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Johansen JS, Halvorsen KH, Svendsen K, Havnes K, Robinson EG, Wetting HL, Haustreis S, Småbrekke L, Kamycheva E, Garcia BH. Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) - a randomized controlled trial. BMC Health Serv Res 2022; 22:1290. [PMID: 36289541 PMCID: PMC9597977 DOI: 10.1186/s12913-022-08648-1] [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: 05/16/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Suboptimal medication use contributes to a substantial proportion of hospitalizations and emergency department visits in older adults. We designed a clinical pharmacist intervention to optimize medication therapy in older hospitalized patients. Based on the integrated medicine management (IMM) model, the 5-step IMMENSE intervention comprise medication reconciliation, medication review, reconciled medication list upon discharge, patient counselling, and post discharge communication with primary care. The objective of this study was to evaluate the effects of the intervention on healthcare use and mortality. Methods A non-blinded parallel group randomized controlled trial was conducted in two internal medicine wards at the University Hospital of North Norway. Acutely admitted patients ≥ 70 years were randomized 1:1 to intervention or standard care (control). The primary outcome was the rate of emergency medical visits (readmissions and emergency department visits) 12 months after discharge. Results Of the 1510 patients assessed for eligibility, 662 patients were asked to participate, and 516 were enrolled. After withdrawal of consent and deaths in hospital, the modified intention-to-treat population comprised 480 patients with a mean age of 83.1 years (SD: 6.3); 244 intervention patients and 236 control patients. The number of emergency medical visits in the intervention and control group was 497 and 499, respectively, and no statistically significant difference was observed in rate of the primary outcome between the groups [adjusted incidence rate ratio of 1.02 (95% CI: 0.82–1.27)]. No statistically significant differences between groups were observed for any of the secondary outcomes, neither in subgroups, nor for the per-protocol population. Conclusions We did not observe any statistical significant effects of the IMMENSE intervention on the rate of emergency medical visits or any other secondary outcomes after 12 months in hospitalized older adults included in this study. Trial registration The trial was registered in clinicaltrials.gov on 28/06/2016, before enrolment started (NCT02816086). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08648-1.
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Affiliation(s)
- Jeanette Schultz Johansen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjell H. Halvorsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kristian Svendsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjerstin Havnes
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Surgery, Cancer and Women’s Health Clinic, The University Hospital of North Norway, Tromsø, Norway
| | | | - Hilde Ljones Wetting
- grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
| | | | - Lars Småbrekke
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elena Kamycheva
- Nøste Private Healthcare Centre, Lier, Norway ,grid.412244.50000 0004 4689 5540Department of Geriatric Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Beate Hennie Garcia
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
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Huynh S, Rush L, Dadalias D, Githinji D, Ta M, Poole SG, Percival M, Bell C, Warner V, Nguyen D. Time and motion study quantifying the activities of the cardiology, respiratory and geriatric clinical pharmacist. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Simon Huynh
- Pharmacy Department Alfred Health Melbourne Australia
| | - Lily Rush
- Pharmacy Department Alfred Health Melbourne Australia
| | | | - Danson Githinji
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Melissa Ta
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Susan G. Poole
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Mia Percival
- Pharmacy Department Alfred Health Melbourne Australia
| | - Chloe Bell
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Victoria Warner
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - David Nguyen
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
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3
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Kiesel EK, Drey M, Pudritz YM. Influence of a ward-based pharmacist on the medication quality of geriatric inpatients: a before-after study. Int J Clin Pharm 2022; 44:480-488. [PMID: 35076810 PMCID: PMC9007813 DOI: 10.1007/s11096-021-01369-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/14/2021] [Indexed: 01/25/2023]
Abstract
Background Despite several international studies demonstrating that ward-based pharmacists improve medication quality, ward pharmacists are not generally established in German hospitals. Aim We assessed the effect of a ward-based clinical pharmacist on the medication quality of geriatric inpatients in a German university hospital. Method The before-after study with a historic control group was conducted on the geriatric ward. During the control phase, patients received standard care without the involvement of a pharmacist. The intervention consisted of a clinical pharmacist providing pharmaceutical care from admission to discharge. Medication quality was measured on admission and discharge using the Medication Appropriateness Index (MAI). A linear regression analysis was conducted to calculate the influence of the intervention on the MAI. Results Patients in the intervention group (n = 152, mean 83 years) were older and took more drugs at admission compared to the control group (n = 159, 81 years). For both groups, the MAI per patient improved significantly from admission to discharge. Although the intervention did not influence the summated MAI score per patient, the intervention significantly reduced the MAI criteria Dosage (p = 0.006), Correct Directions (p = 0.016) and Practical Directions (p = 0.004) as well as the proportion of overall inappropriate MAI ratings (at least 1 of 9 criteria inappropriate) (p = 0.015). Conclusion Although medication quality was already high in the control group, a ward-based clinical pharmacist could contribute meaningfully to the medication quality on an acute geriatric ward.
