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Günther M, Schuler M, Hentschel L, Salm H, Schmitz MT, Jaehde U. Medication Risks and Their Association with Patient-Reported Outcomes in Inpatients with Cancer. Cancers (Basel) 2024; 16:2110. [PMID: 38893228 PMCID: PMC11171248 DOI: 10.3390/cancers16112110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND We aimed to assess medication risks and determine factors influencing the health-related quality of life (HRQOL) in cancer inpatients. METHODS A retrospective analysis was conducted to identify drug-related problems (DRPs) based on medication reviews, including patient-reported outcomes (PROs). Multiple linear regression analyses were performed to identify sociodemographic, disease-related, and drug therapy-related factors influencing changes from hospital admission to discharge in the scales of the EORTC QLQ-C30 questionnaire. RESULTS A total of 162 inpatients with various hematological and solid cancer diseases was analyzed. Patients received a mean of 11.6 drugs and 92.6% of patients exhibited polymedication resulting in a mean of 4.0 DRPs per patient. Based on PRO data, 21.5% of DRPs were identified. Multiple linear regression models described the variance of the changes in global HRQOL and physical function in a weak-to-moderate way. While drug therapy-related factors had no influence, relapse status and duration of hospital stay were identified as significant covariates for global HRQOL and physical function, respectively. CONCLUSION This analysis describes underlying DRPs in a German cancer inpatient population. PROs provided valuable information for performing medication reviews. The multiple linear regression models for global HRQOL and physical function provided explanations for changes during hospital stay.
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Affiliation(s)
- Maximilian Günther
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, 53121 Bonn, Germany;
| | - Markus Schuler
- Onkologischer Schwerpunkt am Oskar-Helene-Heim, 14195 Berlin, Germany;
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany;
| | - Leopold Hentschel
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany;
| | - Hanna Salm
- Klinik und Poliklinik für Innere Medizin C, Universitätsmedizin Greifswald, 17489 Greifswald, Germany;
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, 15526 Bad Saarow, Germany
| | - Marie-Therese Schmitz
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53127 Bonn, Germany;
| | - Ulrich Jaehde
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, 53121 Bonn, Germany;
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Fentie AM, Huluka SA, Gebremariam GT, Gebretekle GB, Abebe E, Fenta TG. Impact of pharmacist-led interventions on medication-related problems among patients treated for cancer: A systematic review and meta-analysis of randomized control trials. Res Social Adm Pharm 2024; 20:487-497. [PMID: 38368123 DOI: 10.1016/j.sapharm.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Medication-related problems (MRPs) continue to impose a voluminous health impact, particularly among patients on anti-cancer therapy, due to the nature and complexity of the care. Pharmacists have a pivotal role in ensuring the safe, effective, and rational use of medicines in this group of patients. OBJECTIVES To examine the impact of pharmacist-led interventions in resolving MRPs among patients treated for cancer. METHODS This systematic review and meta-analysis was conducted and reported following the PRISMA protocol and registered in PROSPERO (Registration number: CRD42022311535). Four database searches, PubMed, EMBASE, Cochrane, and International Pharmaceuticals Abstracts, were systematically searched from August 2022 to January 2023. Only randomized control trials (RCTs) were included. The Cochrane risk of bias assessment tool was used to check the quality of the included studies. The outcome measures were overall MRPs, adherence, medication errors, and adverse drug events (ADEs). Data for meta-analysis were analyzed used using STATA version 17 and standardized mean difference effect sizes were calculated for continuous outcomes and odds ratio for categorical outcomes. RESULTS Out of the 90 studies screened for eligibility, 20 RCT studies were included for the systematic review and 15 for the meta-analysis. Close to two-thirds of the studies were from Europe (n = 7) and Asia (n = 6). A combination of educational and behavioral intervention strategies were used for a period ranged from 8 days to 12 months. The pharmacist-led intervention improved adherence to treatment by 4.79 times (AOR = 4.79; 95%CI = 2.64, 8.68; p-value<0.0001), reduced the occurrence of ADEs by 1.28 (SMD = -1.28; 95%CI = -0.04-2.52; p-value = 0.04) and decreased the overall MRPs by 0.53 (SMD = -0.53; 95%CI = -0.79, -0.28; p-value<0.0001) compared to control groups. CONCLUSION This study found out that pharmacist-led interventions can significantly lower MRPs among patients treated for cancer. Hence, a global concerted effort has to be made to integrate pharmacists in a multidisciplinary direct cancer care.
