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Sluggett JK, Caughey GE, Air T, Lang C, Moldovan M, Martin G, Stafford AC, Carter SR, Jackson S, Wesselingh SL, Inacio MC. Health outcomes following provision of Home Medicines Reviews for older people receiving aged care services at home. Res Social Adm Pharm 2024; 20:1064-1069. [PMID: 39187425 DOI: 10.1016/j.sapharm.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 07/25/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The impact of Home Medicines Reviews (HMRs) on long-term health outcomes among individuals receiving long-term in-home aged care services is unknown. OBJECTIVES To examine associations between HMR provision and hospitalization, long-term care facility (LTCF) entry and mortality among older people receiving long-term in-home aged care services. METHODS This retrospective cohort study included individuals aged 65-105 years from three Australian states who accessed in-home aged care services between 2013 and 2017. Using propensity score matching, HMR recipients (n = 1530) were matched to individuals who did not receive an HMR (n = 1530). Associations between HMR provision and outcomes were estimated using multivariable regression models. RESULTS Over a median of 414 days (interquartile range 217-650) of follow-up, HMR provision was not associated with hospitalizations for unplanned events (subdistribution hazard ratio (sHR) 1.04, 95%CI 0.96-1.14), falls-related hospitalizations (sHR 0.97, 95%CI 0.83-1.13), LTCF entry (sHR 0.97, 95%CI 0.83-1.13), or all-cause mortality (adjusted HR 0.86, 95%CI 0.72-1.01). CONCLUSIONS In a cohort of older people receiving long-term in-home aged care services, no differences in unplanned hospitalizations, falls, LTCF entry or mortality were observed those with HMRs compared to those that did not receive an HMR.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Max Moldovan
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Biometry Hub, Faculty of Sciences, Engineering and Technology, The University of Adelaide, Waite Campus, Urrbrae, South Australia, Australia
| | - Grant Martin
- Australian Association of Consultant Pharmacy, Fyshwick, Australian Capital Territory, Australia
| | - Andrew C Stafford
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Stephen R Carter
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shane Jackson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Steve L Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Lee K, Kouladjian O'Donnell L, Cross AJ, Hawthorne D, Page AT. Clinical pharmacists' reported approaches and processes for undertaking Home Medicines Review services: A national survey. Arch Gerontol Geriatr 2023; 109:104965. [PMID: 36821873 DOI: 10.1016/j.archger.2023.104965] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Comprehensive medicines reviews are a strategy to reduce medicines-related harm. In Australia, Home Medicines Review services (HMRs) are provided by consultant pharmacists to community-dwelling consumers, on referral from the consumer's medical practitioner. Limited research exists on the processes undertaken by consultant pharmacists when delivering HMRs, particularly as it relates to the information types received, collected, and reported. OBJECTIVE Describe the types of information consultant pharmacists report receiving in HMR referrals, collect before and during consumer consultations, and include in their written reports. MATERIALS AND METHODS We conducted a national online survey of Australian consultant pharmacists who deliver HMRs. Participants were recruited using a broad advertising strategy, including social and traditional media platforms, and snowballing. Data were analysed descriptively. RESULTS Of the 248 eligible participants, 179 (72%) completed the survey. The most commonly included information in the referral was medication list (97%), the least were details of hospitalisations (8%) and specialist letters (5%). Information pertaining to hospitalisation and specialist letters were collected by 20% of participants prior to the consultation. Details of, and history from, community pharmacy was the most sought information prior to consultations. Less than a quarter of participants 'most of the time' or 'always' formally assess adherence using a validated instrument during the consultation. Participants commonly (80%) report consumer concerns in the written report. CONCLUSIONS Consultant pharmacists collect a broad variety of information, beyond medicines-related content. Written HMR reports by consultant pharmacists were often reported to be consumer-centric.
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Affiliation(s)
- Kenneth Lee
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.
| | - Lisa Kouladjian O'Donnell
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Sydney, Australia
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Australia
| | - Deborah Hawthorne
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia; Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Amy Theresa Page
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia; Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
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Wheeler AJ, Hu J, Tadakamadla SK, Hall K, Miller A, Kelly F. Development and feasibility testing of a training programme for community pharmacists to deliver a culturally responsive medication review intervention. Pilot Feasibility Stud 2022; 8:51. [PMID: 35241184 PMCID: PMC8892753 DOI: 10.1186/s40814-022-01006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Cultural differences between health professionals and Indigenous peoples contribute to health inequalities, and effective cross-cultural communication and person-centred healthcare are critical remedial elements. Community pharmacists can play a significant role by reducing medication-related problems through medication reviews, yet barriers to access include cultural and linguistic challenges. The Indigenous Medication Review Service (IMeRSe) aimed to address these barriers via a culturally responsive intervention. The aim of this paper is to present the cross-cultural training framework developed as a component of this intervention and the feasibility evaluation of the first stage of the training framework. Methods A training framework was developed, emphasising pharmacists’ skills and confidence in effective cross-cultural communication and relationship-building with Indigenous Australians (Please note that the use of the term ‘Indigenous’ in this manuscript includes all Aboriginal and Torres Strait Islander people and acknowledges their rich traditions and heterogenous cultures) across three stages: (1) online and workshop-based, covering Indigenous history and health, cross-cultural communication and a holistic, strengths-based approach to intervention delivery; (2) orientation to local Aboriginal Health Services, community and cultural protocols; and (3) ongoing mentoring. The feasibility evaluation of the first stage included the following: self-reported levels of cultural capability, cultural confidence and skills, motivators and barriers to working with Indigenous Australians, assessed pre- and post-training. Participants completed self-administered questionnaires including a 22-item validated Cultural Capability Measurement Tool. Paired t tests assessed change in mean scores of Likert scale data. Results Stage 1 development resulted in an 8.5-h standardised cross-cultural training programme tested with 39 pharmacists working across urban and rural/remote Australia. Thirty-six pharmacists completed the feasibility evaluation (75.7% female, all non-Indigenous, 75.7% never attended prior cross-cultural training). Participants reported overall acceptability with training; the majority perceived it added value to their practice. Improved cultural capability post-training was reflected in increased scores for 21/22 items, nine reaching statistical significance. There were significant improvements for all 26 confidence and skills statements, and selected motivational and barrier statements, particularly participants role in improving Indigenous health outcomes and cross-cultural communication. Conclusions This study provides preliminary evidence that the training programme was feasible to deliver and prepared pharmacists to deliver a culturally responsive medication review intervention. The online knowledge-based modules and face-to-face workshops provide a standardised framework for larger-scale implementation of the intervention training. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12618000188235.Prospectively registered 22 January 2018.
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Affiliation(s)
- Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Nathan campus, Brisbane, 4111, Australia. .,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Jie Hu
- Menzies Health Institute Queensland, Griffith University, Nathan campus, Brisbane, 4111, Australia
| | | | - Kerry Hall
- Menzies Health Institute Queensland, Griffith University, Nathan campus, Brisbane, 4111, Australia
| | | | - Fiona Kelly
- School of Pharmacy & Medical Sciences, Griffith University, Gold Coast, Australia
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Cousins J, Parameswaran Nair N, Curtain C, Bereznicki B, Wilson K, Adamczewski B, Barratt A, Webber L, Simpson T, McKenzie D, Connolly M, Bereznicki L. Preventing Adverse Drug Reactions After Hospital Discharge (PADR-AD): Protocol for a randomised-controlled trial in older people. Res Social Adm Pharm 2021; 18:3284-3289. [PMID: 34593344 DOI: 10.1016/j.sapharm.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Adverse drug reactions (ADRs) and adverse drug events (ADEs) in older people contribute to a significant proportion of hospital admissions and are common following discharge. Effective interventions are therefore required to combat the growing burden of preventable ADRs. The Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community Dwelling Patients (PADR-EC) score is a validated risk score developed to assess the risk of ADRs in people aged 65 years and older and has the potential to be utilised as part of an intervention to reduce ADRs. OBJECTIVES This trial was designed to investigate the effectiveness of an intervention to reduce ADR incidence in older people and to obtain further information about ADRs and ADEs in the 12-24 months following hospital discharge. METHODS The study is an open-label randomised-controlled trial to be conducted at the Royal Hobart Hospital, a 500-bed public hospital in Tasmania, Australia. Community-dwelling patients aged 65 years and older with an unplanned overnight admission to a general medical ward will be recruited. Following admission, the PADR-EC ADR score will be calculated by a research pharmacist, with the risk communicated to clinicians and discussed with participants. Following discharge, nominated general practitioners and community pharmacists will receive the risk score and related medication management advice to guide their ongoing care of the patient. Follow-up with participants will occur at 3 and 12 and 18 and 24 months to identify ADRs and ADEs. The primary outcome is moderate-severe ADRs at 12 months post-discharge, and will be analysed using the cumulative incidence proportion, survival analysis and Poisson regression. SUMMARY It is hypothesised that the trial will reduce ADRs and ADEs in the intervention population. The study will also provide valuable data on post-discharge ADRs and ADEs up to 24 months post-discharge.
