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Sluggett JK, Caughey GE, Air T, Lang C, Moldovan M, Martin G, Stafford AC, Carter SR, Jackson S, Wesselingh SL, Inacio MC. Health outcomes following provision of Home Medicines Reviews for older people receiving aged care services at home. Res Social Adm Pharm 2024:S1551-7411(24)00235-3. [PMID: 39187425 DOI: 10.1016/j.sapharm.2024.08.004] [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: 12/18/2023] [Revised: 07/25/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The impact of Home Medicines Reviews (HMRs) on long-term health outcomes among individuals receiving long-term in-home aged care services is unknown. OBJECTIVES To examine associations between HMR provision and hospitalization, long-term care facility (LTCF) entry and mortality among older people receiving long-term in-home aged care services. METHODS This retrospective cohort study included individuals aged 65-105 years from three Australian states who accessed in-home aged care services between 2013 and 2017. Using propensity score matching, HMR recipients (n = 1530) were matched to individuals who did not receive an HMR (n = 1530). Associations between HMR provision and outcomes were estimated using multivariable regression models. RESULTS Over a median of 414 days (interquartile range 217-650) of follow-up, HMR provision was not associated with hospitalizations for unplanned events (subdistribution hazard ratio (sHR) 1.04, 95%CI 0.96-1.14), falls-related hospitalizations (sHR 0.97, 95%CI 0.83-1.13), LTCF entry (sHR 0.97, 95%CI 0.83-1.13), or all-cause mortality (adjusted HR 0.86, 95%CI 0.72-1.01). CONCLUSIONS In a cohort of older people receiving long-term in-home aged care services, no differences in unplanned hospitalizations, falls, LTCF entry or mortality were observed those with HMRs compared to those that did not receive an HMR.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Max Moldovan
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Biometry Hub, Faculty of Sciences, Engineering and Technology, The University of Adelaide, Waite Campus, Urrbrae, South Australia, Australia
| | - Grant Martin
- Australian Association of Consultant Pharmacy, Fyshwick, Australian Capital Territory, Australia
| | - Andrew C Stafford
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Stephen R Carter
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shane Jackson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Steve L Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Roncal-Belzunce V, Gutiérrez-Valencia M, Leache L, Saiz LC, Bell JS, Erviti J, Martínez-Velilla N. Systematic review and meta-analysis on the effectiveness of multidisciplinary interventions to address polypharmacy in community-dwelling older adults. Ageing Res Rev 2024; 98:102317. [PMID: 38692414 DOI: 10.1016/j.arr.2024.102317] [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: 11/26/2023] [Revised: 03/31/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
Interventions to address polypharmacy in community-dwelling older adults often focus on medication-related outcomes. The aim was to explore the impact of multidisciplinary interventions to manage polypharmacy on clinical outcomes for community-dwelling older adults. This systematic review and meta-analysis included randomized controlled trials (RCTs) on interventions by at least a pharmacist and a physician, indexed in MEDLINE, EMBASE or CENTRAL up to January 2023. Evidence certainty was assessed using the GRADE approach. Seventeen RCTs were included. Fifteen were rated as 'high' risk of bias. No relevant benefits were found in functional and cognitive status (primary outcomes), falls, mortality, quality of life, patient satisfaction, hospital admissions, emergency department or primary care visits. Interventions reduced medication costs, improved medication appropriateness (odds ratio [OR] 0.39), reduced number of medications (mean difference [MD] -0.57), resolved medication-related problems (MD -0.45), and improved medication adherence (relative risk [RR] 1.14). There was a low or very low certainty of the evidence for most outcomes. Multidisciplinary interventions to address polypharmacy appear effective in improving multiple dimensions of medication use. However, evidence for corresponding improvements in functional or cognitive status is scarce. New efficient models of multidisciplinary interventions to address polypharmacy impacting clinical outcomes should be explored.
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Affiliation(s)
- Victoria Roncal-Belzunce
- Public University of Navarre (UPNA), Pamplona, Navarre, Spain; Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain.
| | - Marta Gutiérrez-Valencia
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain; Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.
| | - Leire Leache
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain; Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.
| | - Luis Carlos Saiz
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain; Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
| | - Juan Erviti
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain; Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.
| | - Nicolás Martínez-Velilla
- Public University of Navarre (UPNA), Pamplona, Navarre, Spain; Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain; Hospital Universitario de Navarra (HUN)- Navarrabiomed, Pamplona, Navarre, Spain.
