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Christopher CM, Blebil AQ, Bhuvan KC, Alex D, Ibrahim MIM, Ismail N, Cheong MWL. Assessing feasibility of conducting medication review with follow-up among older adults at community pharmacy: a pilot randomised controlled trial. Int J Clin Pharm 2024:10.1007/s11096-024-01711-3. [PMID: 38635115 DOI: 10.1007/s11096-024-01711-3] [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: 08/30/2023] [Accepted: 02/08/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Medication review with follow-up is essential for optimising medication utilisation among the older adult population in primary healthcare. AIM This study aimed to evaluate the feasibility of implementing medication reviews with follow-up for older adults in community pharmacies and examined potential outcomes on medication use. METHOD A pilot randomised controlled trial was conducted with 4 cluster-randomised community pharmacies to assess the feasibility of the intervention. Two community pharmacies served as intervention and control groups. Both groups recruited older adults over 60 who were followed over 6 months. The translated Medication use Questionnaire (MedUseQ) was administered at baseline and 6 months for both groups. The outcomes were to assess the feasibility of conducting medication review with follow-up and the probable medication use outcomes from the intervention. RESULTS The intervention and control groups comprised 14 and 13 older adults. A total of 35 recommendations were made by pharmacists in the intervention group and 8 in the control group. MedUseQ was easily administered, providing some evidence the feasibility of the intervention. However, there were feasibility challenges such as a lack of pharmacists, collaborative practice, difficulties with the tool language, time constraints, and limited funds. Questionnaire results provided a signal of improvement in medication administration, adherence, and polypharmacy among intervention participants. The incidence of drug related problems was significantly higher in the control group (median = 1) after 6 months, U = 15, z = - 2.98, p = 0.01. CONCLUSION Medication review with follow-up is potentialy practical in community pharmacies, but there are feasibility issues. While these challenges can be addressed, it is essential to study larger sample sizes to establish more robust evidence regarding outcomes. CLINICAL TRIAL REGISTRY ClinicalTrials.Gov NCT05297461.
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Affiliation(s)
| | - Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
| | - K C Bhuvan
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Deepa Alex
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
- Department of Geriatrics and Healthy Living, KIMSHEALTH, Thiruvananthapuram, Kerala, India
| | | | - Norhasimah Ismail
- Bayan Lepas Health Clinic, Ministry of Health, Bayan Lepas, Penang, Malaysia
| | - Mark Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
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Dimitrow M, Saarenmaa R, Airaksinen M, Hassan G, Puumalainen E, Pitrová M, Kivelä SL, Fialová D, Puustinen J, Toivo T. Medication risk checklist for older adults (LOTTA) - development and validation of a self-assessment tool. Ann Med 2023; 55:2287707. [PMID: 38035545 PMCID: PMC10732188 DOI: 10.1080/07853890.2023.2287707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Patient safety strategies highlight patients' own active involvement in ensuring medication safety. A prerequisite for involving patients in their medication therapy is having tools that can assist them in ensuring safe medicine use. Older home-dwelling adults with multiple medications are at high risk for medication-related problems, yet only a few age-specific patient self-administered medication risk screening tools exist. This study aimed to develop, validate, and assess the feasibility of a self-administered medication risk checklist for home-dwelling older adults ≥65 years. MATERIALS AND METHODS The draft checklist was formed based on a validated practical nurse-administered Drug Related Problem Risk Assessment Tool supplemented with findings from two systematic literature reviews. The content validity of the draft checklist was determined by a three-round Delphi survey with a panel of 19 experts in geriatric care and pharmacotherapy. An agreement of ≥80% was required. A feasibility assessment (i.e. understandability of the items, fill-out time of the checklist) of the content-validated checklist was conducted among older adults ≥65 years (n = 87) visiting community pharmacies (n = 4). Data were analysed using qualitative content analysis. RESULTS The final validated and feasibility-tested Medication Risk Checklist (LOTTA) for home-dwelling older adults consists of eight items screening the highest priority systemic risks (three items), potentially drug-induced symptoms (one item), adherence, and self-management problems (four items). The checklist proved feasible for self-administration, the mean fill-out time being 6.1 min. CONCLUSIONS A wide range of potential medication risks related to the medication use process can be identified by patient self-assessment. Screening tools such as LOTTA can enhance early detection of potential medication risks and risk communication between older adults and their healthcare providers. A wider and more integrated use of the checklist could be facilitated by making it electronically available as part of the patient information systems.
