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Sánchez-Valle J, Correia RB, Camacho-Artacho M, Lepore R, Mattos MM, Rocha LM, Valencia A. Prevalence and differences in the co-administration of drugs known to interact: an analysis of three distinct and large populations. BMC Med 2024; 22:166. [PMID: 38637816 PMCID: PMC11027217 DOI: 10.1186/s12916-024-03384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The co-administration of drugs known to interact greatly impacts morbidity, mortality, and health economics. This study aims to examine the drug-drug interaction (DDI) phenomenon with a large-scale longitudinal analysis of age and gender differences found in drug administration data from three distinct healthcare systems. METHODS This study analyzes drug administrations from population-wide electronic health records in Blumenau (Brazil; 133 K individuals), Catalonia (Spain; 5.5 M individuals), and Indianapolis (USA; 264 K individuals). The stratified prevalences of DDI for multiple severity levels per patient gender and age at the time of administration are computed, and null models are used to estimate the expected impact of polypharmacy on DDI prevalence. Finally, to study actionable strategies to reduce DDI prevalence, alternative polypharmacy regimens using drugs with fewer known interactions are simulated. RESULTS A large prevalence of co-administration of drugs known to interact is found in all populations, affecting 12.51%, 12.12%, and 10.06% of individuals in Blumenau, Indianapolis, and Catalonia, respectively. Despite very different healthcare systems and drug availability, the increasing prevalence of DDI as patients age is very similar across all three populations and is not explained solely by higher co-administration rates in the elderly. In general, the prevalence of DDI is significantly higher in women - with the exception of men over 50 years old in Indianapolis. Finally, we show that using proton pump inhibitor alternatives to omeprazole (the drug involved in more co-administrations in Catalonia and Blumenau), the proportion of patients that are administered known DDI can be reduced by up to 21% in both Blumenau and Catalonia and 2% in Indianapolis. CONCLUSIONS DDI administration has a high incidence in society, regardless of geographic, population, and healthcare management differences. Although DDI prevalence increases with age, our analysis points to a complex phenomenon that is much more prevalent than expected, suggesting comorbidities as key drivers of the increase. Furthermore, the gender differences observed in most age groups across populations are concerning in regard to gender equity in healthcare. Finally, our study exemplifies how electronic health records' analysis can lead to actionable interventions that significantly reduce the administration of known DDI and its associated human and economic costs.
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Affiliation(s)
- Jon Sánchez-Valle
- Life Sciences Department, Barcelona Supercomputing Center, 08034, Barcelona, Spain.
| | | | | | - Rosalba Lepore
- Life Sciences Department, Barcelona Supercomputing Center, 08034, Barcelona, Spain
- Department of Biomedicine, Basel University Hospital and University of Basel, CH-4031, Basel, Switzerland
| | - Mauro M Mattos
- Universidade Regional de Blumenau, Blumenau, 89030-903, Brazil
| | - Luis M Rocha
- Instituto Gulbenkian de Ciência, 2780-156, Street, Oeiras, Portugal.
- Department of Systems Science and Industrial Engineering, Binghamton University, Binghamton, 13902, USA.
| | - Alfonso Valencia
- Life Sciences Department, Barcelona Supercomputing Center, 08034, Barcelona, Spain.
- ICREA, 08010, Barcelona, Spain.
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Gareri P, Gallelli L, Gareri I, Rania V, Palleria C, De Sarro G. Deprescribing in Older Poly-Treated Patients Affected with Dementia. Geriatrics (Basel) 2024; 9:28. [PMID: 38525745 PMCID: PMC10961769 DOI: 10.3390/geriatrics9020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Polypharmacy is an important issue in older patients affected by dementia because they are very vulnerable to the side effects of drugs'. Between October 2021 and September 2022, we randomly assessed 205 old-aged outpatients. The study was carried out in a Center for Dementia in collaboration with a university center. The primary outcomes were: (1) deprescribing inappropriate drugs through the Beers and STOPP&START criteria; (2) assessing duplicate drugs and the risk of iatrogenic damage due to drug-drug and drug-disease interactions. Overall, 69 men and 136 women (mean age 82.7 ± 7.4 years) were assessed. Of these, 91 patients were home care patients and 114 were outpatient. The average number of the drugs used in the sample was 9.4 drugs per patient; after the first visit and the consequent deprescribing process, the average dropped to 8.7 drugs per patient (p = 0.04). Overall, 74 potentially inappropriate drugs were used (36.1%). Of these, long half-life benzodiazepines (8.8%), non-steroidal anti-inflammatory drugs (3.4%), tricyclic antidepressants (3.4%), first-generation antihistamines (1.4%), anticholinergics (11.7%), antiplatelet drugs (i.e., ticlopidine) (1.4%), prokinetics in chronic use (1.4%), digoxin (>0.125 mg/day) (1.4%), antiarrhythmics (i.e., amiodarone) (0.97%), and α-blockers (1.9%) were included. The so-called "duplicate" drugs were overall 26 (12.7%). In total, ten potentially dangerous prescriptions were found for possible interactions (4.8%). We underline the importance of checking all the drugs taken periodically and discontinuing drugs with the lowest benefit-to-harm ratio and the lowest probability of adverse reactions due to withdrawal. Computer tools and adequately trained teams (doctors, nurses, and pharmacists) could identify, treat, and prevent possible drug interactions.
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Affiliation(s)
- Pietro Gareri
- Department of Frailty, Center for Cognitive Disorders and Dementia (CDCD) Catanzaro Lido—ASP Catanzaro, Magna Graecia University, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Unit of Clinical Pharmacology and Pharmacovigilance, “Renato Dulbecco” University Hospital, 88100 Catanzaro, Italy; (L.G.); (V.R.); (G.D.S.)
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Ilaria Gareri
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
| | - Vincenzo Rania
- Unit of Clinical Pharmacology and Pharmacovigilance, “Renato Dulbecco” University Hospital, 88100 Catanzaro, Italy; (L.G.); (V.R.); (G.D.S.)
| | - Caterina Palleria
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Unit of Clinical Pharmacology and Pharmacovigilance, “Renato Dulbecco” University Hospital, 88100 Catanzaro, Italy; (L.G.); (V.R.); (G.D.S.)
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
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Albayrak A, Düzenli T, Kayıkçıoğlu E. Potential drug-drug interactions in patients with non-small cell lung cancer at a university hospital in Turkey. J Cancer Res Clin Oncol 2023; 149:9621-9627. [PMID: 37222813 DOI: 10.1007/s00432-023-04890-0] [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: 04/25/2023] [Accepted: 05/20/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The aim of this study was to determine the drug profile of patients with non-small cell lung cancer (NSCLC) and to identify potential drug-drug interactions (PDDIs) during hospitalization. In particular, PDDIs in categories X and D were determined. METHODS This retrospective cross-sectional study was conducted in the oncology services of a university hospital between 2018 and 2021. PDDIs were evaluated using Lexicomp Drug Interactions® software included in UpToDate®. RESULTS A total of 199 patients were included in the study. Polypharmacy was present in 92.5% of the patients and the median (min-max) number of drugs used was 8 (2-16). 32% of the patients had D and X PDDIs. A total of 16 PDDIs at risk grade X were found in 15 (7.5%) patients. A total of 81 PDDIs of risk grade D were found in 54 (27.1%) patients and a total of 276 PDDIs of risk grade C were identified in 97 (48.7%) patients. Anticancer drugs (p = 0.008), opioids (p = 0.046), steroids (p = 0.003), 5-HT3 receptor antagonists (p = 0.012), aprepitant (p = 0.025) and antihistamines (p < 0.001) were statistically more frequent among patients with PDDIs than among those without. CONCLUSION The results of our study indicated that polypharmacy and PDDIs are common in hospitalized patients with NSCLC cancer. The monitoring of medications is critical for maximizing therapeutic effects and minimizing side effects related to PDDIs. As a part of multidisciplinary team, clinical pharmacists can contribute significantly to preventing, detecting and managing PDDIs.
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Affiliation(s)
- Aslınur Albayrak
- Department of Clinical Pharmacy, Faculty of Pharmacy, Suleyman Demirel University, Isparta, Turkey.
| | - Tuğdenur Düzenli
- Faculty of Pharmacy, Suleyman Demirel University, Isparta, Turkey
| | - Erkan Kayıkçıoğlu
- Department of Medical Oncology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Ketenci S, Akpınar G. Potential drug-drug interactions in adults receiving oral anticoagulant and antiaggregant therapy. Expert Opin Drug Saf 2023; 22:733-739. [PMID: 36860167 DOI: 10.1080/14740338.2023.2186397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Anticoagulant and antiaggregant drugs are drug groups with high mortality and the most common cause of malpractice. RESEARCH DESIGN AND METHODS 18 and 65 years were scheduled for pharmacotherapy in the Family Health Center. 122 patients during their anticoagulant and/or antiaggregant treatment were evaluated in terms of drug-drug interactions. RESULTS Drug-drug interactions were detected in 89.7% of the patients included in the study. A total of 212 drug-drug interactions were found in 122 patients. Of these, 12 (5.6%) were identified as A, 16 (7.5%) B, 146 (68.6%) C, 32 (15.2%) D and 6 (2.8%) X risk category. The number of DDI was found to be significantly higher in patients aged between 56 and 65 years. The most drug interactions are significantly higher in the C and D categories, respectively. The most predicted clinical outcomes of DDI's were increased in the therapeutic effect and adverse/toxic reactions. CONCLUSIONS Contrary to expectations, it is seen that although polypharmacy is relatively less in patients aged 18-65 years compared to patients over 65 years of age, it is very important to detect drug interactions in this age group in terms of safety, efficacy and treatment benefit in terms of drug-drug interaction.