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Kim IJ, Ryu G, Rhie SJ, Kim HJ. Pharmacist interventions in Asian healthcare environments for older people: a systematic review and meta-analysis on hospitalization, mortality, and quality of life. BMC Geriatr 2024; 24:513. [PMID: 38867148 PMCID: PMC11170896 DOI: 10.1186/s12877-024-05089-9] [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: 02/07/2024] [Accepted: 05/17/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Pharmaceutical interventions play a key role in the care of older people experiencing polypharmacy. Despite the rapid increase in the aging population in Asia, there is a lack of evidence regarding the effectiveness of pharmacist interventions on older adult's healthcare. This systematic review and meta-analysis assessed the effects of pharmacist interventions in Asian health care environments on hospitalization, mortality, and quality of life (QoL) among older people in Asia. METHODS A comprehensive search was conducted across 5 databases, encompassing studies published from inception through June 2023. Only studies involving pharmacist interventions for people aged 65 years or older, residing in Asian countries, were considered. Studies without evidence of pharmacist involvement or conducted outside of Asia were excluded. Data extraction was performed by two reviewers, one reviewer (I.K.) performed the initial extraction, and another reviewer (G.R.) verified the extracted data. Forest plots were generated using a random effects model to obtain risk ratios or pooled standardized mean differences (SMDs). RESULTS A total of 170 articles underwent thorough review, and ultimately, ten studies meeting the inclusion criteria were included in the meta-analyses. These studies encompassed diverse healthcare settings such as outpatient, inpatient, and nursing homes, with sample sizes ranging from 32 to 306 older people. Pharmacist interventions were found to significantly reduce hospitalization rates (n = 5, risk ratio = 0.57, 95% CI = 0.41-0.81) and mortality rates (n = 4, risk ratio = 0.57, 95% CI = 0.37-0.88) among older people. The analysis revealed less significant improvement in QoL in these patients than in those receiving usual care (n = 6, SMD = 0.36, P = 0.057). CONCLUSIONS These findings highlight the crucial role of pharmacists within healthcare teams in Asian countries. Pharmacist interventions have an impact on reducing hospitalization and mortality rates among the elderly people, underscoring the importance of optimizing patient outcomes in Asia.
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Affiliation(s)
- In-Ja Kim
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Research Institute of Pharmaceutical Science, Ewha Womans University, 52 Ewhayeodae-Gil, Seodaemun-Gu, Seoul, 03760, Republic of Korea
| | - Gina Ryu
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Research Institute of Pharmaceutical Science, Ewha Womans University, 52 Ewhayeodae-Gil, Seodaemun-Gu, Seoul, 03760, Republic of Korea
| | - Sandy Jeong Rhie
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Research Institute of Pharmaceutical Science, Ewha Womans University, 52 Ewhayeodae-Gil, Seodaemun-Gu, Seoul, 03760, Republic of Korea
| | - Hwa-Jung Kim
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Research Institute of Pharmaceutical Science, Ewha Womans University, 52 Ewhayeodae-Gil, Seodaemun-Gu, Seoul, 03760, Republic of Korea.
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Taguchi R, Hamada S, Michihata N, Tsuchiya-Ito R, Kitamura S, Ishikawa T, Iwagami M. Factors associated with the introduction of visiting-pharmacist services in older adults in Japan: A nested case-control study. Geriatr Gerontol Int 2024; 24:344-351. [PMID: 38379434 DOI: 10.1111/ggi.14838] [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: 10/25/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 02/22/2024]
Abstract
AIM To investigate the factors associated with introducing visiting-pharmacist services for community-dwelling older adults in Japan. METHODS We conducted a nested case-control study using claims data in a cohort from a city in Tokyo. Patients aged ≥65 years who received visiting-pharmacist services for the first time between April 2014 and March 2020 were considered case patients. A maximum of four controls to each case patient were randomly selected on the basis of sex, age, health insurance systems, and month-year. Medical and long-term care service usage and patient condition were assessed using claims data from the index and preceding months, along with long-term care needs certification data. Multivariable conditional logistic regression analysis was conducted to estimate the adjusted odds ratios with 95% confidence intervals for factors associated with visiting-pharmacist service introduction. RESULTS A total of 22 949 participants (4591 cases and 18 358 controls) were included, with a median age of 85 years; 59.3% were women. The adjusted odds ratios (95% confidence intervals) of the three most related factors were 27.61 (23.98-31.80) for physicians' home visits, 5.83 (5.08-6.70) for hospitalization, and 4.97 (4.16-5.95) for designated-facility admission. Factors such as prescribing ≧10 medications, visiting nursing, and cancer were positively associated. In contrast, low household income and a high need for support due to cognitive function or disability were negatively associated. CONCLUSIONS This study provides insights into the introduction of visiting-pharmacist services for older adults in Japan. Geriatr Gerontol Int 2024; 24: 344-351.