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Affiliation(s)
- Maarit Dimitrow
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Roosa Saarenmaa
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Marja Airaksinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Ghada Hassan
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Emmi Puumalainen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Markéta Pitrová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
- Clinical Pharmacy Department, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Sirkka-Liisa Kivelä
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Juha Puustinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Service Unit of Neurology, Satasairaala Central Hospital, Wellbeing County of Satakunta, Pori, Finland
| | - Terhi Toivo
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Zhou D, Chen Z, Tian F. Deprescribing Interventions for Older Patients: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:1718-1725. [PMID: 37582482 DOI: 10.1016/j.jamda.2023.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Deprescribing reduces polypharmacy in older adults. A thorough study of the effect of deprescribing interventions on clinical outcomes in older adults is presently lacking. As a result, we evaluated the impact of deprescribing on clinical outcomes in older patients. DESIGN Meta-analysis and systematic review of randomized controlled trials (RCTs). PubMed, EMBASE, and Cochrane Library were searched from the time of creation to March 2023. SETTING AND PARTICIPANTS Randomized controlled trial with participants at least 60 years old. MEASURES Mortality, falls (number of fallers), hospitalization rates, emergency department visits, medication adherence, HRQoL (health-regulated quality of life), incidence of ADR (adverse drug reactions), PIM (potentially inappropriate medication), and PPO (potentially prescription omission) were evaluated in the meta-analysis. RESULTS A total of 32 RCTs (18,670 patients) were included. Deprescribing interventions significantly reduced proportions of older adults with PIM, PPO, and the incidence of ADRs. The interventions group also improved medication compliance. CONCLUSIONS AND IMPLICATIONS Compared to routine care, deprescribing interventions significantly improve clinical outcome indicators for older adults.
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Affiliation(s)
- Dan Zhou
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China; Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Zaij S, Pereira Maia K, Leguelinel-Blache G, Roux-Marson C, Kinowski JM, Richard H. Intervention of pharmacist included in multidisciplinary team to reduce adverse drug event: a qualitative systematic review. BMC Health Serv Res 2023; 23:927. [PMID: 37649018 PMCID: PMC10470127 DOI: 10.1186/s12913-023-09512-6] [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: 10/18/2022] [Accepted: 05/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Preventable harm in healthcare is a growing public health challenge. In addition to the economic costs of safety failures, adverse drug events (ADE) may lead to complication or even death. Multidisciplinary care team involving a pharmacist appears to be an adequate response to prevention of adverse drug event. This qualitative systematic review aims to identify and describe multidisciplinary planned team-based care involving at least one pharmacist to limit or prevent adverse drug events in the adult patients. METHODS To determine the type of interprofessional collaboration to prevent adverse drug event in which a pharmacist was involved, we conducted a qualitative systematic review of the literature of randomized controlled trials. Two independent reviewers screened trials in three databases: Medline, Web of Science, ScienceDirect. Prospective studies of at least three different health professionals' interventions, one of whom was a pharmacist in the last five years were included. Two reviewers performed data extraction and quality appraisal independently. We used TIDieR checklist to appraise articles quality. RESULTS In total 803 citations were retrieved, 34 were analysed and 16 full-text articles were reviewed. Only 3 studies published an implementation evaluation. More than half of the interventions (62%) targeted elderly patients including 6 whom lived in nursing homes. Studies outcomes were heterogeneous, and we did not perform a statistical analysis of the impact of these interventions. Most teams are composed of a physician/pharmacist/nurse trio (94%; 100%; 88%). Half of the teams were composed of the primary care physician. Other professionals were included such as physical therapists (25%), social worker (19%), occupational therapists (12%), and community health educator (6%). Multidisciplinary medication review was the most common intervention and was generally structured in four steps: data collection and baseline assessment, appraisal report by health professionals, a multidisciplinary medication review meeting and a patient follow-up. CONCLUSIONS The most common multidisciplinary intervention to prevent ADE in the adult population is the multidisciplinary drug review meeting at least the physician/pharmacist/nurse trio. Interventions target mostly elderly people in nursing homes, although complex chronic patients could benefit from this type of assessment. TRIAL REGISTRATION PROSPERO registration: CRD42022334685.
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Affiliation(s)
- Sarah Zaij
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France.