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Affiliation(s)
- Sema Ketenci
- Faculty of Medicine, Department of Medical Phamacology, Atlas University, Kagıthane, Turkiye
| | - Gökçe Akpınar
- Turkish Ministry of Health, Gebze Family Health Center, Istanbul, Turkiye
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Sánchez-Valle J, Correia RB, Camacho-Artacho M, Lepore R, Mattos MM, Rocha LM, Valencia A. Analysis of electronic health records from three distinct and large populations reveals high prevalence and biases in the co-administration of drugs known to interact. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.06.23285566. [PMID: 36798425 PMCID: PMC9934797 DOI: 10.1101/2023.02.06.23285566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The co-administration of drugs known to interact has a high impact on morbidity, mortality, and health economics. We study the drug-drug interaction (DDI) phenomenon by analyzing drug administrations from population-wide Electronic Health Records (EHR) in Blumenau (Brazil), Catalonia (Spain), and Indianapolis (USA). Despite very different health care systems and drug availability, we find a common large risk of DDI administration that affected 13 to 20% of patients in these populations. In addition, the increasing risk of DDI as patients age is very similar across all three populations but is not explained solely by higher co-administration rates in the elderly. We also find that women are at higher risk of DDI overall- except for men over 50 years old in Indianapolis. Finally, we show that PPI alternatives to Omeprazole can reduce the number of patients affected by known DDIs by up to 21% in both Blumenau and Catalonia, and 2% in Indianapolis, exemplifying how analysis of EHR data can lead to a significant reduction of DDI and its associated human and economic costs. Although the risk of DDIs increases with age, administration patterns point to a complex phenomenon that cannot be solely explained by polypharmacy and multimorbidity. The lack of safer drug alternatives, particularly for chronic conditions, further overburdens health systems, thus highlighting the need for disruptive drug research.
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Affiliation(s)
- Jon Sánchez-Valle
- Life Sciences Department, Barcelona Supercomputing Center, Barcelona, 08034, Spain
| | | | | | - Rosalba Lepore
- Life Sciences Department, Barcelona Supercomputing Center, Barcelona, 08034, Spain
- Department of Biomedicine, asel University Hospital and University of Basel, Basel, CH-4031, Switzerland
| | - Mauro M. Mattos
- Universidade Regional de Blumenau, Blumenau, 89030-903, Brazil
| | - Luis M. Rocha
- Instituto Gulbenkian de Ciência, Street, Oeiras, 2780-156, Portugal
- Department of Systems Science and Industrial Engineering, Binghamton University, Binghamton, 13902, USA
| | - Alfonso Valencia
- Life Sciences Department, Barcelona Supercomputing Center, Barcelona, 08034, Spain
- ICREA, Barcelona, 08010, Spain
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Hughes JE, Waldron C, Bennett KE, Cahir C. Prevalence of Drug-Drug Interactions in Older Community-Dwelling Individuals: A Systematic Review and Meta-analysis. Drugs Aging 2023; 40:117-134. [PMID: 36692678 PMCID: PMC9925489 DOI: 10.1007/s40266-022-01001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Drug-drug interactions (DDIs) can lead to medication-related harm, and the older population is at greatest risk. We conducted a systematic review and meta-analysis to estimate DDI prevalence and identify common DDIs in older community-dwelling adults. METHODS PubMed and EMBASE were searched for observational studies published between 01/01/2010 and 10/05/2021 reporting DDI prevalence in community-dwelling individuals aged ≥ 65 years. Nursing home and inpatient hospital studies were excluded. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Meta-analysis was performed using a random-effects model with logit transformation. Heterogeneity was evaluated using Cochran's Q and I2. DDI prevalence and 95% confidence intervals (CIs) are presented. All analyses were performed in R (version 4.1.2). RESULTS There were 5144 unique articles identified. Thirty-three studies involving 17,011,291 community-dwelling individuals aged ≥ 65 years met inclusion criteria. Thirty-one studies reported DDI prevalence at the study-participant level, estimates ranged from 0.8% to 90.6%. The pooled DDI prevalence was 28.8% (95% CI 19.3-40.7), with significant heterogeneity (p < 0.10; I2 = 100%; tau2 = 2.13) largely explained by the different DDI identification methods. Therefore, 26 studies were qualitatively synthesised and seven studies were eligible for separate meta-analyses. In a meta-analysis of three studies (N = 1122) using Micromedex®, pooled DDI prevalence was 57.8% (95% CI 52.2-63.2; I2 = 69.6%, p < 0.01). In a meta-analysis of two studies (N = 809,113) using Lexi-Interact®, pooled DDI prevalence was 30.3% (95% CI 30.2-30.4; I2 = 6.8%). In a meta-analysis of two studies (N = 947) using the 2015 American Geriatrics Society Beers criteria®, pooled DDI prevalence was 16.6% (95% CI 5.6-40.2; I2 = 97.5%, p < 0.01). Common DDIs frequently involved cardiovascular drugs, including ACE inhibitor-potassium-sparing diuretic; amiodarone-digoxin; and amiodarone-warfarin. CONCLUSIONS DDIs are prevalent among older community-dwelling individuals; however, the methodology used to estimate these events varies considerably. A standardised methodology is needed to allow meaningful measurement and comparison of DDI prevalence.
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Affiliation(s)
- John E Hughes
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.
| | - Catherine Waldron
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Kathleen E Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Caitriona Cahir
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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7
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Zhang Y, Gao J, Xu Y, Liu J, Huang S, Li G, Yao B, Sun Z, Wang X. Investigation of cytochrome P450 inhibitory properties of deoxyshikonin, a bioactive compound from Lithospermum erythrorhizon Sieb. et Zucc. Phytother Res 2022. [PMID: 36317387 DOI: 10.1002/ptr.7664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Deoxyshikonin, a natural naphthoquinone compound extracted from Lithospermum erythrorhizon Sieb. et Zucc (Boraginaceae), has a wide range of pharmacological activities, including anti-tumor, anti-bacterial and wound healing effects. However, the inhibitory effect of deoxyshikonin on cytochrome P450 (CYP) remains unclear. This study investigated the potential inhibitory effects of deoxyshikonin on CYP1A2, 2B1/6, 2C9/11, 2D1/6, 2E1 and 3A2/4 enzymes in human and rat liver microsomes (HLMs and RLMs) by the cocktail approach in vitro. The single-point inactivation experiment showed that deoxyshikonin presented no time-dependent inhibition on CYP activities in HLMs and RLMs. Enzyme inhibition kinetics indicated that in HLMs, deoxyshikonin was not only a competitive inhibitor of CYP1A2 and 2E1, but also a mixed inhibitor of CYP2B6, 2C9, 2D6 and 3A4, with Ki of 2.21, 1.78, 1.68, 0.20, 4.08 and 0.44 μM, respectively. In RLMs, deoxyshikonin not only competitively inhibited CYP2B1 and 2E1, but also exhibited mixed inhibition on CYP1A2, 2C11, 2D1 and 3A2, with Ki values of no more than 18.66 μM. In conclusion, due to the low Ki values of deoxythiokonin on CYP enzymes in HLMs, this may lead to drug-drug interactions (DDI) and potential toxicity.