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Affiliation(s)
- Reina Taguchi
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Rumiko Tsuchiya-Ito
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Satomi Kitamura
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Tomoki Ishikawa
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Kelly WN, Ho MJ, Smith T, Bullers K, Kumar A. Association of pharmacist intervention counseling with medication adherence and quality of life: A systematic review and meta-analysis of randomized trials. J Am Pharm Assoc (2003) 2023; 63:1095-1105. [PMID: 37142053 DOI: 10.1016/j.japh.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE(S) To assess the association between pharmacist intervention counseling with medication adherence and quality of life. Also, to assess if these associations vary by the focus, structure, training, or robustness of the counseling. METHODS The initial search identified 1805 references, of which 62 randomized trials (RCTs) met inclusion criteria for the systematic review. Of the 62 RCTs, 60 (with 62 results) had extractable data for the meta-analysis. Data were pooled using a random-effects model. RESULTS Most study patients were older and taking multiple prescription drugs. The pooled results showed a statistically significant increase in the odds of medication adherence with the pharmacist counseling intervention versus no counseling (pooled odds ratio [OR] = 4.41; 95% confidence interval [CI] 2.46-7.91; P < 0.01). The results of a subgroup analysis suggest the primary disease, counseling focus, location, and robustness may modify the effect of pharmacist counseling on medication adherence. There was a statistically significant improvement in the quality of life with pharmacist counseling versus no pharmacist counseling (pooled standardized mean difference [SMD] = 0.69; 95% CI 0.41-0.96; P < 0.01). The results of a subgroup analysis suggest that counseling focus, location, training, robustness, and the measurement method, but not the disease category, may modify the effect of pharmacist counseling on quality of life. CONCLUSION The evidence supports pharmacist intervention counseling to increase mediation adherence and quality of life. The counseling location and structure may be significant factors in improving medication adherence. The overall methodological quality of evidence was very low.
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Al-Diery T, Freeman H, Page AT, Cross AJ, Hawthorne D, Lee K. What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis. Int J Clin Pharm 2023:10.1007/s11096-023-01561-5. [PMID: 36932315 DOI: 10.1007/s11096-023-01561-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/17/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Comprehensive medication management reviews are an established intervention to identify medication-related problems, such as the prescribing of potentially inappropriate medications, and under- and over-prescribing. However, the types of information included in written reports of comprehensive medication management reviews, beyond types of medication-related problems, are unknown. AIM This study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews. METHOD Australian consultant pharmacists were invited to upload their 10 most recent written reports of their domiciliary-based comprehensive medication management reviews. A random selection of the reports, stratified by each pharmacist, were included for qualitative content analysis. RESULTS Seventy-two de-identified reports from eight consultant pharmacists located in five of the eight Australian States and Territories were included for analysis. From the evaluated reports, four major categories of information were identified: (1) patient details such as date of interview (n = 72, 100%) and medicine history (n = 70, 97%); (2) pharmacist assessment including assessment of the patient (n = 70, 97%), medicines management (n = 68, 94%) and medicine-related issues (n = 60, 83%); (3) pharmacist recommendations, specifically pharmacological recommendations (n = 67, 93%); and (4) patient-centred experiences such as perspectives on medicines (n = 56, 78%). Reporting of patient-centred experiences appeared most variably in the included reports, including patient concerns (n = 38, 53%), willingness for change (n = 27, 38%), patient preferences (n = 13, 18%), and patient goals (n = 7, 10%). CONCLUSION Pharmacists within our study included a wide variety of information in their comprehensive medication management review reports. Aside from medication-related problems, pharmacists commonly provided a holistic assessment of the patients they care for. However, variability across reports has the potential to impact consistent service delivery.
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Affiliation(s)
| | - Hollie Freeman
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia
| | - Amy Theresa Page
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.,Western Australian Centre for Health and Ageing, School of Allied Health, University of Western Australia, Perth, Australia.,Consultant Pharmacist Services Research Network, Coherent, Australia
| | - Amanda J Cross
- Consultant Pharmacist Services Research Network, Coherent, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Australia
| | - Deborah Hawthorne
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.,Western Australian Centre for Health and Ageing, School of Allied Health, University of Western Australia, Perth, Australia.,Consultant Pharmacist Services Research Network, Coherent, Australia
| | - Kenneth Lee
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Australia
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An Overview of Systematic Reviews and Meta-Analyses on the Effect of Medication Interventions Targeting Polypharmacy for Frail Older Adults. J Clin Med 2023; 12:jcm12041379. [PMID: 36835915 PMCID: PMC9960328 DOI: 10.3390/jcm12041379] [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: 11/21/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023] Open
Abstract
Frailty refers to the lack of resilience and a reduction in a person's ability to recover following a health problem, and it is increasingly becoming a challenging aspect of ageing populations. Many older adults are exposed to polypharmacy; i.e., they continue to be on medications without timely re-evaluation. Medication reviews have proven successful in managing polypharmacy in the general population, but there is uncertainty regarding their effect among frail older adults. This overview of published systematic reviews assesses the impact of medication reviews on polypharmacy in frail older adults. Embase was searched from its inception to January 2021 and 28 systematic reviews were identified, out of which 10 were included in the overview. Medication reviews were the most common intervention in 8 out of 10 systematic reviews. The frailty score was reported as an outcome in one systematic review that found no evidence for fundamental pharmacological effects on frailty. Six systematic reviews reported a statistically significant reduction in the number of inappropriately prescribed medications. Four systematic reviews reported on hospital admissions, with two of them reporting a decrease in hospitalisations. The quality assessment was moderate in six and critically low in four of the systematic reviews. We conclude that medication reviews help in reducing the use of inappropriate medications in frail older adults, but that there is insufficient evidence in terms of frailty score and hospital admissions.
