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Gavazova E, Staynova R, Grekova-Kafalova D. Managing polypharmacy through medication review tools - pros and cons. Folia Med (Plovdiv) 2024; 66:161-170. [PMID: 38690810 DOI: 10.3897/folmed.66.e117783] [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: 12/24/2023] [Accepted: 02/01/2024] [Indexed: 05/03/2024] Open
Abstract
Inappropriate polypharmacy is a common occurrence in elderly patients, resulting in increased adverse drug reactions, nonadherence, and increased healthcare costs. Medication review and deprescribing are the primary strategies described in the literature for dealing with problematic polypharmacy. To effectively carry out the medication review, various tools have been developed. These tools can support medication review in a variety of ways. Some tools include a list of medications requiring detailed attention, while others guide medical professionals with principles and algorithms for reviewing and prescribing medicines. A third category of tools focuses on tracking and identifying symptoms that may be due to drug-related problems.
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Basger BJ, Moles RJ, Chen TF. Uptake of pharmacist recommendations by patients after discharge: Implementation study of a patient-centered medicines review service. BMC Geriatr 2023; 23:183. [PMID: 36991378 PMCID: PMC10061906 DOI: 10.1186/s12877-023-03921-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process. OBJECTIVES To describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service; to assess service impact on older patients and their caregivers. METHOD An implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge. RESULTS Of 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. CONCLUSION Implementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12th July 2022 with the ISRCTN registry, ISRCTN21156862, https://www.isrctn.com/ISRCTN21156862 .
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Affiliation(s)
- Benjamin Joseph Basger
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia.
- Wolper Jewish Hospital, 8 Trelawney Street, Woollahra, Sydney, NSW, 2025, Australia.
| | - Rebekah Jane Moles
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
| | - Timothy Frank Chen
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
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Ruangritchankul S, Peel NM, Shafiee Hanjani L, Gray LC. The Changes in Medication Prescribing Among the Older People with Cognitive Impairment in the Acute Care Setting. Clin Interv Aging 2020; 15:865-876. [PMID: 32606626 PMCID: PMC7292256 DOI: 10.2147/cia.s252432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/18/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Most older people with cognitive impairment usually have multiple comorbidities. In the last decade, the guidelines for the management of chronic diseases have been changed, leading to changes in the patterns of medication prescribing and in the prevalence of drug-related problems (DRPs). The main objectives were to explore the changes in medication use and in the prevalence of polypharmacy (PP), the use of potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs) among older hospitalized adults with cognitive impairment in a 5-year period. PATIENTS AND METHODS Older hospitalized patients with cognitive impairment diagnosed by cognitive performance scale (CPS) score of 2 or more at tertiary hospital in Brisbane, Australia in 2009 and 2015 to 2016 were enrolled. Prescribed medication use, and exposures to PP, PIM and/or DDI were evaluated at two time points. The associated factors with patients exposed to >1 criteria of PP, PIM or DDI were analyzed by using logistic regression analyses. RESULTS The median number of prescribed medications was not significantly different between the two periods. The number of medications use as dermatological agents and analgesics substantially increased over 5 years. In contrast, there was a decrease in prescription of drugs for acid-related disorders, drugs used in diabetes, and mineral supplements. Most of the participants were exposed to at least one of PP, PIM or DDI. In multivariate regression analysis, the presence of diabetes diagnosis was a risk factor associated with increased exposure to >1 criteria of PP, PIM or DDI. CONCLUSION The patterns of many prescribed medications use have altered in a 5-year period. The present study confirms that the majority of older adults with cognitive impairment admitted in an acute care setting are prone to PP, PIM and DDI. Comprehensive medication reviews should be undertaken in clinical care of older patients with cognitive impairment.
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Affiliation(s)
- Sirasa Ruangritchankul
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nancye M Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Guo GN, Jonnagaddala J, Farshid S, Huser V, Reich C, Liaw ST. Comparison of the cohort selection performance of Australian Medicines Terminology to Anatomical Therapeutic Chemical mappings. J Am Med Inform Assoc 2019; 26:1237-1246. [PMID: 31545380 PMCID: PMC7647230 DOI: 10.1093/jamia/ocz143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/10/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Electronic health records are increasingly utilized for observational and clinical research. Identification of cohorts using electronic health records is an important step in this process. Previous studies largely focused on the methods of cohort selection, but there is little evidence on the impact of underlying vocabularies and mappings between vocabularies used for cohort selection. We aim to compare the cohort selection performance using Australian Medicines Terminology to Anatomical Therapeutic Chemical (ATC) mappings from 2 different sources. These mappings were taken from the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) and the Pharmaceutical Benefits Scheme (PBS) schedule. MATERIALS AND METHODS We retrieved patients from the electronic Practice Based Research Network data repository using 3 ATC classification groups (A10, N02A, N06A). The retrieved patients were further verified manually and pooled to form a reference standard which was used to assess the accuracy of mappings using precision, recall, and F measure metrics. RESULTS The OMOP-CDM mappings identified 2.6%, 15.2%, and 24.4% more drugs than the PBS mappings in the A10, N02A and N06A groups respectively. Despite this, the PBS mappings generally performed the same in cohort selection as OMOP-CDM mappings except for the N02A Opioids group, where a significantly greater number of patients were retrieved. Both mappings exhibited variable recall, but perfect precision, with all drugs found to be correctly identified. CONCLUSION We found that 1 of the 3 ATC groups had a significant difference and this affected cohort selection performance. Our findings highlighted that underlying terminology mappings can greatly impact cohort selection accuracy. Clinical researchers should carefully evaluate vocabulary mapping sources including methodologies used to develop those mappings.