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Affiliation(s)
- Justin Cousins
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Nibu Parameswaran Nair
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Colin Curtain
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Bonnie Bereznicki
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania, 7001, Australia.
| | - Kiara Wilson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Blair Adamczewski
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Annette Barratt
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Liz Webber
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Tom Simpson
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Duncan McKenzie
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Michael Connolly
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Luke Bereznicki
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
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Abrahamsen B, Hansen RN, Rossing C. For which patient subgroups are there positive outcomes from a medication review? A systematic review. Pharm Pract (Granada) 2020; 18:1976. [PMID: 33224322 PMCID: PMC7672485 DOI: 10.18549/pharmpract.2020.4.1976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background: A medication review is a possibility to assess and optimise a
patient’s medicine. A model that includes a medication review and a
follow-up seem to provide the best results. However, it is not known whether
specific subgroups of patients benefit more from a medication review than
others. Objective: This literature review summarises the evidence that is available on which
patient subgroups exist positive outcomes from a medication review carried
out in a primary care setting. Methods: We performed a PICO analysis to identify keywords for setting, medication
review and effect. We then conducted a search using the PubMed database
(2004 to 2019) to identify studies relevant for our investigation. A
screening process was carried out based on either title or abstract, and any
study that matched the aim and inclusion criteria was included. All matching
studies were obtained and read, and were included if they met predefined
criteria such as study design, medication review and primary care. The
studies were divided into subgroups. First, each subgroup was divided
according to the studies’ own definition. Secondly, each subgroup was
allocated as either risk patients if the subgroup described a specific
patient subgroup or risk medication, if the subgroup was defined as using a
specific type of medication. This was done after discussion in the author
group. Results: 28 studies from a total of 935 studies were included. Identified studies were
divided into either risk patients; frail, recently discharged or multimorbid
patients, or risk medication; heart medication, antithrombotic medication,
blood pressure lowering medication, antidiabetic medication, anti-Parkinson
medication or medication increasing the risk of falls. The subgroups
identified from a medication review in primary care were defined as being
frail, recently discharged from hospital or multimorbid (risk patients), or
defined as patients using anticoagulant or blood pressure lowering
medication (risk medication). Most of the medication reviews in the studies
that showed an economic effect included at least one follow-up and were
delivered by a pharmacist. Conclusions: The literature review demonstrates that medication reviews delivered by
pharmacists to specific subgroups of patients are a way of optimising the
economic effect of medication reviews in primary care. This is obtained by
reducing health-related costs or the number of contacts with primary or
secondary health care services.
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Affiliation(s)
- Bjarke Abrahamsen
- PhD, MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Rikke N Hansen
- MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Charlotte Rossing
- PhD, MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
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6
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Home medicines reviews and residential medication management reviews in Western Australia. Int J Clin Pharm 2020; 42:567-578. [PMID: 32162188 DOI: 10.1007/s11096-020-01001-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Background Australian government funding for Residential Medication Management Reviews and Home Medicines Reviews commenced in 1997 and 2001 respectively. Limited data are available on their provision in Australia. Objective To investigate the extent and characteristics of Home Medicines Review and Residential Medication Management Review services provided by accredited pharmacists practising in Western Australia. Setting Pharmacists in Western Australia accredited by the Australian Association of Consultant Pharmacy or Society of Hospital Pharmacists of Australia. Method A paper questionnaire was developed and sent to 198 accredited pharmacists in Western Australia in June 2017. Simple descriptive statistics summarised demographic information and other responses. Logistic regression evaluated factors associated with the frequency of provision of Home Medicines Reviews. Main outcome measure Frequency and factors influencing services provided. Results Of 102 (51.5%) questionnaires returned, 67 (65.7%) respondents were female. Many were aged between 31 and 40 years (53; 52.0%). Most were accredited by the Australian Association of Consultant Pharmacy (101; 99.0%) and mainly offered Home Medicines Reviews (70; 68.6%). Home Medicines Reviews provided over the previous 12 months were limited in frequency with one quarter providing either 1-10 (27; 26.5%) or 21-50 (28; 27.5%) reviews. The median "average" preparation, interview and report writing times, plus communication with other health professionals aggregated to 175.0 min (interquartile range: 140.0-235.0 min) for Home Medicine Reviews and 110.0 min (90.0-140.0) for Residential Medication Management Reviews. Pharmacists born overseas and those who were accredited for a longer time were associated with performing 51 or more Home Medicines Reviews annually. Only one-third (36/101; 35.6%) agreed the current payment was appropriate. Most agreed their Home Medicines Reviews (92/96; 95.8%) and Residential Medication Management Reviews (26/28; 92.9%) provided improved patient outcomes. Over 97% of accredited pharmacists intended to continue to remain accredited. Conclusions Wide variations were evident in the times taken for tasks associated with performing reviews. Most respondents considered their medication reviews contributed to improved patient outcomes. The wide variation in times taken for the reviews suggests a tiered structure for service provision, with appropriate payment within each tier, since most consider current remuneration inadequate.
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Weir KR, Naganathan V, Rigby D, McCaffery K, Bonner C, Trevena L, McLachlan AJ, Jansen J. Home medicines reviews: a qualitative study of GPs' experiences. Aust J Prim Health 2019; 26:24-30. [PMID: 31733660 DOI: 10.1071/py19072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/23/2019] [Indexed: 11/23/2022]
Abstract
This qualitative study explored GPs' experiences with pharmacist-led home medicines reviews (HMRs) and the barriers and facilitators to GPs using HMRs to optimise medicines for older people. Semi-structured interviews were conducted with 32 GPs Australia-wide. Purposeful sampling was undertaken to obtain a representative group in terms of age, gender and location. Data were analysed using framework analysis. Overall, GPs found HMRs useful for educating patients about their medicines, improving adherence and understanding the patient's home environment. Barriers to effective use of HMRs included patient resistance to having medicines reviewed and limited access to HMRs in regional or rural areas. GPs differed in the extent and way they use HMRs. One group found HMRs very useful, wanted more access to HMRs and reported frequent interactions with pharmacists. A second group was ambivalent, and perceived HMRs could be useful but had limitations in what they can achieve. A third group was sceptical, and reported HMRs rarely provide new insights, and recommendations were not clinically relevant to patients. Understanding GPs' expectations and preferences through interprofessional communication and partnerships are ways to address these barriers. Future improvements to the HMR program may include incentives and resources that promote collaboration between GPs and pharmacists.