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Lau CLL, Hor CY, Ong ST, Roslan MF, Beh XY, Permal D, Rama S. Home medication management problems and associated factors among psychiatric patients using home care pharmacy services at government hospitals in western Malaysia. BMC Health Serv Res 2022; 22:726. [PMID: 35650614 PMCID: PMC9157038 DOI: 10.1186/s12913-022-08069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Proper home medication management plays a role in improving medication adherence, preserving drug efficacy and ensuring safe medication practices, which is crucial to establish positive treatment outcomes. However, no published studies are available on home medication management among psychiatric patients. The study aimed to identify home medication management problems among psychiatric patients in Malaysia and to examine the associations of inappropriate medication storage and lack of a medication administration schedule with sociodemographic factors, disease insight, number of medications and type of home care pharmacy services (HCPS). Methods This multicentre cross-sectional study was conducted among psychiatric patients using HCPS in six government hospitals in western Malaysia. Data were extracted from the HCPS form used for each visit as per the protocol published by the Pharmaceutical Services Division, Ministry of Health Malaysia. A minimum sample size of 169 was needed. Proportional random sampling was applied. The associations of inappropriate medication storage and lack of medication administration schedule with study parameters were analysed using multiple logistic regressions. Results A total of 205 home visits were conducted with 229 home medication management problems identified; inappropriate medication storage and lack of medication administration schedule topped the list. Inappropriate medication storage was significantly associated with low income [AOR = 4.34 (95% CI 1.17:15.98), p = 0.027], alcohol consumption [AOR = 14.26 (95% CI 1.82:111.38), p = 0.011], poor insight [AOR = 2.34 (95% CI 1.08:5.06), p = 0.030] and part-time HCPS [AOR = 2.60 (95% CI 1.20:5.67), p = 0.016]. Lack of administration schedule was significantly associated with low income [AOR = 6.90 (95% CI 1.46:32.48), p = 0.014], smoking [AOR = 2.43 (95% CI 1.20:4.92), p = 0.013], poor insight [AOR = 5.32 (95% CI 2.45:11.56), p < 0.05] and part-time HCPS [AOR = 2.96 (95% CI 1.42:6.15), p = 0.004]. Conclusions Inappropriate medication storage and a lack of a medication administration schedule are common among psychiatric patients. The study also highlighted the potential of HCPS to improve disease insight and home medication management among psychiatric patients if the service is utilized fully.
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Affiliation(s)
- Christine Li Ling Lau
- Pharmacy Department, Bahagia Ulu Kinta Hospital, Ministry of Health Malaysia, Jalan Besar, 31250, Tanjung Rambutan, Perak, Malaysia.
| | - Cheah Yen Hor
- Pharmacy Department, Seri Manjung Hospital, Ministry of Health Malaysia, Seri Manjung, Perak, Malaysia
| | - Siew Ting Ong
- Pharmacy Department, Teluk Intan Hospital, Ministry of Health Malaysia, Teluk Intan, Perak, Malaysia
| | - Muhammad Fadhlullah Roslan
- Pharmacy Department, Raja Permaisuri Bainun Hospital, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
| | - Xin Yi Beh
- Pharmacy Department, Taiping Hospital, Ministry of Health Malaysia, Taiping, Perak, Malaysia
| | - Dashnilatha Permal
- Pharmacy Department, Slim River Hospital, Ministry of Health Malaysia, Slim River, Perak, Malaysia
| | - Shamini Rama
- Pharmacy Department, Raja Permaisuri Bainun Hospital, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
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Reducing Medication Problems among Minority Individuals with Low Socioeconomic Status through Pharmacist Home Visits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074234. [PMID: 35409914 PMCID: PMC8998841 DOI: 10.3390/ijerph19074234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/10/2022]
Abstract
Introduction: In this study, pharmacists conducted home visits for individuals of medically underserved populations in Taiwan (i.e., socioeconomically disadvantaged individuals, middle-aged or older adults, and individuals living alone, with dementia, or with disabilities) to understand their medication habits. We quantified medication problems among various groups and investigated whether the pharmacist home visits helped to reduce the medication problems. Materials and Methods: From April 2016 to March 2019, pharmacists visited the homes of the aforementioned medically underserved individuals in Taipei to evaluate their drug-related problems and medication problems. Age, living alone, diagnoses of dementia or disabilities, and socioeconomic disadvantages contributed significantly to inadequate disease and medical treatment knowledge and self-care skills as well as lifestyle inappropriateness among patients. The patients who were living alone and socioeconomically disadvantaged stored their drugs in inappropriate environments. Results: After the pharmacists visited the patients’ homes twice, the patients improved considerably in their disease and medical treatment knowledge, self-care skills, and lifestyles (p < 0.001). Problems related to the uninstructed reduction or discontinuation of drug use (p < 0.05) and use of expired drugs (p < 0.001) were also mitigated substantially. Discussion and conclusion: Through the home visits, the pharmacists came to fully understand the medicine (including Chinese medicine) and health food usage behaviors of the patients and their lifestyles, enabling them to provide thorough health education. After the pharmacists’ home visits, the patients’ drug-related problems were mitigated, and their knowledge of diseases, drug compliance, and drug storage methods and environments improved, reducing drug waste. Our findings can help policymakers address the medication problems of various medically underserved groups, thereby improving the utilization of limited medical resources.
