1
|
Niriayo YL, Kifle R, Asgedom SW, Gidey K. Drug therapy problems among hospitalized patients with cardiovascular disease. BMC Cardiovasc Disord 2024; 24:50. [PMID: 38221638 PMCID: PMC10788969 DOI: 10.1186/s12872-024-03710-8] [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: 07/11/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Optimal utilization of cardiovascular drugs is crucial in reducing morbidity and mortality associated with cardiovascular diseases. However, the effectiveness of these drugs can be compromised by drug therapy problems. Hospitalized patients with cardiovascular diseases, particularly those with multiple comorbidities, polypharmacy, and advanced age, are more susceptible to experiencing drug therapy problems. However, little is known about drug therapy problems and their contributing factors among patients with cardiovascular disease in our setting. Therefore, our study aimed to investigate drug therapy problems and their contributing factors in patients with cardiovascular diseases. METHOD A prospective observational study was conducted among hospitalized patients with cardiovascular disease at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia from December 2020 to May 2021. We collected the data through patient interviews and review of patients' medical records. We employed Cipolle's method to identify and categorize drug therapy problems and sought consensus from a panel of experts through review. Data analysis was performed using the Statistical Software Package SPSS version 22. Binary logistic regression analysis was performed to determine the contributing factors of drug therapy problems in patients with cardiovascular disease. Statistical significance was set at p < 0.05. RESULTS The study included a total of 222 patients, of whom 117 (52.7%) experienced one or more drug-related problems. We identified 177 drug therapy problems equating to 1.4 ± 0.7 drug therapy problems per patients. The most frequently identified DTP was the need for additional drug therapy (32.4%), followed by ineffective drug therapy (14%), and unnecessary drug therapy (13.1%). The predicting factors for drug therapy problems were old age (AOR: 3.97, 95%CI: 1.68-9.36) and number of medications ≥ 5 (AOR: 2.68, 95%CI: 1.47-5.11). CONCLUSION More than half of the patients experienced drug therapy problems in our study. Old age and number of medications were the predicting factors of drug therapy problems. Therefore, greater attention and focus should be given to patients who are at risk of developing drug therapy problems.
Collapse
Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
| | - Roba Kifle
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| |
Collapse
|
2
|
Kerliu L, Citaku D, Rudhani I, Hughes JD, Rose O, Hoti K. Exploring instruments used to evaluate potentially inappropriate medication use in hospitalised elderly patients in Kosovo. Eur J Hosp Pharm 2019; 28:223-228. [PMID: 34162674 DOI: 10.1136/ejhpharm-2019-001904] [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: 02/19/2019] [Revised: 06/17/2019] [Accepted: 06/26/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES A number of instruments are used to identify potentially inappropriate medications (PIMs) in the elderly. In this study we identify PIMs in elderly patients and aim to compare three different instruments used to assess PIMs. METHODS In this prospective cohort study, we compared medications of elderly patients against three commonly used instruments: Beers' list, PRISCUS and STOPP/START, at the point of hospital admission and discharge in the nephrology clinic of Kosovo's largest hospital. Readmission risk was evaluated using the LACE Index and correlations with the number of PIMs and PIMs criteria were analysed. RESULTS Of 184 patients admitted to the nephrology clinic, 84 met study inclusion criteria. Patients had a median of three drugs at admission and four at discharge. Hospital readmission risk was high with median LACE Index being 11 (63% of patients). A higher number of PIMs was associated at the point of discharge compared with admission for all three tools (Beers' list: 29% vs 38 %, P=0.04; STOPP/STRART: 20% vs 23%, P<0.001; PRISCUS list: 12% vs 21%, P<0.001). The number of drugs at admission predicted the number of PIMs at discharge only when using Beers' criteria (P=0.006). At discharge, each increase in medication was associated with an increase in PIMs based on Beers' [0.134; (P=0.007)] and STOPP/START criteria [0.130; (P=0.005)]. Nitrofurantoin was the main PIM identified with Beers' and PRISCUS list in comparison to proton- pump-inhibitors being the most prevalent agents identified with STOPP/START criteria. CONCLUSIONS There are differences when using Beers' criteria, STOPP/START criteria and PRISCUS list during identification of PIMs in elderly patients with high readmission risk. These differences should be considered when identifying PIMs in hospital settings.
