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Bou Malham C, El Khatib S, Cestac P, Andrieu S, Rouch L, Salameh P. Management of potentially inappropriate medication use among older adult's patients in primary care settings: description of an interventional prospective non-randomized study. BMC PRIMARY CARE 2024; 25:213. [PMID: 38872125 PMCID: PMC11170768 DOI: 10.1186/s12875-024-02334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/07/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The management of inappropriate medication use in older patients suffering from multimorbidity and polymedication is a major healthcare challenge. In a primary care setting, a medication review is an effective tool through which a pharmacist can collaborate with a practitioner to detect inappropriate drug use. AIM This project described the implementation of a systematic process for the management of potentially inappropriate medication use among Lebanese older adults. Its aim was to involve pharmacists in geriatric care and to suggest treatment optimization through the analysis of prescriptions using explicit and implicit criteria. METHOD This study evaluated the medications of patients over 65 years taking a minimum of five chronic medications a day in different regions of Lebanon. Descriptive statistics for all the included variables using mean and standard deviation (Mean (SD)) for continuous variables and frequency and percentage (n, (%)) for multinomial variables were then performed. RESULTS A total of 850 patients (50.7% women, 28.6% frail, 75.7 (8.01) mean age (SD)) were included in this study. The mean number of drugs per prescription was 7.10 (2.45). Roughly 88% of patients (n = 748) had at least one potentially inappropriate drug prescription: 66.4% and 64.4% of the patients had at least 1 drug with an unfavorable benefit-to-risk ratio according to Beers and EU(7)-PIM respectively. Nearly 50.4% of patients took at least one medication with no indication. The pharmacists recommended discontinuing medication for 76.5% of the cases of drug related problems. 26.6% of the overall proposed interventions were implemented. DISCUSSION The rate of potentially inappropriate drug prescribing (PIDP) (88%) was higher than the rates previously reported in Europe, US, and Canada. It was also higher than studies conducted in Lebanon where it varied from 22.4 to 80% depending on the explicit criteria used, the settings, and the medical conditions of the patients. We used both implicit and explicit criteria with five different lists to improve the detection of all types of inappropriate medication use since Lebanon obtains drugs from many different sources. Another potential source for variation is the lack of a standardized process for the assessment of outpatient medication use in the elderly. CONCLUSION The prevalence PIDP detected in the sample was higher than the percentages reported in previous literature. Systematic review of prescriptions has the capacity to identify and resolve pharmaceutical care issues thus improving geriatric care.
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Affiliation(s)
- Carmela Bou Malham
- Aging Research Team, Center for Epidemiology and Research in POPulation health (CERPOP), Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, 31000, France.
- University Paul Sabatier Toulouse III, Toulouse, 31062, France.
| | - Sarah El Khatib
- Aging Research Team, Center for Epidemiology and Research in POPulation health (CERPOP), Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, 31000, France
- University Paul Sabatier Toulouse III, Toulouse, 31062, France
| | - Philippe Cestac
- Aging Research Team, Center for Epidemiology and Research in POPulation health (CERPOP), Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, 31000, France
- University Paul Sabatier Toulouse III, Toulouse, 31062, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, Toulouse, 31059, France
| | - Sandrine Andrieu
- Aging Research Team, Center for Epidemiology and Research in POPulation health (CERPOP), Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, 31000, France
- University Paul Sabatier Toulouse III, Toulouse, 31062, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, Toulouse, 31059, France
| | - Laure Rouch
- Aging Research Team, Center for Epidemiology and Research in POPulation health (CERPOP), Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, 31000, France
- University Paul Sabatier Toulouse III, Toulouse, 31062, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, Toulouse, 31059, France
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, 1401, Lebanon
- University of Nicosia Medical School, Nicosia, 1065, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadath, 1100, Lebanon
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie INSPECT-LB), Beirut, 1100, Lebanon
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Khatib SE, Malham CB, Andrieu S, Strumia M, Cestac P, Salameh P. Fall risk factors among poly-medicated older Lebanese patients in primary care settings: a secondary cross-sectional analysis of the "MGPIDP-L project". BMC Geriatr 2024; 24:327. [PMID: 38600461 PMCID: PMC11008041 DOI: 10.1186/s12877-024-04951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Falling is a major concern for the health of older adults and significantly affects their quality of life. Identifying the various risk factors and the differences between older patients can be challenging. The objective of this study was to identify the risk factors for falls among polymedicated community-dwelling older Lebanese patients following a medication review. METHODS In this analytical cross-sectional study, we examined the risk factors for falls in 850 patients aged ≥ 65 years who were taking ≥ 5 medications daily. The study involved conducting a medication review over the course of a year in primary care settings and using multivariate logistic regression analysis to analyze the data. RESULTS Our results showed that 106 (19.5%) of the 850 included patients had fallen at least once in the three months prior to the medication review. Loss of appetite and functional dependence were identified as the most significant predictors of falls ORa = 3.020, CI [2.074-4.397] and ORa = 2.877, CI [1.787-4.632], respectively. Other risk factors for falls included drowsiness ORa = 2.172, CI [1.499-3.145], and the use of beta-blockers ORa = 1.943, CI [1.339-2.820]. CONCLUSION Our study highlights the importance of addressing multiple risk factors for falls among Lebanese older adults and emphasizes the need for customized interventions and ongoing monitoring to prevent falls and improve health outcomes. This study sheds light on a critical issue in the Lebanese older population and provides valuable insight into the complex nature of falls among poly-medicated Lebanese community-dwelling older adults. TRIAL REGISTRATION 2021REC-001- INSPECT -09-04.