| | - Kelly Pereira Maia
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Géraldine Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
- Department of Law and Health Economics, Faculty of Pharmacy, University of Montpellier, Montpellier, France
| | - Clarisse Roux-Marson
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Jean Marie Kinowski
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Hélène Richard
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
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Ryskina K, Lo D, Zhang T, Gerlach L, Bynum J, Shireman TI. Potentially Harmful Medication Prescribing by the Degree of Physician Specialization in Nursing Home Practice: An Observational Study. J Am Med Dir Assoc 2023; 24:1240-1246.e2. [PMID: 37088104 PMCID: PMC10524654 DOI: 10.1016/j.jamda.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/14/2023] [Accepted: 03/12/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES The use of anticholinergics, antipsychotics, benzodiazepines, and other potentially harmful medications (PHMs) is associated with particularly poor outcomes in nursing home (NH) residents with Alzheimer's disease and related dementias (ADRD). Our objective was to compare PHM prescribing by NH physicians and advanced practitioners who focus their practice on NH residents (NH specialists) vs non-NH specialists. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We included a 20% random sample of Medicare beneficiaries with ADRD who resided in 12,278 US NHs in 2017. Long-stay NH residents with ADRD were identified using MDS, Medicare Parts A and B claims. Residents <65 years old or without continuous Part D coverage were excluded. METHODS Physicians in generalist specialties and advanced practitioners with ≥90% of Part B claims for NH care were considered NH specialists. Residents were assigned to NH specialists vs non-NH specialists based on plurality of Part D claims submitted for that resident. Any PHM use (defined using the Beers Criteria) and the proportion of NH days on a PHM were modeled using generalized estimating equations. Models included resident demographics, clinical characteristics, cognitive and functional status, behavioral assessments, and facility characteristics. RESULTS Of the 54,713 residents in the sample, 27.9% were managed by an NH specialist and 72.1% by a non-NH specialist. There was no statistically significant difference in any PHM use [odds ratio (OR) 0.97, 95% CI 0.93-1.02, P = .23]. There were lower odds of prolonged PHM use (OR 0.87, 95% CI 0.81-0.94, P < .001, for PHM use on >75% vs >0%-<25% of NH days) for NH specialists vs non-NH specialists. CONCLUSIONS AND IMPLICATIONS Although the use of PHMs among NH residents with ADRD managed by NH specialists was not lower, they were less likely to receive PHMs over longer periods of time. Future work should evaluate the underlying causes of these differences to inform interventions to improve prescribing for NH residents.
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Affiliation(s)
- Kira Ryskina
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Derrick Lo
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Tingting Zhang
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Lauren Gerlach
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Julie Bynum
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Theresa I Shireman
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA
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Martín-Díaz M, Pino-Merlo G, Bueno-Cabanillas A, Khan KS. [Longitudinality in Primary Care and Polypharmacy. A Systematic Review]. Semergen 2023; 49:101994. [PMID: 37276757 DOI: 10.1016/j.semerg.2023.101994] [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: 01/16/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023]
Abstract
The aim of this work was to collect, evaluate and interpret the available evidence on the relationship between continuity in primary care (i.e., longitudinality), and the prevalence of polypharmacy and its associated problems. Following the PRISMA reporting statement, we carried out a systematic review of the literature searching PubMed and Scopus databases. The screening of titles and summaries and the review of references carried out independently by two authors detected 16 works of potential interest, of which 4 were discarded after the independent review of all the originals because they did not meet inclusion criteria. The 12 papers selected studied the relationship between Longitudinality, measured with various quantitative indices, and the rate of polypharmacy or various associated problems, such as duplicate drugs, inadequate prescriptions or drug interactions. They all showed a significant relationship, often strong (RR>2 or<0.5), between longitudinality indicators and the various dependent variables. Although our knowledge could be improved by prospective studies that more directly evaluate longitudinality and its impact on problems due to excess medication, with the existing evidence, we can affirm that the protection and promotion of continuity in primary care can be a key element for the control of polypharmacy and associated problems.
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Affiliation(s)
- M Martín-Díaz
- Cirugía General y del Aparato Digestivo, Hospital General Básico Santa Ana de Motril, Área de Gestión Sanitaria Sur de Granada, Motril, Granada, España.
| | - G Pino-Merlo
- Unidad de Calidad y Seguridad del Paciente, Área de Gestión Sanitaria Sur de Granada, Granada, España
| | - A Bueno-Cabanillas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación BioSanitaria de Granada (IBS-Granada), Granada, España
| | - K S Khan
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
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Daunt R, Curtin D, O'Mahony D. Polypharmacy stewardship: a novel approach to tackle a major public health crisis. THE LANCET. HEALTHY LONGEVITY 2023; 4:e228-e235. [PMID: 37030320 DOI: 10.1016/s2666-7568(23)00036-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 04/10/2023] Open
Abstract
With growing global concern regarding medication-related harm, WHO launched a global patient safety challenge, Medication Without Harm, in March, 2017. Multimorbidity, polypharmacy, and fragmented health care (ie, patients attending appointments with multiple physicians in various health-care settings) are key drivers of medication-related harm, which can result in negative functional outcomes, high rates of hospitalisation, and excess morbidity and mortality, particularly in patients with frailty older than 75 years. Some studies have examined the effect of medication stewardship interventions in older patient cohorts, but focused on a narrow spectrum of potentially adverse medication practices, with mixed results. In response to the WHO challenge, we propose the novel concept of broad-spectrum polypharmacy stewardship, a coordinated intervention designed to improve the management of multimorbidities, taking into account potentially inappropriate medications, potential prescribing omissions, drug-drug and drug-disease interactions, and prescribing cascades, aligning treatment regimens with the condition, prognosis, and preferences of the individual patient. Although the safety and efficacy of polypharmacy stewardship need to be tested with well designed clinical trials, we propose that this approach could minimise medication-related harm in older people with multimorbidities exposed to polypharmacy.
