1
|
Gerard E, Quindroit P, Calafiore M, Baran J, Gautier S, Genay S, Decaudin B, Lemaitre M, Vambergue A, Beuscart JB. Development of explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A multidisciplinary qualitative study. PLoS One 2024; 19:e0309290. [PMID: 39331645 PMCID: PMC11432865 DOI: 10.1371/journal.pone.0309290] [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: 03/01/2024] [Accepted: 08/09/2024] [Indexed: 09/29/2024] Open
Abstract
PURPOSE The management of type 2 diabetes mellitus patients has changed over the past decade, and a large number of antidiabetic drug treatment options are now available. This complexity poses challenges for healthcare professionals and may result in potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus which can be limited using screening tools. The effectiveness of explicit tools such as lists of potentially inappropriate prescriptions has been widely demonstrated. The aim was to set up nominal groups of healthcare professionals from several disciplines and develop a list of explicit definition of potentially inappropriate prescriptions of antidiabetic drugs. METHODS In a qualitative, nominal-groups approach, 30 diabetologists, general practitioners, and pharmacists in France developed explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus. A nominal group technique is a structured method that encourages all the participants to contribute and makes it easier to reach an agreement quickly. Each meeting lasted for two hours. RESULTS The three nominal groups comprised 14 pharmacists, 10 diabetologists, and 6 general practitioners and generated 89 explicit definitions. These definitions were subsequently merged and validated by the steering committee and nominal group participants, resulting in 38 validated explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs. The definitions encompassed four contexts: (i) the temporary discontinuation of a medication during acute illness (n = 9; 24%), (ii) dose level adjustments (n = 23; 60%), (iii) inappropriate treatment initiation (n = 3; 8%), and (iv) the need for further monitoring in the management of type 2 diabetes mellitus (n = 3; 8%). CONCLUSION The results of our qualitative study show that it is possible to develop a specific list of explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus by gathering the opinions of healthcare professionals caring for these patients. This list of 38 explicit definitions necessitates additional confirmation by expert consensus before use in clinical practice.
Collapse
Affiliation(s)
- Erwin Gerard
- CHU Lille, ULR 2694 - METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Univ. Lille, Lille, France
| | - Paul Quindroit
- CHU Lille, ULR 2694 - METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Univ. Lille, Lille, France
| | - Matthieu Calafiore
- CHU Lille, ULR 2694 - METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Univ. Lille, Lille, France
- Department of General Practice, University of Lille, Lille, Lille, France
| | - Jan Baran
- Department of General Practice, University of Lille, Lille, Lille, France
| | - Sophie Gautier
- CHU de Lille, UMR-S1172, Center for Pharmacovigilance, Univ. Lille, Lille, France
| | - Stéphanie Genay
- CHU Lille, Institut de Pharmacie, Lille, France
- CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, Lille, France
| | - Bertrand Decaudin
- CHU Lille, Institut de Pharmacie, Lille, France
- CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, Lille, France
| | - Madleen Lemaitre
- CHU Lille, ULR 2694 - METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Univ. Lille, Lille, France
- Department of Diabetology, CHU Lille, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
| | - Anne Vambergue
- Department of Diabetology, CHU Lille, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
- European Genomic Institute for Diabetes, University School of Medicine, Lille, France
| | - Jean-Baptiste Beuscart
- CHU Lille, ULR 2694 - METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Univ. Lille, Lille, France
| |
Collapse
|
2
|
Craske M, Hardeman W, Steel N, Twigg MJ. Pharmacist-led medication reviews: A scoping review of systematic reviews. PLoS One 2024; 19:e0309729. [PMID: 39240903 PMCID: PMC11379247 DOI: 10.1371/journal.pone.0309729] [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: 10/17/2023] [Accepted: 08/17/2024] [Indexed: 09/08/2024] Open
Abstract
BACKGROUND Medication reviews aim to support patients who take medicines, and they are often led by pharmacists. There are different types of medication reviews undertaken in various settings. Previous research undertaken in 2015 found mixed evidence that medication reviews in community settings improve clinical outcomes, but further work needs to be undertaken to establish their impact on patient-orientated and economic outcomes. AIM This scoping review aims to explore the extent and range of systematic reviews of medication reviews conducted by pharmacists, the nature of the intervention, the evidence for effectiveness, and reported research gaps. METHOD Systematic reviews were included irrespective of participants, settings or outcomes and were excluded if pharmacists did not lead the delivery of the included interventions. Data extracted included the design of included studies, population, setting, main results, description of interventions, and future research recommendations. RESULTS We identified twenty-four systematic reviews that reported that medication review interventions were diverse, and their nature was often poorly described. Two high-quality reviews reported that there was evidence of no effect on mortality; of these one reported an improvement in medicines-related problems (all studies reported an increase of identified problems), and another a reduction in hospital readmissions (Risk ratio 0.93 [95% CI 0.89, 0.98]). Other lower-quality reviews reported evidence supporting intervention effectiveness for some clinical outcomes (odds ratio: achieving diabetes control = 3.11 95% prediction intervals (PI), 1.48-6.52, achieving blood pressure target = 2.73, 95% PI, 1.05-7.083.50). CONCLUSION There is mixed evidence of effectiveness for medication reviews across settings and patient populations. There is limited data about the implementation of medication reviews, therefore is difficult to ascertain which components of the intervention lead to improved outcomes. As medication reviews are widely implemented in practice, further research should explore the nature of the interventions, linking the components of these to outcomes.
Collapse
Affiliation(s)
- Miriam Craske
- School of Pharmacy, University of East Anglia, Norwich, England
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, England
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, England
| | | |
Collapse
|
3
|
Hurley E, Dalton K, Byrne S, Foley T, Walsh E. Pharmacist-Led Deprescribing Using STOPPFrail for Frail Older Adults in Nursing Homes. J Am Med Dir Assoc 2024; 25:105122. [PMID: 38950585 DOI: 10.1016/j.jamda.2024.105122] [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: 02/21/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To evaluate the impact of pharmacist-guided deprescribing using the STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with a limited life expectancy) criteria in frail older nursing home residents. DESIGN Prospective, unblinded, non-randomized, intervention study. SETTING AND PARTICIPANTS Adults aged ≥65 years with advanced frailty resident in 6 independent nursing homes in Ireland. METHODS STOPPFrail-based deprescribing recommendations were developed by a pharmacist and presented to residents' general practitioners (GPs), who decided to implement or not. Measured outcomes included number of prescribed medications, medication costs, anticholinergic cognitive burden (ACB), drug burden index (DBI), modified medication appropriateness index (MMAI), quality of life (QoL), non-elective hospitalizations, emergency department visits, falls, and mortality were measured at baseline, post review, and at 6 months post review. RESULTS Ninety-nine residents were recruited. Most (94%) were prescribed ≥1 potentially inappropriate medication (PIM). The most frequent PIMs were medications without a clearly documented indication (29.6%) and vitamin D (16.9%). Of 348 recommendations provided to GPs, 203 (58%) were accepted and 193 (55%) were implemented. Relating to baseline, post review, and at 6 months: the mean ± standard deviation (SD) number of medications was 16.0 ± 6.1, 14.6 ± 5.7 (P < .001), and 15.4 ± 5.5 (P < .001). The monthly mean ± SD medication cost per patient was €186.8 ± 123.7, €172.7 ± 119.0 (P < .001), and €186.4 ± 121.2 (P = .95). There were significant post-review decreases in the mean DBI, ACB, and MMAI of 9.7%, 9.6%, and 3.7%, respectively (P < .001), which remained significant at 6 months (P < .001). There were no significant differences in falls, emergency department visits, non-elective hospitalizations, or QoL. CONCLUSIONS AND IMPLICATIONS STOPPFrail-guided deprescribing led by a pharmacist in nursing homes appeared to significantly reduce PIMs, medication costs (initially), and anticholinergic and sedative burdens, without adversely affecting other patient outcomes. Greater consideration should therefore be given to the wider integration of pharmacists into nursing homes to optimize the medications and health outcomes of frail older adults.
Collapse
Affiliation(s)
- Eoin Hurley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Tony Foley
- Department of General Practice, School of Medicine and Health, University College Cork, Cork, Ireland
| | - Elaine Walsh
- Department of General Practice, School of Medicine and Health, University College Cork, Cork, Ireland
| |
Collapse
|
4
|
Robberechts A, Stas K, Puttemans M, Poppe L, Steurbaut S, De Meyer GRY, De Loof H. Use of the BRANT-MERQS scoring table for the quality assessment of type 3 medication review in patients with rheumatoid arthritis and those with type 2 diabetes mellitus. Front Pharmacol 2024; 15:1359568. [PMID: 39221142 PMCID: PMC11362585 DOI: 10.3389/fphar.2024.1359568] [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: 12/21/2023] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Background A type 3 medication review (MR3) is a patient-centred medication service primarily provided by pharmacists and is presently employed routinely in several countries. In this process, pharmacists interview patients and collaborate with the treating physician to optimize the patient's pharmacotherapy, taking into account the patient's medication history and other medical data including laboratory values. The need to maintain the quality of such interventions during and after their initial implementation cannot be overstated. Aim The objective of this study was to refine and assess a scoring table to evaluate the quality of MR3 conducted in Belgian community pharmacies. Methods The comprehensive quality of MR3s was assessed by scoring its various components using a previously developed scoring table, called BRANT-MERQS, Brussels Antwerp Medication Review Quality Score. MR3s were analysed from an implementation study with patients suffering from rheumatoid arthritis (RA, subproject 1) and type 2 diabetes mellitus (T2DM, subproject 2). Additional information was obtained during a telephone call with a subset of participating pharmacists of subproject 1 who finalized their first MR3. Results In subproject 1, a total of 21 MR3s of patients with RA were examined. The assessment showed favourable scores for elements such as a well-organized medication schedule, treatment adherence, and the elaboration of specific interventions. However, certain other quality criteria posed challenges in the evaluation, for example, the use of simple and understandable language. Pharmacists faced time constraints, and elderly general practitioners (GPs) displayed limited enthusiasm, which were notable barriers observed for this subproject. In the context of subproject 2 that investigated 41 MR3s in patients with T2DM, the quality criteria of interaction between pharmacist and GP, and used sources and tools received high scores. However, there was still room for improvement, especially in areas such as accurate dosing, handling kidney function, QT prolongation, correctly associating laboratory values with relevant drugs and medical conditions, and optimisation of medication schedules for patients. Conclusion This study demonstrated the feasibility of MR3 quality assessment through a scoring system. However, it also unveiled the tool's current imperfections and highlighted the ongoing need for refinement, something expected of a new service in an implementation phase.
Collapse
Affiliation(s)
- Anneleen Robberechts
- Meduplace, Royal Pharmacists Association of Antwerp (KAVA), Antwerp, Belgium
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
- Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kaat Stas
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Margot Puttemans
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Laura Poppe
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Stephane Steurbaut
- Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Hospital Pharmacy, UZ Brussel, Jette, Belgium
| | - Guido R. Y. De Meyer
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
- Infla-Med Research Center of Excellence, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
- Infla-Med Research Center of Excellence, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
5
|
Robinson EG, Gyllensten H, Granas AG, Halvorsen KH, Garcia BH. Health-related quality of life among older adults following acute hospitalization: longitudinal analysis of a randomized controlled trial. Qual Life Res 2024; 33:2219-2233. [PMID: 38884880 PMCID: PMC11286627 DOI: 10.1007/s11136-024-03689-x] [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] [Accepted: 05/17/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE To describe the longitudinal change of health-related quality of life (HRQoL) over 12 months from acute hospitalization in older adults ≥ 70 years (IMMENSE study), and associated factors, to investigate how a medication optimization intervention influenced this change. METHODS The EQ-5D-3L was used at discharge and 1, 6 and 12 months after discharge during a randomized controlled trial including 285 participants. Multilevel logistic (EQ-5D-3L dimensions) and mixed model regression (EQ-5D-3L index scores, EQ-VAS) were used to explore the longitudinal change with/without the intervention, and associations with medications, comorbidities, and socioeconomic variables. Subgroup analyses were performed for non-long and long stayers with hospitalizations < or ≥ 14 days. RESULTS EQ-5D-3L index scores significantly declined after 12 months (β -0.06 [95% confidence interval (CI:) -0.10--0.02], p = 0.003). Non-long stayers showed significant improvement 1 month from discharge (β 0.05 [0.00-0.09], p = 0.040). The number of medications and receiving home-care services were the main factors associated with reduced HRQoL. Being home-dwelling was the main factor associated with higher HRQoL. Non-long stayers of the intervention group reported significantly higher EQ-VAS than the control group (β 4.02 [0.11-7.93], p = 0.044). CONCLUSION We observed no significant difference in the longitudinal change in HRQoL between the two IMMENSE study groups over 12 months after hospitalization. However, the non-long stayer subgroup analysis indicates that the intervention may have had a long-term effect on HRQoL in some of intervention patients. The number of medications and the ability to live and care for oneself should be taken into consideration when planning future patient care and health-care services. TRIAL REGISTRATION The trial was registered in clinicaltrials.gov on 28/06/2016 before enrolment started (NCT02816086).
Collapse
Affiliation(s)
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Kjell H Halvorsen
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Beate Hennie Garcia
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
| |
Collapse
|
6
|
Vogt CJ, Moecker R, Jacke CO, Haefeli WE, Seidling HM. Exploring the heterogeneity in community pharmacist-led medication review studies - A systematic review. Res Social Adm Pharm 2024; 20:679-688. [PMID: 38811260 DOI: 10.1016/j.sapharm.2024.03.012] [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: 08/31/2023] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Findings on the effectiveness of medication reviews led by community pharmacists (CPs) are often inconclusive. It has been hypothesized that studies are not sufficiently standardized, and thus, it is difficult to draw conclusions. OBJECTIVE(S) To examine differences in the way CP-led medication review studies are set up. This was accomplished by investigating (1) patient selection criteria, (2) components of the medication review interventions, (3) types of outcomes, and (4) measurement instruments used. METHODS A systematic literature search of randomized controlled trials of CP-led medication reviews was carried out in PubMed and Cochrane Library. Information on patient selection, intervention components, and outcome measurements was extracted, and frequencies were analyzed. Where possible, outcomes were mapped to the Core Outcome Set (COS) for medication review studies. Finally, a network analysis was conducted to explore the influence of individual factors on outcome effects. RESULTS In total, 30 articles (26 studies) were included. Most articles had a drug class-specific or disease-specific patient selection criterion (n = 19). Half of the articles included patients aged ≥60 years (n = 15), and in 40% (n = 12/30) patients taking 4 drugs or more. In 24 of 30 articles, a medication review was comprised with additional interventions, such as distribution of educational material and training or follow-up visits. About 40 different outcomes were extracted. Within specific outcomes, the measurement instruments varied, and COS was rarely represented. CONCLUSION The revealed differences in patient selection, intervention delivery, and outcome assessment highlight the need for more standardization in research on CP-led medication reviews. While intervention delivery should be more precisely described to capture potential differences between interventions, outcome assessment should be standardized in terms of outcome selection by application of the COS, and with regard to the selected core outcome measurement instruments to enable comparison of the results.
