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Lee S, Yu YM, Han E, Park MS, Lee JH, Chang MJ. Effect of Pharmacist-Led Intervention in Elderly Patients through a Comprehensive Medication Reconciliation: A Randomized Clinical Trial. Yonsei Med J 2023; 64:336-343. [PMID: 37114637 PMCID: PMC10151230 DOI: 10.3349/ymj.2022.0620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/19/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE Polypharmacy can cause drug-related problems, such as potentially inappropriate medication (PIM) use and medication regimen complexity in the elderly. This study aimed to investigate the feasibility and effectiveness of a collaborative medication review and comprehensive medication reconciliation intervention by a pharmacist and hospitalist for older patients. MATERIALS AND METHODS This comprehensive medication reconciliation study was designed as a prospective, open-label, randomized clinical trial with patients aged 65 years or older from July to December 2020. Comprehensive medication reconciliation comprised medication reviews based on the PIM criteria. The discharge of medication was simplified to reduce regimen complexity. The primary outcome was the difference in adverse drug events (ADEs) throughout hospitalization and 30 days after discharge. Changes in regimen complexity were evaluated using the Korean version of the medication regimen complexity index (MRCI-K). RESULTS Of the 32 patients, 34.4% (n=11/32) reported ADEs before discharge, and 19.2% (n=5/26) ADEs were reported at the 30-day phone call. No ADEs were reported in the intervention group, whereas five events were reported in the control group (p=0.039) on the 30-day phone call. The mean acceptance rate of medication reconciliation was 83%. The mean decreases of MRCI-K between at the admission and the discharge were 6.2 vs. 2.4, although it was not significant (p=0.159). CONCLUSION As a result, we identified the effect of pharmacist-led interventions using comprehensive medication reconciliation, including the criteria of the PIMs and the MRCI-K, and the differences in ADEs between the intervention and control groups at the 30-day follow-up after discharge in elderly patients. TRIAL REGISTRATION (Clinical trial number: KCT0005994).
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Affiliation(s)
- Sunmin Lee
- Department of Pharmaceutical Medicines and Regulatory Science, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Korea
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Korea
- Department of Pharmacy, Inha University Hospital, Incheon, Korea
| | - Yun Mi Yu
- Department of Pharmaceutical Medicines and Regulatory Science, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Korea
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Korea
| | - Euna Han
- Department of Pharmaceutical Medicines and Regulatory Science, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Korea
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Korea
| | - Min Soo Park
- Department of Pharmaceutical Medicines and Regulatory Science, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Korea
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Hwan Lee
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
| | - Min Jung Chang
- Department of Pharmaceutical Medicines and Regulatory Science, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Korea
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Korea.
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Whitman A, Fitch E, Nightingale G. The role of oncology pharmacists and comprehensive medication reconciliation in informing treatment plans for older adults with cancer and downstream outcomes. Curr Opin Support Palliat Care 2023; 17:3-7. [PMID: 36695863 DOI: 10.1097/spc.0000000000000634] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Proper medication management is an essential part of older adult cancer care. An aging population, an increase in anticancer treatment options, and high rates of comorbid conditions make navigating general medication reconciliation complicated. This review will highlight the recent literature describing the roles of the oncology pharmacist in caring for older adults with cancer. RECENT FINDINGS The body of literature highlighting oncology pharmacist roles in this population is mainly focused on polypharmacy and potentially inappropriate medication assessments, deprescribing nonessential therapies, drug-drug interaction reviews, and immunization optimization. Outcomes associated with oncology pharmacist interventions are still lacking as well as the development of benchmarks for appropriate pharmacy-based care in the older adult oncology population. SUMMARY Oncology pharmacist interventions in older adults with cancer have the potential to improve patient care. Future randomized studies in this area of practice are warranted in order to clearly define the optimal impact of oncology pharmacists.