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Affiliation(s)
- Esther Katharina Kiesel
- Technical University of Munich, Hospital Pharmacy, University Hospital rechts der Isar, Munich, Germany
- University Hospital, Doctoral Programme Clinical Pharmacy, LMU Munich, Munich, Germany
| | - Michael Drey
- University Hospital, Department of Medicine IV, LMU Munich, Munich, Germany
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4
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Martin J, Barral M, Janoly Dumenil A, Carre E, Poletto N, Goutelle S, Rioufol C, Novais T, Pivot C, Hoegy D, Mouchoux C. Implementation assessment of a patient personalized clinical pharmacy programme (5P project) into orthogeriatric care pathway. J Clin Pharm Ther 2022; 47:956-963. [PMID: 35218218 DOI: 10.1111/jcpt.13627] [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: 01/04/2022] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The orthogeriatric path (hip-fractured elderly patients) is composed of several transition points (emergency surgery, orthopaedic, geriatric and rehabilitation units). The intervention of clinical pharmacists can ensure the continuity of patients' drug management during their hospital stay. The aim of the study was to assess the implementation of clinical pharmacy activities in an orthogeriatric pathway, regarding its impact on medication error prevention, the healthcare professionals' and patients' satisfaction, and the estimated associated pharmaceutical workload. METHODS Participants were aged 75 or older and managed for proximal femoral fracture. Their admission prescription was reviewed. If they were evaluated at high risk of adverse event (AE), medication reconciliation (MedRec) and pharmaceutical interviews (admission, discharge, and targeted on oral anticoagulant) were added at different steps of their care pathway. The achievement and duration of each clinical pharmacy activity were recorded. The number of pharmaceutical interventions (PI) made during prescription review, and unintentional discrepancies (UID) identified during MedRec were collected. A satisfaction questionnaire was sent to patients and healthcare professionals. RESULTS AND DISCUSSION Among 455 included patients, 284 patients were considered at high risk of AE. Clinical pharmacy activity achievement rates varied between 12% and 98%. A total of 622 PI and 333 UID were identified. The overall patients' and healthcare professionals' satisfaction was rated from 63% to 100%. The total workload was estimated at 376 h: on average 16 min per prescription review, 43 min per admission MedRec, 26 min per discharge MedRec and 17 to 25 minutes per interview. CONCLUSION The implementation of the programme showed a high potential of drug management securing. To sustain it, additional pharmaceutical human resources and high-performance computing tools are needed.