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Affiliation(s)
- Ruth Daunt
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis Curtin
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
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Lalani M, Wytrykowski S, Hogan H. Approaches to improving patient safety in integrated care: a scoping review. BMJ Open 2023; 13:e067441. [PMID: 37015799 PMCID: PMC10083780 DOI: 10.1136/bmjopen-2022-067441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES This scoping review aimed to establish the approaches employed to improving patient safety in integrated care for community-dwelling adults with long-term conditions. DESIGN Scoping review. SETTING All care settings. SEARCH STRATEGY Systematic searches of seven academic and grey literature databases for studies published between 2000 and 2021. At the full-text review stage both the first and second reviewer (SW) independently assessed full texts against the eligibility criteria and any discrepancies were discussed. RESULTS Overall, 24 studies were included in the review. Two key priorities for safety across care boundaries for adults with long-term conditions were falls and medication safety. Approaches for these priorities were implemented at different levels of an integrated care system. At the micro-level, approaches involved care primarily in the home setting provided by multi-disciplinary teams. At the meso-level, the focus was on planning and designing approaches at the managerial/organisational level to deliver multi-disciplinary care. At the macro-level, system-wide approaches included integrated care records, training and education and the development of care pathways involving multiple organisations. Across the included studies, evaluation of these approaches was undertaken using a wide range of process and outcome measures to capture patient harm and contributory factors associated with falls and medication safety. CONCLUSIONS For integrated care initiatives to fulfil their promise of improving care for adults with long-term conditions, approaches to improve patient safety need to be instituted across the system, at all levels to support the structural and relational aspects of integrated care as well as specific risk-related safety improvements.
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Affiliation(s)
- Mirza Lalani
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Ravi P, Pfaff K, Ralph J, Cruz E, Bellaire M, Fontanin G. Nurse-pharmacist collaborations for promoting medication safety among community-dwelling adults: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100079. [PMID: 38745597 PMCID: PMC11080473 DOI: 10.1016/j.ijnsa.2022.100079] [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: 12/17/2021] [Revised: 03/23/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Despite good evidence that supports improved clinical health outcomes and the cost effectiveness of nurse-pharmacist collaboration for promoting medication safety among adults in acute care settings, there is limited research in community settings. Objective This scoping review examines, maps, and identifies gaps in the existing literature on nurse-pharmacist collaboration to augment medication safety among community-dwelling adults. Design Setting(s): Community setting. Participants This review consists of 3,464 participants across 23 studies. Methods We used the enhanced Arksey and O'Malley framework by Levac and colleagues. Studies from MEDLINE, CINAHL, ProQuest, Scopus, and PubMed databases implementing medication safety through nurse-pharmacist collaboration for community-dwelling adults were included. We extracted data according to country of origin, intervention, and relevance to the current review. Results Twenty-three studies were included in this review. Nurse-pharmacist collaborations in community settings are still evolving and are in a nascent form. Five sub-themes emerged from literature review of collaboration between nurses and pharmacists in community settings for medication safety. They are creating new opportunities to address gaps in community medication safety, enabling complementary interprofessional roles in medication safety, facilitating of efficient and cost-effective measures for medication safety, diverse nature of assessments done by nurses and pharmacists, and incohesive teams due to poor collaborative practices. Conclusions Nurse-pharmacist collaborations in community settings improved disease management, prevented adverse drug events, and reduced hospitalizations. They resulted in early identification and correction of medication safety related issues, reduced wait periods to see general practitioners, and enhanced chronic disease self-management skills among community-dwelling adults. There is a need to improve existing systems and policies through research for sustaining such collaborations especially in community settings.
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Affiliation(s)
- Padma Ravi
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Kathryn Pfaff
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Jody Ralph
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Edward Cruz
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | | | - Gemma Fontanin
- Faculty of Nursing, University of Windsor, Windsor, Canada
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Gorman A, Rankin A, Hughes C, O'Dwyer M, Ryan C. Theoretically derived interventions aimed at improving appropriate polypharmacy in primary care: A systematic review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 7:100166. [PMID: 36039374 PMCID: PMC9418988 DOI: 10.1016/j.rcsop.2022.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Polypharmacy (the use of multiple medications) is common in older patients and achieving a balance between appropriate and inappropriate polypharmacy is a challenge routinely faced by prescribers. It is recommended to incorporate the use of theory when developing complex interventions, but it is not known if theoretically derived interventions aimed at improving appropriate polypharmacy are effective. Objective This systematic review aimed to establish the overall effectiveness of theoretically derived interventions on improving appropriate polypharmacy and to investigate the degree to which theory informed intervention design. Methods Seven electronic databases were searched from inception to August 2021 including hand-searching of reference lists. Interventions developed using a theory, involving the use of a validated tool to assess prescribing, delivered in primary care to participants with a mean age of ≥65 years and prescribed ≥four medications, were included. Data was extracted independently by two reviewers. The Theory Coding Scheme (TCS) was applied to evaluate the use of theory; Risk of Bias (RoB) was assessed using the Cochrane RoB 2.0 tool. Results Two studies, one feasibility study and one randomised controlled trial (RCT) were included, and therefore overall effectiveness of the theoretically derived intervention could not be assessed. Theory used in development included the Theoretical Domains Framework and Reason's system-based risk management theory. The RCT was rated to have a high RoB. Based on the TCS, neither study used theory completely. Conclusion The effectiveness of theoretically derived interventions to improve appropriate polypharmacy in primary care could not be determined due to the small number of studies and their heterogeneity. Further incorporation of theory into intervention development is required to understand the effectiveness of this approach. Prospero registration: CRD42020157175.