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McCormick P, Coleman B, Bates I. The value of domiciliary medication reviews - a thematic analysis of pharmacist's views. Int J Clin Pharm 2022; 44:1004-1012. [PMID: 35834092 PMCID: PMC9393132 DOI: 10.1007/s11096-022-01427-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Domiciliary medication reviews are thought to enable comprehensive medication reviews centred around the needs of individuals. However, there is no clear consensus on where the value of these services lie. AIM To determine the value of domiciliary medication reviews to service providers through semi-structured focus groups, interviews and thematic analysis. METHOD Study participants were recruited from domiciliary medication review services provided in the United Kingdom. Semi-structured focus groups and interviews were analysed using thematic analysis. RESULTS Six themes were identified: the scope of domiciliary medication review services, the professional role, advantages over traditional settings, disadvantages of domiciliary medication reviews for the professional, levels of engagement and outcomes. CONCLUSION Pharmacy professionals believe that the domiciliary setting provides advantages over traditional healthcare settings when conducting medication reviews. They believe it enables a more in-depth review of an individual's medications and needs. The traditional clinical outcomes recorded by services may not be capturing the holistic impact of domiciliary medication reviews.
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Affiliation(s)
- Patricia McCormick
- School of Pharmacy, University College London, 29-39 Brunswick Square, Bloomsbury, WC1N 1AX, London, England. .,Level 1, Pharmacy Department, Whittington Health, Whittington Hospital, Magdala Avenue, N19 5NF, London, England.
| | - Bridget Coleman
- Level 1, Pharmacy Department, Whittington Health, Whittington Hospital, Magdala Avenue, N19 5NF London, England
| | - Ian Bates
- School of Pharmacy, University College London, 29-39 Brunswick Square, Bloomsbury, WC1N 1AX London, England
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11
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Farag M, Hoti K, Hughes J, Chalmers L. Impact of a clinical pharmacist on medication safety in mental health Hospital-in-the-Home: a retrospective analysis. Int J Clin Pharm 2022; 44:947-955. [PMID: 35438472 PMCID: PMC9016122 DOI: 10.1007/s11096-022-01409-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Integration of clinical pharmacists into multidisciplinary Mental Health Hospital-in-the-Home teams is increasing but little is known about the medication safety contribution these pharmacists make. AIM To evaluate whether clinical pharmacist involvement in a Mental Health Hospital-in-the-Home service improved medication safety key performance indicators. METHOD Medical records were retrospectively reviewed of all patients admitted to 2 Western Australian Mental Health Hospital-in-the-Home services from September to November 2015. SITE 1: was a 16-bed service incorporating a clinical pharmacist as part of its multidisciplinary team. SITE 2: was a similarly structured 18-bed service but without clinical pharmacist involvement. The primary outcome measure was completion of medication safety key performance indicators obtained from the Western Australian Government Pharmaceutical Review Policy and mental health-specific best practice guidelines. RESULTS Key performance indicators from Site 1 (n = 75 records), which incorporated a clinical pharmacist, demonstrated significantly (p < 0.001) higher rates of completion of medication reconciliation [65 (87%) versus 17 (29%)], accurate adverse drug reaction list [73 (97%) versus 34 (58%)], accurate discharge medication list [51 (74%) versus 18 (45%)], accurate medication profile [74 (99%) versus 40 (68%)] and medication chart review [74 (99%) versus 0 (0%)] than Site 2 (n = 59). CONCLUSION Integrating a clinical pharmacist into a Mental Health Hospital-in-the-Home program significantly improved achievement of medication safety key performance indicators.
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Affiliation(s)
- Mechaiel Farag
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,North Metropolitan Health Service-Mental Health Pharmacy, Brockway Road, Mount Claremont, WA, 6010, Australia.