Collapse
Affiliation(s)
- Cathrin J Vogt
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Robert Moecker
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Christian O Jacke
- Scientific Institute of Private Health Insurance (WIP), Gustav-Heinemann-Ufer 74c, 50968, Cologne, Germany.
| | - Walter E Haefeli
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Hanna M Seidling
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| |
Collapse
|
7
|
Craske ME, Hardeman W, Steel N, Twigg MJ. Components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review and narrative synthesis. BMJ Qual Saf 2024:bmjqs-2024-017283. [PMID: 39013596 DOI: 10.1136/bmjqs-2024-017283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Pharmacist-led medication reviews are an established intervention to support patients prescribed multiple medicines or with complex medication regimes. For this systematic review, a medication review was defined as 'a consultation between a pharmacist and a patient to review the patient's total medicines use with a view to improve patient health outcomes and minimise medicines-related problems'. It is not known how varying approaches to medication reviews lead to different outcomes. AIM To explore the common themes associated with positive outcomes from pharmacist-led medication reviews. METHOD Randomised controlled trials of pharmacist-led medication reviews in adults aged 18 years and over were included. The search terms used in MEDLINE, EMBASE and Web of Science databases were "medication review", "pharmacist", "randomised controlled trial" and their synonyms, time filter 2015 to September 2023. Studies published before 2015 were identified from a previous systematic review. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Descriptions of medication reviews' components, implementation and outcomes were narratively synthesised to draw out common themes. Results are presented in tables. RESULTS Sixty-eight papers describing 50 studies met the inclusion criteria. Common themes that emerged from synthesis include collaborative working which may help reduce medicines-related problems and the number of medicines prescribed; patient involvement in goal setting and action planning which may improve patients' ability to take medicines as prescribed and help them achieve their treatment goals; additional support and follow-up, which may lead to improved blood pressure, diabetes control, quality of life and a reduction of medicines-related problems. CONCLUSION This systematic review identified common themes and components, for example, goal setting, action planning, additional support and follow-up, that may influence outcomes of pharmacist-led medication reviews. Researchers, health professionals and commissioners could use these for a comprehensive evaluation of medication review implementation. PROSPERO REGISTRATION NUMBER CRD42020173907.
Collapse
Affiliation(s)
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norwich, UK
- Research Design and Development, NHS Norfolk and Waveney ICB, Norwich, UK
| |
Collapse
|
8
|
Nymoen LD, Pettersen JLS, Flatebø TE, Øie E, Viktil KK. Drug-related emergency department visits: external validation of an assessment tool in a general emergency department population. Int J Clin Pharm 2024:10.1007/s11096-024-01760-8. [PMID: 38958864 DOI: 10.1007/s11096-024-01760-8] [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: 03/07/2024] [Accepted: 05/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The process of identifying drug-related hospitalisations is subjective and time-consuming. Assessment tool for identifying hospital admissions related to medications (AT-HARM10) was developed to simplify and objectify this process. AT-HARM10 has not previously been externally validated, thus the predictive precision of the tool is uncertain. AIM To externally validate AT-HARM10 in adult patients admitted to the emergency department (ED). METHOD This retrospective cross-sectional study investigated 402 patients admitted to the ED, Diakonhjemmet Hospital, Oslo, Norway. A trained 5th-year pharmacy student used AT-HARM10 to assess all patients and to classify their ED visits as possibly or unlikely drug-related. Assessment of the same patients by an interdisciplinary expert panel acted as the gold standard. The external validation was conducted by comparing AT-HARM10 classifications with the gold standard. RESULTS According to AT-HARM10 assessments, 169 (42%) patients had a possible drug-related ED visit. Calculated sensitivity and specificity values were 95% and 71%, respectively. Further, positive and negative predictive values were 46% and 98%, respectively. Adverse effects/over-treatment and suboptimal treatment were the issues most frequently overestimated by AT-HARM10 compared with the gold standard. CONCLUSION AT-HARM10 identifies drug-related ED visits with high sensitivity. However, the low positive predictive value indicates that further review of ED visits classified as possible drug-related by AT-HARM10 is necessary. AT-HARM10 can serve as a useful first-step screening that efficiently identifies unlikely drug-related ED visits, thus only a smaller proportion of the patients need to be reviewed by an interdisciplinary expert panel.
Collapse
Affiliation(s)
| | | | | | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten K Viktil
- Diakonhjemmet Hospital Pharmacy, Oslo, Norway.
- Department of Pharmacy, University of Oslo, Oslo, Norway.
| |
Collapse
|
9
|
Bhattacharya D, Kantilal K, Martin-Kerry J, Millar V, Clark A, Wright D, Murphy K, Turner D, Scott S. Developing a core outcome set for evaluating medication adherence interventions for adults prescribed long-term medication in primary care. Res Social Adm Pharm 2024; 20:625-632. [PMID: 38614842 DOI: 10.1016/j.sapharm.2024.04.002] [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: 07/13/2023] [Revised: 03/05/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Approximately half of people prescribed medications do not take them as prescribed. There is a significant unmet need regarding the barriers to medication adherence not being addressed in primary care. There is no agreement on which outcomes should be measured and reported in trials of medication adherence interventions. OBJECTIVE To develop a core outcome set (COS) for trials of medication adherence interventions in primary care for adults prescribed medications for long-term health conditions. METHODS A list of potentially relevant outcomes from the literature was developed. Using a two-round Delphi survey of stakeholder groups representing patients and their carers; primary care staff; and academic researchers with an interest in medication adherence; each outcome was scored in terms of importance for determining the effectiveness of medication adherence interventions in primary care. This was followed by two consensus workshops, where importance, as well as feasibility and acceptability of measurement, were considered in order to finalise the COS. RESULTS One hundred and fifty people took part in Delphi Round 1 and 101 took part in Round 2. Eight people attended the workshops (four attendees per workshop). Seven outcomes were identified as most important, feasible and acceptable to collect in medication adherence trials: Health-related quality of life, number of doses taken, persistence with medicines, starting (initiating) a medicine, relevance of the medication adherence intervention for an individual, mortality, and adverse medicine events. CONCLUSIONS This COS represents the minimum outcomes that should be collected and reported in all medication adherence trials undertaken in primary care. When developing and finalizing the COS, feasibility and acceptability of collection of outcomes has been considered. In addition to the COS, medication adherence trials can choose to include outcomes to suit their specific context such as the health condition associated with their medication adherence intervention.
Collapse
Affiliation(s)
| | - Kumud Kantilal
- School of Healthcare, University of Leicester, Leicester, UK
| | | | - Vanessa Millar
- School of Healthcare, University of Leicester, Leicester, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Wright
- School of Healthcare, University of Leicester, Leicester, UK / School of Pharmacy, University of Bergen, Bergen, Norway
| | | | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sion Scott
- School of Healthcare, University of Leicester, Leicester, UK
| |
Collapse
|
10
|
Thompson W, Lundby C, Bleik A, Waring H, Hong JA, Xi C, Hughes C, Salzwedel DM, McDonald EG, Pruskowski J, Scott S, Spinewine A, Kutner JS, Graabæk T, Elmi S, Moriarty F. Measuring Quality of Life in Deprescribing Trials: A Scoping Review. Drugs Aging 2024; 41:379-397. [PMID: 38709466 DOI: 10.1007/s40266-024-01113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Quality of life (QoL) is an important outcome to capture in clinical trials evaluating deprescribing interventions. OBJECTIVE We aimed to conduct a scoping review to examine how QoL has been measured in deprescribing trials among older people and identify potentially relevant QoL scales, to better inform QoL measurement in future deprescribing trials. METHODS We searched MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials, Google Scholar, Epistemonikos, ClinicalTrials.gov, and reference lists of eligible studies (from inception to October 2023). We included randomized and non-randomized comparative studies with a control group that evaluated deprescribing and polypharmacy reduction interventions in people ≥ 65 years of age and measured QoL as an outcome. We also included studies describing the development and validation of QoL scales related to deprescribing, polypharmacy, or medication burden in adults ≥ 18 years of age. Two independent reviewers screened titles and abstracts, then full texts. Two independent reviewers extracted data from 25% of eligible studies in order to verify agreement, then a single reviewer extracted data from the remaining studies, which a second reviewer cross-checked. We critically appraised scales based on the COSMIN checklist. RESULTS We retrieved 7290 articles, of which 52 were eligible for inclusion, including 44 deprescribing trials and eight scale development studies. From these studies, we found 21 scales that have been used in the context of deprescribing/polypharmacy (12 generic scales used in clinical trials and nine medication-specific scales). Variations of the generic EQ-5D were the most used scales. The measurement properties of scales for capturing changes in QoL from deprescribing were uncertain. Medication-specific QoL scales have not been employed in deprescribing clinical trials and thus, their performance in this context is also not clear. CONCLUSIONS Several existing QoL scales have been applied to the context of deprescribing/polypharmacy clinical trials, and new scales specific to the problem have been proposed. If deprescribing does impact QoL, our findings suggest it is uncertain whether existing QoL scales can practically and reliably capture such a change or whether any scale is best. However, this review compares various aspects of the scales that researchers and clinicians can consider in decisions about measuring QoL in deprescribing trials, and in planning future research. PROTOCOL REGISTRATION Open Science Framework: osf.io/aez6w.
Collapse
Affiliation(s)
- Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, 317-2176 Health Sciences Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Carina Lundby
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
| | - Adam Bleik
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Harman Waring
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jung Ah Hong
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chris Xi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
| | - Douglas M Salzwedel
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, 317-2176 Health Sciences Mall, Vancouver, BC, V6T 2A1, Canada
| | - Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jennifer Pruskowski
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Geriatric Research Education and Clinical Center, Pittsburgh Veteran Affairs Healthcare System, Pittsburgh, PA, USA
| | - Sion Scott
- School of Healthcare, University of Leicester, Leicester, UK
| | - Anne Spinewine
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, UCLouvain, Brussels, Belgium
| | - Jean S Kutner
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Trine Graabæk
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
| | - Shahrzad Elmi
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, 317-2176 Health Sciences Mall, Vancouver, BC, V6T 2A1, Canada
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
11
|
Wang J, Shen JY, Conwell Y, Podsiadly EJ, Caprio TV, Nathan K, Yu F, Ramsdale EE, Fick DM, Mixon AS, Simmons SF. Implementation considerations of deprescribing interventions: A scoping review. J Intern Med 2024; 295:436-507. [PMID: 36524602 DOI: 10.1111/joim.13599] [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] [Indexed: 12/23/2022]
Abstract
Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health-care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health-care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high-risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health-care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions.
Collapse
Affiliation(s)
- Jinjiao Wang
- Elaine, Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric J Podsiadly
- Harriet J. Kitzman Center for Research Support, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- UR Medicine Home Care, University of Rochester Medical Center, Rochester, New York, USA
- University of Rochester Medical Center, Finger Lakes Geriatric Education Center, Rochester, New York, USA
| | - Kobi Nathan
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Erika E Ramsdale
- Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - Donna M Fick
- Ross and Carol Nese College of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Amanda S Mixon
- Department of Medicine, Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
12
|
Bailly R, Wuyts S, Toelen L, Mets T, Van Hauwermeiren C, Scheerlinck T, Cortoos PJ, Lieten S. Introducing a pharmacist-led transmural care program to reduce drug-related problems in orthogeriatric patients: a prospective interventional study. BMC Geriatr 2024; 24:47. [PMID: 38212699 PMCID: PMC10782737 DOI: 10.1186/s12877-023-04591-w] [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: 07/11/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Orthogeriatric patients have an increased risk for complications due to underlying comorbidities, chronic drug therapy and frequent treatment changes during hospitalization. The clinical pharmacist (CP) plays a key role in transmural communication concerning polypharmacy to improve continuity of care by the general practitioner (GP) after discharge. In this study, a pharmacist-led transmural care program, tailored to orthogeriatric patients, was evaluated to reduce drug related problems (DRPs) after discharge. METHODS An interventional study was performed (pre-period: 1/10/2021-31/12/2021; post-period: 1/01/2022-31/03/2022). Patients (≥ 65 years) from the orthopedic department were included. The pre-group received usual care, the post-group received the pharmacist-led transmural care program. The DRP reduction rate one month after discharge was calculated. Associated factors for the DRP reduction rate were determined in a multiple linear regression analysis. The GP acceptance rate was determined for the proposed interventions, as well as their clinical impact using the Clinical, Economic and Organizational (CLEO) tool. Readmissions one month after discharge were evaluated. RESULTS Overall, 127 patients were included (control n = 61, intervention n = 66). The DRP reduction rate was statistically significantly higher in the intervention group compared to the control group (p < 0.001). The pharmacist's intervention was associated with an increased DRP reduction rate (+ 1.750, 95% confidence interval 1.222-2.278). In total, 141 interventions were suggested by the CP, of which 71% were accepted one month after discharge. In both periods, four patients were readmitted one month after discharge. 58% of the interventions had a clinical impact (≥ 2 C level using the CLEO-tool) according to the geriatrician and for the CP it was 45%, indicating that they had the potential to avoid patient harm. CONCLUSIONS The pharmacist-led transmural care program significantly reduced DRPs in geriatric patients from the orthopedic department one month after discharge. The transmural communication with GPs resulted in a high acceptance rate of the proposed interventions.