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Affiliation(s)
- Sarah El Khatib
- Paul Sabatier University III, 31063, Toulouse, France.
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France.
| | - Carmela Bou Malham
- Paul Sabatier University III, 31063, Toulouse, France
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France
| | - Sandrine Andrieu
- Paul Sabatier University III, 31063, Toulouse, France
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, 31059, Toulouse, France
| | - Mathilde Strumia
- Paul Sabatier University III, 31063, Toulouse, France
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, 31059, Toulouse, France
| | - Philippe Cestac
- Paul Sabatier University III, 31063, Toulouse, France
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, 31059, Toulouse, France
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, 1401, Lebanon
- University of Nicosia Medical School, 1065, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadath, 1100, Lebanon
- Institut National de Santé Publique, Epidémiologie Clinique Et Toxicologie INSPECT-LB), Beirut, 1100, Lebanon
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Canning ML, Barras M, McDougall R, Yerkovich S, Coombes I, Sullivan C, Whitfield K. Defining quality indicators, pharmaceutical care bundles and outcomes of clinical pharmacy service delivery using a Delphi consensus approach. Int J Clin Pharm 2024; 46:451-462. [PMID: 38240963 DOI: 10.1007/s11096-023-01681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/28/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Clinical pharmacy quality indicators are often non-uniform and measure individual activities not linked to outcomes. AIM To define a consensus agreed pharmaceutical care bundle and patient outcome measures across an entire state health service. METHOD A four-round modified-Delphi approach with state Directors of Pharmacy was performed (n = 25). They were asked to rate on a 5-point Likert scale the relevance and measurability of 32 inpatient clinical pharmacy quality indicators and outcome measures. They also ranked clinical pharmacy activities in order from perceived most to least beneficial. Based upon these results, pharmaceutical care bundles consisting of multiple clinical pharmacy activities were formed, and relevance and measurability assessed. RESULTS Response rate ranged from 40 to 60%. Twenty-six individual clinical pharmacy quality indicators reached consensus. The top ranked clinical pharmacy quality indicator was 'proportion of patients where a pharmacist documents an accurate list of medicines during admission'. There were nine pharmaceutical care bundles formed consisting between 3 and 7 activities. Only one pharmaceutical care bundle reached consensus: medication history, adverse drug reaction/allergy documentation, admission and discharge medication reconciliation, medication review, provision of medicines education and provision of a medication list on discharge. Sixteen outcome measures reached consensus. The top ranked were hospital acquired complications, readmission due to medication misadventure and unplanned readmission within 10 days. CONCLUSION Consensus has been reached on one pharmaceutical care bundle and sixteen outcomes to monitor clinical pharmacy service delivery. The next step is to measure the extent of pharmaceutical care bundle delivery and the link to patient outcomes.
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Affiliation(s)
- Martin Luke Canning
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia.
| | - Michael Barras
- Princess Alexandra Hospital, Woolloongabba, Australia
- The University of Queensland, Woolloongabba, Australia
| | - Ross McDougall
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research, Casuarina, Australia
- Queensland University of Technology, Brisbane, Australia
| | - Ian Coombes
- The University of Queensland, Woolloongabba, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Clair Sullivan
- The University of Queensland, Woolloongabba, Australia
- Digital Metro North, Herston, Australia
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Nardolillo JA, Lobkovich A, Berlie H, Konja J, Salinitri F, Martirosov AL. Evaluation of an ambulatory care elective to improve practice readiness perceptions utilizing entry-level competencies. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:184-195. [PMID: 38177019 DOI: 10.1016/j.cptl.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND AND PURPOSE The objectives of this study are to (1) describe the impact of an ambulatory care elective on students' future interests in ambulatory care careers and (2) evaluate students' perception of practice readiness using entry-level competencies. EDUCATIONAL ACTIVITY AND SETTING This study employed a mixed methods approach to provide a comprehensive evaluation of a newly designed ambulatory care elective. A pre-post survey was developed to evaluate students' career plans and perceptions of practice readiness in an ambulatory care setting. The primary outcome analyzed the change in students' career plans and pre-post changes in self-perceptions using the institutional advanced pharmacy practice experience (APPE) ambulatory care rotation assessment and key skills from the American Society of Health-System Pharmacists entry-level readiness objectives. A qualitative analysis was also conducted to analyze open-ended response questions within the post-survey as well as the overall course reflections from the students. FINDINGS There was no significant difference in career plans; however, students' perception of practice readiness for the ambulatory care setting significantly improved following the elective course. SUMMARY This elective course improved students' perception of practice readiness for the ambulatory care setting. Future research is required to assess the impact of student performance in APPE and post-graduate pursuits.