| | - Kreshnik Hoti
- grid.1032.00000 0004 0375 4078Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102 Australia ,grid.449627.a0000 0000 9804 9646Division of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Jeff Hughes
- grid.1032.00000 0004 0375 4078Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102 Australia
| | - Leanne Chalmers
- grid.1032.00000 0004 0375 4078Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102 Australia
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12
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Parodi López N, Svensson SA, Wallerstedt SM. Association between recorded medication reviews in primary care and adequate drug treatment management - a cross-sectional study. Scand J Prim Health Care 2021; 39:419-428. [PMID: 34549673 PMCID: PMC8725889 DOI: 10.1080/02813432.2021.1973239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/11/2021] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To investigate the association between a recorded procedure code for a medication review and adequate drug treatment management, and to explore factors associated with this code. DESIGN AND SETTING Cross-sectional study; two primary health care centres, in Region Västra Götaland, Sweden. SUBJECTS A total of 302 consecutive patients (≥65 years old, 59% female; median number of drugs: six) requiring a non-urgent consultation with a physician in October-November 2017. MAIN OUTCOME MEASURE Adequate drug treatment management (treatment that did not require any further action), determined in consensus by two specialists in family medicine blinded to the medication review code. RESULTS Adequate drug treatment management was, overall, less common in those with a recorded medication review over the last year: 63% versus 73% (p = 0.047). This negative association was evident among patients aged 65-74 years: 49% versus 74% (p = 0.003), but absent in those ≥75 years old: 67% versus 70% (p = 0.77). Recommendations from consensus included the search for additional information to be able to make a decision regarding initiation or withdrawal of a drug (n = 53), withdrawal of a drug (n = 41), or ordering a laboratory test (n = 25). Factors associated with a recorded procedure code included age above the remuneration limit of 75 years (odds ratio: 9.8; 95% confidence interval 5.0-19), type 2 diabetes (3.0 (1.5-6.2)), hypertension (2.4 (1.2-4.8)), and depression (2.5 (1.02-6.0)). CONCLUSIONS The presence of a recorded medication review was not positively associated with adequate drug treatment management but was associated with the age limit for remuneration, and some chronic diseases.Key pointsTo improve drug treatment in older people in primary care, a remuneration system linked to recorded medication reviews has been introduced.In this study, fewer patients with than without a recorded medication review (63% versus 73%) had adequate drug treatment management.A recorded medication review was ten times more common in those ≥75 years, that is, the age limit for remuneration.Recorded codes for medication reviews were also common in those with type 2 diabetes, hypertension, and depression.
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Affiliation(s)
- Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden
| | - Staffan A. Svensson
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Hjällbo Health Centre, Gothenburg, Sweden
| | - Susanna M. Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- HTA-Centrum, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Albert V, Baumgartner PC, Hersberger KE, Arnet I. How do elderly outpatients manage polypharmacy including DOAC - A qualitative analysis highlighting a need for counselling. Res Social Adm Pharm 2021; 18:3019-3026. [PMID: 34393080 DOI: 10.1016/j.sapharm.2021.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with polypharmacy are challenged with the management of their daily medication. Medication management strategies for direct oral anticoagulants (DOAC) are especially important to guarantee medication adherence and to prevent thromboembolic events. Patients are often left alone with finding an appropriate strategy. OBJECTIVE(S) To explore medication management strategies, to measure adherence to DOAC with the aim of deducing recommendations for practice. METHODS Face-to-face semi-structured interviews were conducted at the home of outpatients who were taking ≥4 medications daily including a DOAC, and self-managing their medication. A small electronic device (Time4Med™) was given to record medication intake during the four following weeks. During a second home visit, participants saw a graph of their medication intake as dot chart, and obtained a feedback. Interviews were transcribed verbatim and thematically analysed. Medication adherence was calculated with electronic data. RESULTS Eighteen individuals (61.1% female; median age 77.5 years) were interviewed and reported 30 different medication management strategies, together with triggers, advantages and limitations. They combined at least five strategies, composed of internal (memory-based) and external (packaging-based or intake-based) strategies. The number of strategies was neither associated with the number of medications nor with medication adherence. Taking adherence was <100% for eight patients (44.4%). The inability of any medication management strategy to adapt to ageing and cognitive decline emerged as its most dramatic limitation, especially because individuals would fail to notice when their strategy became unsuited. CONCLUSIONS Elderly patients develop manifold medication management strategies, which can inspire future medication users. Limitations are present such as forgetting medication intake in spite of a management strategy. The moment to adapt the strategy to ageing or cognitive decline is crucial and often goes unnoticed. It is therefore decisive that healthcare professionals regularly re-evaluate the appropriateness of the medication management strategies during counselling or ideally during home visits.
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Affiliation(s)
- Valerie Albert
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001, Basel, Switzerland.
| | - Pascal C Baumgartner
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001, Basel, Switzerland.
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001, Basel, Switzerland.
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001, Basel, Switzerland.
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14
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McCormick P, Coleman B, Bates I. The value of domiciliary medication reviews: a thematic analysis of patient views. Int J Clin Pharm 2021; 43:1594-1601. [PMID: 34085186 PMCID: PMC8642367 DOI: 10.1007/s11096-021-01288-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
Background Medication reviews are recognised as essential to tackling problematic polypharmacy. Domiciliary medication reviews (DMRs) have become more prevalent in recent years. They are proclaimed as being patient-centric but published literature mainly focuses on clinical outcomes. However, it is not known where the value of DMRs lies for patients who participate in them. Objective To determine the value of domiciliary medication reviews to service users. Setting Interviews took place with recipients of domiciliary medication reviews residing in the London boroughs of Islington and Haringey. Method Semi-structured interviews analysed using thematic analysis. Main outcome measure Themes and sub-themes identified from interview transcripts. Results Five themes were identified: advantages over traditional settings, attributes of the professional, adherence, levels of engagement and knowledge. Conclusion For many patients, the domiciliary setting is preferred to traditional healthcare settings. Patients appreciated the time spent with them during a DMR and felt listened to. Informal carers felt reassured that the individual medication needs of their relative had been reviewed by an expert.