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Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review. J Clin Med 2022; 11:jcm11030714. [PMID: 35160166 PMCID: PMC8836376 DOI: 10.3390/jcm11030714] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults. AIMS This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions. METHODS We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults. RESULTS We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect. CONCLUSION This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults.
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Aoki T, Fujinuma Y, Matsushima M. Associations of primary care structures with polypharmacy and patient-reported indicators in patients with complex multimorbidity: a multicentre cross-sectional study in Japan. BMJ Open 2022; 12:e054348. [PMID: 34996796 PMCID: PMC8744111 DOI: 10.1136/bmjopen-2021-054348] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Evidence supporting the effects of primary care structures on the quality of care for patients with complex multimorbidity, which is one of the most important challenges facing primary care, is scarce internationally. This study aimed to examine the associations of the types of primary care facilities with polypharmacy and patient-reported indicators in patients with complex multimorbidity, with a focus on differences between community clinics and hospitals. DESIGN Multicentre cross-sectional study. SETTING A total of 25 primary care facilities (19 community clinics and 6 small- and medium-sized hospitals). PARTICIPANTS Adult outpatients with complex multimorbidity, which was defined as the co-occurrence of three or more chronic conditions affecting three or more different body systems within one person. PRIMARY OUTCOME MEASURE Polypharmacy, the Patient-Reported Experience Measure using the Japanese version of Primary Care Assessment Tool Short Form (JPCAT-SF) and the Patient-Reported Outcome Measure using self-rated health status (SRH). RESULTS Data were analysed for 492 patients with complex multimorbidity. After adjustment for possible confounders and clustering within facilities, clinic-based primary care practices were significantly associated with a lower prevalence of polypharmacy, higher JPCAT-SF scores in coordination and community orientation, and a lower prevalence of poor or fair SRH compared with hospital-based primary care practices. In contrast, the JPCAT-SF score in first contact was significantly lower in clinic-based practices. The associations between the types of primary care facilities and JPCAT-SF scores in longitudinality and comprehensiveness were not statistically significant. CONCLUSIONS Clinic-based primary care practices were associated with a lower prevalence of polypharmacy, better patient experience of coordination and community orientation, and better SRH in patients with complex multimorbidity compared with hospital-based primary care practices. In the primary care setting, small and tight teams may improve the quality of care for patients with complex multimorbidity.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
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Tahvanainen H, Kuitunen S, Holmström AR, Airaksinen M. Integrating medication risk management interventions into regular automated dose dispensing service of older home care clients - a systems approach. BMC Geriatr 2021; 21:663. [PMID: 34814848 PMCID: PMC8609790 DOI: 10.1186/s12877-021-02607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 10/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Automated dose dispensing (ADD) services have been implemented in many health care systems internationally. However, the ADD service itself is a logistic process that requires integration with medication risk management interventions to ensure safe and appropriate medication use. National policies and regulations guiding ADD in Finland have recommended medication reconciliation, review, and follow-up for suitable risk management interventions. This implementation study aimed to develop a medication management process integrating these recommended risk management interventions into a regular ADD service for older home care clients. METHODS This study applied an action research method and was carried out in a home care setting, part of primary care in the City of Lahti, Finland. The systems-approach to risk management was applied as a theoretical framework. RESULTS The outcome of the systems-based development process was a comprehensive medication management procedure. The medication risk management interventions of medication reconciliation, review and follow-up were integrated into the medication management process while implementing the ADD service. The tasks and responsibilities of each health care professional involved in the care team became more explicitly defined, and available resources were utilized more effectively. In particular, the hospital pharmacists became members of the care team where collaboration between physicians, pharmacists, and nurses shifted from parallel working towards close collaboration. More efforts are needed to integrate community pharmacists into the care team. CONCLUSION The transition to the ADD service allows implementation of the effective medication risk management interventions within regular home care practice. These systemic defenses should be considered when national ADD guidelines are implemented locally. The same applies to situations in which public home care organizations responsible for services e.g., municipalities, purchase ADD services from private service providers.