Collapse
Affiliation(s)
- Rachel Bailly
- Departement of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | - Stephanie Wuyts
- Departement of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Research Group Clinical Pharmacology and Clinical Pharmacy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Loic Toelen
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tony Mets
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | | | - Thierry Scheerlinck
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Orthopedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Pieter-Jan Cortoos
- Departement of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Siddhartha Lieten
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| |
Collapse
|
13
|
Wu T, Yu Y, Huang Q, Chen X, Yang L, Liu S, Guo X. Current status and implementation strategies of patient education in core outcome set development. PATIENT EDUCATION AND COUNSELING 2024; 118:108027. [PMID: 37918218 DOI: 10.1016/j.pec.2023.108027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Patient participation is essential for Core Outcome Set (COS) development studies. Patient education during participation may help patients better express their views in COS studies. This study aimed to investigate the current status of patient participation and the specified educational information in COS studies. METHODS We conducted a systematic review of COS development studies. Information on patient participation in COS research, and especially details of patient education, was analyzed. RESULTS In total, 146 COS development studies were included in this review. Of these, 125 studies (85.6%) mentioned patient participation. Most studies did not provide explicit information on patient participation. Some studies mentioned recruiting patients, but ultimately, none of them responded. Six studies reported conducting patient education through workshops, creating patient forums, or providing videos and slides. However, these studies did not provide details on education. Twenty-three studies used the plain language to explain patient outcomes. CONCLUSION COS developers are increasingly focusing on patient participation. However, only a few COS studies have explicitly reported conducting measures related to patient education. Further patient education is necessary when they participate in the development of a new Core Outcome Set. PRACTICE IMPLICATION This article provides implementation strategies related to patient education for future COS development studies.
Collapse
Affiliation(s)
- Tongtong Wu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan Yu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qian Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Xueyin Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Lihong Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Shaonan Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
| | - Xinfeng Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
| |
Collapse
|
14
|
van Poelgeest E, Seppala L, Bahat G, Ilhan B, Mair A, van Marum R, Onder G, Ryg J, Fernandes MA, Cherubini A, Denkinger M, Eidam A, Egberts A, Gudmundsson A, Koçak FÖK, Soulis G, Tournoy J, Masud T, Wehling M, van der Velde N. Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper. Eur Geriatr Med 2023; 14:1195-1209. [PMID: 37812379 PMCID: PMC10754739 DOI: 10.1007/s41999-023-00872-0] [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: 07/16/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
Inappropriate polypharmacy is highly prevalent among older adults and presents a significant healthcare concern. Conducting medication reviews and implementing deprescribing strategies in multimorbid older adults with polypharmacy are an inherently complex and challenging task. Recognizing this, the Special Interest Group on Pharmacology of the European Geriatric Medicine Society has compiled evidence on medication review and deprescribing in older adults and has formulated recommendations to enhance appropriate prescribing practices. The current evidence supports the need for a comprehensive and widespread transformation in education, guidelines, research, advocacy, and policy to improve the management of polypharmacy in older individuals. Furthermore, incorporating deprescribing as a routine aspect of care for the ageing population is crucial. We emphasize the importance of involving geriatricians and experts in geriatric pharmacology in driving, and actively participating in this transformative process. By doing so, we can work towards achieving optimal medication use and enhancing the well-being of older adults in the generations to come.
Collapse
Affiliation(s)
- Eveline van Poelgeest
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Lotta Seppala
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey
| | - Birkan Ilhan
- Division of Geriatrics, Department of Internal Medicine, Liv Hospital Vadistanbul, Istanbul, Turkey
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
- Edinburgh Napier University, Edinburgh, UK
| | - Rob van Marum
- Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Elderly Care Medicine, Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Graziano Onder
- Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marília Andreia Fernandes
- Department of Internal Medicine, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Antonio Cherubini
- Geriatria Accettazione geriatrica e Centro di Ricerca per l'invecchiamento IRCCS INRCA, Ancona, Italy
| | - Michael Denkinger
- Agaplesion Bethesda Clinic Ulm, Institute for Geriatric Research, Ulm University, Geriatric Center Ulm, Ulm, Germany
| | - Annette Eidam
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Angelique Egberts
- Department of Hospital Pharmacy, Franciscus Gasthuis & Vlietland, Rotterdam, Schiedam, The Netherlands
| | - Aðalsteinn Gudmundsson
- Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Fatma Özge Kayhan Koçak
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
- Hellenic Open University, Patras, Greece
| | - Jos Tournoy
- Department of Geriatric Medicine, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nathalie van der Velde
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
15
|
Sharma R, Mahajan N, Fadaleh SA, Patel H, Ivo J, Faisal S, Chang F, Lee L, Patel T. Medication Reviews and Clinical Outcomes in Persons with Dementia: A Scoping Review. PHARMACY 2023; 11:168. [PMID: 37888512 PMCID: PMC10609910 DOI: 10.3390/pharmacy11050168] [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: 08/06/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Persons diagnosed with dementia are often faced with challenges related to polypharmacy and inappropriate medication use and could benefit from regular medication reviews. However, the benefit of such reviews has not been examined in this population. Therefore, the current scoping review was designed to identify the gaps in the current knowledge regarding the impact of medication reviews on the clinical outcomes in older adults with dementia. Relevant studies were identified by searching three databases (Ovid MEDLINE, Ovid EMBASE, and Scopus) from inception to January 2022 with a combination of keywords and medical subject headings. After the removal of duplicates and ineligible articles, 22 publications of the initial 8346 were included in this review. A total of 57 outcomes were identified, including those pertaining to the evaluation of medication use (n = 17), drug-related interventions (n = 11), drug-related problems (n = 10), dementia-related behavioral symptoms (n = 8), cost-effectiveness (n = 2), drug-related hospital admissions (n = 1), as well as outcomes classified as other (n = 7). Gaps identified through this scoping review included the paucity of studies measuring the impact of medication reviews on the medication management capacity and medication adherence, quality of life, and mortality.
Collapse
Affiliation(s)
- Rishabh Sharma
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Neil Mahajan
- Faculty of Health, Western University, 1151 Richmond St, London, ON N6A 5B9, Canada;
| | - Sarah Abu Fadaleh
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Hawa Patel
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Jessica Ivo
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Sadaf Faisal
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Feng Chang
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Linda Lee
- CFFM MINT Memory Clinic, 25 Joseph St, Kitchener, ON N2G 4X6, Canada;
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON N2J 0E2, Canada
- Department of Family Medicine, McMaster University, 100 Main St W 5th Floor, Hamilton, ON L8P 1H6, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
- CFFM MINT Memory Clinic, 25 Joseph St, Kitchener, ON N2G 4X6, Canada;
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON N2J 0E2, Canada
| |
Collapse
|
16
|
Robberechts A, Michielsen M, Steurbaut S, De Meyer GRY, De Loof H. Key elements in the quality assessment of a type 3 medication review. Front Pharmacol 2023; 14:1258364. [PMID: 37860120 PMCID: PMC10582266 DOI: 10.3389/fphar.2023.1258364] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Background: Medication reviews are a structured evaluation of a patient's pharmacotherapy with the aim of optimizing medicines use and improving health outcomes. This entails detecting drug related problems and recommending interventions. A high level of quality is essential for the successful implementation of this service in community pharmacies but currently there is no instrument or tool to assess that overall quality. Aim: This study investigated the development of quality criteria of type 3 medication reviews (MR3s). Methods: After surveying the literature, an electronic questionnaire was developed to gather information about quality criteria for MR3. This survey, in Dutch, was distributed electronically. Four groups were queried: 1) pharmacists, mainly working in the Netherlands, involved in practice research and contacted through the PRISMA (Practice Research In Collaboration With Pharmacists) foundation, 2) Belgian pharmacy academics and pharmacists active in professional associations (APA), 3) Belgian pharmacists trained in medication review (MR) by the Royal Pharmacists Association of Antwerp (KAVA) and 4) Belgian pharmacy students. The survey included 57 criteria, divided into eight domains, which were ranked according to their importance by the participants. The results were analyzed statistically using the nonparametric Kruskal-Wallis test. Results: The survey was completed by 95 participants, including 42 PRISMA pharmacists, 19 APA pharmacists, 18 KAVA pharmacists and 16 pharmacy students. Opinions from participants from the different groups overlapped significantly. The use of simple and understandable language in the conversation with the patient was considered essential by the majority. Discussing the usefulness and purpose of a MR3 with the patient was also rated highly by all groups. Differences of opinion were present in aspects about laboratory values, the use of specific tools, and reporting to and consultation with the treating physician. The participants themselves formulated a limited number of additional assessment criteria. Conclusion: There was widespread agreement on the hierarchy of the quality assessment criteria for MR3s. Minor differences were related to the experience of the participants. With these results and a small number of suggested extra criteria, a quality assessment instrument for MR3 can be created.
Collapse
Affiliation(s)
- Anneleen Robberechts
- Meduplace, Royal Pharmacists Association of Antwerp (KAVA), Antwerp, Belgium
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
- Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Melissa Michielsen
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Hospital Pharmacy, Jette, Belgium
| | | | - Hans De Loof
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
17
|
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.
Collapse
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.
| |
Collapse
|
18
|
Onan D, Wells-Gatnik WD, Bentivegna E, Lampl C, Martelletti P. New Migraine Drugs for Older Adults. Drugs Aging 2023; 40:301-305. [PMID: 36826751 DOI: 10.1007/s40266-023-01012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
Migraine is one of the most widespread and burdensome diseases, affecting one in every seven individuals in the world, for an estimated global prevalence of 14%. Until recently, therapeutic choices for older migraineurs have been limited by safety concerns and such patients have typically been excluded from clinical trials. However, randomized controlled trials (RCTs) of new migraine drugs have begun to include participants aged over 65 years, offering clinicians relevant safety and efficacy data to be able to treat older patients with the newest drug classes, including monoclonal antibodies for CGRP (r), CGRP antagonists, and drugs targeting the serotonin 5-HT1F receptor. RCT inclusion criteria nonetheless select the most appropriate older patients, usually excluding polymorbid participants. In a real-life setting, older patients may have several comorbidities, and this reduces the clinical applicability of the new drugs to these patients. Two main points should be addressed to solve this barrier: the inclusion of a sufficient number of migraineurs aged over 65 years in RCTs and the publication of appropriate guidelines for a tailored treatment that considers the existence of multimorbid pathologies in this population of individuals.
Collapse
Affiliation(s)
- Dilara Onan
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Back and Neck Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | | | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Christian Lampl
- Department of Neurology and Headache Medical Centre, Konventhospital Barmherzige Brüder Linz, Seilerstätte 2, 4021, Linz, Austria
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
| |
Collapse
|
19
|
Mavragani A, Dixe MDA, Gonçalves Pereira S, Meyer-Massetti C, Verloo H. An Intervention Program to Reduce Medication-Related Problems Among Polymedicated Home-Dwelling Older Adults (OptiMed): Protocol for a Pre-Post, Multisite, Pilot, and Feasibility Study. JMIR Res Protoc 2023; 12:e39130. [PMID: 36696165 PMCID: PMC9909524 DOI: 10.2196/39130] [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: 04/30/2022] [Revised: 11/20/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Effective medication management is one of the essential preconditions for enabling polymedicated home-dwelling older adults with multiple chronic conditions to remain at home and preserve their quality of life and autonomy. Lack of effective medication management predisposes older adults to medication-related problems (MRPs) and adverse health outcomes, which can lead to the degradation of a patient's acute clinical condition, physical and cognitive decline, exacerbation of chronic medical conditions, and avoidable health care costs. Nonetheless, it has been shown that MRPs can be prevented or reduced by using well-coordinated, patient-centered, interprofessional primary care interventions. OBJECTIVE This study aimed to explore the feasibility and acceptability of an evidence-based, multicomponent, interprofessional intervention program supported by informal caregivers to decrease MRPs among polymedicated home-dwelling older adults with multiple chronic conditions. METHODS This quasi-experimental, pre-post, multisite pilot, and feasibility study will use an open-label design, with participants knowing the study's objectives and relevant information, and it will take place in primary health care settings in Portugal and Switzerland. The research population will comprise 30 polymedicated, home-dwelling adults, aged ≥65 years at risk of MRPs and receiving community-based health care, along with their informal caregivers and health care professionals. RESULTS Before a projected full-scale study, this pilot and feasibility study will focus on recruiting and ensuring the active collaboration of its participants and on the feasibility of expanding this evidence-based, multicomponent, interprofessional intervention program throughout both study regions. This study will also be essential to projected follow-up research programs on informal caregivers' multiple roles, enhancing their coordination tasks and their own needs. Results are expected at the end of 2024. CONCLUSIONS Designing, establishing, and exploring the feasibility and acceptability of an intervention program to reduce the risks of MRPs among home-dwelling older adults is an underinvestigated issue. Doing so in collaboration with all the different actors involved in that population's medication management and recording the first effects of the intervention will make this pilot and feasibility study's findings very valuable as home care becomes an ever more common solution. TRIAL REGISTRATION Swiss National Clinical Trials Portal 000004654; https://tinyurl.com/mr3yz8t4.
Collapse
Affiliation(s)
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | | | - Carla Meyer-Massetti
- Institute for Primary Health Care BIHAM, University of Bern, Bern, Switzerland.,Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences (HES-SO) Valais/Wallis, Sion, Switzerland.,Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
20
|
Lion S, Evrard P, Foulon V, Spinewine A. Drug-drug interactions in nursing home residents: analysis from the COME-ON trial. Age Ageing 2023; 52:6974850. [PMID: 36633299 DOI: 10.1093/ageing/afac278] [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: 04/22/2022] [Revised: 09/09/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND as a result of the high prevalence of polypharmacy in nursing homes (NHs), nursing home residents (NHRs) are exposed to numerous drug-drug interactions (DDIs) that can lead to adverse drug effects, and increased morbidity and mortality. OBJECTIVES to evaluate (i) the prevalence of DDIs among NHRs and its evolution over time, and (ii) factors associated with a favourable evolution. DESIGN posthoc analysis of the COME-ON study, a cluster-randomised controlled trial aiming at reducing potentially inappropriate prescriptions in NHs, through the implementation of a complex intervention. SETTING AND SUBJECTS 901 NHRs from 54 Belgian NHs. METHODS DDIs were identified using a validated list of 66 potentially clinically relevant DDIs in older adults. We defined a favourable evolution at 15 months as the resolution of at least one DDI present at baseline, without the introduction of any new DDI. Factors associated with a favourable evolution were analysed using multivariable logistic regression. RESULTS at baseline, 475 NHRs (52.7%) were exposed to at least 1 DDI and 225 NHRs (25.0%) to more than one DDI. Most common DDI was 'Concomitant use of at least three central nervous system active drugs'. At 15 months, we observed a 6.3% absolute decrease in DDI prevalence in intervention group, and a 1.0% absolute increase in control group. The intervention, older age and private NH ownership were significantly associated with a favourable DDI evolution. CONCLUSION a high prevalence of DDI in Belgian NHs was observed, but the COME-ON intervention was associated with a favourable evolution over time.