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Affiliation(s)
- Yuanjin Zhang
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, People's Republic of China
| | - Jing Gao
- The College of Life Sciences, Northwest University, Xi'an, People's Republic of China
| | - Yuan Xu
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, People's Republic of China
| | - Jie Liu
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, People's Republic of China
| | - Shengbo Huang
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, People's Republic of China
| | - Guihong Li
- Southern Medical University Affiliated Fengxian Hospital, Shanghai, People's Republic of China
| | - Bingyi Yao
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, People's Republic of China
| | - Zhenliang Sun
- Southern Medical University Affiliated Fengxian Hospital, Shanghai, People's Republic of China
| | - Xin Wang
- Changning Maternity and Infant Health Hospital and School of Life Sciences, Shanghai Key Laboratory of Regulatory Biology, East China Normal University, Shanghai, People's Republic of China
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Heck J, Ihlefeld C, Krause O, Stichtenoth DO, Schulze Westhoff M, Noltemeyer N, Jahn K, Prost L, Gerbel S, Klietz M, Bleich S, Frieling H, Groh A. Medication-related problems in geriatric psychiatry-a retrospective cohort study. Int J Geriatr Psychiatry 2022; 37. [PMID: 36005273 DOI: 10.1002/gps.5800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/12/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Information on medication-related problems (MRPs) in elderly psychiatric patients is scarce. In the present study, we analyzed the frequency and characteristics of MRPs in patients ≥60 years treated on the gerontopsychiatric ward of Hannover Medical School in 2019. METHODS Taking advantage of an interdisciplinary approach, two independent investigators screened hospital discharge letters of 230 psychiatric inpatients for clinically relevant MRPs, followed by validation through an interdisciplinary expert panel. Drug interactions as a subset of MRPs were analyzed with the aid of two different drug interaction programs. RESULTS 230 patients (63.0% female, mean age 73.7 ± 8.4 years, median length of stay 18 days) were prescribed a median of 6 drugs. In total, 2180 MRPs were detected in the study population and 94.3% of the patients exhibited at least one MRP. Patients displayed a median of 7 MRPs (interquartile range 3-15). Pharmacodynamic interactions accounted for almost half of all MRPs (48.1%; 1048/2180). The number of drugs prescribed and the number of MRPs per patient showed a strong linear relationship (adjusted R2 = 0.747). CONCLUSION An exceedingly high proportion of elderly psychiatric inpatients displayed clinically relevant MRPs in the present study, which may be explained by the multimorbidity prevalent in the study population and the associated polypharmacy. The number of drug interactions was largely in accordance with previous studies. As a novel finding, we detected that a considerable proportion of elderly psychiatric inpatients were affected by potential prescribing omissions, potentially inappropriate duplicate prescriptions, and insufficient documentation.
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Affiliation(s)
- Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany.,Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christian Ihlefeld
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.,Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Olaf Krause
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany.,Center for Medicine of the Elderly, DIAKOVERE Henriettenstift, Hannover, Germany
| | - Dirk O Stichtenoth
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany.,Drug Commissioner of Hannover Medical School, Hannover, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Nina Noltemeyer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kirsten Jahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lea Prost
- Center for Information Management, Hannover Medical School, Hannover, Germany
| | - Swetlana Gerbel
- Center for Information Management, Hannover Medical School, Hannover, Germany
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Safety pharmacology in 2022: Taking one small step for cardiovascular safety assay development but one giant leap for regulatory drug safety assessment. J Pharmacol Toxicol Methods 2022; 117:107206. [PMID: 35926772 PMCID: PMC9356617 DOI: 10.1016/j.vascn.2022.107206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
The 2021 Annual Safety Pharmacology (SP) Society (SPS) meeting was held virtually October 4–8, 2021 due to the continuing COVID-19 global pandemic. This themed issue of J Pharmacol Toxicol Methods comprises articles arising from the meeting. As in previous years the manuscripts reflect various areas of innovation in SP including a perspective on aging and its impact on drug attrition during safety assessments, an integrated assessment of respiratory, cardiovascular and animal activity of in vivo nonclinical studies, development of a dynamic QT-rate correction method in primates, evaluation of the “comprehensive in vitro proarrhythmia assay” (CiPA) ion channel protocol to the automated patch clamp, and best practices regarding the conduct of hERG electrophysiology studies and an analysis of secondary pharmacology assays by the FDA. The meeting also generated 85 abstracts (reproduced in the current volume of J Pharmacol Toxicol Methods). It appears that the validation of methods remains a challenge in SP. Nevertheless, the continued efforts to mine approaches to detection of proarrhythmia liability remains a baffling obsession given the ability of Industry to completely prevent drugs entering into clinical study only to be found to have proarrhythmic properties, with no reports of such for at least ten years. Perhaps it is time to move on from CiPA and find genuine problems to solve?
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Adem L, Tegegne GT. Medication Appropriateness, Polypharmacy, and Drug-Drug Interactions in Ambulatory Elderly Patients with Cardiovascular Diseases at Tikur Anbessa Specialized Hospital, Ethiopia. Clin Interv Aging 2022; 17:509-517. [PMID: 35464156 PMCID: PMC9020506 DOI: 10.2147/cia.s358633] [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: 01/25/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Limi Adem
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gobezie T Tegegne
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Gobezie T Tegegne, Email
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Anand TV, Wallace BK, Chase HS. Prevalence of potentially harmful multidrug interactions on medication lists of elderly ambulatory patients. BMC Geriatr 2021; 21:648. [PMID: 34798832 PMCID: PMC8603594 DOI: 10.1186/s12877-021-02594-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background It has been hypothesized that polypharmacy may increase the frequency of multidrug interactions (MDIs) where one drug interacts with two or more other drugs, amplifying the risk of associated adverse drug events (ADEs). The main objective of this study was to determine the prevalence of MDIs in medication lists of elderly ambulatory patients and to identify the medications most commonly involved in MDIs that amplify the risk of ADEs. Methods Medication lists stored in the electronic health record (EHR) of 6,545 outpatients ≥60 years old were extracted from the enterprise data warehouse. Network analysis identified patients with three or more interacting medications from their medication lists. Potentially harmful interactions were identified from the enterprise drug-drug interaction alerting system. MDIs were considered to amplify the risk if interactions could increase the probability of ADEs. Results MDIs were identified in 1.3 % of the medication lists, the majority of which involved three interacting drugs (75.6 %) while the remainder involved four (15.6 %) or five or more (8.9 %) interacting drugs. The average number of medications on the lists was 3.1 ± 2.3 in patients with no drug interactions and 8.6 ± 3.4 in patients with MDIs. The prevalence of MDIs on medication lists was greater than 10 % in patients prescribed bupropion, tramadol, trazodone, cyclobenzaprine, fluoxetine, ondansetron, or quetiapine and greater than 20 % in patients prescribed amiodarone or methotrexate. All MDIs were potentially risk-amplifying due to pharmacodynamic interactions, where three or more medications were associated with the same ADE, or pharmacokinetic, where two or more drugs reduced the metabolism of a third drug. The most common drugs involved in MDIs were psychotropic, comprising 35.1 % of all drugs involved. The most common serious potential ADEs associated with the interactions were serotonin syndrome, seizures, prolonged QT interval and bleeding. Conclusions An identifiable number of medications, the majority of which are psychotropic, may be involved in MDIs in elderly ambulatory patients which may amplify the risk of serious ADEs. To mitigate the risk, providers will need to pay special attention to the overlapping drug-drug interactions which result in MDIs. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02594-z.
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Affiliation(s)
- Tara V Anand
- Department of Biomedical informatics, Columbia University Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Brendan K Wallace
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Herbert S Chase
- Department of Biomedical informatics, Columbia University Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
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Prevalence and Factors Associated with Potential Drug-Drug Interactions in Older Community-Dwelling Adults: A Prospective Cohort Study. Drugs Aging 2021; 38:1025-1037. [PMID: 34632551 PMCID: PMC8594274 DOI: 10.1007/s40266-021-00898-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/04/2022]
Abstract
Background Older patients are at increased risk of drug-drug interactions (DDIs) due to polypharmacy. Cardiovascular and central nervous system (CNS) drugs are commonly implicated in serious DDIs. Objectives This study aimed to determine the prevalence and factors associated with potential ‘severe’ cardiovascular and CNS DDIs among older (≥ 70 years) community-dwellers. Methods This was a prospective cohort study using linked data from a national pharmacy claims database and waves 1 and 2 of The Irish LongituDinal study on Ageing (TILDA). ‘Severe’ cardiovascular and CNS DDIs were identified using the British National Formulary 77 and Stockley’s Drug Interactions. The prevalence of ‘severe’ DDIs (any DDI vs. none) was calculated. Logistic regression was used to examine the association between sociodemographic, functional ability, and medication-related factors and the risk of DDI exposure between waves 1 and 2. Results A total of 1466 patients were included [mean age (standard deviation) = 78 (5.5) years; female n = 795, 54.2%]. In total, 332 community-dwellers aged ≥ 70 years [22.65%, 95% confidence interval (CI) 20.58–24.86] were potentially exposed to at least one ‘severe’ cardiovascular or CNS DDI, with more than half (54.82%) of this cohort dispensed the same DDI for a prolonged time (≥ 3 consecutive claims). Aspirin-warfarin was the most frequently dispensed (co-prescribed) DDI (n = 34, 10.24%, 95% CI 7.39–14.00), followed by atorvastatin-clarithromycin (n = 19, 5.72%, 95% CI 3.64–8.81). Polypharmacy [≥ 10 vs. < 5 drugs, odds ratio (OR) 13.40, 95% CI 8.22–21.85] and depression (depressed vs. not, OR 2.12, 95% CI 1.34–3.34) were significantly associated with these DDIs, after multivariable adjustment. Conclusion ‘Severe’ cardiovascular and CNS DDIs are prevalent in older community-dwellers in Ireland, and those with polypharmacy and depression are at a significantly increased risk. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00898-8.