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Affiliation(s)
- Heidi Tahvanainen
- Doctoral Programme in Drug Research, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland
| | - Sini Kuitunen
- Doctoral Programme in Drug Research, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland
| | - Anna-Riia Holmström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland
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Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2021; 9:healthcare9111577. [PMID: 34828622 PMCID: PMC8625440 DOI: 10.3390/healthcare9111577] [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: 09/18/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
This review and meta-analysis aimed to determine the clinical and humanistic outcomes of community pharmacy-based interventions on medication-related problems of older adults at the primary care level. We identified randomized controlled trials (RCTs) examining the impact of various community pharmacy-based interventions from five electronic databases (namely, MEDLINE (Ovid), EMBASE (Ovid), CINAHL, APA PSYInfo, and Scopus) from January 2010 to December 2020. Consequently, we assessed these interventions’ clinical and humanistic outcomes on older adults and compared them with non-intervention. We included 13 RCTs in the current review and completed a meta-analysis with six of them. The included studies had a total of 6173 older adults. Quantitative analysis showed that patient education was significantly associated with an increase in the discontinuation of sedative–hypnotics use (risk ratio 1.28; 95% CI (1.20, 1.36) I2 = 0%, p < 0.00001). Moreover, the qualitative analysis showed that medication reviews and education with follow-ups could improve various clinical outcomes, including reducing adverse drug events, reducing uncontrolled health outcomes, and improving appropriate medication use among the elderly population. However, medication review could not significantly reduce the number of older adults who fall (risk ratio 1.25; 95% CI (0.78, 1.99) I2 = 0%, p = 0.36) and require hospitalization (risk ratio 0.72; 95% CI (0.47, 1.12) I2 = 45%, p = 0.15). This study showed that community pharmacy-based interventions could help discontinue inappropriate prescription medications among older adults and could improve several clinical and humanistic outcomes. However, more effective community pharmacy-based interventions should be implemented, and more research is needed to provide further evidence for clinical and humanistic outcomes of such interventions on older adults.
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Veldhuizen J, Hafsteinsdóttir T, Mikkers M, Bleijenberg N, Schuurmans M. Evidence-based interventions and nurse-sensitive outcomes in district nursing care: A systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Chen MJ, Kao FH. The Role of Pharmacists in Home Health Care: A Study Set in a Regional Hospital in Taipei City. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/10848223211016416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In response to population aging, there is an increase in demand for the coverage of and the necessary services provided by home health care and home care for socially vulnerable groups. This study explored whether the instructions and recommendations offered by pharmacists during their home visits play a key role in the factors that influence a patient’s prognosis. A home health care database was analyzed in this study. The subjects received home visits from pharmacists. There were 262 subjects following the exclusion of closed cases that were not due to improved outcomes or death. To validate the research framework, multiple regression analysis was employed for model validation. The level of consciousness and Barthel Index score mediated the effects of multimorbidities, and these mediating effects significantly affected patient outcomes (improvement or death). The medication-related knowledge and instructions for correct medication use provided by pharmacists did not exhibit significant moderating effects on the influence of a patient’s level of consciousness and Barthel Index score on their improved outcomes. However, the pharmacists’ provision of instructions and recommendations for patient self-care had significant moderating effects on the path by which patients with multimorbidities experienced improved outcomes through higher total Barthel Index scores. In comparison with physician home visits, which merely cover the treatments for diseases, pharmacists also play a vital role in home health care. Pharmacists provide patients with medication-related knowledge and instructions for correct medication use. This study addressed aspects that have not been considered in previous studies.
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Affiliation(s)
- Mei-Ju Chen
- Heping Fuyou Branch of Taipei City Hospital, Taipei
- National Taipei University of Nursing and Health Science, Taipei
| | - Feng-Hsia Kao
- National Taipei University of Nursing and Health Science, Taipei
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17
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Roca B, Roca M. Assessment of Drug Interactions with Online Electronic Checkers in Multi-Pathological Patients. Pharmacology 2021; 107:111-115. [PMID: 34818251 DOI: 10.1159/000518439] [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: 03/24/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Multi-pathological patients are at high risk of drug interactions and side effects. We aimed to assess the usefulness of 3 online drug interaction checkers. METHODS In a cross-sectional study, carried out in the Medicine Department of Hospital General of Castellon, Spain, in February 2020, we assessed drug interaction detection with 3 online electronic checkers, Drugs.com, Lexicomp®, and Medscape, and compared results obtained with the 3 tools. From every hospitalized patient, we obtained the list of drugs he or she had been taking until admission. Bivariable tests were used for analysis. p values <0.05 were considered significant. RESULTS We included data from 134 patients; 68 (51%) were male; median (and interquartile range) of their age was 82 (76-88) years. A total of 1,082 substance drugs were entered in the checkers. The number of highest grade interactions found with every program was Drugs.com 85, Lexicomp® 33, and Medscape 67. Positive correlations were found between age and number of drug substances prescribed (p = 0.009) and between number of drug substances prescribed and interactions found with any of the 3 checkers (p < 0.001 in all 3 cases). Regarding highest grade interactions, agreement among all 3 checkers was poor. CONCLUSIONS The 3 online checkers we assessed found a large number of interactions. The 3 programs gave very discrepant results. Impact on Practice Statements: The analyzed programs, Drugs.com, Lexicomp®, and Medscape Interactions, found a large number of drug interactions in the studied patients. The 3 programs gave very discrepant results among them.