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Affiliation(s)
- Atalay Mulu Fentie
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Ethiopia.
| | - Solomon Assefa Huluka
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Ethiopia
| | - Girma Tekle Gebremariam
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Ethiopia
| | | | - Ephrem Abebe
- Purdue University, College of Pharmacy, West Lafayette, IN, USA; Indiana University, School of Medicine, Indianapolis, IN, USA
| | - Teferi Gedif Fenta
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Social Pharmacy and Pharmaceutics, Ethiopia
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Nguyen PM, Nguyen KT, Pham ST, Thanh Le VT, Thi Le TC, Diep HG, Minh Le NN, Vinh Ly HH, Nhu Nguyen TT, Lam AN, Nguyen TH, Nguyen T. Pharmacist-Led Interventions to Reduce Drug-Related Problems in Prescribing for Pediatric Outpatients in a Developing Country: A Randomized Controlled Trial. J Pediatr Pharmacol Ther 2023; 28:212-221. [PMID: 37303771 PMCID: PMC10249979 DOI: 10.5863/1551-6776-28.3.212] [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: 02/06/2022] [Accepted: 06/28/2022] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate a pharmacist-led intervention's effectiveness in reducing drug-related problems (DRPs ( related to prescriptions for pediatric outpatients. METHODS We conducted a randomized controlled trial. We recruited and randomly assigned 31 physicians to control or intervention groups. We collected 775 prescriptions (375 from the control group and 400 from the intervention group) at the start. For 3 weeks, intervention physicians received additional information and meetings with pharmacists in addition to the usual practices of the hospital. We then collected prescriptions at the end of the study. We classified DRPs, based on reliable references (Supplemental Table S1) at baseline and endpoint (a week after the intervention). The primary outcome was the proportion of prescriptions with DRPs, and secondary outcomes were the proportions of prescriptions with specific DRP types. RESULTS The influence of the intervention on general DRPs and specific DRPs was the study's main finding. The pharmacist-led intervention helped reduce the prescriptions with DRPs proportion in the intervention group to 41.0%, compared with 49.3% in the control group (p < 0.05). The DRPs proportion related to the timing of administration relative to meals, unlike the other DRP types, increased in the control group (from 31.7% to 34.9%) and decreased in the intervention group (from 31.3% to 25.3%), with a significant difference between the 2 groups at endpoint (p < 0.01). Patients aged >2 to ≤6 years (OR, 1.871; 95% CI, 1.340-2.613) and receiving ≥5 drugs (OR, 5.037; 95% CI, 2.472-10.261) were at greater risk of experiencing DRPs related to prescribing. CONCLUSIONS A pharmacist-led intervention improved DRP occurrence related to physicians' prescribing. Pharmacists could be involved in in-depth research with physicians in the prescribing process to provide tailored interventions.
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Affiliation(s)
- Phuong Minh Nguyen
- Faculty of Medicine (PMN, TKN, HHVL), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Kien Trung Nguyen
- Faculty of Medicine (PMN, TKN, HHVL), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Department of Pharmacology and Clinical Pharmacy (STP, TTCL, HGD, TN), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Faculty of Pharmacy (KT), University of Groningen, Groningen, the Netherlands
| | - Suol Thanh Pham
- Department of Pharmacology and Clinical Pharmacy (STP, TTCL, HGD, TN), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Vy Tran Thanh Le
- Department of Pharmacy (VTTL), Can Tho Children's Hospital, Can Tho, Vietnam
| | - Tu Cam Thi Le
- Department of Pharmacology and Clinical Pharmacy (STP, TTCL, HGD, TN), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Han Gia Diep
- Department of Pharmacology and Clinical Pharmacy (STP, TTCL, HGD, TN), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Ngoc Nguyen Minh Le
- Department of Traditional Medicine (NMNL), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Hung Huynh Vinh Ly
- Faculty of Medicine (PMN, TKN, HHVL), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Trang Thi Nhu Nguyen
- Office of Sciences and Technology – External Relations (TTNN), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Anh Nhut Lam
- Faculty of Public Health (ANL), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thao Huong Nguyen
- Department of Clinical Pharmacy (THN), University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy (STP, TTCL, HGD, TN), Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
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