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Affiliation(s)
- Joseph A Nardolillo
- University of Rhode Island, Kingston, RI, United States of America; Rhode Island Primary Care Physicians Corporation, Cranston, RI, 7 Greenhouse Road, Room 244R, Kingston, RI 02881, United States of America.
| | - Alison Lobkovich
- Wayne State University, Ambulatory Care Specialist, Henry Ford Hospital, 259 Mack Avenue, Detroit, MI 48201, United States of America.
| | - Helen Berlie
- Wayne State University, Ambulatory Care Specialist, Health Centers Detroit Medical Group, 259 Mack Avenue, Detroit, MI 48201, United States of America.
| | - Jewel Konja
- PGY1 Pharmacy Practice Resident, Henry Ford Hospital, 259 Mack Avenue, Detroit, MI 48201, United States of America.
| | - Francine Salinitri
- Wayne State University, 259 Mack Avenue, Detroit, MI 48201, United States of America.
| | - Amber Lanae Martirosov
- Wayne State University, Ambulatory Care Specialist, Henry Ford Hospital, 259 Mack Avenue, Detroit, MI 48201, United States of America.
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Alaa Eddine N, Schreiber J, El-Yazbi AF, Shmaytilli H, Amin MEK. A pharmacist-led medication review service with a deprescribing focus guided by implementation science. Front Pharmacol 2023; 14:1097238. [PMID: 36794277 PMCID: PMC9922726 DOI: 10.3389/fphar.2023.1097238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Background: Little research addressed deprescribing-focused medication optimization interventions while utilizing implementation science. This study aimed to develop a pharmacist-led medication review service with a deprescribing focus in a care facility serving patients of low income receiving medications for free in Lebanon followed by an assessment of the recommendations' acceptance by prescribing physicians. As a secondary aim, the study evaluates the impact of this intervention on satisfaction compared to satisfaction associated with receiving routine care. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to address implementation barriers and facilitators by mapping its constructs to the intervention implementation determinants at the study site. After filling medications and receiving routine pharmacy service at the facility, patients 65 years or older and taking 5 or more medications, were assigned into two groups. Both groups of patients received the intervention. Patient satisfaction was assessed right after receiving the intervention (intervention group) or just before the intervention (control group). The intervention consisted of an assessment of patient medication profiles before addressing recommendations with attending physicians at the facility. Patient satisfaction with the service was assessed using a validated translated version of the Medication Management Patient Satisfaction Survey (MMPSS). Descriptive statistics provided data on drug-related problems, the nature and the number of recommendations as well as physicians' responses to recommendations. Independent sample t-tests were used to assess the intervention's impact on patient satisfaction. Results: Of 157 patients meeting the inclusion criteria, 143 patients were enrolled: 72 in the control group and 71 in the experimental group. Of 143 patients, 83% presented drug-related problems (DRPs). Further, 66% of the screened DRPs met the STOPP/START criteria (77%, and 23% respectively). The intervention pharmacist provided 221 recommendations to physicians, of which 52% were to discontinue one or more medications. Patients in the intervention group showed significantly higher satisfaction compared to the ones in the control group (p < 0.001, effect size = 1.75). Of those recommendations, 30% were accepted by the physicians. Conclusion: Patients showed significantly higher satisfaction with the intervention they received compared to routine care. Future work should assess how specific CFIR constructs contribute to the outcomes of deprescribing-focused interventions.