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McMahon M, Hatton C, Bowring DL, Hardy C, Preston NJ. The prevalence of potential drug-drug interactions in adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:930-940. [PMID: 33988262 DOI: 10.1111/jir.12844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/13/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is a high use of medications in adults with intellectual disability (ID). One implication of taking multiple medications is the potential for drug-drug interactions (DDIs). However, despite this being well highlighted in the mainstream literature, little is known about the incidence or associations of DDIs in the ID population. METHODS This study describes the prevalence, patterns and associations of potential DDIs in a total administrative sample of adults with ID known to services in Jersey. Demographic, health-related and medication data were collected from 217 adults known to ID services. Data were collected using a face-to-face survey. The Anatomical Therapeutic Chemical classification system was used to categorise medications, and Stockley's Drug Interaction Checker was used to classify potential DDIs. Drug-drug pairings were considered to be of clinical significance if they were to be 'avoided, adjusted, monitored or required further information'. RESULTS Potential DDIs of clinical significance were common. Exposure to potential DDIs of clinical significance was associated with being female, taking more than five medications (polypharmacy), living in residential care and having more health conditions. A simple regression was used to understand the effect of number of prescribed medications on potential DDIs of clinical significance. Every prescribed drug led to a 0.87 (95% confidence interval: 0.72-1.00) increase in having a potential DDI of clinical significance. CONCLUSION Adults with ID who live in residential care, who are female, exposed to polypharmacy and have more health conditions may be more likely to have potential DDIs of clinical significance. Urgent consideration needs to be given to the potential of DDIs in this population given their exposure to high levels of medication.
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Affiliation(s)
- M McMahon
- Division of Health Research, Lancaster University, Lancaster, UK
- Health and Community Services, Government of Jersey, Saint Helier, Jersey
| | - C Hatton
- Division of Health Research, Lancaster University, Lancaster, UK
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - D L Bowring
- Health and Community Services, Government of Jersey, Saint Helier, Jersey
- CEDAR, University of Warwick, Coventry, UK
| | - C Hardy
- Division of Health Research, Lancaster University, Lancaster, UK
| | - N J Preston
- Division of Health Research, Lancaster University, Lancaster, UK
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14
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Rashid K, Khan Y, Ansar F, Waheed A, Aizaz M. Potential Drug-Drug Interactions in Hospitalized Medical Patients: Data From Low Resource Settings. Cureus 2021; 13:e17336. [PMID: 34557372 PMCID: PMC8450024 DOI: 10.7759/cureus.17336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Adverse events related to Drug-Drug Interactions (DDIs) are among the few common reasons for hospitalization worldwide; however, they can be prevented with an efficient patient-centered system. Different mechanisms have successfully limited the prevalence of DDIs in developed countries. There are limited data regarding DDIs from limited-resource settings. Furthermore, there is no cost-effective system that has shown promising results in preventing them in this setting. This study aims to assess the frequency of potential DDIs in a low-resource setting and to check its association with different factors such as poly-pharmacy and demographics. Methods Through this cross-sectional study, drug charts of patients admitted to a medical unit in November 2019 were analyzed using a structured questionnaire. A list of drugs co-prescribed to each patient was entered into the Medscape Drug Interaction checker to calculate the frequency and severity of potential DDIs. Results The mean age of patients was 49 years, and on average, seven drugs were prescribed to each patient. Among 100 analyzed prescriptions, 400 potential DDIs were identified with a mean of 4±5.42 per patient. According to Medscape interaction checker classification, 2 DDIs were contraindicated, 28 were serious, 246 required close monitoring, and 124 were minor. The most frequently encountered drug interaction was "spironolactone with furosemide." There was a significant correlation of the occurrence of potential DDIs with increased numbers of prescribed drugs. Conclusion Our patient population was prescribed more drugs per patient than calculated in other settings. Poly-pharmacy is an independent risk factor for DDIs. Lastly, advancing age exposes patients to poly-pharmacy, and therefore, they are at a higher risk of developing DDIs.
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Affiliation(s)
- Khalid Rashid
- Internal Medicine, James Cook University Hospital, Middlesbrough, GBR
| | - Yahya Khan
- Department of Medical Education, Pak International Medical College, Peshawar, PAK
| | - Farrukh Ansar
- Medicine, Northwest School of Medicine, Khyber Medical University, Peshawar, PAK
| | - Aamir Waheed
- Internal Medicine, Northampton General Hospital, Northampton, GBR
| | - Muhammad Aizaz
- Community Health Sciences, Peshawar Medical College, Peshawar, PAK
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15
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Chen R, Zhang Y, Dou Z, Chen F, Xie K, Wang S. Data Sharing and Privacy in Pharmaceutical Studies. Curr Pharm Des 2021; 27:911-918. [PMID: 33438533 DOI: 10.2174/1381612827999210112204732] [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] [Received: 06/01/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022]
Abstract
Adverse drug events have been a long-standing concern for the wide-ranging harms to public health, and the substantial disease burden. The key to diminish or eliminate the impacts is to build a comprehensive pharmacovigilance system. Application of the "big data" approach has been proved to assist the detection of adverse drug events by involving previously unavailable data sources and promoting health information exchange. Even though challenges and potential risks still remain. The lack of effective privacy-preserving measures in the flow of medical data is the most important Accepted: one, where urgent actions are required to prevent the threats and facilitate the construction of pharmacovigilance systems. Several privacy protection methods are reviewed in this article, which may be helpful to break the barrier.
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Affiliation(s)
- Rufan Chen
- Department of Bioinformatics, Hangzhou Nuowei Information Technology Co., Ltd, Hangzhou, China
| | - Yi Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zuochao Dou
- Department of Bioinformatics, Hangzhou Nuowei Information Technology Co., Ltd, Hangzhou, China
| | - Feng Chen
- Department of Bioinformatics, Hangzhou Nuowei Information Technology Co., Ltd, Hangzhou, China
| | - Kang Xie
- Key Lab of Information Network Security of Ministry of Public Security, the Third Research Institute of Ministry of Public Security, Shanghai, China
| | - Shuang Wang
- Department of Bioinformatics, Hangzhou Nuowei Information Technology Co., Ltd, Hangzhou, China
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Pham Nguyen TP, Jacobs D, Thibault D, Willis AW. Multiple sclerosis hospitalizations among users of oral disease-modifying therapies. Mult Scler Relat Disord 2021; 52:102944. [PMID: 33894480 DOI: 10.1016/j.msard.2021.102944] [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: 10/28/2020] [Revised: 03/06/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Oral disease-modifying therapies, namely dimethyl fumarate, fingolimod and teriflunomide, have become standard treatments for multiple sclerosis. Clinical trials demonstrated a reduction in annual relapse rate, but real-world data is lacking, particularly in older adults. The objective of our study is to evaluate the real-world effectiveness of oral disease-modifying therapies among individuals with multiple sclerosis. METHODS We used OptumTM ClinformaticsTM Data Mart, a large dataset representative of commercially insured individuals in the United States, to conduct a retrospective cohort study of adult users of three oral disease-modifying therapies from September 2010 through September 2015. The therapies of interest included dimethyl fumarate, teriflunomide, and fingolimod. Hospitalization for multiple sclerosis, an approximation of the clinical trial endpoint for relapse, was the study outcome. Cox proportional hazards models were built to evaluate the association of demographic and clinical factors with multiple sclerosis hospitalization. A subgroup analysis was performed on individuals ages 55 years or older. RESULTS We identified 1,823, 318, and 1,156 users of dimethyl fumarate, teriflunomide, and fingolimod that met our inclusion criteria, respectively. Rates of hospitalizations for multiple sclerosis were low among these 3,297 persons (1,041 ages 55+): 36/1,000 patient-years for dimethyl fumarate, 43/1,000 for teriflunomide, and 45/1,000 for fingolimod. Multiple sclerosis hospitalization was associated with therapy switching (adjusted hazard ratio 2.21, 95% confidence interval 1.57-2.84), minority (1.44, 1.10-1.89), and history of relapse in the year preceding oral therapy initiation (5.25, 3.89-7.09). CONCLUSION Oral disease-modifying therapies are comparably effective for the outcome of multiple sclerosis hospitalization, even in older adults.
