | | - Mark Jeffries
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Division of Population Health, Health Service Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Richard N Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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