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Affiliation(s)
- Kristie Rebecca Weir
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Corresponding author
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia; and Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, NSW 2139, Australia
| | - Debbie Rigby
- DR Pharmacy Consulting, Brisbane, Qld 4001, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Carissa Bonner
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Lyndal Trevena
- Ask Share Know Centre for Research Excellence, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Andrew J McLachlan
- Centre for Education and Research on Ageing (CERA), Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia; and Faculty of Medicine and Health, Sydney Pharmacy School, University of Sydney, NSW 2006, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
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Zhang H, Du W, Gnjidic D, Chong S, Glasgow N. Trends in adverse drug reaction-related hospitalisations over 13 years in New South Wales, Australia. Intern Med J 2019; 49:84-93. [PMID: 30281186 DOI: 10.1111/imj.14134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Adverse drug reactions (ADR) are severe problems in global public health, and result in high mortality and morbidity. Various trends of ADR-related hospitalisations have been studied in many countries, while estimates of the trends in Australia are limited. AIM To examine trends in ADR-related hospitalisations in New South Wales (NSW). METHODS Data were extracted from the Admitted Patient Data Collection, a census of hospital separations in NSW. We estimated age-adjusted rates of ADR-related hospitalisation between 1 July 2001 and 30 June 2014 and rates by patient characteristics, main therapeutic medication groups and clinical condition groups that warranted the hospitalisation. We used the percentage change annualised estimator to evaluate rates over time. RESULTS A total of 315 274 NSW residents admitted for urgent care of ADR was identified. The age-adjusted rates of ADR-related hospitalisations nearly doubled and increased by 5.8% (95% CI: 5.0-6.6%) per annum, with an in-hospital death rate increase of 2.4% (1.6-3.3%). Agranulocytosis (2.7%), nausea and vomiting (2.4%) and heart failure (2.4%) were the most common conditions that led to ADR-related hospitalisations over 13 years, with acute renal failure (1.4%) recently emerging as the leading adverse condition. Participants aged between 65 and 84 years accounted for nearly half of ADR hospitalisations (45.6%), with age-adjusted rate increasing from 103.9 in 2001-2002 to 189.0 per 100 000 NSW residents in 2013-2014. Anticoagulants (13.5%) were the most common medications contributing to ADR-related hospitalisation, followed by opioid analgesics (9.6%). CONCLUSION ADR-related hospitalisation remains a population health burden, with significant increase over time. The findings call for continuing efforts to prevent ADR, especially among high-risk populations, such as older people.
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Affiliation(s)
- Hanwen Zhang
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Wei Du
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Shanley Chong
- South Western Sydney Local Health District and South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicholas Glasgow
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Roseleur J, Partington A, Karnon J. Evaluations of healthcare delivery models in Australia: a scoping review protocol. JBI Evid Synth 2019; 18:128-134. [PMID: 31356574 DOI: 10.11124/jbisrir-d-19-00094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this review is to identify and describe the evidence base of published primary, comparative healthcare delivery model evaluations that require the employment of additional healthcare practitioners undertaken in Australia. INTRODUCTION In Australia, formal processes are utilized in assessing the value of new pharmaceuticals and medical services, which inform decisions on whether to list new items on the Pharmaceutical Benefits Schedule and Medicare Benefits Schedule, respectively. There are no formal processes to aid in decision making on the funding of new, evaluated healthcare delivery models. This imbalance undervalues the available evidence on healthcare delivery models, leading to the sub-optimal allocation of resources between new health technologies and new healthcare delivery models within the Australian health system. INCLUSION CRITERIA Eligible studies will evaluate healthcare delivery models that require the employment of additional healthcare practitioners (either to replace existing practitioners of another type or to provide new services). Studies must include a comparator to evaluate a condition of interest being treated using alternative healthcare delivery models, or no treatment, and will involve observation of outcomes over a similar period of time. Studies in any Australian setting will be included. Interventions aimed at primary preventions will be excluded. METHODS PubMed, Embase and CINAHL will be searched for articles published from 2008. One reviewer will review titles, and then two reviewers will independently review abstracts to identify eligible studies. One reviewer will extract data on study characteristics and design. The results of the data extraction will be presented in a table with examples of case studies.
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Affiliation(s)
- Jacqueline Roseleur
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Andrew Partington
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Macquarie University Centre for the Health Economy, Macquarie University, Sydney, Australia
| | - Jonathan Karnon
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Papastergiou J, Luen M, Tencaliuc S, Li W, van den Bemt B, Houle S. Medication management issues identified during home medication reviews for ambulatory community pharmacy patients. Can Pharm J (Ott) 2019; 152:334-342. [PMID: 31534588 DOI: 10.1177/1715163519861420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background The health risks associated with poor medication practices in the home suggest that patients would benefit from home-based medication reviews that could detect and resolve these issues. However, remuneration for home visits often excludes ambulatory, nonhomebound patients. A subset of these patients have issues that cannot be adequately identified and resolved during the course of a typical pharmacy-based medication review. Purpose This study aims to characterize the prevalence and nature of "hidden in the home" medication management issues in nonhomebound patients. Methods Pharmacists facilitated subject enrollment among patients at 6 community pharmacies in Toronto over a 15-month period, from January 2016 to March 2017. Patients taking 5 or more chronic medications who were ambulatory (able to visit the pharmacy) and scored 3 points or higher on a prescreening questionnaire were invited to participate. Visits included a standard medication review, the identification of drug therapy problems and an assessment of the patient's medication and organization/storage practices, followed by a medication cabinet cleanup. Results One hundred patients were recruited, with a mean age of 76.9 years and taking on average 10 chronic medications. Pharmacists identified a total of 275 drug therapy problems (2.75 per patient). The most common issues reported additional therapy required (23.6%), nonadherence (23.3%) and adverse drug reactions (17.8%). For those patients 65 years or older (87%), 32% were found to be using at least 1 medication on the Beers Criteria list, while 6% were using 3 or more. Sulfonylureas, non-steroidal anti-inflammatory drugs and short-acting benzodiazepines were the most commonly implicated drugs. Medications were removed from the homes of 67% of the patients, with expiry of medication being the most common reason for removal (54.2%). The mean duration of a home visit was 49.5 minutes. Conclusion Pharmacist-directed home medication reviews offer an effective mechanism to address the pharmacotherapy issues of patients taking multiple medications. These findings highlight the frequency of medication management issues in this group and suggest that home medication reviews could serve to minimize inappropriate use of medication and maximize health care cost savings in this unique patient population. Can Pharm J (Ott) 2019;152:xx-xx.
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Affiliation(s)
- John Papastergiou
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Mathew Luen
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Simona Tencaliuc
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Wilson Li
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Bart van den Bemt
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Sherilyn Houle
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
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11
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Mifsud EM, Wirth F, Camilleri L, Azzopardi LM, Serracino-Inglott A. Pharmacist-led medicine use review in community pharmacy for patients on warfarin. Int J Clin Pharm 2019; 41:741-750. [PMID: 31006832 DOI: 10.1007/s11096-019-00824-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/10/2019] [Indexed: 01/03/2023]
Abstract
Background Medicine use review by pharmacists has the potential to improve anticoagulation therapy management in patients on warfarin. Objective To develop, implement and evaluate a pharmacist-led medication use review service for patients on warfarin. Setting Six community pharmacies in Malta. Method Patients (N = 100) aged 18 or older and on warfarin were recruited through pre-selected community-pharmacies. These patients were then invited to attend two sessions: a review session (t1) and a follow-up session after 2 months (t2). During the medication use review session, medication reconciliation was performed (a) to detect drug-related problems using the DOCUMENT classification system, (b) to develop an individualised care plan for each patient and (c) to recommend an action for each identified problem for physician, pharmacist or patient consideration. At t2, the degree of acceptance of the recommendations was determined by assessing the number of drug-related problems for which action was taken to address the problem. International normalisation ration (INR) control was evaluated by calculating the percentage Time in Therapeutic Range (TTR) at t1 and t2 using the Rosendaal linear interpolation method. Main outcome measures Frequency and type of drug-related problems detected; percentage of accepted recommendations; and INR control. Results A total of 481 drug-related problems were identified; 40% (n = 190) were related to warfarin treatment. Need for monitoring (30%; n = 145), lack of compliance (20%; n = 97) and need for patient education (19%; n = 90) were the top three problems identified. There was a significant correlation between frequency of the problems and number of chronic medications (Spearman Correlation 0.583, p < 0.001), number of comorbidities (Spearman Correlation 0.327, p = 0.001) and older age (Spearman Correlation 0.285, p = 0.04). A total of 475 recommendations were followed-up; 49% (n = 234) were referred for consideration by the physician. The percentage of recommendations accepted (84%; n = 397) was significantly higher than the percentage of recommendations not accepted (16%; n = 78) (p < 0.001). The time in therapeutic range improved significantly from 68.7% at t1 to 79.8% at t2 (p = 0.01). Conclusions The high percentage of accepted recommendations and the improvement in INR control indicate that a pharmacist-led medication use review service in community pharmacy contributes to improving anticoagulation therapy management in patients on warfarin.