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Affiliation(s)
- Thanh Phuong Pham Nguyen
- Department of Neurology, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA; Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA.
| | - Dina Jacobs
- Department of Neurology, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA; Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA
| | - Dylan Thibault
- Department of Neurology, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA; Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA
| | - Allison W Willis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA; Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA
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Hansen RN, Nørgaard LS, Hedegaard U, Søndergaard L, Servilieri K, Bendixen S, Rossing C. Integration of and visions for community pharmacy in primary health care in Denmark. Pharm Pract (Granada) 2021; 19:2212. [PMID: 33520039 PMCID: PMC7844971 DOI: 10.18549/pharmpract.2021.1.2212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In 2014, the Danish government launched a plan for health entitled: "Healthier lives for everyone - national goals for the health of Danes within the next 10 years". The overall objective is to prolong healthy years of life and to reduce inequality in health. In Denmark, the responsibility for health and social care is shared between the central government, the regions and the municipalities. National and local strategies seek to enhance public health through national and local initiatives initiated by different stakeholders. The Danish community pharmacies also contribute to promoting public health through distribution of and counselling on medication in the entire country and through offering several pharmacy services, six of which are fully or partly remunerated on a national level. Because of greater demands from patients, health care professionals and society and a lack of general practitioners, the Danish community pharmacies now have the opportunity to suggest several new functions and services or to extend existing services. The Danish pharmacy law changed in 2015 with the objective to maintain and develop community pharmacies and to achieve increased patient accessibility. The change in the law made it possible for every community pharmacy owner to open a maximum of seven pharmacy branches (apart from the main pharmacy) in a range of 75 km. This change also increased the competition between community pharmacies and consequently the pharmacies are now under financial pressure. On the other hand, each pharmacy may have been given an incentive to develop their specific pharmacy and become the best pharmacy for the patients. Community pharmacies are working to be seen as partners in the health care system. This role is in Denmark increasingly being supported by the government through the remunerated pharmacy services and through contract with municipalities. Concurrent with the extended tasks for the Danish community pharmacies and utilisation of their excellent competencies in medication the community pharmacies need to focus on their main tasks of supplying medicines and implementing services. This requires efficient management, an increased use of technology for distribution and communication and continuing education and training.
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Affiliation(s)
- Rikke N Hansen
- MSc (Pharmacy). Head of Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Lotte S Nørgaard
- PhD (Pharmacy). Associate Professor. University of Copenhagen. Copenhagen (Denmark).
| | - Ulla Hedegaard
- PhD (Pharmacy). Associate Professor. University of Southern Denmark. Odense (Denmark).
| | - Lone Søndergaard
- MSc (Pharmacy). Deputy manager, Aarhus Viby Pharmacy. Aarhus (Denmark).
| | - Kerly Servilieri
- MSc (Pharmacy). Pharmacy owner Kløver Pharmacy. Brædstrup (Denmark).
| | - Susanne Bendixen
- MSc (Pharmacy). Pharmacy owner, Copenhagen Sønderbro Pharmacy, Sydhavns Pharmacy, Sluseholmen Pharmacy. Copenhagen (Denmark).
| | - Charlotte Rossing
- PhD (Pharmacy), Director of Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
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18
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Modelling drugs interaction in treatment-experienced patients on antiretroviral therapy. Soft comput 2020. [DOI: 10.1007/s00500-020-05024-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abrahamsen B, Hansen RN, Rossing C. For which patient subgroups are there positive outcomes from a medication review? A systematic review. Pharm Pract (Granada) 2020; 18:1976. [PMID: 33224322 PMCID: PMC7672485 DOI: 10.18549/pharmpract.2020.4.1976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background: A medication review is a possibility to assess and optimise a
patient’s medicine. A model that includes a medication review and a
follow-up seem to provide the best results. However, it is not known whether
specific subgroups of patients benefit more from a medication review than
others. Objective: This literature review summarises the evidence that is available on which
patient subgroups exist positive outcomes from a medication review carried
out in a primary care setting. Methods: We performed a PICO analysis to identify keywords for setting, medication
review and effect. We then conducted a search using the PubMed database
(2004 to 2019) to identify studies relevant for our investigation. A
screening process was carried out based on either title or abstract, and any
study that matched the aim and inclusion criteria was included. All matching
studies were obtained and read, and were included if they met predefined
criteria such as study design, medication review and primary care. The
studies were divided into subgroups. First, each subgroup was divided
according to the studies’ own definition. Secondly, each subgroup was
allocated as either risk patients if the subgroup described a specific
patient subgroup or risk medication, if the subgroup was defined as using a
specific type of medication. This was done after discussion in the author
group. Results: 28 studies from a total of 935 studies were included. Identified studies were
divided into either risk patients; frail, recently discharged or multimorbid
patients, or risk medication; heart medication, antithrombotic medication,
blood pressure lowering medication, antidiabetic medication, anti-Parkinson
medication or medication increasing the risk of falls. The subgroups
identified from a medication review in primary care were defined as being
frail, recently discharged from hospital or multimorbid (risk patients), or
defined as patients using anticoagulant or blood pressure lowering
medication (risk medication). Most of the medication reviews in the studies
that showed an economic effect included at least one follow-up and were
delivered by a pharmacist. Conclusions: The literature review demonstrates that medication reviews delivered by
pharmacists to specific subgroups of patients are a way of optimising the
economic effect of medication reviews in primary care. This is obtained by
reducing health-related costs or the number of contacts with primary or
secondary health care services.
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Affiliation(s)
- Bjarke Abrahamsen
- PhD, MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Rikke N Hansen
- MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Charlotte Rossing
- PhD, MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
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Marinović I, Bačić Vrca V, Samardžić I, Marušić S, Grgurević I. Potentially inappropriate medications involved in drug-drug interactions at hospital discharge in Croatia. Int J Clin Pharm 2020; 43:566-576. [PMID: 33001315 DOI: 10.1007/s11096-020-01164-4] [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] [Received: 07/22/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
Background The potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs) can significantly affect patient safety in the elderly, especially at transition of health care. Objective The aim of this study is to evaluate PIMs involved in potentially clinically significant DDIs in prescribed pharmacotherapy of elderly patients at hospital discharge. Setting Internal Medicine Clinic of University Hospital Dubrava, Zagreb, Croatia. Method During a 16-month period, the pharmacotherapy data were assessed using Lexicomp Online screening software to identify category C (monitor drug therapy), D (consider therapy modification) and X (avoid combination) DDIs. The European Union (EU)(7)-PIM criteria were applied to detect inappropriately prescribed medications involved in DDIs. Clinical pharmacists obtained data from patients' medical records and patient/caregiver interviews. Main outcome measure The incidence of PIMs involved in potentially clinically significant DDIs. Results A total of 364 consecutive elderly patients were enrolled in the study. The mean number of prescription medications at discharge was 9.3. Overall, 2833 potentially clinically significant DDIs were identified: 2445 (86.3%) of them were category C, 347 (12.3%) category D and 41 (1.4%) were category X interactions. A total of 1164 PIMs were involved in 31.2% of category C interactions, 60.2% of category D interactions and 43.9% of category X interactions. The most frequent PIMs involved in potentially clinically significant DDIs were tramadol, benzodiazepines, moxonidine, vildagliptin and metoclopramide. Conclusion A very high incidence of DDIs in elderly patients and a high incidence of PIMs involved in DDIs was determined at hospital discharge.
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Affiliation(s)
- Ivana Marinović
- Department of Clinical Pharmacy, University Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, Croatia.
| | - Vesna Bačić Vrca
- Department of Clinical Pharmacy, University Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ivana Samardžić
- Department of Clinical Pharmacy, University Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, Croatia
| | - Srećko Marušić
- Department of Endocrinology, University Hospital Dubrava, Zagreb, Croatia
| | - Ivica Grgurević
- Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia
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Hoppe LK, Muhlack DC, Koenig W, Brenner H, Schöttker B. The Associations of Diuretics and Laxatives Use with Cardiovascular Mortality. An Individual Patient-Data Meta-analysis of Two Large Cohort Studies. Cardiovasc Drugs Ther 2020; 33:567-579. [PMID: 31375970 PMCID: PMC6904395 DOI: 10.1007/s10557-019-06894-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose To investigate the associations of diuretics overall, non-potassium-sparing diuretics in specific, and laxative use with cardiovascular mortality (CVM) in subjects with antihypertensive treatment. Methods Analyses included 4253 participants, aged 50 to 75 years, from the German ESTHER cohort and 105,359 participants, aged 50 to 69 years, from the UK Biobank. Cox proportional hazard regression models were applied in both studies, and then results were pooled using random-effects model meta-analyses. Results During 14 and 7 years of follow-up, 476 and 1616 CVM cases were observed in the ESTHER study and the UK Biobank, respectively. Compared to non-users, a 1.6-fold (hazard ratio [95% confidence interval] 1.57 [1.29; 1.90]), a 1.4-fold (1.39 [1.26; 1.53]), and no statistically significantly increased (1.13 [0.94; 1.36]) CVM were observed in users of diuretics overall, non-potassium-sparing diuretics in specific, and laxatives, respectively. Concurrent use of non-potassium-sparing diuretics and laxatives was associated with a 2-fold increased CVM (2.05 [1.55; 2.71]) when compared to users of neither diuretics nor laxatives. However, a test for interaction slightly missed statistical significance (p = 0.075). Conclusions These consistent results from two large cohort studies imply that more research is needed on the safety of diuretics in routine care. Although not statistically significant in this study, a drug-drug interaction of non-potassium-sparing diuretics and laxatives appears plausible. Physicians and pharmacists are advised to clarify additional laxative use in users of non-potassium-sparing diuretics and inform about the risk of concurrent use. Moreover, closer potassium monitoring intervals (e.g., every 3 months) might be indicated in concurrent users to prevent fatal cardiovascular events. Electronic supplementary material The online version of this article (10.1007/s10557-019-06894-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liesa Katharina Hoppe
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany
| | - Dana Clarissa Muhlack
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Pettenkoferstraße 8a & 9, 80336, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstraße 22, 89081, Ulm, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
- Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany.