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Affiliation(s)
- Patricia McCormick
- School of Pharmacy, University College London, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX, UK. .,Pharmacy Department, Whittington Health, Magdala Avenue, London, N19 5NF, UK.
| | - Bridget Coleman
- Pharmacy Department, Whittington Health, Magdala Avenue, London, N19 5NF, UK
| | - Ian Bates
- School of Pharmacy, University College London, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX, UK
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15
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Uitvlugt EB, Heer SEND, van den Bemt BJF, Bet PM, Sombogaard F, Hugtenburg JG, van den Bemt PMLA, Karapinar-Çarkit F. The effect of a transitional pharmaceutical care program on the occurrence of ADEs after discharge from hospital in patients with polypharmacy. Res Social Adm Pharm 2021; 18:2651-2658. [PMID: 34049802 DOI: 10.1016/j.sapharm.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Transitional care programs (i.e. interventions delivered both in hospital and in primary care), could increase continuity and consequently quality of care. However, limited studies on the effect of these programs on Adverse Drug Events (ADEs) post-discharge are available. Therefore, the aim of this study was to investigate the effect of a transitional pharmaceutical care program on the occurrence of ADEs 4 weeks post-discharge. METHODS A multicentre prospective before-after study was performed in a general teaching hospital, a university hospital and 49 community pharmacies. The transitional pharmaceutical care program consisted of: teach-back to the patient at discharge, a pharmaceutical discharge letter, a home visit by a community pharmacist and a clinical medication review by both the community and the clinical pharmacist, on top of usual care. Usual care consisted of medication reconciliation at admission and discharge by pharmacy teams. The primary outcome was the proportion of patients who reported at least 1 ADE 4 weeks post-discharge. Multivariable logistic regression was used to adjust for potential confounders. RESULTS In total, 369 patients were included (control: n = 195, intervention: n = 174). The proportion of patients with at least 1 ADE did not statistically significant differ between the intervention and control group (general teaching hospital: 59% vs. 67%, ORadj 0.70 [95% CI 0.38-1.31], university hospital: 63% vs 50%, OR adj 1.76 [95% CI 0.75-4.13]). CONCLUSION The transitional pharmaceutical care program did not decrease the proportion of patients with ADEs after discharge. ADEs after discharge were common and more than 50% of patients reported at least 1 ADE. A process evaluation is needed to gain insight into how a transitional pharmaceutical care program could diminish those ADEs.
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Affiliation(s)
- Elien B Uitvlugt
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
| | - Selma En-Nasery-de Heer
- Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands. Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
| | - Ferdi Sombogaard
- Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
| | - Patricia M L A van den Bemt
- University Medical Center Rotterdam, Department of Hospital Pharmacy. University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
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16
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Delgado-Silveira E, Vélez-Díaz-Pallarés M, Muñoz-García M, Correa-Pérez A, Álvarez-Díaz AM, Cruz-Jentoft AJ. Effects of hospital pharmacist interventions on health outcomes in older polymedicated inpatients: a scoping review. Eur Geriatr Med 2021; 12:509-544. [PMID: 33959912 DOI: 10.1007/s41999-021-00487-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/16/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE To identify the evidence that supports the effect of interventions made by hospital pharmacists, individually or in collaboration with a multidisciplinary team, in terms of healthcare outcomes, a more effective utilization of resources and lower costs in older polymedicated inpatients. METHODS We searched the following databases: MEDLINE, EMBASE and the Cochrane Library. We also conducted a hand search by checking the references cited in the primary studies and studies included in reviews identified during the process of research. Four review authors working by pairs searched for studies, extracted data, and drew up the results tables. RESULTS Twenty-six studies were included in the review. In 13 of them pharmacists carried out their intervention exclusively while the patients were in hospital, whereas in 13 interventions were delivered during admission and after hospital discharge. Outcomes identified were mortality, length of stay, visits to the emergency department, readmissions and reported quality of life, among others. Pharmacist interventions were found to be beneficial in fifteen studies, specifically on hospital readmissions, visits to the emergency department and healthcare costs. CONCLUSION There is no hard evidence demonstrating the effectiveness of hospital pharmacist interventions in older polymedicated patients. Mortality does not show as a relevant outcome. Other health care outcomes, such as hospital readmissions, visits to the emergency department and healthcare costs, seem to be more relevant and amenable to change. Interventions that include pharmacists in multidisciplinary geriatric teams seem to be more promising that isolated pharmacist interventions. Interventions prolonged after hospital discharge seem to be more appropriate that interventions delivered only during hospital admission. Better-designed studies should be conducted in the future to provide further insight into the effect of hospital pharmacist interventions.