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Affiliation(s)
- Elena M Mifsud
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | - Francesca Wirth
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - Lilian M Azzopardi
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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12
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Du W, Gnjidic D, Pearson SA, Hilmer SN, McLachlan AJ, Blyth F, Viney R, Joshy G, Day C, Banks E. Patterns of high-risk prescribing and other factors in relation to receipt of a home medicines review: a prospective cohort investigation among adults aged 45 years and over in Australia. BMJ Open 2019; 9:e027305. [PMID: 30772867 PMCID: PMC6398774 DOI: 10.1136/bmjopen-2018-027305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/27/2018] [Accepted: 01/04/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors. DESIGN Prospective cohort analysis. SETTINGS, PARTICIPANTS, MEASUREMENTS Questionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009-June 2014. Medication-related factors included exposure to five and more medications (polypharmacy), narrow therapeutic index medicines, potentially inappropriate prescribing defined using Beers Criteria medicines, and anticholinergic and sedative drugs, defined using the Drug Burden Index (DBI). Poisson and Cox regression models were used to evaluate HMR receipt in relation to sociodemographic, behavioural and health characteristics, and time-varying factors including medication use and hospitalisations. PRIMARY OUTCOME HMR receipt during the 5-year study period. RESULTS Over 5 years of follow-up, 4.7% (n=6115) of 131 483 participants received at least one HMR. Five-year HMR receipt was: 1.5% in people using <5 medications at baseline, 6.8% with 5-9 medications, 12.7% with ≥10 medications, 8.8% using Narrow Therapeutic Index medicines, 6.8% using Beers Criteria potentially inappropriate medicines and 7.4% using DBI medicines. Age-sex stratified HRs for HMR receipt were 6.07 (95% CI: 5.58 to 6.59) and 12.46 (11.42 to 13.59) for concurrent use of 5-9 and ≥10 versus <5 medications, respectively. The age-sex adjusted rate ratio for HMR receipt was 2.65 (2.51 to 2.80) with poor versus good self-reported health; this association was attenuated substantially following additional adjustment for polypharmacy. CONCLUSIONS HMR was common in individuals using multiple medications, a formal indication for general practitioner referral and, to a lesser extent, with poorer health and other markers of high-risk prescribing. Despite this, HMR use over a 5-year period was generally below 10%, even in high-risk groups, suggesting substantial potential for improvement in uptake and targeting.
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Affiliation(s)
- Wei Du
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School and Centre for Education and Research on Ageing, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Sydney Medical School, Royal North Shore Hospital, University of Sydney, North Shore, Sydney, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School and Centre for Education and Research on Ageing, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, Sydney Medical School University of Sydney, Camperdown, Camperdown, Australia
| | - Rosalie Viney
- Centre for Health Economics Research Eval., University of Technology, Sydney, New South Wales, Australia
| | - Grace Joshy
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
| | - Cathy Day
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
| | - Emily Banks
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
- The Sax Institute, Sydney, New South Wales, Australia
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13
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Mc Namara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? INTEGRATED PHARMACY RESEARCH AND PRACTICE 2019; 8:1-11. [PMID: 30788283 PMCID: PMC6366352 DOI: 10.2147/iprp.s133088] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of death globally. This article explores the evidence surrounding community pharmacist interventions to reduce cardiovascular events and related mortality and to improve the management of CVD risk factors. We summarize a range of systematic reviews and leading randomized controlled trials and provide critical appraisal. Major observations are that very few trials directly measure clinical outcomes, potentially owing to a range of challenges in this regard. By contrast, there is an extensive, high-quality evidence to suggest that improvements can be achieved for key CVD risk factors such as hypertension, dyslipidemia, tobacco use, and elevated hemoglobin A1c. The heterogeneity of interventions tested and considerable variation of the context under which implementation occurred suggest that caution is warranted in the interpretation of meta-analyses. It is highly important to generate evidence for pharmacist interventions in developing countries where a majority of the global CVD burden will be experienced in the near future. A growing capacity for clinical registry trials and data linkage might allow future research to collect clinical outcomes data more often.
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Affiliation(s)
- Kevin Mc Namara
- School of Medicine, Deakin University, Geelong, VIC, Australia,
- Deakin Health Economics, Centre for Population Health, Deakin University, Geelong, VIC, Australia,
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
| | - Hamzah Alzubaidi
- Institute for Medical Research and College of Pharmacy, University of Sharjah, Sharjah, Sharjah, United Arab Emirates
| | - John Keith Jackson
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
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14
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Wheeler AJ, Spinks J, Kelly F, Ware RS, Vowles E, Stephens M, Scuffham PA, Miller A. Protocol for a feasibility study of an Indigenous Medication Review Service (IMeRSe) in Australia. BMJ Open 2018; 8:e026462. [PMID: 30391923 PMCID: PMC6231589 DOI: 10.1136/bmjopen-2018-026462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The age-adjusted rate of potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people is almost five times the rate of other Australians. Quality use of medicines has an important role in alleviating these differences. This requires strengthening existing medication reviewing services through collaboration between community pharmacists and health workers, and ensuring services are culturally appropriate. This Indigenous Medication Review Service (IMeRSe) study aims to develop and evaluate the feasibility of a culturally appropriate medication management service delivered by community pharmacists in collaboration with Aboriginal health workers. METHODS AND ANALYSIS This study will be conducted in nine Aboriginal health services (AHSs) and their associated community pharmacies in three Australian states over 12 months. Community pharmacists will be trained to improve their awareness and understanding of Indigenous health and cultural issues, to communicate the quality use of medicines effectively, and to strengthen interprofessional relationships with AHSs and their staff. Sixty consumers (with a chronic condition/pregnant/within 2 years post partum and at risk of medication-related problems (MRPs) per site will be recruited, with data collection at baseline and 6 months. The primary outcome is the difference in cumulative incidence of serious MRPs in the 6 months after IMeRSe introduction compared with the 6 months prior. Secondary outcomes include potentially preventable medication-related hospitalisations, medication adherence, total MRPs, psychological and social empowerment, beliefs about medication, treatment satisfaction and health expenditure. ETHICS AND DISSEMINATION The protocol received approval from Griffith University (HREC/2018/251), Queensland Health Metro South (HREC/18/QPAH/109), Aboriginal Health and Medical Research Council of New South Wales (1381/18), Far North Queensland (HREC/18/QCH/86-1256) and the Central Australian HREC (CA-18-3090). Dissemination to Indigenous people and communities will be a priority. Results will be available on the Australian Sixth Community Pharmacy Agreement website and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12618000188235; Pre-results.
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Affiliation(s)
- Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Faculty of Medical and Health Sciences, Auckland University, Auckland, New Zealand
| | - Jean Spinks
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Fiona Kelly
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Pharmacy and Pharmacology, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Erica Vowles
- The Pharmacy Guild of Australia, National Secretariat, Canberra, Australian Capital Territory, Australia
| | - Mike Stephens
- National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Adrian Miller
- Office of the Pro Vice-Chancellor Indigenous Engagement, CQ University, Townsville, Queensland, Australia
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15
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Flanagan PS, Barns A. Current perspectives on pharmacist home visits: do we keep reinventing the wheel? INTEGRATED PHARMACY RESEARCH AND PRACTICE 2018; 7:141-159. [PMID: 30319952 PMCID: PMC6171762 DOI: 10.2147/iprp.s148266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The scope of clinical pharmacy services available in outpatient settings, including home care, continues to expand. This review sought to identify the evidence to support pharmacist provision of clinical pharmacy services in a home care setting. Seventy-five reports were identified in the literature that provided evaluation and description of clinical pharmacy home visit services available around the world. Based on results from randomized controlled trials, pharmacist home visit interventions can improve patient medication adherence and knowledge, but have little impact on health care resource utilization. Other literature reported benefits of a pharmacist home visit service such as patient satisfaction, improved medication appropriateness, increased persistence with warfarin therapy, and increased medication discrepancy resolution. Current perspectives to consider in establishing or evaluating clinical pharmacy services offered in a home care setting include: staff competency, ideal target patient population, staff safety, use of technology, collaborative relationships with other health care providers, activities performed during a home visit, and pharmacist autonomy.