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Abrahamsen B, Burghle AH, Rossing C. Pharmaceutical care services available in Danish community pharmacies. Int J Clin Pharm 2020; 42:315-320. [PMID: 32026353 DOI: 10.1007/s11096-020-00985-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 01/28/2020] [Indexed: 11/27/2022]
Abstract
In recent years, increased longevity of the Danish population has resulted in a growing segment with age-related and chronic health conditions. This, together with a general increase in the demand on the services of doctors, has augmented the role of pharmacies in the provision of healthcare services. In Denmark, a variety of pharmacy services has been developed, evaluated and implemented since the introduction of pharmaceutical care. The services are aimed at the person responsible for administering the medicine e.g. the patient themselves or care workers, thereby supporting medication safety. The services available have been developed, evaluated and implemented in collaboration between community pharmacies, the Danish Association of Pharmacies, the Danish College of Pharmacy Practice and international collaborators. In this commentary we present an overview of the available pharmacy service, the contents of each service, remuneration and the scientific evidence behind each service. The commentary covers: Inhaler Technique Assessment Service; New Medicines Service; Medication Review; and Medication Safety in Residential Facilities.
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Affiliation(s)
- Bjarke Abrahamsen
- Research and Development, Danish College of Pharmacy Practice, Hillerød, Denmark
| | | | - Charlotte Rossing
- Research and Development, Danish College of Pharmacy Practice, Hillerød, Denmark.
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Štuhec M, Potočin I, Stepan D, Ušaj L, Petek Šter M, Beović B. Potential drug interactions with antibacterials in long-term care facilities analyzed by two interaction checkers. Int J Clin Pharm 2019; 41:932-938. [PMID: 31172409 DOI: 10.1007/s11096-019-00855-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
Background Residents in long-term care facilities take many medications concomitantly, including antibacterials, which increases the risk of drug-drug interactions. Objectives The aims of the study were to investigate the prevalence of severe potential interactions between antibacterials and other medications in Slovenian long-term care facilities and to compare the performance of two different drug-drug interaction checkers in these settings. Setting Residents in long-term care facilities in Slovenia. Method A point-prevalence study was conducted from April 2016 to June 2016. Residents' characteristics, antibacterial treatment, and concomitant medications were obtained from their medical charts. Potential drug-drug interactions were determined using Lexicomp Online™ 3.0.2 and the online Drugs.com Drug Interactions Checker. The study only included potential drug-drug interactions categorized as type MA (major interactions) by the Drugs.com checker and as type X (should be avoided) by Lexicomp Online™. The study calculated the differences in the number of type X and MA potential drug-drug interactions between different antibacterial classes and between the two drug-drug interactions checkers. Main outcome measure Number of medications per patient, number of potential drug-drug interactions with antibacterial, and differences between two drug-drug interactions checkers. Results Eighty (68.4%) of Slovenian general long-term care facilities with 13,032 residents responded to the invitation. 317 (2.4%) of the residents received antibacterial treatment and 212 residents were included in the analysis. On average, they received 10.9 medications (SD = 3.9). Antibacterials were involved in 24.1% type MA potential drug-drug interactions and 26.4% type X potential drug-drug interactions. A significant difference in the total number of potential drug-drug interaction between the two checkers was found for all antibacterials, co-trimoxazole and fluoroquinolones (p < 0.005). Type X and MA potential drug-drug interactions were more common with fluoroquinolones than with beta-lactams or co-trimoxazole (p < 0.005). Conclusion Potential interactions between antibacterials, especially fluoroquinolones and other drugs, were common in long-term care facility residents treated with antibacterials. Differences in the number of potential drug-drug interactions between the two checkers indicate that if available the use of several sources of information is recommended in clinical practice. The results call for a collaborative approach to address the risks of drug-drug interactions.
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Affiliation(s)
- Matej Štuhec
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.,Department for Clinical Pharmacy, Psychiatric Hospital Ormoz, Ormoz, Slovenia.,Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia
| | - Ines Potočin
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Dora Stepan
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lea Ušaj
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marija Petek Šter
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bojana Beović
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. .,Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525, Ljubljana, Slovenia.
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Iniesta-Navalón C, Gascón-Cánovas JJ, Gama ZADS, Sánchez-Ruiz JF, Gutiérrez-Estrada EA, De-la-Cruz-Sánchez E, Harrington-Fernández O. Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain. CIENCIA & SAUDE COLETIVA 2019; 24:1895-1902. [PMID: 31166522 DOI: 10.1590/1413-81232018245.16032017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022] Open
Abstract
This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.
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Affiliation(s)
- Carles Iniesta-Navalón
- Farmacia Hospitalaria, Hospital General Universitario Reina Sofia. Av. Intendente Jorge Palacios 1. 30003 Murcia Espanha.
| | | | - Zenewton André da Silva Gama
- Departamento de Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte. Natal RN Brasil
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Das S, Behera SK, Xavier AS, Dharanipragada S, Selvarajan S. Are drug-drug interactions a real clinical concern? Perspect Clin Res 2019; 10:62-66. [PMID: 31008071 PMCID: PMC6463504 DOI: 10.4103/picr.picr_55_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Although drug-drug interactions (DDIs) cause major adverse drug reactions (ADRs) in patients under polypharmacy, the risk of some specific DDIs may be overrated in literature and different software. This study was conducted to determine the frequency and type of potential and clinically significant DDIs among inpatients admitted in a tertiary care hospital in South India. Materials and Methods: This longitudinal study was conducted for 30 days. Preformatted forms were used to collect data on the second day of admission. “Medscape Drug Interaction Checker” was used to evaluate and grade the DDIs. All the potential serious DDIs were intimated to the treating physicians and their responses in the prescriptions were noted. The same patients were followed up to evaluate the occurrence of any clinically significant DDIs. Results: A total of 763 drugs with 125 discrete types were prescribed in 155 patients with an average of 4.9 drugs per patient. One hundred and eight minor, 169 significant, and 24 serious potential DDIs were identified. Patient's age did not correlate, but number of drugs prescribed strongly correlated (P < 0.001) with the incidence of different types of DDIs. The prescription was modified in only 6 (25%) cases where potential serious DDIs were reported. Interestingly, no ADRs or impaired efficacy was observed due to the potential serious DDIs. Conclusion: There was a disparity between the potential and clinically relevant DDIs. Hence, clinical prudency is required before changing prescription due to potential DDIs reported by different software.
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Affiliation(s)
- Saibal Das
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sapan Kumar Behera
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Alphienes Stanley Xavier
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Subrahmanyam Dharanipragada
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Nachtigall A, Heppner HJ, Thürmann PA. Influence of pharmacist intervention on drug safety of geriatric inpatients: a prospective, controlled trial. Ther Adv Drug Saf 2019; 10:2042098619843365. [PMID: 31019678 PMCID: PMC6469284 DOI: 10.1177/2042098619843365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/20/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Demographic shift leads to an increasing number of geriatric patients suffering from multimorbidity and resulting polypharmacy. Polypharmacy is shown to be associated with drug-related problems (DRPs) and increased morbidity. For Germany, a hospital-based intervention may be successful optimizing of polypharmacy. The aim of this study was to reduce DRPs in geriatric inpatients by a structured pharmacist's intervention and to measure the acceptance rate of pharmaceutical recommendations. METHODS This study followed an open, prospective, quasi-randomized, controlled design and was conducted in a geriatric department in a teaching hospital in Germany. Patients of all sexes were included, with a minimum age of 70 years, a written informed consent and a regular intake of at least five drugs daily. Primary outcome was the percentage of patients having a DRP at admission and discharge. A DRP was defined as a prescription without indication or a relevant drug-drug interaction or prescription of a potentially inappropriate medication or presence of an adverse drug reaction. Recommendations were classified and discussed face to face. Statistical analyses were performed using a full-set analysis and a matched-pairs design. RESULTS Within 12 months, 411 patients were recruited with median age of 82 years (intervention: n = 209; control: n = 202). Median number of drugs at admission was 10 (range 5-24), at discharge 9 (range 3-21). In the intervention group, the percentage of patients with a DRP was reduced from 86.6% to 56.0%; in the control group, from 76.7% to 76.2% (p value < 0.001). Medication appropriateness index score was reduced by 56% in the intervention group and by 0.2% in the control group (p value < 0.001). Implementation rate of the pharmaceutical recommendation was 80%. CONCLUSION This prospective controlled trial showed that a pharmacist's intervention was successful in optimizing polypharmacy in geriatric inpatients.