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Affiliation(s)
- Nada Alaa Eddine
- Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon,*Correspondence: Nada Alaa Eddine, ; Mohamed Ezzat Khamis Amin,
| | - James Schreiber
- School of Nursing, Duquesne University, Pittsburgh, PA, United States
| | - Ahmed F. El-Yazbi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt,Faculty of Pharmacy, Alamein International University, El Alamein, Egypt
| | - Haya Shmaytilli
- Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Mohamed Ezzat Khamis Amin
- Faculty of Pharmacy, Alamein International University, El Alamein, Egypt,*Correspondence: Nada Alaa Eddine, ; Mohamed Ezzat Khamis Amin,
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The MGPIDP-L project: Potentially inappropriate drug prescribing and its associated factors. Arch Gerontol Geriatr 2023; 109:104947. [PMID: 36746016 DOI: 10.1016/j.archger.2023.104947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/22/2022] [Accepted: 01/27/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of this study was to identify the prevalence of potentially inappropriate drug prescribing1 (PIDP) using a combination of explicit and implicit criteria in a sample of Lebanese older adults taking 5 or more chronic medications per day in ambulatory care settings and to identify which factors were associated with PIDP. The explicit criteria included five different lists: Beers, Laroche, European Union (EU(7)-PIM list), STOPP/ START, STOPP Frail, and Alert and Mastering of Iatrogenesis issued by the French High Authority of Health. We also performed a sensitivity analysis to compare the potentially inappropriate medications according to each criterion. METHODS Data were collected from each patient via a face-to-face interview. Logistic regressions were conducted to evaluate both objectives. RESULTS Many factors were positively associated with PIDP. The risk of PIDP was positively associated with age (OR =4.692, 95% CI [1.889-11.655]). Treatment for insomnia doubled the odds of PIDP (P<0.05). Participants who picked their medications from the pharmacy and had excess stock of drugs were at higher risk of having PIDP by 2.042 (95% CI [1.199-3.478]) and 2.965(95% CI [1.133-7.762]) respectively. However, patients with a perception of being heavily medicated and patients with a missed dose in the last two weeks had lower odds of PIDP. CONCLUSION Our study showed a high prevalence of PIDP in Lebanon, which is associated with various correlates. Selecting the appropriate tools to assess PIDP and providing patient education regarding the risks associated with potentially inappropriate medications are issues to be addressed among older adults.
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Pharmacist Intervention in Portuguese Older Adult Care. Healthcare (Basel) 2022; 10:healthcare10101833. [DOI: 10.3390/healthcare10101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Healthy ageing has become one of the most significant challenges in a society with an increasing life expectancy. Older adults have a greater prevalence of chronic disease, with the need for multiple medications to appropriately control these issues. In addition to their health concerns, ageing individuals are prone to loneliness, dependence, and economic issues, which may affect their quality of life. Governments and health professionals worldwide have developed various strategies to promote active and healthy ageing to improve the quality of life of older adults. Pharmacists are highly qualified health professionals, easily accessible to the population, thus playing a pivotal role in medication management. Their proximity to the patient puts them in a unique position to provide education and training to improve therapeutic adherence and identify medication-related problems. This paper aims to address the importance of Portuguese community pharmacists in the medication management of older adults, emphasising their intervention in health promotion, patient education, medication-related problems, deprescription, dose administration aids, and medication review and reconciliation. We also discuss home delivery services and medication management in long-term care facilities.
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Bremer S, Henjum S, Sæther EM, Hovland R. Drug-related problems and satisfaction among patients receiving pharmacist-led consultations at the initiation of cardiovascular drugs. Res Social Adm Pharm 2022; 18:3939-3947. [PMID: 35750567 DOI: 10.1016/j.sapharm.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) lead to substantial morbidity and mortality and increase healthcare costs. Several interventions have been developed to reduce DRPs and improve the outcome of drug therapy. OBJECTIVE To investigate DRPs identified through a pharmacist-led intervention and to assess patient satisfaction with the intervention. METHODS Patients received two pharmacist consultations 1-2 weeks and 3-5 weeks after collecting a new cardiovascular medicine. Information about patient characteristics, beliefs about medicines (BMQ), DRPs, and patient evaluations were collected using questionnaires. RESULTS Pharmacists identified DRPs among 52.4% and 43.1% of the 633 patients at consultation 1 and 2, respectively. Of the DRPs reported in consultation 1, 43.7% were solved at consultation 2. Among patients with side effects, patients who received advice on managing these in consultation 1 where more likely to have solved problems at consultation 2 (61.2% vs. 42.6%, p = 0.008). Female gender, high BMQ concern and the number of new medicines were associated with DRPs. Patients were highly satisfied with the intervention. Predictors of satisfaction were female gender, older age, higher BMQ necessity, face-to-face consultations, longer duration of consultation 1, and solved problems in consultation 2. CONCLUSIONS The results indicate that the pharmacist-led follow-up intervention can aid early identification and solving of DRPs in patients prescribed new cardiovascular drugs. Knowledge of factors associated with DRPs and patients' satisfaction may allow further improvement of the intervention.
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Affiliation(s)
- Sara Bremer
- Apokus, National Centre for Development of Pharmacy Practice, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway.
| | - Solveig Henjum
- Norwegian Pharmacy Association, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway
| | | | - Ragnar Hovland
- Apokus, National Centre for Development of Pharmacy Practice, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway
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Pharmacist Strategies for Addressing Medication Cost Barriers to Equitable Health in Primary Care. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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