Collapse
Affiliation(s)
- Simon Lion
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
| | - Perrine Evrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.,Pharmacy Department, UCLouvain, CHU UCL Namur, Yvoir, Belgium
| |
Collapse
|
21
|
Maierhöfer S, Waltering I, Jacobs M, Würthwein G, Appelrath M, Koling S, Hempel G. Decision support software-guided medication reviews in elderly patients with polypharmacy: a prospective analysis of routine data from community pharmacies (OPtiMed study protocol). J Pharm Policy Pract 2022; 15:100. [PMID: 36494764 PMCID: PMC9732986 DOI: 10.1186/s40545-022-00495-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pharmacist-led medication reviews are considered a valuable measure to address risks of polypharmacy. The software Medinspector® is used in community pharmacies to assist the performance of this complex service by structuring the medication review process and supporting pharmacists in their decision-making with targeted clinical knowledge. Key feature is a computerized risk assessment of both the initial and adjusted medication regimen of a patient in multiple domains, thus aiming to support the identification and solving of drug-related problems. This study will examine the effects of medication reviews performed with the clinical decision support system in daily routine practice on medication-related and patient-reported outcomes in elderly patients with polypharmacy. METHODS A prospective, before-after observational study is conducted in German community pharmacies aiming to include 148 patients aged 65 or older, who chronically use five or more active pharmaceutical substances with systemic effects and utilize the software-supported medication review service. The study is based on routine documentation within the software over the course of the medication review, including a patient's baseline medication, the medication proposed by pharmacists, and the final medication regimen. A software-implemented questionnaire comprising self-developed and literature-derived instruments is used to collect patient-reported outcome data at baseline and follow-up. Primary outcome is the appropriateness of medication measured with an adapted version of the Medication Appropriateness Index (MAI). Secondary medication-related outcomes are medication underuse, exposition towards anticholinergic/sedative drugs, number of drugs in long-term use and the implementation of pharmacist-proposed medication adjustments by the physicians. Secondary patient-reported outcomes are symptom burden, medication-related quality of life, adherence, fulfillment of medication review-related goals, and perception of the service. DISCUSSION With the recently introduced remuneration of community pharmacist-led MR in Germany, the demand for digital tools supporting the MR process is assumed to rise. The OPtiMed-study is expected to create evidence on the effects of a novel tool on patient care in a vulnerable patient population. Trial registration German Clinical Trials Register, DRKS00027410. Registered 22 December 2021, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027410 . Also available on the WHO meta-registry: https://trialsearch.who.int/?TrialID=DRKS00027410.
Collapse
Affiliation(s)
- Stefan Maierhöfer
- grid.5949.10000 0001 2172 9288Department of Pharmaceutical and Medicinal Chemistry — Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany
| | - Isabell Waltering
- grid.5949.10000 0001 2172 9288Department of Pharmaceutical and Medicinal Chemistry — Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany
| | | | - Gudrun Würthwein
- grid.5949.10000 0001 2172 9288Department of Pharmaceutical and Medicinal Chemistry — Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany
| | | | - Susanne Koling
- Clinic for Pediatrics and Adolescent Medicine — Evangelical Hospital Hamm, Hamm, Germany
| | - Georg Hempel
- grid.5949.10000 0001 2172 9288Department of Pharmaceutical and Medicinal Chemistry — Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany
| |
Collapse
|
22
|
Sallevelt BTGM, Egberts TCG, Huibers CJA, Ietswaart J, Drenth-van Maanen AC, Jennings E, O'Mahony C, Jungo KT, Feller M, Rodondi N, Sibille FX, Spinewine A, van Puijenbroek EP, Wilting I, Knol W. Detectability of Medication Errors With a STOPP/START-Based Medication Review in Older People Prior to a Potentially Preventable Drug-Related Hospital Admission. Drug Saf 2022; 45:1501-1516. [PMID: 36319944 PMCID: PMC9700573 DOI: 10.1007/s40264-022-01237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Multimorbidity and polypharmacy are risk factors for drug-related hospital admissions (DRAs) in the ageing population. DRAs caused by medication errors (MEs) are considered potentially preventable. The STOPP/START criteria were developed to detect potential MEs in older people. OBJECTIVE The aim of this study was to assess the detectability of MEs with a STOPP/START-based in-hospital medication review in older people with polypharmacy and multimorbidity prior to a potentially preventable DRA. METHODS Hospitalised older patients (n = 963) with polypharmacy and multimorbidity from the intervention arm of the OPERAM trial received a STOPP/START-based in-hospital medication review by a pharmacotherapy team. Readmissions within 1 year after the in-hospital medication review were adjudicated for drug-relatedness. A retrospective assessment was performed to determine whether MEs identified at the first DRA were detectable during the in-hospital medication review. RESULTS In total, 84 of 963 OPERAM intervention patients (8.7%) were readmitted with a potentially preventable DRA, of which 72 patients (n = 77 MEs) were eligible for analysis. About half (48%, n = 37/77) of the MEs were not present during the in-hospital medication review and therefore were not detectable at that time. The pharmacotherapy team recommended a change in medication regimen in 50% (n = 20/40) of present MEs, which corresponds to 26% (n = 20/77) of the total identified MEs at readmission. However, these recommendations were not implemented. CONCLUSION MEs identified at readmission were not addressed by a prior single in-hospital medication review because either these MEs occurred after the medication review (~50%), or no recommendation was given during the medication review (~25%), or the recommendation was not implemented (~25%). Future research should focus on optimisation of the timing and frequency of medication review and the implementation of proposed medication recommendations. REGISTRATION ClinicalTrials.gov identifier: NCT02986425. December 8, 2016. FUNDING European Union HORIZON 2020, Swiss State Secretariat for Education, Research and Innovation (SERI), Swiss National Science Foundation (SNSF).
Collapse
Affiliation(s)
- Bastiaan T G M Sallevelt
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - Toine C G Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Corlina J A Huibers
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jimmy Ietswaart
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - A Clara Drenth-van Maanen
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emma Jennings
- School of Medicine, University College Cork, Cork, Republic of Ireland
| | - Cian O'Mahony
- School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | | | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - François-Xavier Sibille
- Clinical Pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium
| | - Anne Spinewine
- Clinical Pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
| | - Eugène P van Puijenbroek
- The Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
- Division of Pharmacotherapy, -Epidemiology & Economics, University of Groningen, Groningen, The Netherlands
| | - Ingeborg Wilting
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
23
|
Martin-Kerry J, Taylor J, Scott S, Patel M, Wright D, Clark A, Turner D, Alldred DP, Murphy K, Keevil V, Witham MD, Kellar I, Bhattacharya D. Developing a core outcome set for hospital deprescribing trials for older people under the care of a geriatrician. Age Ageing 2022; 51:6782998. [PMID: 36317291 PMCID: PMC9724769 DOI: 10.1093/ageing/afac241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Half of older people are prescribed unnecessary/inappropriate medications that are not routinely deprescribed in hospital hence there is a need for deprescribing trials. We aimed to develop a Core Outcome Set (COS) for deprescribing trials for older people under the care of a geriatrician during hospital admission. METHODS We developed a list of potentially relevant outcomes from the literature. Using a two-round Delphi survey of stakeholder groups representing older people and carers, hospital clinicians, hospital managers, and ageing/deprescribing researchers, each outcome was scored according to Grading of Recommendations Assessment, Development and Evaluation, followed by two consensus workshops to finalise the COS. RESULTS Two hundred people completed Round 1 and 114 completed Round 2. Representing all stakeholder groups, 10 people participated in workshop 1 and 10 in workshop 2. Six outcomes were identified as most important, feasible and acceptable to collect in a trial: number of prescribed medicines stopped; number of prescribed medicines with dosage reduced; quality of life; mortality; adverse drug events and number of hospital stays. Three other outcomes were identified as important, but currently too burdensome to collect: number of potentially inappropriate medicines prescribed; burden from medication routine; and medication-related admissions to hospital. CONCLUSIONS A COS represents the minimum outcomes that should be collected and reported. Whilst uncommon practice for COS development, the value of considering outcome collection feasibility is demonstrated by the removal of three potential outcomes that, if included, may have compromised COS uptake due to challenges with collecting the data.
Collapse
Affiliation(s)
| | - Jo Taylor
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Sion Scott
- School of Healthcare, University of Leicester, Leicester LE1 7RH, UK
| | - Martyn Patel
- Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK,Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - David Wright
- School of Healthcare, University of Leicester, Leicester LE1 7RH, UK,School of Pharmacy, University of Bergen, Bergen 5008, Norway
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | | | - Katherine Murphy
- Patient and Public Involvement Lead, School of Healthcare, University of Leicester, Leicester, LE1 7RH, UK
| | - Victoria Keevil
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Miles D Witham
- Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, UK,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK
| | - Debi Bhattacharya
- School of Healthcare, University of Leicester, Leicester LE1 7RH, UK
| |
Collapse
|
24
|
Johansen JS, Halvorsen KH, Svendsen K, Havnes K, Robinson EG, Wetting HL, Haustreis S, Småbrekke L, Kamycheva E, Garcia BH. Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) - a randomized controlled trial. BMC Health Serv Res 2022; 22:1290. [PMID: 36289541 PMCID: PMC9597977 DOI: 10.1186/s12913-022-08648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Suboptimal medication use contributes to a substantial proportion of hospitalizations and emergency department visits in older adults. We designed a clinical pharmacist intervention to optimize medication therapy in older hospitalized patients. Based on the integrated medicine management (IMM) model, the 5-step IMMENSE intervention comprise medication reconciliation, medication review, reconciled medication list upon discharge, patient counselling, and post discharge communication with primary care. The objective of this study was to evaluate the effects of the intervention on healthcare use and mortality. Methods A non-blinded parallel group randomized controlled trial was conducted in two internal medicine wards at the University Hospital of North Norway. Acutely admitted patients ≥ 70 years were randomized 1:1 to intervention or standard care (control). The primary outcome was the rate of emergency medical visits (readmissions and emergency department visits) 12 months after discharge. Results Of the 1510 patients assessed for eligibility, 662 patients were asked to participate, and 516 were enrolled. After withdrawal of consent and deaths in hospital, the modified intention-to-treat population comprised 480 patients with a mean age of 83.1 years (SD: 6.3); 244 intervention patients and 236 control patients. The number of emergency medical visits in the intervention and control group was 497 and 499, respectively, and no statistically significant difference was observed in rate of the primary outcome between the groups [adjusted incidence rate ratio of 1.02 (95% CI: 0.82–1.27)]. No statistically significant differences between groups were observed for any of the secondary outcomes, neither in subgroups, nor for the per-protocol population. Conclusions We did not observe any statistical significant effects of the IMMENSE intervention on the rate of emergency medical visits or any other secondary outcomes after 12 months in hospitalized older adults included in this study. Trial registration The trial was registered in clinicaltrials.gov on 28/06/2016, before enrolment started (NCT02816086). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08648-1.
Collapse
Affiliation(s)
- Jeanette Schultz Johansen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjell H. Halvorsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kristian Svendsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjerstin Havnes
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Surgery, Cancer and Women’s Health Clinic, The University Hospital of North Norway, Tromsø, Norway
| | | | - Hilde Ljones Wetting
- grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
| | | | - Lars Småbrekke
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elena Kamycheva
- Nøste Private Healthcare Centre, Lier, Norway ,grid.412244.50000 0004 4689 5540Department of Geriatric Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Beate Hennie Garcia
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
| |
Collapse
|
25
|
Wallerstedt SM, Svensson SA, Lönnbro J, Hieronymus F, Fastbom J, Hoffmann M, Parodi López N. Performance of 3 Sets of Criteria for Potentially Inappropriate Prescribing in Older People to Identify Inadequate Drug Treatment. JAMA Netw Open 2022; 5:e2236757. [PMID: 36264579 PMCID: PMC9585423 DOI: 10.1001/jamanetworkopen.2022.36757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) are used in research to reflect the quality of drug treatment in older people and have been suggested for inclusion in core outcome sets for evaluation of interventions for improved prescribing. Their validation so far, however, is primarily restricted to expert opinion-based processes. OBJECTIVE To evaluate the performance of 3 explicit PIM/PPO criteria sets as diagnostic tools to identify inadequate drug treatment in older patients. DESIGN, SETTING, AND PARTICIPANTS This diagnostic study analyzed patients aged 65 years or older consecutively included from 2 primary health care centers from October to November 2017. Data were analyzed from February to August 2022. EXPOSURES The PIMs/PPOs were concordantly identified by 2 specialist physicians (2018-2019) retrospectively after a planned physician visit, using 3 European PIM/PPO criteria sets and without knowledge of this diagnostic study. MAIN OUTCOMES AND MEASURES Area under the receiver operating characteristic (ROC) curve, reflecting the ability of PIM/PPO criteria sets to identify the reference standard of inadequate drug treatment, determined by 2 specialist physicians in consensus. Inadequate drug treatment implied that additional action related to the medication could be medically justified before the next regular visit. RESULTS A total of 302 patients were analyzed (median age, 74 [IQR, 69-81] years; 178 women [59%]; median number of drugs in the medication list, 6 [IQR, 3-9]); 98 patients (32%) had inadequate drug treatment. A total of 0 to 8 PIMs/PPOs per patient were identified using the Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) criteria, 0 to 6 with the European EU(7)-PIM list, and 0 to 12 with the Swedish set of indicators of prescribing quality. The areas under the ROC curve for the 3 sets to identify the reference standard for inadequate drug treatment were 0.60 (95% CI, 0.53-0.66) for the STOPP/START criteria, 0.69 (95% CI, 0.63-0.75) for the EU(7)-PIM list, and 0.73 (95% CI, 0.67-0.80) for the Swedish set. For comparison, the area under the ROC curve was 0.71 (95% CI, 0.65-0.78) using the number of drugs in the medication list. CONCLUSIONS AND RELEVANCE In this diagnostic study, the evaluated PIM/PPO sets had poor to fair performance as diagnostic tools to identify inadequate drug treatment, comparable with a simple count of the number of drugs in the medication list. These findings suggest that use of PIMs/PPOs as indicators of drug treatment quality in core outcome sets for the evaluation of interventions for improved prescribing may need reconsideration.