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Affiliation(s)
- Andrew Whitman
- Department of Pharmacy Services, University of Virginia Health, Charlottesville, Virginia
| | - Emily Fitch
- Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Herledan C, Cerfon MA, Baudouin A, Larbre V, Lattard C, Poletto N, Ranchon F, Rioufol C. Impact of pharmaceutical care interventions on multidisciplinary care of older patients with cancer: A systematic review. J Geriatr Oncol 2023; 14:101450. [PMID: 36813686 DOI: 10.1016/j.jgo.2023.101450] [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: 08/02/2022] [Revised: 11/22/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Optimizing medication use is a major issue in older patients with cancer and pharmacists are increasingly involved in their multidisciplinary care. The implementation of pharmaceutical care interventions must be supported by impact evaluations to enable their development and funding. This systematic review aims to synthesize evidence on the impact of pharmaceutical care interventions in older patients with cancer. MATERIALS AND METHODS A comprehensive search was performed in the PubMed/Medline, Embase, and Web of Science databases, for articles reporting evaluations of pharmaceutical care interventions for patients with cancer aged 65 years or older. RESULTS Eleven studies met the selection criteria. Most pharmacists were part of multidisciplinary geriatric oncology teams. Whether in outpatient or inpatient settings, interventions had common components, including patient interview, medication reconciliation, and comprehensive medication review to assess drug-related problems (DRPs). DRPs were identified in 95% of patients with 1.7 to 3 DRPs on average. Pharmacist recommendations resulted in a 20-40% reduction in the total number of DRPs and a 20-25% decrease in the prevalence of DRP. Prevalence of potentially inappropriate or omitted medications and their subsequent deprescribing or addition varied greatly between studies, notably depending on detection tools used. Clinical impact was insufficiently evaluated. Only one study reported a reduction of anticancer treatment toxicities following a joint pharmaceutical and geriatric assessment. A single economic evaluation calculated a potential net benefit of $3,864.23 per patient resulting from the intervention. DISCUSSION These encouraging results must be confirmed by more robust evaluations to support the involvement of pharmacists in multidisciplinary care of older patients with cancer.
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Affiliation(s)
- Chloé Herledan
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France.
| | - Marie-Anne Cerfon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France
| | - Amandine Baudouin
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France
| | - Virginie Larbre
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Claire Lattard
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Nicolas Poletto
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France
| | - Florence Ranchon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Catherine Rioufol
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
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Bülow C, Clausen SS, Lundh A, Christensen M. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev 2023; 1:CD008986. [PMID: 36688482 PMCID: PMC9869657 DOI: 10.1002/14651858.cd008986.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND A medication review can be defined as a structured evaluation of a patient's medication conducted by healthcare professionals with the aim of optimising medication use and improving health outcomes. Optimising medication therapy though medication reviews may benefit hospitalised patients. OBJECTIVES We examined the effects of medication review interventions in hospitalised adult patients compared to standard care or to other types of medication reviews on all-cause mortality, hospital readmissions, emergency department contacts and health-related quality of life. SEARCH METHODS In this Cochrane Review update, we searched for new published and unpublished trials using the following electronic databases from 1 January 2014 to 17 January 2022 without language restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). To identify additional trials, we searched the reference lists of included trials and other publications by lead trial authors, and contacted experts. SELECTION CRITERIA We included randomised trials of medication reviews delivered by healthcare professionals for hospitalised adult patients. We excluded trials including outpatients and paediatric patients. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data and assessed risk of bias. We contacted trial authors for data clarification and relevant unpublished data. We calculated risk ratios (RRs) for dichotomous data and mean differences (MDs) or standardised mean differences (SMDs) for continuous data (with 95% confidence intervals (CIs)). We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the overall certainty of the evidence. MAIN RESULTS In this updated review, we included a total of 25 trials (15,076 participants), of which 15 were new trials (11,501 participants). Follow-up ranged from 1 to 20 months. We found that medication reviews in hospitalised adults may have little to no effect on mortality (RR 0.96, 95% CI 0.87 to 1.05; 18 trials, 10,108 participants; low-certainty evidence); likely reduce hospital readmissions (RR 0.93, 95% CI 0.89 to 0.98; 17 trials, 9561 participants; moderate-certainty evidence); may reduce emergency department contacts (RR 0.84, 95% CI 0.68 to 1.03; 8 trials, 3527 participants; low-certainty evidence) and have very uncertain effects on health-related quality of life (SMD 0.10, 95% CI -0.10 to 0.30; 4 trials, 392 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Medication reviews in hospitalised adult patients likely reduce hospital readmissions and may reduce emergency department contacts. The evidence suggests that mediation reviews may have little to no effect on mortality, while the effect on health-related quality of life is very uncertain. Almost all trials included elderly polypharmacy patients, which limits the generalisability of the results beyond this population.