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Affiliation(s)
- Bernardino Roca
- Hospital General Universitario of Castellon, Universitat Jaume I, Castelló, Spain
| | - Manuel Roca
- Hospital of Vinaros, Universitat Jaume I, Castellon, Spain
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18
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Yoshioka-Maeda K, Kono A. Factors related to complex care needs of older adults in community-based integrated care centers in Japan: A cross-sectional study. Jpn J Nurs Sci 2021; 18:e12440. [PMID: 34196480 DOI: 10.1111/jjns.12440] [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: 11/27/2020] [Revised: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to identify the factors related to complex care needs of older adults in community-based integrated care centers. METHODS We sent 936 self-reported questionnaires to community-based integrated care center directors in the Kinki region of Japan. These questionnaires included questions not only about the directors' demographic data, but also regarding the sociodemographic, psychosocial, and family-related dimensions of the older adults in the community centers. The directors divided their cases into two categories: "Complex cases" and "Straightforward cases." We compared the intergroup differences and examined the factors related to complex care needs in older adults. RESULTS A total of 232 directors responded. Complex cases were significantly associated with younger age, poor health conditions, and having a family member who needs care, as compared to straightforward cases where these associations were not present. Logistic regression showed that in older adults, factors of refusing support or social services, social isolation, and trouble with neighbors were associated with their complexities. Additionally, family members with a high likelihood of refusing social services, older adults without a key family member, and difficulties in forming their consensus regarding care were associated with older adults' complexities. CONCLUSION Older adults with complex care needs could have the risk of self-neglect, and their families faced difficulties in supporting them as family members. Healthcare professions should carefully assess these factors and develop needs-oriented services for them without their family support as an upstream intervention.
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Affiliation(s)
- Kyoko Yoshioka-Maeda
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
| | - Ayumi Kono
- Department of Home Health Nursing, Osaka City University, Osaka, Japan
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Bories M, Bouzillé G, Cuggia M, Le Corre P. Drug-Drug Interactions in Elderly Patients with Potentially Inappropriate Medications in Primary Care, Nursing Home and Hospital Settings: A Systematic Review and a Preliminary Study. Pharmaceutics 2021; 13:pharmaceutics13020266. [PMID: 33669162 PMCID: PMC7919637 DOI: 10.3390/pharmaceutics13020266] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/18/2023] Open
Abstract
Drug–drug interactions (DDI) occurring with potentially inappropriate medications (PIM) are additional risk factors that may increase the inappropriate character of PIM. The aim of this study was (1) to describe the prevalence and severity of DDI in patients with PIM and (2) to evaluate the DDI specifically regarding PIM. This systematic review is based on a search carried out on PubMed and Web-of-Science from inception to June 30, 2020. We extracted data of original studies that assessed the prevalence of both DDI and PIM in elderly patients in primary care, nursing home and hospital settings. Four hundred and forty unique studies were identified: 91 were included in the qualitative analysis and 66 were included in the quantitative analysis. The prevalence of PIM in primary care, nursing home and hospital were 19.1% (95% confidence intervals (CI): 15.1–23.0%), 29.7% (95% CI: 27.8–31.6%) and 44.6% (95% CI: 28.3–60.9%), respectively. Clinically significant severe risk-rated DDI averaged 28.9% (95% CI: 17.2–40.6), in a hospital setting; and were approximately 7-to-9 lower in primary care and nursing home, respectively. Surprisingly, only four of these studies investigated DDI involving specifically PIM. Hence, given the high prevalence of severe DDI in patients with PIM, further investigations should be carried out on DDI involving specifically PIM which may increase their inappropriate character, and the risk of adverse drug reactions.
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Affiliation(s)
- Mathilde Bories
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
| | - Guillaume Bouzillé
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
| | - Marc Cuggia
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
| | - Pascal Le Corre
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France
- Correspondence:
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Airaksinen M, Toivo T, Jokinen L, Savela E, Parkkamäki S, Sandler C, Kalliomäki H, Dimitrow M. Policy and vision for community pharmacies in Finland: A roadmap towards enhanced integration and reduced costs. Pharm Pract (Granada) 2021; 19:2288. [PMID: 33628348 PMCID: PMC7886313 DOI: 10.18549/pharmpract.2021.1.2288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Finland's community pharmacy system provides an example of a privately-owned regulated system being proactively developed by the profession and its stakeholders. Community pharmacists have a legal duty to promote safe and rational medicine use in outpatient care. The development of professionally oriented practice has been nationally coordinated since the 1990s with the support of a national steering group consisting of professional bodies, authorities, pharmacy schools and continuing education centers. The primary focus has been in patient counseling services and public health programs. The services have extended towards prospective medication risk management applying evidence-based tools, databases and digitalization. Research has been essential in informing progress by indicating high-risk patients, medications, practices and processes needing improvement. Despite the commitment of the profession and pharmacy owners, large-scale implementation of services has been challenging because of lack of remuneration, the pharmacy income still consisting primarily of sale of prescription and nonprescription medicines. Policy documents by the Ministry of Social Affairs and Health have supported the extension of the community pharmacists' role beyond traditional dispensing to promote rational pharmacotherapy. The current roadmap by the Ministry of Social Affairs and Health emphasizes ensuring adequate regional availability and accessibility of medicines, regardless of the future pharmacy system. It also emphasizes the importance of strong regulation on pharmacy business operations and sale of medicines to ensure medication safety. At the same time, the roadmap requires that the regulation must enable implementation of new patient-oriented services and procedures, and further promote digitalization in service provision. Competition and balance of funding should be enhanced, e.g., through price competition, but the risk of pharmaceutical market concentration should be managed. The regulation should also consider influence of the new social and health care system on drug delivery. Year 2021 will be crucial for making long-term political decisions on the future direction of tasks and finances of Finnish community pharmacies in this framework. Government-funded studies are underway to guide decision making. Ongoing Covid-19 crisis has demonstrated the readiness of Finnish community pharmacies to adapt fast to meet the changing societal needs.