Collapse
Affiliation(s)
- Susanna M. Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- HTA-Centrum, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Staffan A. Svensson
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Hjällbo Health Center, Gothenburg, Sweden
| | - Johan Lönnbro
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fredrik Hieronymus
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Fastbom
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Mikael Hoffmann
- NEPI Foundation–Swedish Network for Pharmacoepidemiology, Linköping University, Linköping, Sweden
| | - Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Kungshöjd Health Center, Gothenburg, Sweden
| |
Collapse
|
26
|
Kalu ME, Dal Bello-Haas V, Griffin M, Ploeg J, Richardson J. A comprehensive mobility discharge assessment framework for older adults transitioning from hospital-to-home in the community—What mobility factors are critical to include? Protocol for an international e-Delphi study. PLoS One 2022; 17:e0267470. [PMID: 36137073 PMCID: PMC9499191 DOI: 10.1371/journal.pone.0267470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Mobility deficits have been identified as an independent risk factor for hospital readmission for adults ≥65 years. Despite evidence indicating how determinants additively influence and predict mobility, no hospital-to-home care transition models comprehensively assess all seven mobility determinants, cognitive, financial, environmental, personal, physical, psychological, and social. There is currently a lack of clarity regarding what factors clinicians and researchers should evaluate for each mobility determinant. The purpose of this e-Delphi study is to prioritize and reach consensus on the factors for each mobility determinant that are critical to assess as part of the Comprehensive Mobility Discharge Assessment Framework (CMDAF) when older adults are discharged from hospital-to-home.
Methods
This protocol paper is an international modified e-Delphi study following the Recommendations for the Conducting and Reporting of Delphi Studies. International researchers, clinicians, older adults and family caregivers residing in a country with universal or near-universal health coverage will be invited to participate as ‘experts’ in three e-Delphi rounds administered through DelphiManager©. The e-Delphi Round 1 questionnaire will be developed based on scoping review findings and will be pilot tested. For each round, experts will be asked to rate factors for each determinant that are critical to assess as part of the CMDAF using a 9-point scale: Not Important (1–3), Important but Not Critical (4–6), and Critical (7–9). The scale will include a selection option of "unable to score" and experts will also be asked to provide a rationale for their scoring and suggest missing factors. Experts will receive feedback summaries in Rounds 2 and 3 to guide them in reflecting on their initial responses and re-rating of factors that have not reached consensus. The criteria for reaching consensus will be if ≥70% of experts rate a factor as "critical" (scores ≥7) and ≤ 15% of experts rate a factor as "not important" (scores≤ 3). Quantitative data will be analyzed using median values, frequencies, percentages, interquartile range, and bar graphs; Wilcoxon matched-pairs signed-rank test will be used to assess the stability of participants’ responses. Rationale (qualitative data) provided in the open-ended comments section will be analyzed using content analysis.
Conclusion
This study is a first step in developing the CMDAF and will be used to guide a subsequent e-Delphi survey to decide on the tools that should be used to measure the examples of each factor included in our framework.
Collapse
Affiliation(s)
- Michael E. Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evaluation and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| |
Collapse
|
27
|
Nymoen LD, Flatebø TE, Moger TA, Øie E, Molden E, Viktil KK. Impact of systematic medication review in emergency department on patients’ post-discharge outcomes—A randomized controlled clinical trial. PLoS One 2022; 17:e0274907. [PMID: 36121830 PMCID: PMC9484649 DOI: 10.1371/journal.pone.0274907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The main objective of this study was to investigate whether systematic medication review conducted by clinical pharmacists can impact clinical outcomes and post-discharge outcomes for patients admitted to the emergency department. Method This parallel group, non-blinded, randomized controlled trial was conducted in the emergency department, Diakonhjemmet Hospital, Oslo, Norway. The study was registered in ClinicalTrials.gov, Identifier: NCT03123640 in April 2017. From April 2017 to May 2018, patients ≥18 years were included and randomized (1:1) to intervention- or control group. The control group received standard care from emergency department physicians and nurses. In addition to standard care, the intervention group received systematic medication review including medication reconciliation conducted by pharmacists, during the emergency department stay. The primary outcome was proportion of patients with an unplanned contact with hospital within 12 months from inclusion stay discharge. Results In total, 807 patients were included and randomized, 1:1, to intervention or control group. After excluding 8 patients dying during hospital stay and 10 patients lacking Norwegian personal identification number, the primary analysis comprised 789 patients: 394 intervention group patients and 395 control group patients. Regarding the primary outcome, there was no significant difference in proportion of patients with an unplanned contact with hospital within 12 months after inclusion stay discharge between groups (51.0% of intervention group patients vs. 53.2% of control group patients, p = 0.546). Conclusion As currently designed, emergency department pharmacist-led medication review did not significantly influence clinical- or post-discharge outcomes. This study did, however pinpoint important practical implementations, which can be used to design tailored pharmacist-led interventions and workflow regarding drug-related issues in the emergency department setting.
Collapse
Affiliation(s)
- Lisbeth Damlien Nymoen
- Diakonhjemmet Hospital Pharmacy AS, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
- * E-mail:
| | | | - Tron Anders Moger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen Molden
- Department of Pharmacy, University of Oslo, Oslo, Norway
- Department of Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Kilvik Viktil
- Diakonhjemmet Hospital Pharmacy AS, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| |
Collapse
|
28
|
Wickman K, Dobszai A, Modig S, Bolmsjö BB, Caleres G, Lenander C. Pharmacist-led medication reviews in primary healthcare for adult community-dwelling patients – a descriptive study charting a new target group. BMC PRIMARY CARE 2022; 23:237. [PMID: 36114459 PMCID: PMC9482154 DOI: 10.1186/s12875-022-01849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
Background Medication treatment can reduce morbidity but can also cause drug-related problems (DRPs). One method to identify and solve DRPs is medication reviews (MRs) that are aimed at increased patient safety and quality in drug treatment. In Skåne county, Sweden, a well-established multi-professional model for MRs in nursing homes is practiced. However, a demand for MRs regarding community-dwelling patients has emerged. These patients may be extra vulnerable since they have less supervision from healthcare personnel. AIM: To describe the community-dwelling patients in primary healthcare considered in need of an MR, as well as the outcomes of these pharmacist-led MRs. Methods Personnel from 14 primary healthcare centers selected patients for the MRs. Based on electronic medical records, the symptom assessment tool PHASE-20 (PHArmacotherapeutical Symptom Evaluation 20 questions) and medication lists, pharmacists conducted MRs and communicated adjustment suggestions via the medical record to the general practitioners (GPs). Results A total of 109 patients were included in the study and 90.8% (n = 99) of the patients were exposed to at least one DRP, with an average of 3.9 DRPs per patient. Patients with impaired renal function (glomerular filtration rate, GFR < 45 ml/min) or ≥ 10 medications were exposed to a significantly higher number of DRPs per patient, 5.1 DRP and 5.3 respectively. The most frequent DRP-categories were Unnecessary drug therapy and Adverse drug reaction, which represented 23.0% respectively 22.9% of the total amount of DRPs. Conclusions Our results indicate a prioritized need for MRs for community-dwelling patients, specifically with impaired renal function or polypharmacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01849-x.
Collapse
|
29
|
Katiri R, Hall DA, Hoare DJ, Fackrell K, Horobin A, Hogan N, Buggy N, Van de Heyning PH, Firszt JB, Bruce IA, Kitterick PT. The Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study: International consensus on outcome measures for trials of interventions for adults with single-sided deafness. Trials 2022; 23:764. [PMID: 36076299 PMCID: PMC9454406 DOI: 10.1186/s13063-022-06702-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Single-sided deafness (SSD) has functional, psychological, and social consequences. Interventions for adults with SSD include hearing aids and auditory implants. Benefits and harms (outcome domains) of these interventions are until now reported inconsistently in clinical trials. Inconsistency in reporting outcome measures prevents meaningful comparisons or syntheses of trial results. The Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) international initiative used structured communication techniques to achieve consensus among healthcare users and professionals working in the field of SSD. The novel contribution is a set of core outcome domains that experts agree are critically important to assess in all clinical trials of SSD interventions. Methods A long list of candidate outcome domains compiled from a systematic review and published qualitative data, informed the content of a two-round online Delphi survey. Overall, 308 participants from 29 countries were enrolled. Of those, 233 participants completed both rounds of the survey and scored each outcome domain on a 9-point scale. The set of core outcome domains was finalised via a web-based consensus meeting with 12 participants. Votes involved all stakeholder groups, with an approximate 2:1 ratio of professionals to healthcare users participating in the Delphi survey, and a 1:1 ratio participating in the consensus meeting. Results The first round of the survey listed 44 potential outcome domains, organised thematically. A further five outcome domains were included in Round 2 based on participant feedback. The structured voting at round 2 identified 17 candidate outcome domains which were voted on at the consensus meeting. Consensus was reached for a core outcome domain set including three outcome domains: spatial orientation, group conversations in noisy social situations, and impact on social situations. Seventy-seven percent of the remaining Delphi participants agreed with this core outcome domain set. Conclusions Adoption of the internationally agreed core outcome domain set would promote consistent assessment and reporting of outcomes that are meaningful and important to all relevant stakeholders. This consistency will in turn enable comparison of outcomes reported across clinical trials comparing SSD interventions in adults and reduce research waste. Further research will determine how those outcome domains should best be measured. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06702-1.
Collapse
Affiliation(s)
- Roulla Katiri
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK. .,National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, UK. .,Audiology Department, Mater Misericordiae University Hospital, North Circular Road, Dublin, D07 R2WY, Ireland.
| | - Deborah A Hall
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,Department of Psychology, School of Social Sciences, Heriot-Watt University Malaysia, Putrajaya, Malaysia
| | - Derek J Hoare
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, UK
| | - Kathryn Fackrell
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, UK.,Wessex Institute, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Adele Horobin
- National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, UK.,Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
| | - Nicholas Hogan
- National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, UK
| | - Nóra Buggy
- National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, UK
| | - Paul H Van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), 2650, Edegem, Antwerp, Belgium.,Experimental Laboratory of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
| | - Jill B Firszt
- Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110-1010, USA
| | - Iain A Bruce
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK.,Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Pádraig T Kitterick
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,National Acoustic Laboratories, Australian Hearing Hub, Macquarie University, Sydney, NSW, 2109, Australia
| | | |
Collapse
|
30
|
Hias J, Hellemans L, Laenen A, Walgraeve K, Liesenborghs A, De Geest S, Luyten J, Spriet I, Flamaing J, Van der Linden L, Tournoy J. The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE (ASPIRE): Protocol for a randomized controlled trial. Contemp Clin Trials 2022; 119:106853. [PMID: 35842106 DOI: 10.1016/j.cct.2022.106853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Unplanned rehospitalizations occur frequently in older patients. Drug-related problems constitute a major and largely preventable cause with inappropriate prescribing being a substantial culprit. Solutions are needed to reduce this risk by targeting pharmacotherapy both during and after hospital stay. Therefore, we aim to perform a randomized controlled trial in geriatric inpatients to investigate the impact of a multifaceted clinical pharmacy intervention on health-related outcomes. METHODS/DESIGN The study concerns a monocenter, non-blinded, randomized controlled trial that will take place at the acute geriatric wards of a large academic hospital. Patients being in a palliative stage with active therapy withdrawal or patients discharged to another ward within the same hospital or another hospital are excluded. In total, 828 patients will be randomized (1:1) to the usual care or intervention group. The multifaceted clinical pharmacy intervention comprises medication reconciliation at admission and discharge, medication review, patient/caregiver education, intensified communication with primary care providers and post-discharge follow-up, which also includes a telepharmacology service. The primary endpoint is defined as the time to an all-cause, unplanned hospital revisit within six months after discharge. Other health-related outcomes such as drug-related readmissions, quality of life and number of potentially inappropriate medications will be analyzed as secondary endpoints. Patient inclusion started in February 2021. DISCUSSION This study will provide useful insights regarding the impact of clinical pharmacy interventions on geriatric wards with the goal to optimize health-related outcomes such as hospital revisits. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04617340.