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Affiliation(s)
- Priti S Flanagan
- Pharmacy Community Programs, Lower Mainland Pharmacy Services, Langley, BC, Canada,
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada,
| | - Andrea Barns
- Pharmacy Community Programs, Lower Mainland Pharmacy Services, Langley, BC, Canada,
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16
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Kalisch Ellett LM, Pratt NL, Sluggett JK, Ramsay EN, Kerr M, LeBlanc VT, Barratt JD, Gilbert AL, Roughead EE. Sustaining practice change in health care: the impact of a national quality improvement program on the uptake of collaborative medicines reviews. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lisa M. Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre Sansom Institute for Health Research University of South Australia Adelaide Australia
| | - Nicole L. Pratt
- Quality Use of Medicines and Pharmacy Research Centre Sansom Institute for Health Research University of South Australia Adelaide Australia
| | - Janet K. Sluggett
- Quality Use of Medicines and Pharmacy Research Centre Sansom Institute for Health Research University of South Australia Adelaide Australia
| | - Emmae N. Ramsay
- Quality Use of Medicines and Pharmacy Research Centre Sansom Institute for Health Research University of South Australia Adelaide Australia
| | - Mhairi Kerr
- Quality Use of Medicines and Pharmacy Research Centre Sansom Institute for Health Research University of South Australia Adelaide Australia
| | - Vanessa T. LeBlanc
- Quality Use of Medicines and Pharmacy Research Centre Sansom Institute for Health Research University of South Australia Adelaide Australia
| | - John D. Barratt
- Quality Use of Medicines and Pharmacy Research Centre Sansom Institute for Health Research University of South Australia Adelaide Australia
| | - Andrew L. Gilbert
- Quality Use of Medicines and Pharmacy Research Centre Sansom Institute for Health Research University of South Australia Adelaide Australia
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre Sansom Institute for Health Research University of South Australia Adelaide Australia
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17
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Pharmacist-led medication review in community settings: An overview of systematic reviews. Res Social Adm Pharm 2017; 13:661-685. [DOI: 10.1016/j.sapharm.2016.08.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/07/2016] [Accepted: 08/19/2016] [Indexed: 02/08/2023]
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18
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Cheen MHH, Goon CP, Ong WC, Lim PS, Wan CN, Leong MY, Khee GY. Evaluation of a care transition program with pharmacist-provided home-based medication review for elderly Singaporeans at high risk of readmissions. Int J Qual Health Care 2017; 29:200-205. [PMID: 28453819 DOI: 10.1093/intqhc/mzw150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/07/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study aimed to determine whether pharmacist-provided home-based medication review (HBMR) can reduce readmissions in the elderly. DESIGN Retrospective cohort study. SETTING Patient's home. PARTICIPANTS Records of patients referred to a care transition program from March 2011 through March 2015 were reviewed. Patients aged 60 years and older taking more than 5 medications and had at least 2 unplanned admissions within 3 months preceding the first home visit were included. INTERVENTION Pharmacist-provided HBMR. MAIN OUTCOME MEASURES Primary outcome was readmission rate over 6 months after the first home visit. Secondary outcomes included emergency department (ED) visits, outpatient visits and mortality. Drug-related problems (DRPs) were reported for the HBMR group. Multivariate incidence rate ratios (IRR) and hazard ratio (HR) were calculated with adjustments for covariates. RESULTS The study included 499 patients (97 HBMR, 402 no HBMR). Pharmacist-provided HBMR reduced readmissions by 26% (IRR = 0.74, 95% CI: 0.59-0.92, P = 0.007), reduced ED visits by 20% (IRR = 0.80, 95% CI: 0.66-0.98, P = 0.030) and increased outpatient visits by 16% (IRR = 1.16, 95% CI: 0.95-1.41, P = 0.150). There were 8 and 44 deaths in the HBMR and no HBMR groups respectively (HR = 0.73, 95% CI: 0.29-1.81, P = 0.492). Pharmacists identified 464 DRPs, with 169 (36.4%) resolved within 1 month after the home visit. CONCLUSIONS The study suggests that pharmacist-provided HBMR is effective in reducing readmissions and ED visits in the elderly. More studies in the Asian population are needed to determine its long term benefits and patient's acceptability.
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Affiliation(s)
- McVin Hua Heng Cheen
- Department of Pharmacy, Singapore General Hospital, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Chong Ping Goon
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Wan Chee Ong
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Paik Shia Lim
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Choon Nam Wan
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Mei Yan Leong
- Agency for Integrated Care, Nursing Division, Singapore General Hospital, Singapore
| | - Giat Yeng Khee
- Department of Pharmacy, Singapore General Hospital, Singapore
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Caughey GE, Vitry AI, Ramsay EN, Gilbert AL, Shakib S, Ryan P, Esterman A, McDermott RA, Roughead EE. Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes. Intern Med J 2016; 46:1430-1436. [PMID: 27718515 DOI: 10.1111/imj.13286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 09/25/2016] [Accepted: 09/25/2016] [Indexed: 01/15/2023]
Affiliation(s)
- G. E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - A. I. Vitry
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - E. N. Ramsay
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - A. L. Gilbert
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - S. Shakib
- Clinical Pharmacology Royal Adelaide Hospital Adelaide South Australia Australia
- Discipline of Clinical Pharmacology University of Adelaide Adelaide South Australia Australia
| | - P. Ryan
- School of Public Health University of Adelaide Adelaide South Australia Australia
| | - A. Esterman
- Sansom Institute of Health Service Research and School of Nursing and Midwifery University of South Australia Adelaide South Australia Australia
- Centre for Research Excellence in Chronic Disease Prevention, The Cairns Institute James Cook University Cairns Queensland Australia
| | - R. A. McDermott
- School of Population Health University of South Australia Adelaide South Australia Australia
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences James Cook University Cairns Queensland Australia
| | - E. E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
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20
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Caughey GE, Kalisch Ellett LM, Goldstein S, Roughead EE. Suboptimal medication-related quality of care preceding hospitalisation of older patients. Med J Aust 2016; 203:220.e1-7. [PMID: 26852053 DOI: 10.5694/mja14.01479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/16/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the prevalence of suboptimal medication-related processes of care before the hospitalisation of older patients. DESIGN AND SETTING We conducted a retrospective cohort study using a clinical indicator set related to medication management that has been validated by an expert panel as consisting of suboptimal aspects of medication use that clinicians should be able to foresee and avoid. Australian Government Department of Veterans' Affairs administrative claims data between 1 July 2007 and 30 June 2012 were analysed according to these clinical indicators to assess medication-related processes of care preceding hospitalisation. PARTICIPANTS Veterans with one or more hospitalisations in Australia for a condition defined by the clinical indicator set. MAIN OUTCOME MEASURE Prevalence of suboptimal medication-related processes of care before hospitalisation as a proportion of all hospitalisations defined by diagnoses in the clinical indicator set. RESULTS During the 5-year study period, there were 164,813 hospitalisations with primary diagnoses for conditions included in the clinical indicator set, encompassing 83,430 patients. The overall proportion of hospitalisations that were preceded by suboptimal medication-related processes of care was 25.2% (41,546 hospitalisations); 34.5% of patients (28,807 patients) had at least one hospitalisation and 10.4% (8640 patients) had two or more hospitalisations preceded by suboptimal medication-related processes of care. At least one in 10 hospitalisations for chronic heart failure, ischaemic stroke, asthma, gastrointestinal ulcer or bleeding, fracture, renal failure or nephropathy, hyperglycaemia or hypoglycaemia were preceded by suboptimal medication-related processes of care. CONCLUSIONS This study highlights conditions for which there are evidence-practice gaps in medication management in the older population. Routine prospective monitoring of these evidence-based, validated, medication-related clinical indicators provides a means for quality improvement in the management of common chronic conditions.