Collapse
Affiliation(s)
- Lloreta Kerliu
- College of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Drilona Citaku
- Faculty of Medicine, Division of Pharmacy, Department of Pharmacy Practice and Pharmaceutical Care, University of Prishtina, Prishtina, Kosovo
| | - Ibrahim Rudhani
- Faculty of Medicine, Division of General Medicine, Department of Internal Medicine, University of Prishtina, Prishtina, Kosovo.,Clinic of Nephrology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Jeffery David Hughes
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Olaf Rose
- College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Kreshnik Hoti
- Faculty of Medicine, Division of Pharmacy, Department of Pharmacy Practice and Pharmaceutical Care, University of Prishtina, Prishtina, Kosovo .,School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
3
|
Schmiedl S, Rottenkolber M, Szymanski J, Drewelow B, Siegmund W, Hippius M, Farker K, Guenther IR, Hasford J, Thuermann PA. Preventable ADRs leading to hospitalization - results of a long-term prospective safety study with 6,427 ADR cases focusing on elderly patients. Expert Opin Drug Saf 2017; 17:125-137. [PMID: 29258401 DOI: 10.1080/14740338.2018.1415322] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Studies evaluating the impact of age and potentially inappropriate medication (PIM) on avoidable adverse drug reactions (ADRs) are scarce. METHODS In this prospective, multi-center, long-term (8.5 years) observational study, we analysed ADRs leading to hospitalization in departments of internal medicine. ADRs causality and preventability were assessed using standardised algorithms. PIM was defined based on the PRISCUS-list. Multivariate analyses and estimation of ADR incidence rates were conducted. RESULTS Of all 6,427 ADR patients, a preventable ADR was present in 1,253 (19.5%) patients (elderly patients ≥70 years: 828). Risk factors for preventable ADRs in elderly patients were multimorbidity, two to four ADR-causative drugs, and intake of particular compounds (e.g. spironolactone) but not sex, PIM usage, or the total number of drugs. Regarding particular compounds associated with preventable ADRs, highest incidence rates for preventable ADRs were found for patients aged ≥70 years for spironolactone (3.3 per 1,000 exposed persons (95% CI: 1.4-6.6)) and intermediate-acting insulin (3.3 per 1,000 exposed persons (95% CI: 1.6-6.1)). CONCLUSION Avoiding PIM usage seems to be of limited value in increasing safety in elderly patients whereas our results underline the importance of an individualized medication review of the most commonly implicated drugs in preventable ADRs (supported by BfArM FoNr: V-11337/68605/2008-2010).