Collapse
Affiliation(s)
- Julie Hias
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Laura Hellemans
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | | | | | - Sabina De Geest
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Jeroen Luyten
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
31
|
Reeve J, Maden M, Hill R, Turk A, Mahtani K, Wong G, Lasserson D, Krska J, Mangin D, Byng R, Wallace E, Ranson E. Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis. Health Technol Assess 2022; 26:1-148. [PMID: 35894932 PMCID: PMC9376985 DOI: 10.3310/aafo2475] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tackling problematic polypharmacy requires tailoring the use of medicines to individual needs and circumstances. This may involve stopping medicines (deprescribing) but patients and clinicians report uncertainty on how best to do this. The TAILOR medication synthesis sought to help understand how best to support deprescribing in older people living with multimorbidity and polypharmacy. OBJECTIVES We identified two research questions: (1) what evidence exists to support the safe, effective and acceptable stopping of medication in this patient group, and (2) how, for whom and in what contexts can safe and effective tailoring of clinical decisions related to medication use work to produce desired outcomes? We thus described three objectives: (1) to undertake a robust scoping review of the literature on stopping medicines in this group to describe what is being done, where and for what effect; (2) to undertake a realist synthesis review to construct a programme theory that describes 'best practice' and helps explain the heterogeneity of deprescribing approaches; and (3) to translate findings into resources to support tailored prescribing in clinical practice. DATA SOURCES Experienced information specialists conducted comprehensive searches in MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials), Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (targeted searches). REVIEW METHODS The scoping review followed the five steps described by the Joanna Briggs Institute methodology for conducting a scoping review. The realist review followed the methodological and publication standards for realist reviews described by the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) group. Patient and public involvement partners ensured that our analysis retained a patient-centred focus. RESULTS Our scoping review identified 9528 abstracts: 8847 were removed at screening and 662 were removed at full-text review. This left 20 studies (published between 2009 and 2020) that examined the effectiveness, safety and acceptability of deprescribing in adults (aged ≥ 50 years) with polypharmacy (five or more prescribed medications) and multimorbidity (two or more conditions). Our analysis revealed that deprescribing under research conditions mapped well to expert guidance on the steps needed for good clinical practice. Our findings offer evidence-informed support to clinicians regarding the safety, clinician acceptability and potential effectiveness of clinical decision-making that demonstrates a structured approach to deprescribing decisions. Our realist review identified 2602 studies with 119 included in the final analysis. The analysis outlined 34 context-mechanism-outcome configurations describing the knowledge work of tailored prescribing under eight headings related to organisational, health-care professional and patient factors, and interventions to improve deprescribing. We conclude that robust tailored deprescribing requires attention to providing an enabling infrastructure, access to data, tailored explanations and trust. LIMITATIONS Strict application of our definition of multimorbidity during the scoping review may have had an impact on the relevance of the review to clinical practice. The realist review was limited by the data (evidence) available. CONCLUSIONS Our combined reviews recognise deprescribing as a complex intervention and provide support for the safety of structured approaches to deprescribing, but also highlight the need to integrate patient-centred and contextual factors into best practice models. FUTURE WORK The TAILOR study has informed new funded research tackling deprescribing in sleep management, and professional education. Further research is being developed to implement tailored prescribing into routine primary care practice. STUDY REGISTRATION This study is registered as PROSPERO CRD42018107544 and PROSPERO CRD42018104176. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 32. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Joanne Reeve
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Amadea Turk
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dan Lasserson
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Chatham, UK
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Byng
- Community and Primary Care Research Group, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | |
Collapse
|
32
|
Parodi López N, Svensson SA, Wallerstedt SM. Clinical relevance of potentially inappropriate medications and potential prescribing omissions according to explicit criteria-a validation study. Eur J Clin Pharmacol 2022; 78:1331-1339. [PMID: 35648150 PMCID: PMC9283130 DOI: 10.1007/s00228-022-03337-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the clinical relevance of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), and to evaluate the association between PIMs/PPOs and inadequate drug treatment. METHODS PIMs/PPOs, concordantly identified by two physicians applying the STOPP/START criteria, the EU(7)-PIM list, and a Swedish set in 302 consecutive older primary care patients, were assessed regarding clinical relevance for the specific patient. The physicians determined, in consensus, whether an action related to the medication was medically justified prior to the next regular consultation. If so, the drug treatment was categorised as inadequate, and if not, the treatment was considered adequate. RESULTS In all, 259 (86%) patients had 1010 PIMs/PPOs, 150 (15%) of which, in 81 (27%) patients, were assessed as clinically relevant (kappa: 0.26). A total of 75 (50%) clinically relevant PIMs and PPOs were prioritised for medical action before the next regular consultation. Action-requiring clinically relevant PIMs most often concerned acetylsalicylic acid (ASA) for primary prevention (four out of 68 patients on ASA). The corresponding PPOs concerned beta-blockers in ischaemic heart disease (four out of 61 patients with this condition). When an overall medical perspective was applied, 164 (63%) out of 259 patients with PIMs/PPOs were assessed as having adequate treatment. In adjusted logistic regression, number of PIMs and/or PPOs and number of drugs were associated with inadequate drug treatment. CONCLUSION One in seven PIMs/PPOs may be clinically relevant, half of these not of priority for medical action. Cautious interpretation is warranted when PIMs/PPOs are used as outcome measures.
Collapse
Affiliation(s)
- Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 431, 405 30, Gothenburg, Sweden. .,Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden.
| | - Staffan A Svensson
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 431, 405 30, Gothenburg, Sweden.,Närhälsan Hjällbo Health Centre, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 431, 405 30, Gothenburg, Sweden.,HTA-Centrum, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
33
|
Tukukino C, Parodi López N, Svensson SA, Wallerstedt SM. Drug interaction alerts in older primary care patients, and related medically justified actions. Eur J Clin Pharmacol 2022; 78:1115-1126. [PMID: 35355082 PMCID: PMC9184366 DOI: 10.1007/s00228-022-03292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To describe presented interaction alerts in older patients, and the extent to which these require further medical action for the specific patient or are already being addressed. METHODS Interaction alerts presented at a physician consultation, for 274 consecutive primary care patients treated with two or more drugs (median age: 75 years; 59% female), were extracted. These alerts are based on Janusmed, a decision support integrated in the medical records that provides recommendations for managing the interactions. One general practitioner (GP) and one GP/clinical pharmacologist determined in retrospect, first independently and then in consensus, whether the alerts justified further medical action, considering each patient's health condition. RESULTS In all, 405 drug interaction alerts in 151 (55%) patients were triggered. Medical action in response was deemed medically justified for 35 (9%) alerts in 26 (17%) patients. These actions most often involved a switch to a less interacting drug from the same drug class (n = 10), a separate intake (n = 9), or the ordering of a laboratory test (n = 8). Out of 531 actions suggested by the alert system, only 38 (7%) were applicable to the specific patient, as, for instance, laboratory parameters were already being satisfactorily monitored or a separate intake implemented. CONCLUSIONS More than every other older patient receives drug treatment that triggers drug interaction alerts. Nine in ten alerts were already being addressed or were not relevant in the clinical setting, whereas, for the remaining tenth, some medical action, that for unknown reasons had not been taken, was reasonable. These findings show that interaction alerts are questionable as indicators of problematic prescribing.
Collapse
Affiliation(s)
- Carina Tukukino
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.,Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.,Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden
| | - Staffan A Svensson
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.,Närhälsan Hjällbo Health Centre, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden. .,HTA-Centrum, Sahlgrenska University Hospital, Gothenburg, Sweden.
| |
Collapse
|
34
|
Mertens B, Hias J, Hellemans L, Walgraeve K, Spriet I, Tournoy J, Van der Linden LR. Drug-related hospital admissions in older adults: comparison of the Naranjo algorithm and an adjusted version of the Kramer algorithm. Eur Geriatr Med 2022; 13:567-577. [PMID: 35312975 DOI: 10.1007/s41999-022-00623-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Drug-related admissions (DRAs) are an important cause of preventable harm in older adults. Multiple algorithms exist to assess causality of adverse drug reactions, including the Naranjo algorithm and an adjusted version of the Kramer algorithm. The performance of these tools in assessing DRA causality has not been robustly shown. This study aimed to evaluate the ability of the adjusted Kramer algorithm to adjudicate DRA causality in geriatric inpatients. METHODS DRAs were assessed in a convenience sample of patients admitted to the acute geriatric wards of an academic hospital. DRAs were identified by expert consensus and causality was evaluated using the Naranjo and the adjusted Kramer algorithms. Positive agreement with expert consensus was calculated for both algorithms. A multivariable logistic regression analysis was performed to explore determinants for a DRA. RESULTS A total of 218 geriatric inpatients was included of whom 65 (29.8%) experienced a DRA. Positive agreement was 72.3% (95% confidence interval (CI), 59.6-82.3%) and 100% (95% CI, 93.0-100%) for the Naranjo and the adjusted Kramer algorithm, respectively. Diuretics were the main culprits and most DRAs were attributed to a fall (n = 18; 27.7%). A fall-related principal diagnosis was independently associated with a DRA (odds ratio 20.11; 95% CI, 5.60-72.24). CONCLUSION The adjusted Kramer algorithm demonstrated a higher positive agreement with expert consensus in assessing DRA causality in geriatric inpatients compared to the Naranjo algorithm. Our results further support implementation of the adjusted Kramer algorithm as part of a standardized DRA assessment in older adults.
Collapse
Affiliation(s)
- Beatrijs Mertens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium. .,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.
| | - Julie Hias
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Laura Hellemans
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Roger Van der Linden
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
35
|
Kempen TGH, Hedman A, Gillespie U. Drug-related emergency department visits in older patients: an applicability and reliability study of an existing assessment tool. Int J Clin Pharm 2022; 44:1078-1082. [PMID: 35840865 PMCID: PMC9393129 DOI: 10.1007/s11096-022-01456-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/10/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AT-HARM10 is a research tool to identify possible drug-related hospital admissions. It is unclear whether the tool can be applied to emergency department visits as well. AIM The aim of this study was to investigate the applicability and reliability to identify drug-related emergency department visits in older patients with AT-HARM10. METHOD A random sample of 400 patients aged 65 years or older from a clinical trial in four Swedish hospitals was selected. All patients' emergency department visits within 12 months after discharge were assessed with AT-HARM10. The main outcome measures were the percentage of successfully assessed visits for applicability and the interrater reliability (Cohen's kappa). RESULTS Of the initial sample (n = 400), 113 patients [median age (interquartile range): 81 (76-88) years] had at least one emergency department visit within 12 months. The patients had in total 184 visits, of which 179 (97%) were successfully assessed. Fifty-three visits (29%) were possibly drug-related. The Cohen's kappa value was 0.70 (substantial). CONCLUSION It seems applicable and reliable to identify possible drug-related emergency department visits in addition to hospital admissions in older patients with AT-HARM10. As a consequence, the tool has been updated to support its novel use in clinical research.
Collapse
Affiliation(s)
- Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden. .,Primary Care and Health, Uppsala County Council, Uppsala, Sweden. .,Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
| | - Anton Hedman
- grid.412354.50000 0001 2351 3333Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden
| | - Ulrika Gillespie
- grid.8993.b0000 0004 1936 9457Department of Pharmacy, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
36
|
Cateau D, Ballabeni P, Niquille A. Effects of an interprofessional deprescribing intervention in Swiss nursing homes: the Individual Deprescribing Intervention (IDeI) randomised controlled trial. BMC Geriatr 2021; 21:655. [PMID: 34798826 PMCID: PMC8603597 DOI: 10.1186/s12877-021-02465-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/26/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Deprescribing polypharmacy and potentially inappropriate medications (PIMs) has been shown to be beneficial to nursing home (NH) residents' health. Medication reviews are the most widely studied deprescribing intervention; in a previous trial, we showed that another intervention, a deprescribing-focused interprofessional quality circle, can reduce the use of inappropriate medications at the NH level. However, this intervention cannot account for the variety of the residents' clinical situations. Therefore, we trialled a subsequent intervention in NH that enacted the quality circle intervention in the previous year. METHODS In 7 NHs, the most heavily medicated residents were recruited and randomised to receive usual care or the intervention. The intervention was a pharmacist-led, deprescribing-focused medication review, followed by the creation of an individualised treatment modification plan in collaboration with nurses and physicians. Intervention's effects were assessed after four months on the number and dose of PIMs used, quality of life, and safety outcomes (mortality, hospitalisations, falls, and use of physical restraints). Data were analysed using Poisson multivariate regression models. RESULTS Sixty-two NH residents participated, falling short of the expected 100 participants; 4 died before initial data collection. Participants used a very high number of drugs (median 15, inter-quartile range [12-19]) and PIMs (median 5, IQR [3-7]) at baseline. The intervention did not reduce the number of PIMs prescribed to the participants; however, it significantly decreased their dose (incidence rate ratio 0.763, CI95 [0.594; 0.979]), in particular for chronic drugs (IRR 0.716, CI95 [0.546; 0.938]). No adverse effects were seen on mortality, hospitalisations, falls, and restraints use, but, in the intervention group, three participants experienced adverse events that required the reintroduction of withdrawn treatments, and a decrease in quality of life is possible. CONCLUSIONS As it did not reach its recruitment target, this trial should be seen as exploratory. Results indicate that, following a NH-level deprescribing intervention, a resident-level intervention can further reduce some aspects of PIMs use. Great attention must be paid to residents' well-being when further developing such deprescribing interventions, as a possible reduction in quality of life was found in the intervention group, and some participants suffered adverse events following deprescribing. TRIAL REGISTRATION ClinicalTrials.gov (NCT03688542, https://clinicaltrials.gov/ct2/show/NCT03688542 ), registered on 31.08.2018.
Collapse
Affiliation(s)
- Damien Cateau
- Community Pharmacy, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | - Pierluigi Ballabeni
- Community Pharmacy, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
- Division of Biostatistics, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Anne Niquille
- Community Pharmacy, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| |
Collapse
|
37
|
McCahon D, Denholm RE, Huntley AL, Dawson S, Duncan P, Payne RA. Development of a model of medication review for use in clinical practice: Bristol medication review model. BMC Med 2021; 19:262. [PMID: 34753511 PMCID: PMC8579564 DOI: 10.1186/s12916-021-02136-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication review is a core aspect of medicine optimisation, yet existing models of review vary substantially in structure and content and are not necessarily easy to implement in clinical practice. This study aimed to use evidence from the existing literature to identify key medication review components and use this to inform the design of an improved review model. METHODS A systematic review was conducted (PROSPERO: CRD42018109788) to identify randomised control trials of stand-alone medication review in adults (18+ years). The review updated that by Huiskes et al. (BMC Fam Pract. 18:5, 2017), using the same search strategy implemented in MEDLINE and Embase. Studies were assessed using the Cochrane risk of bias tool. Key review components were identified, alongside relevant clinical and health service outcomes. A working group (patients, doctors and pharmacists) developed the model through an iterative consensus process (appraisal of documents plus group discussions), working from the systematic review findings, brief evidence summaries for core review components and examples of previous models, to agree on the main purpose of the review model, overarching model structure, review components and supporting material. RESULTS We identified 28 unique studies, with moderate bias overall. Consistent medication review components included reconciliation (26 studies), safety assessment (22), suboptimal treatment (19), patient knowledge/preferences (18), adherence (14), over-the-counter therapy (13) and drug monitoring (10). There was limited evidence from studies for improvement in key clinical outcomes. The review structure was underpinned by patient values and preferences, with parallel information gathering and evaluation stages, feeding into the final decision-making and implementation. Most key components identified in the literature were included. The final model was considered to benefit from a patient-centred, holistic approach, which captured both patient-orientated and medication-focused problems, and aligned with traditional consultation methods thus facilitating implementation in practice. CONCLUSIONS The Bristol Medication Review Model provides a framework for standardised delivery of structured reviews. The model has the potential for use by all healthcare professionals with relevant clinical experience and is designed to offer flexibility of implementation not limited to a particular healthcare setting.