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Affiliation(s)
- Julie Martin
- Pharmacie, Hospices Civils de Lyon, Lyon, France
| | | | - Audrey Janoly Dumenil
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Emmanuelle Carre
- Pharmacie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Poletto
- Pharmacie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Goutelle
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Catherine Rioufol
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.,EA3738, CICLY Centre pour l'innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Teddy Novais
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Univ Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Christine Pivot
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Delphine Hoegy
- Pharmacie, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Christelle Mouchoux
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, INSERM U1028, CNRS, UMR5292, Lyon, France
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Barral M, Martin J, Carre E, Janoly-Dumenil A, Ranchon F, Parat S, Rioufol C, Goutelle S, Bourguignon L, Novais T, Doh S, Malatray M, Chaudier P, Gauthier J, Pivot C, Mouchoux C, Hoegy D. How a Patient Personalised Clinical Pharmacy Programme Can Secure Therapeutic Care in an Orthogeriatric Care Pathway (5P Project)? Clin Interv Aging 2021; 16:1857-1867. [PMID: 34707352 PMCID: PMC8544550 DOI: 10.2147/cia.s325035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
Background A new model was developed for integrating a personalised clinical pharmacy programme (5P project) into the orthogeriatric care pathway. Objective To secure the therapeutic care of orthogeriatric patients. Design and Setting Prospective descriptive study in a multisite teaching hospital from June 2019 to January 2020. Subjects Patients aged ≥75 years admitted for hip fracture. Methods A prescription review was performed for all patients at inclusion. Other clinical pharmacy activities (additional prescription review, pharmaceutical interviews, medication reconciliation) were dedicated to “high-risk” patients. Potential medication errors (ME), either pharmaceutical interventions (PI) or unintentional discrepancies (UID), were recorded. The potential clinical impact of PI was evaluated by a pluriprofessional expert panel using a validated tool. Results In the 455 patients included, 955 potential ME were detected, that is ≥1 potential ME for 324/455 (71%) patients. In acute care, 561 PI were formulated during prescription review for 440/455 (97%) patients and 348/561 (62%) were accepted by physicians. Medication reconciliation was performed for 213 patients, 316 UID were identified. In rehabilitation units, a second prescription review was performed for 112/122 (92%) “high-risk” patients, leading to 61 PI. The clinical impact was evaluated for 519/622 (83%) PI. A consensus was obtained for 310/519 (60%) PI: 147/310 (47%) were rated as having minor clinical impact, 138/310 (45%) moderate, 22/310 (7%) major, 2/310 (0.6%) vital, and 1/310 (0.3%) null. Conclusion The 5P project secured the orthogeriatric care pathway by detecting a great number of potential ME, including PI mostly considered as having a significant clinical impact.
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Affiliation(s)
| | - Julie Martin
- Pharmacie, Hospices Civils de Lyon, Lyon, France
| | - Emmanuelle Carre
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Audrey Janoly-Dumenil
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Florence Ranchon
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA3738, CICLY Centre pour l'Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Stéphanie Parat
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Catherine Rioufol
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA3738, CICLY Centre pour l'Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Sylvain Goutelle
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Laurent Bourguignon
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Teddy Novais
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Sebastien Doh
- Service de Gériatrie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Malatray
- Service de Chirurgie Orthopédique Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Philippe Chaudier
- Service de Chirurgie Orthopédique Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jerome Gauthier
- Service d'anesthésie et réanimation Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christine Pivot
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Christelle Mouchoux
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Lyon, France
| | - Delphine Hoegy
- Pharmacie, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
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6
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Delgado-Silveira E, Vélez-Díaz-Pallarés M, Muñoz-García M, Correa-Pérez A, Álvarez-Díaz AM, Cruz-Jentoft AJ. Effects of hospital pharmacist interventions on health outcomes in older polymedicated inpatients: a scoping review. Eur Geriatr Med 2021; 12:509-544. [PMID: 33959912 DOI: 10.1007/s41999-021-00487-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/16/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE To identify the evidence that supports the effect of interventions made by hospital pharmacists, individually or in collaboration with a multidisciplinary team, in terms of healthcare outcomes, a more effective utilization of resources and lower costs in older polymedicated inpatients. METHODS We searched the following databases: MEDLINE, EMBASE and the Cochrane Library. We also conducted a hand search by checking the references cited in the primary studies and studies included in reviews identified during the process of research. Four review authors working by pairs searched for studies, extracted data, and drew up the results tables. RESULTS Twenty-six studies were included in the review. In 13 of them pharmacists carried out their intervention exclusively while the patients were in hospital, whereas in 13 interventions were delivered during admission and after hospital discharge. Outcomes identified were mortality, length of stay, visits to the emergency department, readmissions and reported quality of life, among others. Pharmacist interventions were found to be beneficial in fifteen studies, specifically on hospital readmissions, visits to the emergency department and healthcare costs. CONCLUSION There is no hard evidence demonstrating the effectiveness of hospital pharmacist interventions in older polymedicated patients. Mortality does not show as a relevant outcome. Other health care outcomes, such as hospital readmissions, visits to the emergency department and healthcare costs, seem to be more relevant and amenable to change. Interventions that include pharmacists in multidisciplinary geriatric teams seem to be more promising that isolated pharmacist interventions. Interventions prolonged after hospital discharge seem to be more appropriate that interventions delivered only during hospital admission. Better-designed studies should be conducted in the future to provide further insight into the effect of hospital pharmacist interventions.