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Young A, Tordoff J, Dovey S, Reith D, Lloyd H, Tilyard M, Smith A. Using an Electronic Decision Support Tool to Reduce Inappropriate Polypharmacy and Optimize Medicines: Rationale and Methods. JMIR Res Protoc 2016; 5:e105. [PMID: 27288200 PMCID: PMC4920961 DOI: 10.2196/resprot.5543] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/15/2016] [Accepted: 03/30/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Polypharmacy and inappropriate continuation of medicines can lead to a significant risk of adverse drug events and drug interactions with patient harm and escalating health care costs as a result. Thorough review of patients' medications focusing on the need for each drug can reduce the potential for harm. Limitations in performing effective medicine reviews in practice include consultation time constraints and funding for pharmacy services. We will aim to overcome these problems by designing an automatic electronic decision support tool (the medicines optimization/review and evaluation (MORE) module) that is embedded in general practice electronic records systems. The tool will focus on medicines optimization and reducing polypharmacy to aid prescribers in reviewing medicines and improve patient outcomes. OBJECTIVE The objectives of this study are: (1) to develop an electronic decision support tool to assist prescribers in performing clinical medication reviews with a particular focus on patients experiencing multimorbidity and polypharmacy, and (2) evaluate and assess the use of the electronic decision support tool, providing pilot data on its usefulness in supporting prescribers during consultations with patients. METHODS The first three study phases involve development of clinical rules outlining clinical interventions and the creation and validation of the MORE decision support tool. Phase four is a community-based, single-blind, prospective, 6-month controlled trial involving two interventions and two control general practices, matched for practice demographics. We will be measuring the number of times prescribers engage with the tool, total number of interventions suggested by the tool, and total number of times prescribers change medicines in response to recommendations. There will also be prospective follow-up of patients in the intervention group to examine whether changes to medications are upheld, and to determine the number of hospitalizations or emergency department visits within 6 months of a medicine intervention. Comparisons between control and intervention practices will measure the changes in proportions of patients with polypharmacy and inappropriately prescribed medicines before and after the introduction of the electronic decision support tool, proportions of patients receiving appropriate treatment in each practice, and changed, maintained, or improved health status, hospitalizations, and deaths in the study year. Initiation rates of inappropriately prescribed medicines will be measured as a secondary outcome. As well as external assessment of the extent of use and application of the tool, prescribers will receive monthly practice progress reports detailing the proportion of their patients experiencing polypharmacy and taking inappropriately prescribed medicines identified for review. RESULTS Phase one has now been completed and the decision support tool is under development. Final data analysis is expected to be available in December 2016. CONCLUSIONS This study will establish whether the MORE decision support tool stands up to real world conditions and promotes changes in prescribing practice.
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Affiliation(s)
- Amber Young
- New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand.
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Jokanovic N, Tan EC, van den Bosch D, Kirkpatrick CM, Dooley MJ, Bell JS. Clinical medication review in Australia: A systematic review. Res Social Adm Pharm 2016; 12:384-418. [DOI: 10.1016/j.sapharm.2015.06.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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Bereznicki LRE, van Tienen EC, Stafford A. Home medicines reviews in Australian war veterans taking warfarin do not influence international normalised ratio control. Intern Med J 2016; 46:288-94. [DOI: 10.1111/imj.12964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/26/2015] [Accepted: 11/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- L. R. E. Bereznicki
- Department of Pharmacy, School of Medicine; University of Tasmania; Hobart Tasmania
| | - E. C. van Tienen
- Department of Pharmacy, School of Medicine; University of Tasmania; Hobart Tasmania
| | - A. Stafford
- WA Dementia Training Study Centre, School of Pharmacy; Curtin University; Perth Western Australia Australia
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24
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Hillen JB, Vitry A, Caughey GE. Trends in general practitioner services to residents in aged care. Aust J Prim Health 2016; 22:517-522. [DOI: 10.1071/py15119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/04/2015] [Indexed: 11/23/2022]
Abstract
To date, access to appropriate and timely GP services for those in aged care has been described as limited, in part due to inadequate models of care and remuneration. As the Australian population ages and more Australians become dependent on aged-care services, the need for good quality medical care that meets the needs of residents will continue to grow. The purpose of this study was to provide a current analysis of trends in GP services in residents in Australian aged-care facilities. Longitudinal population data (2005–2014) was used to describe the changing population demographics and calculate annual rates for GP services specific to this population. Total population and age-group strata (<85 years and 85+ years) rates were calculated for standard consultations, after-hours consultations, contribution to a care plan and collaborative medication review. For the period 2005–2014 there was an increase of 1.5 million GP services to this population, which had simultaneously grown by 19800 residents, aged (6% increase in residents aged 85+ years) and become more dependent (14% increase is high-care residents). Significant increases in all GP service rates were observed, with a shift towards after-hours consultations. Residents aged <85 years received significantly more services than residents aged 85+ years. GP service delivery to the whole aged-care population continues to be heavily weighted towards standard and after-hours consultations, while collaborative GP services remain a very small proportion of services accessed by this population. There is scope to increase collaborative GP services, which have been linked to improved outcomes for this population.
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25
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Pharmacy roles, conventional and less so, are reasons for optimism in modern times. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/jppr.1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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26
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Nanaumi Y, Onda M, Tsubota K, Tanaka R, Mukai Y, Matoba S, Tanaka Y, Arakawa Y. Effectiveness of Pharmacists' Comprehensive Assessment of Medication Profiles in Dementia Patients. YAKUGAKU ZASSHI 2015; 135:1057-67. [DOI: 10.1248/yakushi.15-00109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Mitsuko Onda
- Clinical Laboratory of Practical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Kenichi Tsubota
- Clinical Laboratory of Practical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Rie Tanaka
- Clinical Laboratory of Practical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Yusuke Mukai
- Clinical Laboratory of Practical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Syunya Matoba
- Clinical Laboratory of Practical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Yuka Tanaka
- Clinical Laboratory of Practical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Yukio Arakawa
- Clinical Laboratory of Practical Pharmacy, Osaka University of Pharmaceutical Sciences
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27
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Deeks LS, Cooper GM, Draper B, Kurrle S, Gibson DM. Dementia, medication and transitions of care. Res Social Adm Pharm 2015; 12:450-60. [PMID: 26265028 DOI: 10.1016/j.sapharm.2015.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/04/2015] [Accepted: 07/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Persons with dementia (PWD) often have complex medication regimens and are at risk of medication problems during the multiple transitions of care experienced as the condition progresses. OBJECTIVES To explore medication processes in acute care episodes and care transitions for PWD and to make recommendations to improve practice. METHOD Semi-structured interviews were conducted by two pharmacy researchers from a focused purposive sample of fifty-one participants (carers, health professionals, Alzheimer's Australia staff) from urban and rural Australia. After written consent, the interviews were audio-recorded then transcribed verbatim for face-to-face interviews, or notes were taken during the interview if conducted by telephone. The transcripts were checked for accuracy by the pharmacy researchers. Thematic analysis of the data was undertaken independently by the two researchers to reduce bias and any disagreements were resolved by discussion. RESULTS Themes identified were: medication reconciliation; no modified planning for care transitions; underutilization of information technology; multiple prescribers; residential aged care facilities; and medication reviews by pharmacists. Sub themes were: access to appropriate staff; identification of dementia; dose administration aids; and staff training. CONCLUSIONS Medication management is sub-optimal for PWD during care transitions and may compromise safety. Suggested improvements included: increased involvement of pharmacists in care transitions; outreach or transitional health care professionals; modified planning for care transitions for individuals over 80 years; co-ordinated electronic records; structured communication; and staff training.