Collapse
Affiliation(s)
- D McCahon
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
| | - R E Denholm
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
| | - A L Huntley
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
| | - S Dawson
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
| | - P Duncan
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
| | - R A Payne
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK.
| |
Collapse
|
38
|
Junius-Walker U, Krause O, Thürmann P, Bernhard S, Fuchs A, Sparenberg L, Wollny A, Stolz R, Haumann H, Freytag A, Kirsch C, Usacheva S, Wilm S, Wiese B. Drug Safety for Nursing-Home Residents - Findings of a Pragmatic, Cluster-Randomized, Controlled Intervention Trial in 44 Nursing Homes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:705-712. [PMID: 34366004 DOI: 10.3238/arztebl.m2021.0297] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/24/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The safety of drug use by nursing-home residents can be impaired by polypharmacy, potentially inappropriate medications (PIM), and neuroleptics, as well as by a lack of adequate interprofessional coordination in the nursing home. The goal of the HIOPP-3- iTBX Trial was to improve drug safety in nursing-home residents, including a reduction of PIM and/or neuroleptic use, by means of a complex interprofessional intervention. METHODS This cluster-randomized, controlled trial was performed in nursing homes in Germany. Residents over age 65 were included in the trial. The intervention was carried out over six months and consisted of four elements: a drug review by trained pharmacists, educational sessions for general practitioners and nurses, a drug safety toolbox, and change management seminars for members of the three participating professions. The nursing homes in the control group continued to provide usual care. The primary endpoint was the prescription of at least one PIM and/or at least two neuroleptic drugs simultaneously. The secondary endpoints were the incidence of falls and hospitalizations, quality of life, and health-care costs. This trial is registered in the German Clinical Trials Registry (DRKS00013588). RESULTS 44 nursing homes with 862 residents were randomized, 23 of them (with 452 residents) to the intervention group and 21 (with 410 residents) to the control group. 41% of all nursinghome residents initially took at least one PIM and/or at least two neuroleptic drugs simultaneously. Follow-up data (including, among other things, the current drug regimen) were obtained for 773 residents. The intention-to-treat analysis continued to show no difference between the intervention group and the control group with respect to the primary endpoint. CONCLUSION This trial of an intervention to improve drug safety in nursing homes led neither to reduced prescribing of PIM and/or neuroleptic drugs, nor to any improvement in the overall health status of the nursing-home residents.
Collapse
|
39
|
Zerah L, Henrard S, Wilting I, O'Mahony D, Rodondi N, Dalleur O, Dalton K, Knol W, Haschke M, Spinewine A. Prevalence of drug-drug interactions in older people before and after hospital admission: analysis from the OPERAM trial. BMC Geriatr 2021; 21:571. [PMID: 34663238 PMCID: PMC8524798 DOI: 10.1186/s12877-021-02532-z] [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] [Received: 07/06/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Drug-drug interactions (DDIs) are highly prevalent in older patients but little is known about prevalence of DDIs over time. Our main objective was to assess changes in the prevalence and characteristics of drug-drug interactions (DDIs) during a one-year period after hospital admission in older people, and associated risk factors. Methods We conducted a sub-study of the European OPERAM trial (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people), which assessed the effects of a structured medication review (experimental arm) compared to usual care (control arm) on reducing drug-related hospital readmissions. All OPERAM patients (≥70 years, with multimorbidity and polypharmacy, hospitalized in four centers in Bern, Brussels, Cork and Utrecht between December 2016 and October 2018, followed over 1 year) who were alive at hospital discharge and had full medication data during the index hospitalization (at baseline i.e., enrolment at admission, and at discharge) were included. DDIs were assessed using an international consensus list of potentially clinically significant DDIs in older people. The point-prevalence of DDIs was evaluated at baseline, discharge, and at 2, 6 and 12 months after hospitalization. Logistic regression models were performed to assess independent variables associated with changes in DDIs 2 months after baseline. Results Of the 1950 patients (median age 79 years) included, 1045 (54%) had at least one potentially clinically significant DDI at baseline; point-prevalence rates were 58, 57, 56 and 57% at discharge, and 2, 6 and 12 months, respectively. The prevalence increased significantly from baseline to discharge (P < .001 [significant only in the control group]), then remained stable over time (P for trend .31). The five most common DDIs –all pharmacodynamic in nature– accounted for 80% of all DDIs and involved drugs that affect potassium concentrations, centrally-acting drugs and antithrombotics. At 2 months, DDIs had increased in 459 (27%) patients and decreased in 331 (19%). The main factor predictive of a change in the prevalence of DDIs was hyperpolypharmacy (≥10 medications). Conclusions DDIs were very common; their prevalence increased during hospitalization and tended to remain stable thereafter. Medication review may help control this increase and minimize the risk of adverse drug events. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02532-z.
Collapse
Affiliation(s)
- Lorène Zerah
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Ingeborg Wilting
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- School of Medicine, Geriatric Medicine, University College Cork, Cork, Ireland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Pharmacy, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Pharmacy Department, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| |
Collapse
|
40
|
Barry HE, Hughes CM. An Update on Medication Use in Older Adults: a Narrative Review. CURR EPIDEMIOL REP 2021; 8:108-115. [PMID: 34306966 PMCID: PMC8294219 DOI: 10.1007/s40471-021-00274-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The global phenomenon of population aging is impacting the health and care needs of society. The use of medications by older adults is acknowledged to be the most common form of medical intervention for many acute and chronic conditions and prescribing in this population continues to increase. In this narrative review, we summarise the age-related factors that should be considered when prescribing for older adults, address some of the perennial challenges related to medicine use in older people, and highlight important emerging research in this area. RECENT FINDINGS A range of age-related factors should be considered when prescribing for older adults. However, the evidence base still lacks data pertaining to older adults due to their continued under-representation in clinical trials. Multimorbidity, polypharmacy, and inappropriate prescribing continue to remain prevalent among older adults, although recent research has been focused on the development and evaluation of complex interventions to address these challenges. SUMMARY Further high-quality studies of interventions to improve and support medication use in older adults are needed, ensuring that older adults are well represented in such trials and consideration is given to the measurement of patient- and provider-focused outcomes.
Collapse
Affiliation(s)
- Heather E. Barry
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Carmel M. Hughes
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
| |
Collapse
|
41
|
Blum MR, Sallevelt BTGM, Spinewine A, O'Mahony D, Moutzouri E, Feller M, Baumgartner C, Roumet M, Jungo KT, Schwab N, Bretagne L, Beglinger S, Aubert CE, Wilting I, Thevelin S, Murphy K, Huibers CJA, Drenth-van Maanen AC, Boland B, Crowley E, Eichenberger A, Meulendijk M, Jennings E, Adam L, Roos MJ, Gleeson L, Shen Z, Marien S, Meinders AJ, Baretella O, Netzer S, de Montmollin M, Fournier A, Mouzon A, O'Mahony C, Aujesky D, Mavridis D, Byrne S, Jansen PAF, Schwenkglenks M, Spruit M, Dalleur O, Knol W, Trelle S, Rodondi N. Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial. BMJ 2021; 374:n1585. [PMID: 34257088 PMCID: PMC8276068 DOI: 10.1136/bmj.n1585] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the effect of optimising drug treatment on drug related hospital admissions in older adults with multimorbidity and polypharmacy admitted to hospital. DESIGN Cluster randomised controlled trial. SETTING 110 clusters of inpatient wards within university based hospitals in four European countries (Switzerland, Netherlands, Belgium, and Republic of Ireland) defined by attending hospital doctors. PARTICIPANTS 2008 older adults (≥70 years) with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 drugs used long term). INTERVENTION Clinical staff clusters were randomised to usual care or a structured pharmacotherapy optimisation intervention performed at the individual level jointly by a doctor and a pharmacist, with the support of a clinical decision software system deploying the screening tool of older person's prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria to identify potentially inappropriate prescribing. MAIN OUTCOME MEASURE Primary outcome was first drug related hospital admission within 12 months. RESULTS 2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. 62.2% (n=491) had ≥1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). The hazard ratio for first fall was 0.96 (0.79 to 1.15; 237 v 263 first falls) and for death was 0.90 (0.71 to 1.13; 172 v 203 deaths). CONCLUSIONS Inappropriate prescribing was common in older adults with multimorbidity and polypharmacy admitted to hospital and was reduced through an intervention to optimise pharmacotherapy, but without effect on drug related hospital admissions. Additional efforts are needed to identify pharmacotherapy optimisation interventions that reduce inappropriate prescribing and improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02986425.
Collapse
Affiliation(s)
- Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
| | - Denis O'Mahony
- School of Medicine, University College Cork, Cork, Republic of Ireland
| | - Elisavet Moutzouri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Nathalie Schwab
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Lisa Bretagne
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Shanthi Beglinger
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Ingeborg Wilting
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Stefanie Thevelin
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
| | - Kevin Murphy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Corlina J A Huibers
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - A Clara Drenth-van Maanen
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Benoit Boland
- Geriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Belgium
| | - Erin Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Anne Eichenberger
- Institute of Hospital Pharmacy, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michiel Meulendijk
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Emma Jennings
- School of Medicine, University College Cork, Cork, Republic of Ireland
| | - Luise Adam
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marvin J Roos
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Laura Gleeson
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Zhengru Shen
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Sophie Marien
- Geriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Belgium
| | - Arend-Jan Meinders
- Department of Internal Medicine and Intensive Care Unit, St Antonius Hospital, Nieuwegein and Utrecht, Netherlands
| | - Oliver Baretella
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Seraina Netzer
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Maria de Montmollin
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Anne Fournier
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
| | - Ariane Mouzon
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
| | - Cian O'Mahony
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dimitris Mavridis
- Department of Primary School Education, University of Ioannina, Greece
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Paul A F Jansen
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Marco Spruit
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
- Pharmacy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sven Trelle
- CTU Bern, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| |
Collapse
|
42
|
Alkhaffaf B, Blazeby JM, Metryka A, Glenny AM, Adeyeye A, Costa PM, Del Val ID, Gisbertz SS, Guner A, Law S, Lee HJ, Li Z, Nakada K, Nuñez RMR, Reim D, Reynolds JV, Vorwald P, Zanotti D, Allum W, Chaudry MA, Griffiths E, Williamson PR, Bruce IA. Methods for conducting international Delphi surveys to optimise global participation in core outcome set development: a case study in gastric cancer informed by a comprehensive literature review. Trials 2021; 22:410. [PMID: 34154641 PMCID: PMC8218463 DOI: 10.1186/s13063-021-05338-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/21/2021] [Indexed: 01/13/2023] Open
Abstract
Background Core outcome sets (COS) should be relevant to key stakeholders and widely applicable and usable. Ideally, they are developed for international use to allow optimal data synthesis from trials. Electronic Delphi surveys are commonly used to facilitate global participation; however, this has limitations. It is common for these surveys to be conducted in a single language potentially excluding those not fluent in that tongue. The aim of this study is to summarise current approaches for optimising international participation in Delphi studies and make recommendations for future practice. Methods A comprehensive literature review of current approaches to translating Delphi surveys for COS development was undertaken. A standardised methodology adapted from international guidance derived from 12 major sets of translation guidelines in the field of outcome reporting was developed. As a case study, this was applied to a COS project for surgical trials in gastric cancer to translate a Delphi survey into 7 target languages from regions active in gastric cancer research. Results Three hundred thirty-two abstracts were screened and four studies addressing COS development in rheumatoid and osteoarthritis, vascular malformations and polypharmacy were eligible for inclusion. There was wide variation in methodological approaches to translation, including the number of forward translations, the inclusion of back translation, the employment of cognitive debriefing and how discrepancies and disagreements were handled. Important considerations were identified during the development of the gastric cancer survey including establishing translation groups, timelines, understanding financial implications, strategies to maximise recruitment and regulatory approvals. The methodological approach to translating the Delphi surveys was easily reproducible by local collaborators and resulted in an additional 637 participants to the 315 recruited to complete the source language survey. Ninety-nine per cent of patients and 97% of healthcare professionals from non-English-speaking regions used translated surveys. Conclusion Consideration of the issues described will improve planning by other COS developers and can be used to widen international participation from both patients and healthcare professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05338-x.
Collapse
Affiliation(s)
- Bilal Alkhaffaf
- Department of Oesophago-Gastric Surgery, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, M6 8HD, UK. .,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Jane M Blazeby
- Centre for Surgical Research and Bristol and Weston NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Aleksandra Metryka
- Paediatric ENT Department, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Paulo Matos Costa
- Hospital Garcia de Orta, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | | | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ali Guner
- Department of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Simon Law
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Ziyu Li
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Koji Nakada
- Department of Laboratory Medicine, The Jikei University Daisan Hospital, Komae, Japan
| | | | - Daniel Reim
- Department of Surgery, TUM School of Medicine, Munich, Germany
| | - John V Reynolds
- Department of Surgery, Trinity Translational Medicine Institute and St James's Hospital, Dublin, Ireland
| | - Peter Vorwald
- Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Daniela Zanotti
- Regional Centre for Oesophago-gastric Surgery, Broomfield Hospital, Chelmsford, UK
| | - William Allum
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - M Asif Chaudry
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - Ewen Griffiths
- Upper GI Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, University of Liverpool and a member of Liverpool Health Partners, Liverpool, UK
| | - Iain A Bruce
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | |
Collapse
|
43
|
Dilles T, Heczkova J, Tziaferi S, Helgesen AK, Grøndahl VA, Van Rompaey B, Sino CG, Jordan S. Nurses and Pharmaceutical Care: Interprofessional, Evidence-Based Working to Improve Patient Care and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5973. [PMID: 34199519 PMCID: PMC8199654 DOI: 10.3390/ijerph18115973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 12/13/2022]
Abstract
Pharmaceutical care necessitates significant efforts from patients, informal caregivers, the interprofessional team of health care professionals and health care system administrators. Collaboration, mutual respect and agreement amongst all stakeholders regarding responsibilities throughout the complex process of pharmaceutical care is needed before patients can take full advantage of modern medicine. Based on the literature and policy documents, in this position paper, we reflect on opportunities for integrated evidence-based pharmaceutical care to improve care quality and patient outcomes from a nursing perspective. Despite the consensus that interprofessional collaboration is essential, in clinical practice, research, education and policy-making challenges are often not addressed interprofessionally. This paper concludes with specific advises to move towards the implementation of more interprofessional, evidence-based pharmaceutical care.