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Affiliation(s)
- Guan N Guo
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
- WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, Australia
| | - Jitendra Jonnagaddala
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
- WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, Australia
| | - Sanjay Farshid
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Vojtech Huser
- Lister Hill National Centre for Biomedical Communications, National Library of Medicine National Institutes of Health, Bethesda, Maryland, USA
| | | | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
- WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, Australia
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Pharmacists' perspectives on medication reviews for long-term care residents with advanced dementia: a qualitative study. Int J Clin Pharm 2019; 41:950-962. [PMID: 31123899 DOI: 10.1007/s11096-019-00821-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
Background Medication reviews by pharmacists have been shown to identify and reduce drug-related problems in long-term care residents. Objective To explore pharmacist perspectives of the Australian Government funded pharmacist-conducted residential medication management review and its role improving the quality and safety of prescribing in long-term care, in particular for those living with advanced dementia. Setting Australian Long-term care pharmacists. Method A qualitative research methodology approach using semi-structured interviews was used, with participants pharmacists with Residential Medication Management Review experience. Interviews were recorded, transcribed and coded utilising a meta-model of Physician-Community Pharmacy Collaboration in medication review. Main outcome measure Pharmacists' perspectives on the Residential Medication Management Review and how to improve the quality of reviews for residents with advanced dementia. Results Fifteen accredited pharmacists participated. The majority believed that the Residential Medication Management Review had the potential to improve the quality and safety of medicines but highlighted systemic issues that worked against collaborative practice. Participants emphasised the importance of three-way collaboration between general practitioners, pharmacists and nursing staff and highlighted key strategies for its optimisation. Conclusion Incorporating avenues for greater communication between team members can improve collaboration between health professionals and ultimately the quality of medication reviews.
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Fialová D, Laffon B, Marinković V, Tasić L, Doro P, Sόos G, Mota J, Dogan S, Brkić J, Teixeira JP, Valdiglesias V, Costa S. Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies). Eur J Clin Pharmacol 2019; 75:451-466. [PMID: 30610276 DOI: 10.1007/s00228-018-2603-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the "age-blind" approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. METHODOLOGY A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). RESULTS Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. CONCLUSION Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.
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Affiliation(s)
- Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic. .,Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Prague, Czech Republic.
| | - Blanca Laffon
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Valentina Marinković
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Tasić
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Peter Doro
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Gyӧngyver Sόos
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Jorge Mota
- Centro de Investigação em Actividade Fìsica, Saúde e Lazer (CIAFEL), University of Porto, Porto, Portugal
| | - Soner Dogan
- Department of Medical Biology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Jovana Brkić
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - João Paulo Teixeira
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Vanessa Valdiglesias
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Solange Costa
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
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Niclós G, Olivar T, Rodilla V. A cross-sectional evaluation of the prevalence and detection of predictors of polypharmacy amongst adult in Spain. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:242-249. [PMID: 28795462 DOI: 10.1111/ijpp.12386] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 05/31/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the association between polypharmacy and sociodemographic factors as well as health status, determinants of health and healthcare use, illness and use of prescribed medicines amongst adults in Spain. METHODS Data from the 2009 European Health Interview Survey in Spain which included 22 188 subjects were used. Polypharmacy was defined as the use of five or more prescribed medicines. The association between polypharmacy and several variables was assessed by means of bivariate analysis and logistic regression analysis (adjusted by age and gender). KEY FINDINGS Amongst study participants, 15.8% were on prescribed polypharmacy (19.3%, women; 10.3%, men (P < 0.001)). A number of sociodemographic factors (e.g. age, gender, educational level), health status factors (e.g. limitation in daily activities, self-perception of health, presence of chronic disease) and other health-related factors (e.g. smoking, alcohol drinking, physical activity) have been studied and have been found to play a role in polypharmacy. Logistic regression analysis provided three variables which together with age could be used to predict polypharmacy. CONCLUSION In Spain, approximately 16% of people who take medicines are on polypharmacy and this is more frequent in women and amongst older adults. From our study, we can conclude that the variables which can predict a higher likelihood of polypharmacy are, together with age, prescribed antidepressants, and prescribed medicines for back/neck pain and joint pain. This may provide a tool for health professionals to readily assess polypharmacy appropriateness in polymedicated patients.