Collapse
Affiliation(s)
- S Schmiedl
- a Philipp Klee-Institute for Clinical Pharmacology , HELIOS Clinic Wuppertal , Wuppertal , Germany.,b Department of Clinical Pharmacology, School of Medicine, Faculty of Health , Witten/Herdecke University , Witten , Germany
| | - M Rottenkolber
- c Institute for Medical Information Sciences, Biometry, and Epidemiology , Ludwig-Maximilians-Universitaet Muenchen , Munich , Germany
| | - J Szymanski
- a Philipp Klee-Institute for Clinical Pharmacology , HELIOS Clinic Wuppertal , Wuppertal , Germany.,b Department of Clinical Pharmacology, School of Medicine, Faculty of Health , Witten/Herdecke University , Witten , Germany
| | - B Drewelow
- d Institute of Clinical Pharmacology, Center for Pharmacology and Toxicology , University of Rostock , Rostock , Germany
| | - W Siegmund
- e Institute of Clinical Pharmacology , University of Greifswald , Greifswald , Germany
| | - M Hippius
- f Department of Clinical Pharmacology , Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena , Jena , Germany
| | - K Farker
- f Department of Clinical Pharmacology , Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena , Jena , Germany.,g Sophien- und Hufeland-Klinikum Weimar , Weimar , Germany
| | - I R Guenther
- f Department of Clinical Pharmacology , Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena , Jena , Germany.,g Sophien- und Hufeland-Klinikum Weimar , Weimar , Germany
| | - J Hasford
- c Institute for Medical Information Sciences, Biometry, and Epidemiology , Ludwig-Maximilians-Universitaet Muenchen , Munich , Germany
| | - P A Thuermann
- a Philipp Klee-Institute for Clinical Pharmacology , HELIOS Clinic Wuppertal , Wuppertal , Germany.,b Department of Clinical Pharmacology, School of Medicine, Faculty of Health , Witten/Herdecke University , Witten , Germany
| | | |
Collapse
|
4
|
Shade MY, Berger AM, Chaperon C, Haynatzki G, Sobeski L. Adverse drug events reported by rural older adults. Geriatr Nurs 2017; 38:584-588. [PMID: 28579081 DOI: 10.1016/j.gerinurse.2017.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/14/2017] [Accepted: 04/24/2017] [Indexed: 01/08/2023]
Abstract
Adverse drug events (ADEs) impact the health and safety of older adults. ADEs may lead to unplanned medical visits that influence health and related costs. The purpose of this study was to explore ADEs reported by rural, community-dwelling older adults. Data were collected on 138 participants' demographics, physical and mental health, sleep, medications, and ADEs. One or more ADEs were reported by 48% of participants, including central nervous symptom disturbances (16%), dry mouth (12%), hoarseness, gastrointestinal irritation, and decreased libido (all 8%). Poor sleep and poor physical health were associated with higher reported ADEs (p < 0.05). Older adults (ages 79-99) and those with higher physical health were 60% less likely to report ADEs. Those with poorer sleep quality were 50% more likely to report ADEs. Viable strategies are needed to monitor and reduce ADEs in community-dwelling older adults who use multiple medications to manage poor health and poor sleep.
Collapse
Affiliation(s)
- Marcia Y Shade
- University of Nebraska Medical Center College of Nursing-Omaha, 985330 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Ann M Berger
- University of Nebraska Medical Center College of Nursing-Omaha, 985330 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Claudia Chaperon
- University of Nebraska Medical Center College of Nursing-Omaha, 985330 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Gleb Haynatzki
- University of Nebraska Medical Center College of Public Health, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA
| | - Linda Sobeski
- University of Nebraska Medical Center College of Pharmacy, 986045 Nebraska Medical Center, Omaha, NE 68198-6045, USA
| |
Collapse
|
5
|
García-Lara JMA, Navarrete-Reyes AP, Medina-Méndez R, Aguilar-Navarro SG, Avila-Funes JA. Successful Aging, a New Challenge for Developing Countries: The Coyoacán Cohort. J Nutr Health Aging 2017; 21:215-219. [PMID: 28112779 DOI: 10.1007/s12603-016-0728-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the socio-demographic and health factors associated with a biomedical phenotype of successful aging (SA) among Mexican community-dwelling elderly. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study of 935 older adults aged 70 or older participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. MEASUREMENTS SA was operationalized in accordance with the phenotype proposed by Rowe and Kahn. Univariate and multivariate logistic regression analyses were carried out in order to identify the correlates of SA. RESULTS The phenotype of SA was present in 10% of participants. Age (P < 0.001), illiteracy (P = 0.021), polypharmacy (P < 0.001), and physical pain (P < 0.001) were factors independently and inversely associated with the presence of the SA phenotype. The only variable positively associated with SA was good self-perceived health-status (P < 0.001). CONCLUSION Although age is not modifiable, several other factors associated with SA are. If we are to promote SA, efforts should be made towards improving those modifiable factors negatively associated with its presence, such as pain or polypharmacy. Also, enhancing factors positively associated to it might play a role in improving wellbeing.