Collapse
Affiliation(s)
- Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium;
| | - Jana Heczkova
- First Faculty of Medicine, Institute of Nursing Theory and Practice, Charles University, 11000 Prague, Czech Republic;
| | - Styliani Tziaferi
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, 22100 Tripolis, Greece;
| | - Ann Karin Helgesen
- Faculty of Health and Welfare, Østfold University College, 1757 Halden, Norway; (A.K.H.); (V.A.G.)
| | | | - Bart Van Rompaey
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium;
| | - Carolien G. Sino
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, 3584 CH Utrecht, The Netherlands;
| | - Sue Jordan
- Department of Nursing, Swansea University, Swansea SA2 8PP, Wales, UK;
| |
Collapse
|
44
|
Spinewine A, Evrard P, Hughes C. Interventions to optimize medication use in nursing homes: a narrative review. Eur Geriatr Med 2021; 12:551-567. [PMID: 33751478 PMCID: PMC8149362 DOI: 10.1007/s41999-021-00477-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/25/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. METHODS We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. RESULTS Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. CONCLUSION Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.
Collapse
Affiliation(s)
- Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, Woluwe-Saint-Lambert, 1200, Brussels, Belgium.
- Pharmacy Department, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Perrine Evrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, Woluwe-Saint-Lambert, 1200, Brussels, Belgium
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| |
Collapse
|
45
|
Visade F, Lefebvre A, Floret E, Decaudin B, Puisieux F, Delecluse C, Beuscart JB. Proposition of a structured list of information items to be transmitted to primary caregivers after in-hospital medication optimization: a qualitative study. Acta Clin Belg 2021; 76:184-189. [PMID: 31787034 DOI: 10.1080/17843286.2019.1699689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and objective: Defective transmission of drug information during the transition from hospital to home care are causes of adverse drug reactions in older patients. We aimed to reach a consensus concerning information about changes in treatment to be transmitted to primary caregivers when an older patient is discharged from hospital.Methods: A qualitative focus group study was conducted with general practitioners, geriatricians, community pharmacists, and hospital pharmacists providing care for older patients. Four steps were used to reach a focus group consensus: 1) presentation of the purpose of the focus group; 2) generation and enumeration of ideas; 3) sharing opinions about these ideas; 4) voting to create a list of ranked items. The process involved three focus groups.Results: A consensus was reached on ten items: indication for continued, discontinued, newly introduced or changed treatments and their duration; reasons for discontinuing drugs or introducing new drugs; information about re-evaluating treatments; reasons for hospital stay, significant elements and diagnosis at discharge; administrative information concerning the patient; the name of the primary care physician, and the discharging hospital unit and the physician(s) in charge; known allergies, information about liver and kidney failure; main adverse effects to monitor; date of latest blood tests; hospital admission/discharge dates.Conclusion: The consensus on the list of information items concerning changes in the treatment should be used by hospital physicians and pharmacists to ensure safe patient discharge.
Collapse
Affiliation(s)
- Fabien Visade
- Geriatrics Department, Lille Catholic Hospitals, University of Lille, Lomme, France
- Univ. Lille, EA2694 - Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Antoine Lefebvre
- Department of Pharmacy, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Emmanuel Floret
- Department of Pharmacy, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Bertrand Decaudin
- Univ. Lille, EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
- CHU Lille, Department of pharmacology, F-59000 Lille, France
| | - François Puisieux
- CHU Lille, Department of pharmacology, F-59000 Lille, France
- CHU Lille, Department of Geriatrics, F-59000 Lille, France
| | - Céline Delecluse
- Geriatrics Department, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, EA2694 - Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
- CHU Lille, Department of Geriatrics, F-59000 Lille, France
| |
Collapse
|
46
|
Tasai S, Kumpat N, Dilokthornsakul P, Chaiyakunapruk N, Saini B, Dhippayom T. Impact of Medication Reviews Delivered by Community Pharmacist to Elderly Patients on Polypharmacy: A Meta-analysis of Randomized Controlled Trials. J Patient Saf 2021; 17:290-298. [PMID: 30920431 DOI: 10.1097/pts.0000000000000599] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the impact of medication reviews delivered by community pharmacists to elderly patients on polypharmacy. METHODS A systematic literature search was performed in four bibliographic databases/search engine (PubMed, Embase, CENTRAL, and IPA) and three gray literature sources (OpenGrey, ClinicalTrials.gov, and Digital Access to Research Theses - Europe) from inception to January 2018. Randomized controlled trials were selected if they met the following criteria: (a) studied in patients 65 years or older who were taking four or more prescribed medications; (b) the "test" interventions were delivered by community pharmacists; and (c) measured one of these following outcomes: hospitalization, emergency department (ED) visit, quality of life, or adherence. Quality of the included studies was assessed using the Cochrane Effective Practice and Organization of Care Group risk of bias tool. Random-effects model meta-analyses were performed. RESULTS Of the 3634 articles screened, four studies with a total of 4633 participants were included. The intervention provided in all included studies was clinical medication review. Three studies were at low risk of bias, and the remaining study had unclear risk of bias. When compared with usual care, medication reviews provided by community pharmacist significantly reduced risk of ED visits (risk ratio = 0.68; 95% confidence interval = 0.48-0.96). There was also a tendency that pharmacist interventions decreased risk of hospitalizations (risk ratio = 0.88; 95% CI = 0.78-1.00), although no statistical significant. CONCLUSIONS The current evidence demonstrates that clinical medication reviews for older people with polypharmacy reduces the risk of ED visits. Medication reviews can be considered as another area where community pharmacists can contribute to improve patient safety.
Collapse
Affiliation(s)
| | | | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | | | - Bandana Saini
- Sydney Pharmacy School, Faculties of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
| | | |
Collapse
|
47
|
Foubert K, Capiau A, Mehuys E, De Bolle L, Somers A, Petrovic M, Boussery K. Ghent Older People's Prescriptions Community Pharmacy Screening (GheOP 3S)-Tool Version 2: Update of a Tool to Detect Drug-Related Problems in Older People in Primary Care. Drugs Aging 2021; 38:523-533. [PMID: 33937965 PMCID: PMC8088986 DOI: 10.1007/s40266-021-00862-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/09/2022]
Abstract
Background The Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP3S)-tool was developed in 2016 as a screening tool to detect drug-related problems (DRPs) and to help in performing medication reviews in older people (≥ 65 years). Objective This study aimed to revise and update the GheOP3S-tool. Methods Users’ comments were collected to improve the usability and appropriateness of the original GheOP3S-tool, followed by a two-round modified Delphi process according to the RAND/UCLA appropriateness method. This included a literature review, a round zero meeting, a first written round (with 15 international and multidisciplinary experts) and a second face-to-face round (with 11 experts) to change, delete or add GheOP3S-criteria. An additional third round with 14 community pharmacists was organised to preserve criteria applicable in the current community pharmacy practice. Results The updated GheOP3S-tool consists of five lists of DRPs and a new addendum containing medications that should be avoided or used with caution in older people with reduced renal function. During the first two rounds, related criteria were grouped, 14 criteria were added and 17 criteria were deleted from the original tool. All criteria were deemed applicable in round 3. This led to a final tool (version 2) with 64 GheOP3S-criteria. Conclusion GheOP3S-criteria were revised and updated according to experts’ agreement on their clinical relevance and recent scientific evidence. Future studies should investigate the impact of pharmacist-led medication reviews with GheOP3S-tool version 2 on clinical, humanistic and economic outcomes in primary care. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00862-6.
Collapse
Affiliation(s)
- Katrien Foubert
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.
| | - Andreas Capiau
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.,Department of Pharmacy, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Leen De Bolle
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Annemie Somers
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.,Department of Pharmacy, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| |
Collapse
|
48
|
Cateau D, Ballabeni P, Niquille A. Effects of an interprofessional Quality Circle-Deprescribing Module (QC-DeMo) in Swiss nursing homes: a randomised controlled trial. BMC Geriatr 2021; 21:289. [PMID: 33933030 PMCID: PMC8088558 DOI: 10.1186/s12877-021-02220-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Potentially inappropriate medications (PIMs) are common among nursing homes (NH) residents, as is polypharmacy. Deprescribing has emerged in the past decade as a safe and effective way to reduce the use of PIMs and improve patient outcomes. However, effective deprescribing interventions are expensive, as they require specialised staff and a great amount of time for each resident. The Quality Circle Deprescribing Module (QC-DeMo) intervention was designed to be less resource-intensive than medication reviews, the current deprescribing gold standard. It consists of a QC session in which physicians, nurses, and pharmacists define a local deprescribing consensus for specific PIMs classes, which is then implemented in the NH. The intervention was trialled in a RCT, with the NH as unit of analysis. Methods After randomisation, intervention NHs enacted the QC-DeMo at the start of the follow-up year. The primary outcomes were the proportion of PIM galenic units and number of PIM defined daily dose per average resident and per day (DDD/res). PIM status was assessed by a combination of the 2015 Beers list and the Norwegian General Practice-Nursing Home criteria. Secondary outcomes were the number of DDD/res to avoid and to reevaluate; safety outcomes were mortality, hospitalisations, falls, and use of physical restraints. Outcomes were evaluated at follow-up using linear regression models, adjusting for the outcome baseline values. Results Fifty-eight NHs took part in the trial; no individual residents were recruited. The intervention did not reduce the primary outcomes, but a strong trend towards reduction was seen for the number of PIM DDD/res, which accounts for the doses used. PIM DDD/res to reevaluate were significantly reduced, mostly through a reduction in the use of proton-pump inhibitors. Falls and use of physical restraints were not affected, but a statistical interaction between the mission of the NH (geriatric unit or specialised dementia unit) and the intervention group was seen for mortality and hospitalisations. Conclusions The QC-DeMo intervention can reduce the use of some PIM classes, and could usefully complement other deprescribing interventions. Trial registration ClinicalTrials.gov (NCT03688542), registered on 26.09.2018, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02220-y.
Collapse
Affiliation(s)
- Damien Cateau
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland. .,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. .,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | - Pierluigi Ballabeni
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
| | - Anne Niquille
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| |
Collapse
|
49
|
An International Consensus List of Potentially Clinically Significant Drug-Drug Interactions in Older People. J Am Med Dir Assoc 2021; 22:2121-2133.e24. [PMID: 33901428 DOI: 10.1016/j.jamda.2021.03.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We aimed to establish an explicit list of potentially clinically significant drug-drug interactions (DDIs) in people aged ≥65 years. DESIGN A preliminary list of potentially clinically significant DDIs was compiled, based on 154 DDIs identified from literature review. Subsequently, a 2-round online Delphi survey was undertaken with a multidisciplinary expert panel. A consensus meeting and a final round were conducted to validate the final DDI list and the scope of information provided. SETTING AND PARTICIPANTS Twenty nine experts, including geriatricians and clinical pharmacists from 8 European countries. MEASURES For each DDI, in the first 2 rounds, experts were asked to score the severity of potential harm on a 5-point Likert-type scale. DDIs were directly included on the final list if the median score was 4 (major) or 5 (catastrophic). DDIs with a median score of 3 (moderate) were discussed at a consensus meeting and included if ≥75% of participants voted for inclusion in the final round. RESULTS Consensus was achieved on 66 potentially clinically significant DDIs (28 had a median score of 4/5 and 48 of 3 in the Delphi survey). Most concerned cardiovascular, antithrombotic, and central nervous system drugs. The final list includes information on the mechanism of interaction, harm, and management. Treatment modification is recommended for three-quarters of DDIs. CONCLUSION AND IMPLICATIONS We validated a list of potentially clinically significant DDIs in older people, which can be used in clinical practice and education to support identification and management of DDIs or to assess prevalence in epidemiologic and intervention studies.
Collapse
|
50
|
Hellemans L, Nuyts S, Hias J, van den Akker M, Van Pottelbergh G, Rygaert X, Spriet I, Vaes B, Tournoy J, Van der Linden L. Polypharmacy and excessive polypharmacy in community-dwelling middle aged and aged adults between 2011 and 2015. Int J Clin Pract 2021; 75:e13942. [PMID: 33340210 DOI: 10.1111/ijcp.13942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/14/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS We aimed to assess the prevalence, components and evolution of polypharmacy and to evaluate risk factors associated with polypharmacy. METHODS A retrospective dynamic cohort study was performed, using a primary healthcare database comprising Flemish community-dwelling adults aged ≥40 years between 2011 and 2015. Polypharmacy and excessive polypharmacy were defined as the use of 5-9 or minimum 10 different medications during 1 year, respectively. Temporal changes were analysed using an autoregressive error model. Risk factors for polypharmacy were evaluated using logistic regression. RESULTS In total, 68 426 patients were included in the analysis. The prevalence of polypharmacy was 29.5% and 16.1% for excessive polypharmacy in 2015. The age-standardised prevalence rate of patients using minimum five medications increased with 1.3% per year (95% confidence interval (CI): 0.1968-2.4279). The mean number of unplanned hospital admissions was 0.07 (standard deviation (SD) 0.33) for polypharmacy patients and 0.19 (SD 0.53) for excessive polypharmacy patients. Four risk factors were found to be significantly correlated with polypharmacy: age (odds ratio (OR) 1.015; 95% CI: 1.013-1.017), female gender (OR 1.161; 95% CI: 1.108-1.216), number of chronic diseases (OR 1.126; 95% CI: 1.114-1.139) and number of general practitioner contacts (OR 1.283; 95% CI: 1.274-1.292). CONCLUSION The prevalence of polypharmacy increased between 2011 and 2015. Polypharmacy and excessive polypharmacy patients appeared to differ based on our observations of characteristics, drug therapy and outcomes. Age, female gender, number of chronic diseases and number of general practitioner contacts were associated with polypharmacy.
Collapse
Affiliation(s)
- Laura Hellemans
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Shauni Nuyts
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- L-BioStat, KU Leuven, Leuven, Belgium
| | - Julie Hias
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Marjan van den Akker
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Gijs Van Pottelbergh
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|