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Affiliation(s)
- E Delgado-Silveira
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.
| | | | - M Muñoz-García
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - A Correa-Pérez
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.,Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - A M Álvarez-Díaz
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - A J Cruz-Jentoft
- Geriatric Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
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17
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Laroche ML, Van Ngo TH, Sirois C, Daveluy A, Guillaumin M, Valnet-Rabier MB, Grau M, Roux B, Merle L. Mapping of drug-related problems among older adults conciliating medical and pharmaceutical approaches. Eur Geriatr Med 2021; 12:485-497. [PMID: 33745106 DOI: 10.1007/s41999-021-00482-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To lay the fundamentals of drug-related problems (DRPs) in older adults, and to organize them according to a logical process conciliating medical and pharmaceutical approaches, to better identify the causes and consequences of DRPs. MATERIALS AND METHODS A narrative overview. RESULTS The causes of DRPs may be intentional or unintentional. They lie in poor prescription, poor adherence, medication errors (MEs) and substance use disorders (SUD). Poor prescription encompasses sub-optimal or off-label drug choice; this choice is either intentional or unintentional, often within a polypharmacy context and not taking sufficiently into account the patient's clinical condition. Poor adherence is often the consequence of a complicated administration schedule. This review shows that MEs are not the most frequent causes of DRPs. SUD are little studied in older adults and needs to be more investigated because the use of psychoactive substances among older people is frequent. Prescribers, pharmacists, nurses, patients, and caregivers all play a role in different causes of DRPs. The potential deleterious outcomes of DRPs result from adverse drug reactions and therapeutic failures. These can lead to a negative benefit-risk ratio for a given treatment regimen. DISCUSSION/CONCLUSION Interdisciplinary pharmacotherapy programs show significant clinical impacts in preventing or resolving adverse drug events and, suboptimal responses. New technologies also seem to be interesting solutions to prevent MEs. Better communication between healthcare professionals, patients and their caregivers would ensure greater safety and effectiveness of treatments.
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Affiliation(s)
- Marie-Laure Laroche
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France. .,Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France. .,Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France.
| | - Thi Hong Van Ngo
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France
| | - Caroline Sirois
- Université Laval, Faculté de Pharmacie, Québec, Canada.,Centre de Recherche VITAM en Santé Durable, Centre D'excellence sur le Vieillissement de Québec, Québec, Canada
| | - Amélie Daveluy
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
| | - Michel Guillaumin
- Centre de Pharmacovigilance de Pharmacoépidémiologie et d'information sur les Médicaments de-Franche Comté, CHU Besançon, Besançon, France.,Département de Gériatrie, CHU de Besançon, Besançon, France
| | - Marie-Blanche Valnet-Rabier
- Centre de Pharmacovigilance de Pharmacoépidémiologie et d'information sur les Médicaments de-Franche Comté, CHU Besançon, Besançon, France
| | - Muriel Grau
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France
| | - Barbara Roux
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France
| | - Louis Merle
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France
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18
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Jordan S, Prout H, Carter N, Dicomidis J, Hayes J, Round J, Carson-Stevens A. Nobody ever questions-Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative. PLoS One 2021; 16:e0244519. [PMID: 33411824 PMCID: PMC7790299 DOI: 10.1371/journal.pone.0244519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/10/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Nurse-led monitoring of patients for signs and symptoms associated with documented 'undesirable effects' of medicines has potential to prevent avoidable harm, and optimise prescribing. INTERVENTION The Adverse Drug Reaction Profile for polypharmacy (ADRe-p) identifies and documents putative adverse effects of medicines commonly prescribed in primary care. Nurses address some problems, before passing ADRe-p to pharmacists and prescribers for review, in conjunction with prescriptions. OBJECTIVES We investigated changes in: the number and nature of residents' problems as recorded on ADRe-p; prescription regimens; medicines optimisation: and healthcare costs. We explored aetiologies of problems identified and stakeholders' perspectives. SETTING AND PARTICIPANTS In three UK care homes, 19 residents completed the study, December 2018 to May 2019. Two service users, three pharmacists, six nurses gave interviews. METHODS This mixed-method process evaluation integrated data from residents' ADRe-ps and medicines charts, at the study's start and 5-10 weeks later. RESULTS We recruited three of 27 homes approached and 26 of 45 eligible residents; 19 completed ADRe-p at least twice. Clinical gains were identified for 17/19 residents (mean number of symptoms 3 SD 1.67, range 0-7). Examples included management of: pain (six residents), seizures (three), dyspnoea (one), diarrhoea (laxatives reduced, two), falls (two of five able to stand). One or more medicine was de-prescribed or dose reduced for 12/19 residents. ADRe administration and review cost ~£30 in staff time. ADRe-p helped carers and nurses bring residents' problems to the attention of prescribers. IMPLICATIONS ADRe-p relieved unnecessary suffering. It supported carers and nurses by providing a tool to engage with pharmacists and prescribers, and was the only observable strategy for multidisciplinary team working around medicines optimisation. ADRe-p improved care by: a) regular systematic checks and problem documentation; b) information transfer from care home staff to prescribers and pharmacists; c) recording changes. REGISTRATION NLM Identifier NCT03955133; ClinicalTrials.gov.
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Affiliation(s)
- Sue Jordan
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Hayley Prout
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Neil Carter
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
| | - John Dicomidis
- Care Home Governance and National Lead Pharmacy Informatics, Pontypool, Wales, United Kingdom
| | - Jamie Hayes
- School of Pharmacy and Pharmaceutical Sciences, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Jeffrey Round
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
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