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Affiliation(s)
- Angela Nachtigall
- Department of Human Medicine, University of
Witten/Herdecke, Witten, Germany, Pharmacy, Helios Clinic Schwelm, Schwelm,
Germany
| | - Hans J. Heppner
- Department of Human Medicine, University of
Witten/Herdecke, Witten, Germany Department of Geriatric Medicine, Helios
Clinic Schwelm, Schwelm, Germany, Institute for Biomedicine of Ageing, FAU
Erlangen-Nuremberg, Nuremberg, Germany
| | - Petra A. Thürmann
- Department of Human Medicine, University of
Witten/Herdecke, Witten, Germany Department of Geriatric Medicine, Helios
Clinic Schwelm, Schwelm, Germany, Institute for Biomedicine of Ageing, FAU
Erlangen-Nuremberg, Nuremberg, Germany
- Department of Human Medicine, University of
Witten/Herdecke, Witten, Germany
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Sousa A, Shah M, Karia S, Merchant H, Shah N. Risperidone-induced skin rash in an elderly female. JOURNAL OF GERIATRIC MENTAL HEALTH 2019. [DOI: 10.4103/jgmh.jgmh_7_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vezmar-Kovačević S, Vučićević K, Topić-Vučenović V, Rajkovača Z, Miljković B. Clinically important drug interactions with opioid and non-opioid analgesics. ARHIV ZA FARMACIJU 2019. [DOI: 10.5937/arhfarm1901071v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Evaluation of Potential Drug-Drug Interactions with Medications Prescribed to Geriatric Patients in a Tertiary Care Hospital. J Aging Res 2018; 2018:5728957. [PMID: 30402286 PMCID: PMC6198551 DOI: 10.1155/2018/5728957] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives The drugs most commonly implicated in major potential interactions are those used in the day-to-day clinical management of elderly patients with chronic diseases. This study is planned to evaluate the profile of drug-drug interactions in the medications prescribed to elderly population and also to identify the possible predictors for potential drug-drug interactions in the elderly. Methods This cross-sectional study included patients aged above 60 years with a minimum of two drugs in the prescriptions. Data were collected from medical prescriptions and patients' medical records. The data collected included demographic characteristics such as age, gender, height, weight, educational status, socioeconomic status, medical history, and medications prescribed. The prescriptions were analyzed for the potential drug interactions using Lexi-Interact™ Online, an online software to check drug-drug interactions. Results A total of 209 patients were included in the study, among them 104 (49.8%) were males and 105 (50.2%) were females. The mean number of medications received was 6.53 ± 2.15 per prescription. Around 138 (66%) patients received more than six medications. The mean number of potential drug interactions seen in the prescription of these patients was 3.17 ± 2.78. Around 18.2% patients had more than five drug interactions. Major drug interactions were observed in 21.42% of cases. Around 3.02% of drug interactions belonged to risk category X, i.e., to be avoided. Logistic regression analysis showed that age above 70 years was associated with the presence of drug interactions. Increased number of medication was independently associated with the occurrence of drug interactions. The presence of drug interactions was not associated with increased number of comorbidities. Conclusion A significant number of potential drug-drug interactions were seen in the prescriptions of elderly patients. Increasing age and polypharmacy were identified as the predictors of potential drug interactions.
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Pohontsch NJ, Löffler A, Luck T, Heser K, Parker D, Haenisch B, Riedel-Heller SG, Jessen F, Scherer M. Informal caregivers' perspectives on health of and (potentially inappropriate) medication for (relatively) independent oldest-old people - a qualitative interview study. BMC Geriatr 2018; 18:169. [PMID: 30045689 PMCID: PMC6060533 DOI: 10.1186/s12877-018-0849-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Oldest-old persons frequently receive potentially inappropriate medication. Medication use takes place under the patients' informal caregivers' influence. We explored informal caregivers' perspectives on medication of (relatively) independent oldest-old persons to identify starting points for safer medication prescription/handling. METHODS In this exploratory qualitative interview study we interviewed 45 informal caregivers of 45 oldest-old persons (23 with potentially inappropriate medication/22 without potentially inappropriate medication). Interviews were recorded, transcribed and content analyzed (deductive/inductive coding). RESULTS Interviewees had little knowledge about/influence on oldest-old persons' medication, but declared to monitor oldest-old persons' needs for assistance. They were unaware of the concept of potentially inappropriate medication but sometimes sensitive to substance dependency. Most informal caregivers were satisfied with the oldest-old persons' medication and viewed medication as increasing the patients' quality of life. Inadequate communication was found between informal caregivers and general practitioners. CONCLUSIONS Influence of informal caregivers on (relatively) independent oldest-old persons' medication seems low. Stakeholders need to be aware that there is a transitional period where independency of oldest-old persons decreases and support needs increase which may be missed by (in-)formal caregivers or concealed by oldest-old persons. Monitoring patients' medication competencies; measures supporting communication between informal caregivers and health care professionals; provision of educational and support resources for informal caregivers and the acceptance of oldest-old persons' increasing assistance needs may increase medication safety.
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Affiliation(s)
- Nadine Janis Pohontsch
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Antje Löffler
- Institute of Health Science, Brandenburg University of Technology (BTU) Cottbus-Senftenberg, Senftenberg, Germany
| | - Tobias Luck
- Department of Economic and Social Sciences & Institute of Social Medicine, Rehabilitation Sciences and Healthcare Research (ISRV), University of Applied Sciences Nordhausen, Nordhausen, Germany
| | - Kathrin Heser
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Debora Parker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Britta Haenisch
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Center for Translational Medicine, University of Bonn, Bonn, Germany
- Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Martin Scherer
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Clinically relevant drug-drug interactions among elderly people with dementia. Eur J Clin Pharmacol 2018; 74:1351-1360. [PMID: 29967921 PMCID: PMC6132551 DOI: 10.1007/s00228-018-2514-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022]
Abstract
Purpose Increased numbers of drugs and changes in pharmacokinetic and pharmacodynamic parameters among elderly people contribute to increased prevalence of adverse drug reactions. Drug–drug interactions (DDIs) are an important reason for admission to hospital and elderly people with dementia are particularly vulnerable. The aims of the present study were to assess the occurrence and characteristics of clinically relevant DDIs and to investigate potential risk factors associated with DDIs among elderly people with dementia. Methods People ≥ 65 years with dementia, admitted to two hospitals in Northern Sweden, were included. The medical records of 458 patients were reviewed. Clinically relevant DDIs were identified using the Janusmed interactions database. Pharmacological classification was conducted using Stockley’s classification system. Results A total of 401 DDIs were identified among 43.2% of the study population, of which 98.5% had interactions that may require dose adjustment and 7.6% had drug combinations that should be avoided. Pharmacodynamic interactions were most common, of which furosemide–citalopram (n = 35) were most frequently observed. Omeprazol–citalopram (n = 25) was the most common drug combination among pharmacokinetic interactions. Citalopram and warfarin were the most commonly involved drug substances. An association was found between a higher number of medications being prescribed and having at least one DDI. Conclusion Clinically relevant drug–drug interactions are prevalent among elderly people with dementia living in Northern Sweden. Drug–drug interactions should be identified in order to manage and prevent adverse outcomes. This is particularly important among this group of people especially when multiple medications are being prescribed.
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Stegemann S. Patient centric drug product design in modern drug delivery as an opportunity to increase safety and effectiveness. Expert Opin Drug Deliv 2018; 15:619-627. [DOI: 10.1080/17425247.2018.1472571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sven Stegemann
- Institute of Process and Particle Engineering, Graz University of Technology, Graz, Austria
- Capsugel a Lonza Company, Lonza, Bornem, Belgium
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Fettah H, Moutaouakkil Y, Sefrioui MR, Moukafih B, Bousliman Y, Bennana A, Lamsaouri J, Makram S, Cherrah Y. Detection and analysis of drug-drug interactions among hospitalized cardiac patients in the Mohammed V Military Teaching Hospital in Morocco. Pan Afr Med J 2018; 29:225. [PMID: 30100979 PMCID: PMC6080962 DOI: 10.11604/pamj.2018.29.225.14169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/11/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Drug-drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. Patients with cardiovascular disorders are at higher risk for DDIs because of the types and number of drugs they receive. The aim of the present study was to assess the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco. METHODS A prospective observational study from June 2016 to September 2016 was carried out in the cardiology department of a hospital in Morocco. Those patients who were taking at least two drugs and had a hospital stay of at least 48 hours were included in the study. The medications of the patients were analysed for possible interactions. All the prescriptions of the study population were screened for drug-drug interactions using a computerized DDI database system (Theriaque®). RESULTS During the study period, 138 patients were included; 360 interactions were detected among 94 patients, with an average number of drugs taken of 5.2. The prevalence of DDIs was estimated at 68.11%, the most common of which concerned Kardegic/Plavix (12.22%), Kardegic/Heparin (8.33%), and Lasilix/Spironolactone (5.83%). Among the 726 prescribed drugs, (372 [51.24%]) were drugs of the cardiovascular system, followed by blood and hematopoietic organ drugs (288 [39.67%]) according to the Anatomical Therapeutic Chemical Classification codes. These interactions were categorized on the basis of level of severity: interactions with major severity accounted for 11.11% (40) of the total DDIs while those with moderate and minor severity accounted for 37.22% (134) and 51.66% (186), respectively. CONCLUSION This study reports the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco. This study shows that DDIs are frequent among hospitalized cardiac patients and highlights the need to screen prescriptions of cardiovascular patients for possible DDIs, as this helps in their detection and prevention.Pan African Medical Journal - ISSN: 1937- 8688 (www.panafrican-med-journal.com)Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net)Pan African Medical Journal - ISSN: 1937- 8688 (www.panafrican-med-journal.com)Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net).