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Affiliation(s)
- Gracia Niclós
- Department of Pharmacy, Universidad CEU Cardenal Herrera, Moncada, Valencia, Spain
| | - Teresa Olivar
- Department of Pharmacy, Universidad CEU Cardenal Herrera, Moncada, Valencia, Spain
| | - Vicent Rodilla
- Department of Pharmacy, Universidad CEU Cardenal Herrera, Moncada, Valencia, Spain
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Kjeldsen LJ, Nielsen TRH, Olesen C. Investigating the Relative Significance of Drug-Related Problem Categories. PHARMACY 2017; 5:E31. [PMID: 28970443 PMCID: PMC5597156 DOI: 10.3390/pharmacy5020031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/24/2017] [Accepted: 06/06/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of the review was to investigate whether an assessment of clinical significance can be related to specific drug-related problems (DRPs) and hence may assist in prioritizing individual categories of DRP categorization systems. The literature search using Google Scholar was performed for the period 1990 to 2013 and comprised primary research studies of clinical pharmacy interventions including DRP and clinical significance assessments. Two reviewers assessed the titles, abstracts, and full-text papers individually, and inclusion was determined by consensus. A total of 27 unique publications were included in the review. They had been conducted in 14 different countries and reported a large range of DRPs (71-5948). Five existing DRP categorisation systems were frequently used, and two methods employed to assess clinical significance were frequently reported. The present review could not establish a consistent relation between the DRP categories and the level of clinical significance. However, the categories "ADR" and possibly "Drug interaction" were often associated with an assessed high clinical significance, albeit they were infrequently identified in the studies. Hence, clinical significance assessments do not seem to be useful in prioritizing individual DRPs in the DRP categorization systems. Consequently, it may be necessary to reconsider our current approach for evaluating DRPs.
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Affiliation(s)
- Lene Juel Kjeldsen
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, 2100 Copenhagen, Denmark.
| | | | - Charlotte Olesen
- The Hospital Pharmacy, Central Denmark Region, 8000 Aarhus, Denmark.
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Basger BJ, Moles RJ, Chen TF. Impact of an enhanced pharmacy discharge service on prescribing appropriateness criteria: a randomised controlled trial. Int J Clin Pharm 2015; 37:1194-205. [DOI: 10.1007/s11096-015-0186-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022]
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Elliott RA, Stehlik P. Identifying Inappropriate Prescribing for Older People. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2013.tb00284.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Rohan A Elliott
- Austin Health, Centre for Medication Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University
| | - Paulina Stehlik
- Centre for Medication Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Victoria
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Development of an Aggregated System for Classifying Causes of Drug-Related Problems. Ann Pharmacother 2015; 49:405-18. [DOI: 10.1177/1060028014568008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: More than 20 different types of classification systems for drug-related problems (DRPs) and their causes have been developed. Classification is necessary to describe and assess clinical, organizational, and economic impacts of DRPs through documentation of collected data. However, many researchers have judged classification systems incomplete when describing their data, and have modified them or developed their own. This variability between systems has made study comparisons difficult. Objectives: To perform a category-by-category comparison of the content of selected DRP classification systems to construct an aggregated cause-of-DRP classification system containing the content of all systems. Method: DRP classification systems were identified after a literature review, with 7 chosen based on their use in varied health care settings, geographical diversity, frequency of use, and method of development. These systems were critically analyzed, and the content of each category was compared and aggregated where appropriate. A hierarchy of categories was constructed to include all content from all systems. Any modifications that previous studies may have made to the 7 systems were also cross-referenced to ensure that no concepts were missing from the newly aggregated system. Clinical examples to optimize application, and instructions for when or when not to use categories, were developed. Interrater agreement for classification of the causes of DRPs from 10 medication reviews was performed between 3 clinical pharmacists and the authors’ gold standard. Results: We found variation in developmental methods, category descriptions, number and types of categories, and validation methods between the 7 selected systems, together with intermingling of categories identified as causes of DRPs with DRPs themselves. A hierarchical classification system was constructed consisting of 9 cause-of-DRP categories, 33 subcategories, and 58 sub-subcategories, for which interrater agreements were 82.5%, 74.6%, and 58.8%, respectively. Conclusion: An aggregated classification system was constructed through a unique and transparent developmental process that may provide the most comprehensive description of causes of DRPs to date. This may facilitate teaching of pharmaceutical care, comparisons of clinical practice, and measurement of the effectiveness of pharmaceutical care interventions.