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Affiliation(s)
- Marja Airaksinen
- MSc(Pharm), PhD. Professor, Head of Clinical Pharmacy Group. Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki. Helsinki (Finland).
| | - Terhi Toivo
- MSc(Pharm), PhD. Medication Safety Officer. Tampere University Hospital. Tampere (Finland).
| | - Lenita Jokinen
- MSc(Pharm), PhD. Proprietary pharmacist. Runosmäki Pharmacy. Turku (Finland).
| | - Eeva Savela
- MSc(Pharm), MSc(SocSci), PhD. Proprietary pharmacist. Lohja 1st Pharmacy. Lohja (Finland).
| | - Stina Parkkamäki
- MSc(Pharm), PhD. Proprietary pharmacist. Willan Kehrä Pharmacy. Hyvinkää (Finland).
| | - Charlotta Sandler
- MSc(Pharm), PhD. Director of Pharmaceutical Affairs. The Association of Finnish Pharmacies. Helsinki (Finland).
| | - Hanna Kalliomäki
- MSc(Pharm). Specialist Pharmacist. Helsinki University Hospital Pharmacy. Helsinki (Finland).
| | - Maarit Dimitrow
- MSc(Pharm), PhD. Visiting Scientist. Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki. Helsinki (Finland).
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Fisher L, Fisher A, Smith PN. Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review). J Clin Med 2020; 9:E3253. [PMID: 33053671 PMCID: PMC7600664 DOI: 10.3390/jcm9103253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world's population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI-OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.
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Affiliation(s)
- Leon Fisher
- Department of Gastroenterology, Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
| | - Paul N Smith
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
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Mononen N, Pohjanoksa-Mäntylä M, Airaksinen MS, Hämeen-Anttila K. How far are we from a medication use process aiming at well-informed adherent patients with long-term medications in Finland? Qualitative study. BMJ Open 2020; 10:e036526. [PMID: 32565471 PMCID: PMC7307543 DOI: 10.1136/bmjopen-2019-036526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Finland is one of the few countries that has established a national Medicines Information (MI) Strategy. The ultimate goal of the strategy is a well-implemented medication use process resulting in well-informed adherent patients. This study aimed at evaluating the implementation of the strategy 3 years after its launch. DESIGN The evaluation applied a pragmatic approach and was conducted by interviewing stakeholders involved in the National MI Network enhancing the MI Strategy's implementation. The network comprises national key stakeholders producing and using MI. Data were deductively analysed according to the medication use process of the MI Strategy using the framework method, complemented with inductively derived categories. SETTING National implementation of the MI Strategy throughout the healthcare system after the first operational period (2012-2014) in 2015. PARTICIPANTS The members of the National MI Network (n=79/111, participation rate 71%, representing 42/53 stakeholder organisations). OUTCOME MEASURES A new conceptual framework was developed based on stakeholders' views on well-implemented actions and actions needing development in the medication use process at (1) infrastructure (macro), (2) healthcare professionals (meso) and (3) patient (micro) levels. RESULTS Medication counselling by community pharmacists was the primary implemented action, followed by physicians' actions while starting a new medication, and advice given by nurses. The major development needs concerned (1) poor access to patient information and its transfer in healthcare, particularly the lack of reconciled medication lists and electronic health records (macro); (2) poorly functioning medication use process in home care and social care units, such as nursing homes (meso); and (3) limited patient involvement in their care (micro). CONCLUSIONS Far more actions for development than well-established practices in the medication use process were identified. Major challenges found in this evaluation are considered in the ongoing Rational Pharmacotherapy Action Plan 2018-2022 by the Ministry of Social Affairs and Health.
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Affiliation(s)
- Niina Mononen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Marika Pohjanoksa-Mäntylä
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Marja Sa Airaksinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Katri Hämeen-Anttila
- Assessment of Pharmacotherapies, Finnish Medicines Agency Fimea, Helsinki, Finland
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