Collapse
Affiliation(s)
- J M A García-Lara
- José Alberto Ávila-Funes. Department of Geriatrics. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. Colonia Belisario Domínguez Sección XVI. CP 14080; Tlalpan, Phone: + 52 (55) 54 87 09 00, 5703. E-mail:
| | | | | | | | | |
Collapse
|
6
|
Wang HY, Yeh MK, Ho CH, Hu MK, Huang YB. Cross-sectional investigation of drug-related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud. Pharmacoepidemiol Drug Saf 2016; 26:71-80. [PMID: 27730699 DOI: 10.1002/pds.4117] [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: 04/27/2016] [Revised: 09/13/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE To analyze and characterize data regarding the prevalence and types of outpatient drug-related problems (DRPs) found by clinical pharmacists after implementation of the Virtual Medicine Record in Cloud System (VMRCS). METHODS A cross-sectional study regarding outpatient pharmaceutical care was conducted at a medical center in Taiwan. Patients aged >20 years old with multiple chronic diseases and polypharmacy were enrolled. In Stage I (1 October-31 December 2014), patients received pharmaceutical care according to prescription data accessed online in the VMRCS. In Stage II (1 June-31 August 2015), the VMRCS were pre-download and arranged to the institute's required format, facilitated DRP detection. Clinical pharmacists then reviewed and evaluated the prescription data through pre-downloaded VMRCS. Overall, 1539 and 1600 prescriptions were evaluated in these two stages, respectively. DRPs were recorded using the Pharmaceutical Care Network Europe (PCNE)-DRP. RESULTS DRPs were found for 50.2% of patients in Stage I and 55.2% in Stage II (p < 0.05) and were most frequently encountered for "Drugs for the cardiovascular system" and caused by "Inappropriate duplication of therapeutic group or active ingredient." In terms of problems, incidence of "Unnecessary drug treatment" was highest. Duplicate medications were most frequently seen for "Drugs for acid-related disorders." The efficiency to identify DRPs was at least 2.4 times higher with pre-downloaded prescription data than with real-time online queries. CONCLUSIONS With VMRCS, DRPs were more easily identified whether patients received medical care in the same hospital or not. DRPs could be efficiently prevented through the use of pre-downloaded patient prescription data. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Hue-Yu Wang
- Department of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan.,College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taiwan.,Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Kuan Hu
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taiwan
| | - Yaw-Bin Huang
- College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
7
|
Clyne B, Smith SM, Hughes CM, Boland F, Cooper JA, Fahey T. Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study). Implement Sci 2016; 11:79. [PMID: 27255504 PMCID: PMC4890249 DOI: 10.1186/s13012-016-0442-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/23/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Potentially inappropriate prescribing (PIP) is common in older people in primary care and can result in increased morbidity, adverse drug events and hospitalisations. We previously demonstrated the success of a multifaceted intervention in decreasing PIP in primary care in a cluster randomised controlled trial (RCT). OBJECTIVE We sought to determine whether the improvement in PIP in the short term was sustained at 1-year follow-up. METHODS A cluster RCT was conducted with 21 GP practices and 196 patients (aged ≥70) with PIP in Irish primary care. Intervention participants received a complex multifaceted intervention incorporating academic detailing, medicine review with web-based pharmaceutical treatment algorithms that provide recommended alternative treatment options, and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions at 1-year follow-up. Intention-to-treat analysis using random effects regression was used. RESULTS All 21 GP practices and 186 (95 %) patients were followed up. We found that at 1-year follow-up, the significant reduction in the odds of PIP exposure achieved during the intervention was sustained after its discontinuation (adjusted OR 0.28, 95 % CI 0.11 to 0.76, P = 0.01). Intervention participants had significantly lower odds of having a potentially inappropriate proton pump inhibitor compared to controls (adjusted OR 0.40, 95 % CI 0.17 to 0.94, P = 0.04). CONCLUSION The significant reduction in the odds of PIP achieved during the intervention was sustained after its discontinuation. These results indicate that improvements in prescribing quality can be maintained over time. TRIAL REGISTRATION Current controlled trials ISRCTN41694007 .