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Affiliation(s)
- Cille Bülow
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Stine Søndersted Clausen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikkel Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research (CCTR), Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Xie C, Gu Y, Wang Y, Ni F, Li Y. Research status and hotspots of medication safety in older adults: A bibliometric analysis. Front Public Health 2023; 10:967227. [PMID: 36684998 PMCID: PMC9849762 DOI: 10.3389/fpubh.2022.967227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Background Medication safety is a significant concern in healthcare. Research on medication safety for older adults has taken a broad approach, resulting in a range of proposals. At this juncture, it is necessary to identify the main contributors and establish the current developmental status of the principal research topics. Objective This study sets out to summarize the state-of-the-art in medication safety for older adults, identifying significant achievements, key topics, and emerging trends. Methods The Web of Science Core Collection (WOSCC) database was searched for relevant documentation over the interval 1st January 2000 to 31st December 2021. Annual outputs and citations were identified from the WOS citation reports. CiteSpace and VOSviewer were adopted for bibliometric analysis and visualization that included the distribution of countries/regions, organizations, authors and journals, and an analysis of co-cited references and keywords. Results A total of 1,638 documents were retrieved for bibliometric analysis, yielding 34.29 citations per document. Publications have increased over the past two decades, reaching 177 outputs in 2019. Our database encompasses 71 countries/regions, 2,347 organizations, and 7,040 authors. The United States ranks first in terms of scientific activity with 604 publications (36.87%). We have identified the University of Sydney as the most prolific organization (53 publications). J. T. Hanlon, J. H. Gurwitz, D. O'Mahony, and G. Onder are the most influential researchers in terms of publications and citations. The Journal of the American Geriatrics Society ranks first with 89 (5.43%) papers. In terms of major research directions, three topics have been identified from co-cited reference and keyword analysis: (1) estimation of the prevalence and variables associated with polypharmacy and potentially inappropriate medication; (2) analysis of interventions involving pharmacists and the associated impact; (3) patient experience and perception associated with medication use or pharmaceutical care. Conclusion Research on medication safety for older adults has progressed significantly over the past two decades. The United States, in particular, has made important contributions to this field. Polypharmacy and potentially inappropriate medication use, interventions involving pharmacists, patient experience and perception represent the current focus of research. Our findings suggest that these directions will continue as research hotspots in the future.
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Affiliation(s)
- Chuantao Xie
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Yanhong Gu
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Yanan Wang
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Feixia Ni
- School of Nursing, Fudan University, Shanghai, China
| | - Yumei Li
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
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Maierhöfer S, Waltering I, Jacobs M, Würthwein G, Appelrath M, Koling S, Hempel G. Decision support software-guided medication reviews in elderly patients with polypharmacy: a prospective analysis of routine data from community pharmacies (OPtiMed study protocol). J Pharm Policy Pract 2022; 15:100. [PMID: 36494764 PMCID: PMC9732986 DOI: 10.1186/s40545-022-00495-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pharmacist-led medication reviews are considered a valuable measure to address risks of polypharmacy. The software Medinspector® is used in community pharmacies to assist the performance of this complex service by structuring the medication review process and supporting pharmacists in their decision-making with targeted clinical knowledge. Key feature is a computerized risk assessment of both the initial and adjusted medication regimen of a patient in multiple domains, thus aiming to support the identification and solving of drug-related problems. This study will examine the effects of medication reviews performed with the clinical decision support system in daily routine practice on medication-related and patient-reported outcomes in elderly patients with polypharmacy. METHODS A prospective, before-after observational study is conducted in German community pharmacies aiming to include 148 patients aged 65 or older, who chronically use five or more active pharmaceutical substances with systemic effects and utilize the software-supported medication review service. The study is based on routine documentation within the software over the course of the medication review, including a patient's baseline medication, the medication proposed by pharmacists, and the final medication regimen. A software-implemented questionnaire comprising self-developed and literature-derived instruments is used to collect patient-reported outcome data at baseline and follow-up. Primary outcome is the appropriateness of medication measured with an adapted version of the Medication Appropriateness Index (MAI). Secondary medication-related outcomes are medication underuse, exposition towards anticholinergic/sedative drugs, number of drugs in long-term use and the implementation of pharmacist-proposed medication adjustments by the physicians. Secondary patient-reported outcomes are symptom burden, medication-related quality of life, adherence, fulfillment of medication review-related goals, and perception of the service. DISCUSSION With the recently introduced remuneration of community pharmacist-led MR in Germany, the demand for digital tools supporting the MR process is assumed to rise. The OPtiMed-study is expected to create evidence on the effects of a novel tool on patient care in a vulnerable patient population. Trial registration German Clinical Trials Register, DRKS00027410. Registered 22 December 2021, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027410 . Also available on the WHO meta-registry: https://trialsearch.who.int/?TrialID=DRKS00027410.