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Affiliation(s)
- E Delgado-Silveira
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.
| | | | - M Muñoz-García
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - A Correa-Pérez
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.,Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - A M Álvarez-Díaz
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - A J Cruz-Jentoft
- Geriatric Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
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Dascanio SA, Nowa S, Nicholas S, Kumwenda H, Urick BY, Steeb DR. Implementation and evaluation of clinical pharmacy services through quality improvement in a Tertiary Hospital in Malawi. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sarah A. Dascanio
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | | | | | | | - Benjamin Y. Urick
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - David R. Steeb
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy Chapel Hill North Carolina USA
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8
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Factors influencing the implementation of clinical pharmacy services for hospitalized patients: A mixed-methods systematic review. Res Social Adm Pharm 2020; 16:437-449. [DOI: 10.1016/j.sapharm.2019.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 05/16/2019] [Accepted: 06/26/2019] [Indexed: 12/24/2022]
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9
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Gutiérrez-Valencia M, Izquierdo M, Beobide-Telleria I, Ferro-Uriguen A, Alonso-Renedo J, Casas-Herrero Á, Martínez-Velilla N. Medicine optimization strategy in an acute geriatric unit: The pharmacist in the geriatric team. Geriatr Gerontol Int 2019; 19:530-536. [PMID: 30950148 DOI: 10.1111/ggi.13659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/28/2018] [Accepted: 02/20/2019] [Indexed: 01/18/2023]
Abstract
AIM Older patients admitted to acute geriatric units (AGU) frequently use many medications and are particularly vulnerable to adverse drug events, so specific interventions in this setting are required. In the present study, we describe a new medicine optimization strategy in an AGU, and explore its potential in reducing polypharmacy and improving medication appropriateness. METHODS The present prospective study included patients aged ≥75 years who were admitted to an AGU in a tertiary hospital. An intervention based on a pharmacist clinical interview, medication history and a structured medication review within a comprehensive geriatric assessment was proposed. The differences regarding polypharmacy as the primary outcome (≥5 chronic drugs), hyperpolypharmacy (≥10), number of drugs, drug-related problems and Screening Tool of Older Person's Prescription/Screening Tool to Alert Doctors to Right Treatment criteria between admission and discharge were evaluated. RESULTS From October 2016 to April 2017, 234 patients were enrolled, aged 87.6 years (SD 4.6 years); 143 (61.1%) were women. The intervention resulted in a statistically significant improvement in polypharmacy (-10.2%, 95% CI -15.3, -5.2), hyperpolypharmacy (-16.6%, 95% CI -22.3 -11.0), number of medications (-1.4, 95% CI -1.8, -1.0), Screening Tool of Older Person's Prescription criteria (-19.2%, 95% CI -24.9, -13.6), Screening Tool to Alert Doctors to Right Treatment criteria (-6.8%, 95% CI -10.1, -3.5) and drug-related problems (-2.7, 95% CI -2.9, -2.4; P ≤ 0.001 for all). CONCLUSIONS A systematic pharmacist-led intervention at hospital admission to an AGU within a comprehensive geriatric assessment was associated to a decrease in polypharmacy, drug-related problems and potentially inappropriate prescribing. Geriatr Gerontol Int 2019; 19: 530-536.
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Affiliation(s)
- Marta Gutiérrez-Valencia
- Health Science Department, Public University of Navarra, Pamplona, Spain.,Geriatrics Research Group, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mikel Izquierdo
- Health Science Department, Public University of Navarra, Pamplona, Spain.,Group CB16/10/00315, CIBER of Frailty and Healthy Aging, Madrid, Spain
| | | | | | - Javier Alonso-Renedo
- Geriatrics Research Group, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Álvaro Casas-Herrero
- Geriatrics Research Group, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Group CB16/10/00315, CIBER of Frailty and Healthy Aging, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Nicolás Martínez-Velilla
- Geriatrics Research Group, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Group CB16/10/00315, CIBER of Frailty and Healthy Aging, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain
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