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Affiliation(s)
- Louise S Deeks
- Discipline of Pharmacy, Faculty of Health, University of Canberra, ACT 2601, Australia.
| | - Gabrielle M Cooper
- Discipline of Pharmacy, Faculty of Health, University of Canberra, ACT 2601, Australia
| | - Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia
| | - Susan Kurrle
- Faculty of Medicine, University of Sydney, Sydney, Australia; Rehabilitation and Aged Care Service, Hornsby Hospital, Sydney, Australia
| | - Diane M Gibson
- Faculty of Health, University of Canberra, ACT 2601, Australia
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28
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Criddle DT, Jayasuriya PH. Medication management post discharge: whose job is it anyway? JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/jppr.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Deirdre T. Criddle
- CoNeCT‐Complex Needs Coordination Team Homelink Sir Charles Gairdner Hospital Nedlands Australia
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29
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Affiliation(s)
- Andy Gilbert
- Division of Health Sciences, School of Pharmacy and Medical Sciences; University of South Australia; Adelaide SA 5001
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30
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Ellett LMK, Ramsay EN, Barratt JD, Gilbert AL, Roughead EE. Home Medicines Reviews: Extent of Uptake by High-Risk Veterans. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2013.tb00250.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute; University of South Australia; Adelaide South Australia
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31
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Bell JS, Kalisch LM, Ramsay EN, Pratt NL, Barratt JD, LeBlanc T, Roughead EE, Gilbert AL. Prescriber Feedback to Improve Quality Use of Medicines among Older People: the Veterans' MATES Program. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2011.tb00112.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Lisa M Kalisch
- School of Pharmacy and Medical SciencesUniversity of South Australia
| | | | - Nicole L Pratt
- Data Management and Analysis Centre, School of Population Health and Clinical PracticeUniversity of Adelaide
| | | | | | | | - Andrew L Gilbert
- School of Pharmacy and Medical SciencesUniversity of South Australia Adelaide South Australia
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O'Quin KE, Semalulu T, Orom H. Elder and caregiver solutions to improve medication adherence. HEALTH EDUCATION RESEARCH 2015; 30:323-335. [PMID: 25725500 DOI: 10.1093/her/cyv009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We conducted a qualitative study to ascertain caregiver and elder perceptions of barriers to medication management and to identify community-derived solutions to improve medication management. Nine focus groups (N = 65, mean age = 71) were conducted with caregivers or elders from five communities. Participants were recruited by key informants utilizing snowball sampling methodology. The following themes were identified in the participant-recommended proposed solutions improving medication adherence: (i) use of personal systems to overcome barriers to medication adherence, (ii) various solutions to address cost concerns, (iii) the need for regular review of medications by doctors or pharmacists to eliminate unnecessary medications, (iv) desire for community-driven support systems, and (v) using medical advocates. Elders and caregivers recognized medication non-adherence as a community-wide issue and were eager to offer solutions they thought would work in their communities. These solutions can lend credibility to strategies currently being developed/utilized and offer innovative recommendations for future interventions.
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Affiliation(s)
- K E O'Quin
- The School of Public Health, Georgia State University, P.O. Box 3965, Atlanta, GA 30302-3965, Northern Ontario School of Medicine, Thunder Bay, ON P7B 5E1, Canada and Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14214, USA
| | - T Semalulu
- The School of Public Health, Georgia State University, P.O. Box 3965, Atlanta, GA 30302-3965, Northern Ontario School of Medicine, Thunder Bay, ON P7B 5E1, Canada and Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14214, USA
| | - H Orom
- The School of Public Health, Georgia State University, P.O. Box 3965, Atlanta, GA 30302-3965, Northern Ontario School of Medicine, Thunder Bay, ON P7B 5E1, Canada and Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14214, USA
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33
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Angley MT, Kellie A, Barrow G. Integration of a consultant pharmacist into a general practice: development of a collaborative care model. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/jppr.1075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Manya T. Angley
- Division of Health Sciences, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia Australia
- East Adelaide Health Care; Adelaide South Australia Australia
| | - Andrew Kellie
- East Adelaide Health Care; Adelaide South Australia Australia
| | - Geoffrey Barrow
- East Adelaide Health Care; Adelaide South Australia Australia
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34
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Elliott RA, C. Booth J. Problems with medicine use in older Australians: a review of recent literature. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2014. [DOI: 10.1002/jppr.1041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Rohan A. Elliott
- Pharmacy Department; Austin Health; Heidelberg Victoria Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Victoria Australia
| | - Jane C. Booth
- Pharmacy Department; Austin Health; Heidelberg Victoria Australia
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35
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Attitudes of pharmacists to provision of Home Medicines Review for Indigenous Australians. Int J Clin Pharm 2014; 36:1260-7. [PMID: 25322893 DOI: 10.1007/s11096-014-0030-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Home Medicines Reviews could improve the quality use of medicines and medicines adherence among Aboriginal people. Despite high level of chronic disease very few Home Medicines Review are currently being conducted for Aboriginal and Torres Strait Islander people. OBJECTIVE The aim of this research was to explore the barriers and facilitators from the pharmacists' perspective for the provision of Home Medicines Review to Aboriginal people attending Aboriginal Health Services. SETTING A cross sectional survey was used to gather demographic, qualitative and quantitative data from 945 Australian pharmacists accredited to undertake Home Medicines Review. METHOD The survey consisted of 39 items which included both closed, open ended and Likert scale questions. Data was extracted from the online survey tool and analysed. Descriptive statistics were used to explore the quantitative data while qualitative data was thematically analysed and coded for emergent themes. MAIN OUTCOME MEASURE Number of Home Medicines Review conducted for Aboriginal and Torres Strait Islander patients. RESULTS A total of 187 accredited pharmacists responded to the survey. They reported that barriers to Home Medicines Review to Aboriginal patients may include lack of understanding of cultural issues by pharmacists; lack of awareness of Home Medicines Review program by Aboriginal Health Service staff; difficulties in implementation of Home Medicine Review processes; burdensome program rules; the lack of patient-pharmacist relationship, and the lack of pharmacist-Aboriginal Health Service relationship. CONCLUSION Changes to the medication review processes and rules are needed to improve the accessibility of the Home Medicine Review program for Aboriginal and Torres Strait Islander people. Improved relationships between pharmacists and Aboriginal health service staff, would increase the likelihood of more Home Medicines Reviews being conducted with Aboriginal and Torres Strait Islander patients.
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36
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Angley M, Rigby D, Dowling HV, Coombes I, Criddle D, Dooley M, Driscoll SE, Jayasuriya PH, Kirsa SW, Tenni P, Bennett S, Vassarotti R. Advocating for Patients and the Pharmacist's Role in Primary Care. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2014. [DOI: 10.1002/j.2055-2335.2014.tb00004.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manya Angley
- Sansom Institute for Health Research; University of South Australia
| | | | | | - Ian Coombes
- Safe Medication Management Unit Medication Services Queensland Queensland Health
| | | | | | | | | | | | - Peter Tenni
- Clinical Pharmacy Training and Consulting
- Consultant Pharmacy Services
- Clinical Division, Medscope
- University of Tasmania
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37
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Lehnbom EC, Stewart MJ, Manias E, Westbrook JI. Impact of Medication Reconciliation and Review on Clinical Outcomes. Ann Pharmacother 2014; 48:1298-312. [DOI: 10.1177/1060028014543485] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the evidence regarding the effectiveness of medication reconciliation and review and to improve clinical outcomes in hospitals, the community, and aged care facilities. Data Source: This systematic review was undertaken in concordance with the PRISMA statement. Electronic databases, including MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for relevant articles published between January 2000 and March 2014. Study Selection and Data Extraction: Randomized and nonrandomized studies rating the severity of medication discrepancies and medication-related problems identified during medication reconciliation and/or review were considered for inclusion. Data were extracted independently by 2 authors using a data collection form. Data Synthesis: Of the 5292 articles identified, 83 articles met the inclusion criteria. Medication reconciliation identified unintentional medication discrepancies in 3.4% to 98.2% of patients. There is limited evidence of the potential of these discrepancies to cause harm. Medication reviews identified medication-related problems or possible adverse drug reactions in 17.2% to 94.0% of patients. The studies reported conflicting findings regarding the impact of medication review on length of stays, readmissions, and mortality. Conclusions: The evidence demonstrates that medication reconciliation has the potential to identify many medication discrepancies and reduce potential harm, but the impact on clinical outcomes is less clear. Similarly, medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Overall, there is limited evidence that medication reconciliation and medication review processes, as currently performed, significantly improve clinical outcomes, such as reductions in hospital readmissions.