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Affiliation(s)
- Stefan Maierhöfer
- grid.5949.10000 0001 2172 9288Department of Pharmaceutical and Medicinal Chemistry — Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany
| | - Isabell Waltering
- grid.5949.10000 0001 2172 9288Department of Pharmaceutical and Medicinal Chemistry — Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany
| | | | - Gudrun Würthwein
- grid.5949.10000 0001 2172 9288Department of Pharmaceutical and Medicinal Chemistry — Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany
| | | | - Susanne Koling
- Clinic for Pediatrics and Adolescent Medicine — Evangelical Hospital Hamm, Hamm, Germany
| | - Georg Hempel
- grid.5949.10000 0001 2172 9288Department of Pharmaceutical and Medicinal Chemistry — Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany
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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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Herawati F, Maharjana IBN, Kuswardhani T, Susilo AP. STOPP-START Medication Review: A Non-Randomized Trial in an Indonesian Tertiary Hospital to Improve Medication Appropriateness and to Reduce the Length of Stay of Older Adults. Hosp Pharm 2021; 56:668-677. [PMID: 34732920 DOI: 10.1177/0018578720942227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Inappropriate prescribing may lead to medication errors among older adults. Pharmacists can curb the occurrences of these errors by conducting medication reviews. Screening Tool of Older Person's Prescriptions (STOPP) or Screening Tool to Alert doctors to Right Treatments (START) may curb the incidence of adverse drug reactions and improve medication appropriateness by providing guides about when particular types of medications should be started or stopped. Objective: This study aimed to evaluate the use of STOPP/START to improve the Adapted Medication Appropriateness Index (MAI), to reduce the risk of ADRs (GerontoNet score), and length of stay (LOS). Setting: Geriatric Inpatient Ward, Sanglah General Hospital, Bali, Indonesia. Method: A non-randomized controlled trial was conducted in older adults (>60 years) who were selected consecutively from inpatient units in a tertiary hospital in Bali, Indonesia. The intervention group received medication reviews by pharmacists in collaboration with physicians to assess its appropriateness with STOPP/START criteria on admission and during their stay at the hospital. The control group obtained standard care. Main Outcome Measures: The outcomes were measured using the Adapted MAI, GerontoNet Score, and LOS. Results: Thirty patients in the intervention group and 33 patients in the control group were included in this study. The adapted MAI was 2.97 (2.25) and 9.94 (6.14) with P < .001. The GerontoNet score was 3.33 (2.28) and 5.18 (2.10) with P = .003, LOS was 7.63 (3.00) days and 14.18 (9.97) days with P = .011, respectively. Conclusion: The use of STOPP/START as a tool for medication review improved medication appropriateness and reduced ADR risk and LOS.
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Khazaka M, Laverdière J, Li CC, Correal F, Mallet L, Poitras M, Nguyen PVQ. Medication appropriateness on an acute geriatric care unit: the impact of the removal of a clinical pharmacist. Age Ageing 2021; 50:527-533. [PMID: 32931546 DOI: 10.1093/ageing/afaa175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND evidence is largely available indicating benefits to adding a pharmacist on acute care wards. The benefits of maintaining pharmacotherapeutic consultant services on a geriatric ward remain unexplored. OBJECTIVES to determine the impact of the removal of a clinical pharmacist from an acute geriatric ward on patients' Medication Appropriateness Index (MAI) scores, admission-related outcomes and drug burdens. METHODS researchers consulted the archives for records of patients admitted to the geriatric care unit before and after the pharmacist's withdrawal. The primary outcome of differential MAI scores and secondary outcomes of rehospitalisations, emergency department visits, durations of hospitalisation and differential drug count were compared pre- and post-intervention. An interrupted time series analysis regression model was used for the primary outcome. RESULTS a total of 305 patients admitted before (n = 208) and after (n = 97) the pharmacist's withdrawal were included in the study. The intervention had a significant impact on the primary outcome, increasing the relative differential MAI score (adjusted mean) by 9.3 points (95% confidence interval 3.9-14.6). As for the secondary outcomes, differences in admission-related outcomes were non-significant but the mean differential drug count significantly increased post-intervention from 0.02 to 1.36 (P < 0.001). CONCLUSION the removal of the pharmacist led to an increase in inappropriate drug prescription. Careful consideration should be given to decisions regarding the removal of the pharmacist from acute geriatric care teams.