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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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Curtain CM, Bindoff IK, Westbury JL, Peterson GM. A comparison of prescribing criteria when applied to older community-based patients. Drugs Aging 2014; 30:935-43. [PMID: 24002743 DOI: 10.1007/s40266-013-0116-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Studies have compared prescribing criteria for older people in general terms, reporting the findings without true side-by-side comparisons of the frequency and type of potential drug-related problems (DRPs). OBJECTIVE The aim of this study was to compare the frequency and type of DRPs identified by several prescribing criteria. Additionally, original pharmacist DRP findings were compared with DRPs identified using the prescribing criteria. METHOD Three prescribing criteria were automated: Beers 2012 (Beers), Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START), and Prescribing Indicators in Elderly Australians (PIEA). The criteria were applied to medication reviews of 570 ambulatory older Australian patients. DRPs identified by each set of criteria were recorded. Each DRP was assigned a descriptive term which highlighted mainly drug classes and/or diagnoses to provide a meaningful common language for comparison between recorded DRPs. Descriptive terms were used to compare the frequency and type of DRP identified by each set of criteria, as well as against original pharmacists' findings. RESULTS Beers identified 399 DRPs via 21 different descriptive terms, STOPP/START identified 1,032 DRPs via 42 terms, and PIEA identified 1,492 DRPs via 33 terms. The various types of DRPs identified by all of the three prescribing criteria were represented by 53 different terms. When constrained to the same 53 different terms, pharmacists identified 862 DRPs. CONCLUSION Each set of criteria displayed relevance through mutual agreement of known high-risk medication classes in older people. The number and scope of DRPs identified by pharmacists was best represented by STOPP/START. The application of STOPP/START may be further augmented with relevant criteria from PIEA and Beers.
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Affiliation(s)
- Colin M Curtain
- Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Tasmania, Australia,
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Manias E, Kusljic S, Berry C, Brown E, Bryce E, Cliffe J, Smykowsky A. Use of the Screening Tool of Older Person's Prescriptions (STOPP) in older people admitted to an Australian hospital. Australas J Ageing 2013; 34:15-20. [PMID: 24520830 DOI: 10.1111/ajag.12054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS To determine the prevalence of potentially inappropriate medications (PIMs) in older people aged 65 years and over who were admitted to hospital, and to examine the medications and medication classes that comprised these PIMs with use of the Screening Tool of Older Person's Prescriptions. METHOD Using a retrospective clinical audit design, the medical records of 100 older patients were randomly selected and examined for the prevalence and characteristics of PIMs. The audit was undertaken of patients admitted over a 12-month period to an Australian public teaching hospital. RESULTS In total, 92 individual occurrences of PIMs were detected, and 54 patients had at least one PIM. The most common type of PIM experienced related to prescribed medications that adversely affected individuals who were prone to falls. CONCLUSION Many older patients experienced a PIM during their hospital admission, where the risk of an adverse event could outweigh the clinical benefit.
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Affiliation(s)
- Elizabeth Manias
- The University of Melbourne, Melbourne, Victoria, Australia; The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Basger BJ, Chen TF, Moles RJ. Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method. BMJ Open 2012; 2:e001431. [PMID: 22983875 PMCID: PMC3467596 DOI: 10.1136/bmjopen-2012-001431] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/20/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To further develop and validate previously published national prescribing appropriateness criteria to assist in identifying drug-related problems (DRPs) for commonly occurring medications and medical conditions in older (≥65 years old) Australians. DESIGN RAND/UCLA appropriateness method. PARTICIPANTS A panel of medication management experts were identified consisting of geriatricians/pharmacologists, clinical pharmacists and disease management advisors to organisations that produce Australian evidence-based therapeutic publications. This resulted in a round-one panel of 15 members, and a round-two panel of 12 members. MAIN OUTCOME MEASURE Agreement on all criteria. RESULTS Forty-eight prescribing criteria were rated. In the first rating round via email, there was disagreement regarding 17 of the criteria according to median panel ratings. During a face-to-face second round meeting, discussion resulted in retention of 25 criteria after amendments, agreement for 14 criteria with no changes required and deletion of 9 criteria. Two new criteria were added, resulting in a final validated list of 41 prescribing appropriateness criteria. Agreement after round two was reached for all 41 criteria, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range. CONCLUSIONS A set of 41 Australian prescribing appropriateness criteria were validated by an expert panel. Use of these criteria, together with clinical judgement and other medication review processes such as patient interview, is intended to assist in improving patient care by efficiently detecting potential DRPs related to commonly occurring medicines and medical conditions in older Australians. These criteria may also contribute to the medication management education of healthcare professionals.
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