Collapse
Affiliation(s)
- Barbara Clyne
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.
| | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland
| | - Carmel M Hughes
- School of Pharmacy, Queen's University Belfast (QUB), 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - Fiona Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland
| | - Janine A Cooper
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland
- School of Pharmacy, Queen's University Belfast (QUB), 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland
| |
Collapse
|
8
|
Medical care and drug-related problems: Do doctors and pharmacists speak the same language? Int J Clin Pharm 2016; 38:191-4. [PMID: 26797769 DOI: 10.1007/s11096-016-0249-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
Abstract
Optimal communication between physicians and pharmacists is important for patient care. However, pharmacists and doctors do not always seem to understand each other. They have been professionalized differently, and do not always speak the same language. Especially in the areas of prescribing, medication review, and medicine use, there can be differences in views. This contribution clarifies some essential concepts that doctors and pharmacists use. Thus we hope that our commentary contributes to a better understanding of each other's role and the importance of interprofessional cooperation for the benefit of the patient.
Collapse
|
9
|
O'Connell MB, Chang F, Tocco A, Mills ME, Hwang JM, Garwood CL, Khreizat HS, Gupta NS. Drug-Related-Problem Outcomes and Program Satisfaction from a Comprehensive Brown Bag Medication Review. J Am Geriatr Soc 2015; 63:1900-5. [DOI: 10.1111/jgs.13597] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mary Beth O'Connell
- Department of Pharmacy Practice; Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
| | - Feng Chang
- School of Pharmacy; University of Waterloo; Waterloo Ontario Canada
| | - Ashley Tocco
- Pharmacy Department; Bronson Methodist Hospital; Kalamazoo Michigan
| | | | - Jamie M. Hwang
- Henry Ford Health System and Health Alliance Plan Ambulatory Clinical Pharmacy Programs; Grosse Pointe Michigan
| | - Candice L. Garwood
- Department of Pharmacy Practice; Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
- Rosa Parks Wellness Institute for Senior Health and Harper University Hospital; Detroit Medical Center; Detroit Michigan
| | - Hanan S. Khreizat
- Henry Ford Health System and Health Alliance Plan Ambulatory Clinical Pharmacy Programs; Novi Michigan
| | - Nishi S. Gupta
- School of Pharmacy; University of Waterloo; Waterloo Ontario Canada
- Valley Plaza Pharmasave; Hanmer Ontario Canada
| |
Collapse
|
10
|
Kim DS, Je NK, Kim GJ, Kang H, Kim YJ, Lee S. Therapeutic duplicate prescribing in Korean ambulatory care settings using the National Health Insurance claim data. Int J Clin Pharm 2014; 37:76-85. [PMID: 25428447 DOI: 10.1007/s11096-014-0042-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/12/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Duplicate prescribing is known to occur across health systems and is one of the most frequent drug related problems. Therapeutic duplication (TD) increases the risk of adverse drug reactions without additional therapeutic benefits. OBJECTIVES This study aimed to develop TD criteria concerning four drug categories which are acid-related disorder drugs, antimicrobials, antihypertensives, and lipid modifying drugs and to estimate the prevalence of therapeutic duplicate prescribing at the ambulatory care settings in Korea. METHODS TD criteria were developed using the WHO anatomical therapeutic chemical classification and modified with an expert consensus panel using the Delphi method. The prevalence of TD including ingredient duplication (ID) of four drug categories was examined using National Health Insurance claim database including 15 million patients during one month in 2009 (December). TD was defined as prescribing medications within the same category in the developed TD criteria list. RESULTS The numbers of patients who received