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Affiliation(s)
| | - Michael Khazaka
- Faculty of pharmacy, Université de Montréal, Montreal, QC, Canada
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Jeanne Laverdière
- Faculty of pharmacy, Université de Montréal, Montreal, QC, Canada
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Chen Chen Li
- Faculty of pharmacy, Université de Montréal, Montreal, QC, Canada
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Florence Correal
- Faculty of pharmacy, Université de Montréal, Montreal, QC, Canada
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Louise Mallet
- Faculty of pharmacy, Université de Montréal, Montreal, QC, Canada
- Department of pharmacy, McGill University Health Centre, Montreal, QC, Canada
| | - Mariane Poitras
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal research centre, Montreal, QC, Canada
| | - Patrick Viet-Quoc Nguyen
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal research centre, Montreal, QC, Canada
- Quebec Network for Research on Aging, Montreal, QC, Canada
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Kavanagh ON, Moriarty F, Bradley C, O'Hagan J, Stack G, Kelly D. More than coffee - a World Café to explore enablers of pharmacy practice research. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:512-521. [PMID: 32342625 DOI: 10.1111/ijpp.12627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/28/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pharmacists are in demand now more than ever to provide high-quality expertise about the effectiveness, safety and use of medications. Amidst an increasingly complex and costly healthcare system, policy makers need robust evidence to justify public spending on pharmacy services. Research on the impact of existing and emerging pharmacy practices is required. OBJECTIVE To explore barriers and opportunities to enhance research among pharmacists in Ireland utilising a World Café methodology. METHODS A pharmacy research discussion day was held in November 2018, open to all pharmacists in Ireland. A World Café methodology was utilised as a mechanism to facilitate group discussions about pharmacy practice research. RESULTS Discussions with 63 attendees identified four themes and seventeen subthemes. The four themes were challenges undertaking research, research motivations, leadership and training. Subthemes included robust evidence, clinical, economic and societal outcomes, alignment with national and international health system priorities, need for incentives from professional training bodies, competitive business model and embed within schools of pharmacy. CONCLUSIONS The most commonly discussed barriers inhibiting research were workload, technology limitations and financial considerations. Organisational leadership to prioritise and coordinate research efforts, training to build research capacity, building on existing examples of excellence and initiation of bottom-up community-based research projects were identified in our study as opportunities to enhance pharmacist involvement in research and ultimately patient health outcomes.
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Affiliation(s)
- Oisín N Kavanagh
- Solid State Pharmaceutical Centre (SSPC), The Science Foundation Ireland Research Centre for Pharmaceuticals, Department of Chemical Sciences, Bernal Institute, University of Limerick, Limerick, Ireland
| | - Frank Moriarty
- Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Catriona Bradley
- Irish Institute of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James O'Hagan
- Irish Institute of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gary Stack
- Department of Nursing and Health Sciences, Faculty of Science and Health, Athlone Institute of Technology, Athlone, Ireland
| | - Dervla Kelly
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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Mangin D, Garfinkel D. Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use. Ther Adv Drug Saf 2019; 10:2042098619883156. [PMID: 31673327 PMCID: PMC6804352 DOI: 10.1177/2042098619883156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Doron Garfinkel
- Geriatric-Palliative consultant, Sheba Medical Center and Homecare Hospice, Israel Cancer Association, Israel
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Twigg G, David T, Taylor J. An Improved Comprehensive Medication Review Process to Assess Healthcare Outcomes in a Rural Independent Community Pharmacy. PHARMACY 2019; 7:E66. [PMID: 31212922 PMCID: PMC6631051 DOI: 10.3390/pharmacy7020066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022] Open
Abstract
For years many pharmacists have been performing 'brown bag' medication reviews for patients. While most pharmacists and student pharmacists are familiar with this process, it is important to determine the value patients receive from this service. Over the course of this study the authors attempted to modernize the medication reconciliation process and collect data on patient prescription drug and over-the-counter drug use, along with quantifying the types of interventions the pharmacy's clinical staff performed for patients during this process. The pharmacy partnered with a Quality Improvement Organization to trial their Blue Bag Intervention (BBI) program. The BBI program offered several additional services to the traditional brown bag review. The BBI was instituted as a follow-up tool in the pharmacy's diabetes self-management education/training clinic to aid in patient follow-up and help the clinical staff identify medication-related events such as medication adherence issues and drug-drug interactions. The clinical staff identified approximately 2.2 events per patient with over 50% being issues that affected patient safety.
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Affiliation(s)
| | - Tosin David
- School of Pharmacy, University of Maryland Eastern Shore, Princess Anne, MD 21853, USA.
| | - Joshua Taylor
- School of Pharmacy, University of Maryland Eastern Shore, Princess Anne, MD 21853, USA.
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