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Affiliation(s)
- Elin C. Lehnbom
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
| | - Michael J. Stewart
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
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38
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Gilbert AM AL. Time to Rethink the Funding Model for Home Medicines Review. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2014. [DOI: 10.1002/j.2055-2335.2014.tb00005.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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39
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Alderman C. The True Impact of Changes to Professional Services Program in Australian Pharmacy. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2014. [DOI: 10.1002/j.2055-2335.2014.tb00003.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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40
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Effects of a three party healthcare network on the incidence levels of drug related problems. Int J Clin Pharm 2013; 35:763-71. [DOI: 10.1007/s11096-013-9804-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 06/03/2013] [Indexed: 12/11/2022]
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41
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Alderman CP, Kong L, Kildea L. Medication-Related Problems Identified in Home Medicines Reviews Conducted in an Australian Rural Setting. ACTA ACUST UNITED AC 2013; 28:432-42. [DOI: 10.4140/tcp.n.2013.432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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42
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Pharmacist-Led Medication Review to Identify Medication-Related Problems in Older People Referred to an Aged Care Assessment Team. Drugs Aging 2012; 29:593-605. [PMID: 22715865 DOI: 10.1007/bf03262276] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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43
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Geurts MME, Talsma J, Brouwers JRBJ, de Gier JJ. Medication review and reconciliation with cooperation between pharmacist and general practitioner and the benefit for the patient: a systematic review. Br J Clin Pharmacol 2012; 74:16-33. [PMID: 22242793 DOI: 10.1111/j.1365-2125.2012.04178.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This article systematically reviews the literature on the impact of collaboration between pharmacists and general practitioners and describes its effect on patients' health. A systematic literature search provided 1041 articles. After first review of title and abstract, 152 articles remained. After review of the full text, 83 articles were included. All included articles are presented according to the following variables: (i) reference; (ii) design and setting of the study; (iii) inclusion criteria for patients; (iv) description of the intervention; (v) whether a patient interview was performed to involve patients' experiences with their medicine-taking behaviour; (vi) outcome; (vii) whether healthcare professionals received additional training; and (viii) whether healthcare professionals received financial reimbursement. Many different interventions are described where pharmacists and general practitioners work together to improve patients' health. Only nine studies reported hard outcomes, such as hospital (re)admissions; however, these studies had different results, not all of which were statistically significant. Randomized controlled trials should be able to describe hard outcomes, but large patient groups will be needed to perform such studies. Patient involvement is important for long-term success.
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Affiliation(s)
- Marlies M E Geurts
- Department of Pharmacotherapy and Pharmaceutical Care, Research Institute SHARE, University of Groningen, Groningen, The Netherlands.
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Abstract
Recent years have seen a formalization of medication review by pharmacists in all settings of care. This article describes the different types of medication review provided in primary care in the UK National Health Service (NHS), summarizes the evidence of effectiveness and considers how such reviews might develop in the future. Medication review is, at heart, a diagnostic intervention which aims to identify problems for action by the prescriber, the clinician conducting the review, the patient or all three but can also be regarded as an educational intervention to support patient knowledge and adherence. There is good evidence that medication review improves process outcomes of prescribing including reduced polypharmacy, use of more appropriate medicines formulation and more appropriate choice of medicine. When 'harder' outcome measures have been included, such as hospitalizations or mortality in elderly patients, available evidence indicates that whilst interventions could improve knowledge and adherence they did not reduce mortality or hospital admissions with one study showing an increase in hospital admissions. Robust health economic studies of medication reviews remain rare. However a review of cost-effectiveness analyses of medication reviews found no studies in which the cost of the intervention was greater than the benefit. The value of medication reviews is now generally accepted despite lack of robust research evidence consistently demonstrating cost or clinical effectiveness compared with traditional care. Medication reviews can be more effectively deployed in the future by targeting, multi-professional involvement and paying greater attention to medicines which could be safely stopped.
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45
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Griese N, Felberg M, Müller U, Schulz M. [Medication management]. PHARMAZIE IN UNSERER ZEIT 2012; 41:350-356. [PMID: 22764005 DOI: 10.1002/pauz.201200483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Nina Griese
- ABDA - Bundesvereinigung Deutscher Apothekerverbände Geschäftsbereich Pharmazie bzw. Arzneimittel, Jägerstraße 49/50, 10117 Berlin
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46
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Kalisch LM, Caughey GE, Barratt JD, Ramsay EN, Killer G, Gilbert AL, Roughead EE. Prevalence of preventable medication-related hospitalizations in Australia: an opportunity to reduce harm. Int J Qual Health Care 2012; 24:239-49. [PMID: 22495574 DOI: 10.1093/intqhc/mzs015] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify the prevalence of potentially preventable medication-related hospitalizations amongst elderly Australian veterans by applying clinical indicators to administrative claims data. DESIGN AND SETTING Retrospective cohort study in the Australian veteran population from 1 January 2004 to 31 December 2008. PARTICIPANTS A total of 109 044 veterans with one or more hospitalizations defined by the medication-related clinical indicator set, during the 5-year study period. MAIN OUTCOME MEASURE The prevalence of potentially preventable medication-related hospitalizations as a proportion of all hospitalizations defined by the clinical indicator set. RESULTS During the 5-year study period, there were a total of 1 630 008 hospital admissions of which 216 527 (13.3%) were for conditions defined by the medication-related clinical indicator set for 109 044 veterans. The overall proportion of potentially preventable medication-related hospitalizations was 20.3% (n= 43 963). Of the 109 044 veterans included in the study, 28 044 (25.7%) had at least one potentially preventable medication-related hospitalization and 7245 (6.6%) veterans had two or more potentially preventable admissions. Conditions with both a high prevalence of hospitalization and preventability included asthma/chronic obstructive pulmonary disorder, depression and thromboembolic cerebrovascular event (23.3, 18.5 and 18.3%, respectively, were potentially preventable). Other hospitalizations that were less common but had a high level of preventability (at least 20%) included hip fracture, impaction, renal failure, acute confusion, bipolar disorder and hyperkalaemia. CONCLUSIONS The results of this study highlight those conditions where hospitalizations could potentially be avoided through improved medication management. Strategies to increase the awareness, identification and resolution of these medication-related problems contributing to these hospitalizations are required in Australia.
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Affiliation(s)
- Lisa M Kalisch
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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47
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Roughead EE, Vitry AI, Caughey GE, Gilbert AL. Multimorbidity, care complexity and prescribing for the elderly. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.64] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There is an increasing number of people living with multiple chronic illnesses and consequently taking multiple medicines. More than 50% of these patients will have concomitant diseases that complicate management and will see multiple providers to manage their conditions. This increases their risk of medication-related problems, adverse events and poor treatment outcomes. All of these patients are at high risk of medication misadventure and most will have at least four medication-related problems, of which more than half will be resolvable. The management of medication in these patients will require the increasing involvement of pharmacists to provide a number of cognitive services including medication reconciliation, medication review, adherence services and proactive adverse reaction monitoring. This needs to be integrated into models of practice that coordinate care between multiple providers and accommodate both patient and provider preferences.
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Affiliation(s)
| | - Agnes I Vitry
- Quality Use of Medicines & Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide 5000, Australia
| | - Gillian E Caughey
- Quality Use of Medicines & Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide 5000, Australia
| | - Andrew L Gilbert
- Quality Use of Medicines & Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide 5000, Australia
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48
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Dooley MJ, McGuiness JV, Choo S, Ngo-Thai LL, Tong E, Neave K, Poole S, Street A. Successful Implementation of a Pharmacist Anticoagulant Dosing Service in Ambulatory Care. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2011. [DOI: 10.1002/j.2055-2335.2011.tb00863.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Shin Choo
- Department of Epidemiology and Preventative Medicine; Monash University
| | | | | | | | | | - Alison Street
- Department of Pathology, Epidemiology and Medicine; Monash University; Clayton Victoria
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49
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Stafford L, Stafford A, Hughes J, Angley M, Bereznicki L, Peterson G. Drug-related problems identified in post-discharge medication reviews for patients taking warfarin. Int J Clin Pharm 2011; 33:621-6. [DOI: 10.1007/s11096-011-9515-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 04/22/2011] [Indexed: 11/30/2022]
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