acid-related disorder drugs, antimicrobials, antihypertensives, and lipid-modifying drugs in the study period were 10,049,292, 7,584,131, 4,349,945, and 1,425,292 respectively. In the field of acid-related disorder drugs prescribed, there were 0.3 % IDs and 2.5 % TDs within a prescription issued by one prescriber. There were 8.4 % IDs and 14.5 % TDs between prescriptions issued at different ambulatory visits. In the field of antimicrobial medicines, there were 0.1 % IDs and 2.6 % TDs within a prescription, while there were 5.0 % IDs and 7.6 % TDs between different prescriptions. Amongst the antihypertensives prescribed, there were 0.4 % IDs and 1.9 % TDs within a prescription, while there were 9.9 % IDs and 11.5 % TDs between prescriptions. Lastly, looking at lipid-modifying drugs prescribed, there were 0.3 % IDs and 0.5 % TDs within one prescription, while there were 8.9 % IDs and 9.4 % TDs between prescriptions. CONCLUSION The prevalence of duplicate prescribing was substantial in the ambulatory care setting which is to be improved using the TD criteria developed from this study in the national drug utilization review system in Korea.
Collapse
Affiliation(s)
- Dong-Sook Kim
- Research Team, Health Insurance Review and Assessment Service, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
11
|
Grimes TC, Deasy E, Allen A, O'Byrne J, Delaney T, Barragry J, Breslin N, Moloney E, Wall C. Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study. BMJ Qual Saf 2014; 23:574-83. [PMID: 24505112 PMCID: PMC4078714 DOI: 10.1136/bmjqs-2013-002188] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We investigated the benefits of the Collaborative Pharmaceutical Care in Tallaght Hospital (PACT) service versus standard ward-based clinical pharmacy in adult inpatients receiving acute medical care, particularly on prevalence of medication error and quality of prescribing. METHODS Uncontrolled before-after study, undertaken in consecutive adult medical inpatients admitted and discharged alive, using at least three medications. Standard care involved clinical pharmacists being ward-based, contributing to medication history taking and prescription review, but not involved at discharge. The innovative PACT intervention involved clinical pharmacists being team-based, leading admission and discharge medication reconciliation and undertaking prescription review. Primary outcome measures were prevalence per patient of medication error and potentially severe error. Secondary measures included quality of prescribing using the Medication Appropriateness Index (MAI) in patients aged ≥65 years. FINDINGS Some 233 patients (112 PACT, 121 standard) were included. PACT decreased the prevalence of any medication error at discharge (adjusted OR 0.07 (95% CI 0.03 to 0.15)); number needed to treat (NNT) 3 (95% CI 2 to 3) and no PACT patient experienced a potentially severe error (NNT 20, 95% CI 10 to 142). In patients aged ≥65 years (n=108), PACT improved the MAI score from preadmission to discharge (Mann-Whitney U p<0.05; PACT median -1, IQR -3.75 to 0; standard care median +1, IQR -1 to +6). CONCLUSIONS PACT, a collaborative model of pharmaceutical care involving medication reconciliation and review, delivered by clinical pharmacists and physicians, at admission, during inpatient care and at discharge was protective against potentially severe medication errors in acute medical patients and improved the quality of prescribing in older patients.
Collapse
Affiliation(s)
- Tamasine C Grimes
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Evelyn Deasy
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Ann Allen
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - John O'Byrne
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - Tim Delaney
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - John Barragry
- Medical Directorate, Tallaght Hospital, Dublin, Ireland
| | - Niall Breslin
- Medical Directorate, Tallaght Hospital, Dublin, Ireland
| | - Eddie Moloney
- Medical Directorate, Tallaght Hospital, Dublin, Ireland
| | | |
Collapse
|