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Affiliation(s)
- Hicham Fettah
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Youssef Moutaouakkil
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Mohamed Reda Sefrioui
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Badreddine Moukafih
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Yassir Bousliman
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Ahmed Bennana
- Laboratory of Medicinal Chemistry, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat, Morocco
| | - Jamal Lamsaouri
- Laboratory of Medicinal Chemistry, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat, Morocco
| | - Sanaa Makram
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Yahia Cherrah
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
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Aljadani R, Aseeri M. Prevalence of drug-drug interactions in geriatric patients at an ambulatory care pharmacy in a tertiary care teaching hospital. BMC Res Notes 2018; 11:234. [PMID: 29622031 PMCID: PMC5887202 DOI: 10.1186/s13104-018-3342-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/30/2018] [Indexed: 11/17/2022] Open
Abstract
Objective A cross-sectional study was performed from February to May 2015, to estimate the prevalence of drug–drug interactions in geriatric patients at the ambulatory care pharmacy at King Abdul-Aziz Medical City in Jeddah, Saudi Arabia. Results A total of 310 patients were included, with a mean age (± SD) of 73.78 ± 6.96, and 48.70% were female. The overall prevalence of DDIs of all categories was 90.64%. Category B DDIs was 55.80%, category C DDIs 87.74%, category D DDIs 51.93%, and category X DDIs 16.45%. Atorvastatine plus omeprazole was identified as the most common interacting pair, with a prevalence of 25.26%. Multivariate logistic regression analysis showed that category D or X DDIs are more likely to occur in the female patient (OR = 1.79; 95% CI 1.07, 2.97), the patient taking more than three medications (OR = 22.62; 95% CI 2.93, 174.83), and the patient with more than two conditions (OR = 3.09; 95% CI 1.81, 5.27).
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Affiliation(s)
- Rawabi Aljadani
- Pharmacy Department, King Saud bin AbdulAziz University for Health Sciences/King AbdulAziz Medical City, Riyadh, Saudi Arabia.
| | - Mohammed Aseeri
- Clinical Pharmacy Services, Pharmacy Department, King Saud bin AbdulAziz University for Health Sciences/King AbdulAziz Medical City, PO Box 9515, Jeddah, 21423, Saudi Arabia
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Vasudev A, Harrison R. Prescribing safely in elderly psychiatric wards: survey of possible drug interactions. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.107.019141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodA cross-sectional survey of patient drug prescriptions on two elderly psychiatric wards was carried out to estimate the potential of drug–drug interactions. Two standardised databases, British National Formulary (BNF; British Medical Association & Royal Pharmaceutical Society of Great Britain, 2007) and Upto Date (www.uptodate.com/), were employed.ResultsA majority (96%) of drug prescriptions in our study could potentially cause drug–drug interactions. Most patients were on multiple drugs (on average eight drugs per patient). There was poor concordance between the two databases: BNF picked up fewer cases of potential drug–drug interactions than Upto Date (43 v. 152 instances) and they also estimated the potential for hazardousness differently.Clinical ImplicationsPolypharmacy is common in elderly psychiatric patients and this increases the possibility of a drug–drug interaction. Estimating the risk of interactions depends on a sound knowledge in therapeutics and/or referring to a standardised source of information. the results of this study question the concordance of two well-referenced databases.
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Vezmar K, Vučićević K, Vučenović T, Rajkovača Z, Miljković B. Clinically important drug interactions with opioid and non-opioid analgesics. ARHIV ZA FARMACIJU 2018. [DOI: 10.5937/arhfarm1806071v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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van Lieshout MRJ, Bleijenberg N, Schuurmans MJ, de Wit NJ. The Effectiveness of a PRoactive Multicomponent Intervention Program on Disability in Independently Living Older People: A Randomized Controlled Trial. J Nutr Health Aging 2018; 22:1051-1059. [PMID: 30379302 DOI: 10.1007/s12603-018-1101-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is an increase in functional limitations and a decline in physical and mental well-being with age. Very few effective lifestyle interventions are available to prevent adverse outcomes such as disability in (pre-) frail older people. The effectiveness of an interdisciplinary multicomponent intervention program to prevent disability in older people in the community was tested. METHOD A randomized controlled trial (RCT) with a one-year follow-up was conducted in the Netherlands. Community-dwelling pre-frail older people aged 65 years and over were invited to participate. Frailty was measured with the Groningen Frailty Indicator (GFI) and categorized into non-frail (GFI=0), pre-frail (GFI = 1-3) and frail (GFI ≥ 4). The intervention program consisted of four components: a medication review, physical fitness, social skills, and nutrition. OUTCOMES The primary outcome was activity of daily living (ADL) measured with the Katz-6. Secondary outcomes were quality of life (SF-12) and healthcare consumption such as hospital admission, nursing home admission and primary care visits. Additional outcomes measured in the intervention group were physical fitness, Instrumental Activities of Daily Living (IADL), muscle strength, walking speed, functional capacity, mobility, feelings of depression and loneliness and nutritional status. The data were collected at baseline, after each intervention component and at a 12-month follow-up. An intention to treat analysis was used. RESULTS In total, there were 290 participants, and 217 (74.8%) completed the study. The mean age was 74 (SD: 7.2), most were pre-frail (59.9%), the majority were female (55.2%), and the individuals were not living alone (61.4%). After the 12-month follow-up, the median Katz-6 score did not change significantly between the two groups; adjusted Odds Ratio (OR) = 0.96 (95% Confidence Interval (CI): 0.39-2.35, p-value 0.92). No statistically significant differences were observed between the groups for quality of life and healthcare consumption. Among the participants in the intervention group, IADL (Friedman's test p <=0.04, X2 =6.50), walking speed (Friedman's test p <0.001, X2 =19.09) and functional capacity (Friedman's test p <0.001, X2 =33.29) improved significantly after the one-year follow-up. Right-hand grip strength improved immediately after completion of the intervention (Wilcoxon signed-rank test p=0.00, z= -3.39) but not after the 12-month follow-up. CONCLUSION The intervention program did not significantly improve daily functioning, quality of life and healthcare consumption among (pre) frail community-dwelling older persons at the one-year follow-up. Participants in the intervention group experienced improvements in walking speed, functional capacity and instrumental activities of daily living. More research is needed to better understand why may benefit and how to identify the target population.
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Affiliation(s)
- M R J van Lieshout
- Dr. Nienke Bleijenberg, Julius Center for Health Sciences and Primary Care, department Nursing Science. University Medical Center Utrecht, Universiteitsweg 100, Utrecht 3508 GA, The Netherlands,
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¿Existe una creciente dificultad en el manejo de los pacientes hospitalizados en servicios médicos? Rev Clin Esp 2018; 218:43-47. [DOI: 10.1016/j.rce.2017.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/21/2017] [Accepted: 07/09/2017] [Indexed: 11/19/2022]
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Montero Muñoz J, Martínez Carrasco S, Montero Ruiz E. Is there increasing difficulty in managing patients hospitalized in medical services? Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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da Cruz HL, Mota FKDC, Araújo LU, Bodevan EC, Seixas SRS, Santos DF. The utility of the records medical: factors associated with the medication errors in chronic disease. Rev Lat Am Enfermagem 2017; 25:e2967. [PMID: 29236841 PMCID: PMC5738858 DOI: 10.1590/1518-8345.2406.2967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/22/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study describes the development of the medication history of the medical records to measure factors associated with medication errors among chronic diseases patients in Diamantina, Minas Gerais. METHODS retrospective, descriptive observational study of secondary data, through the review of medical records of hypertensive and diabetic patients, from March to October 2016. RESULTS The patients the mean age of patient was 62.1 ± 14.3 years. The number of basic nursing care (95.5%) prevailed and physician consultations were 82.6%. Polypharmacy was recorded in 54% of sample, and review of the medication lists by a pharmacist revealed that 67.0% drug included at least one risk. The most common risks were: drug-drug interaction (57.8%), renal risk (29.8%), risk of falling (12.9%) and duplicate therapies (11.9%). Factors associated with medications errors history were chronic diseases and polypharmacy, that persisted in multivariate analysis, with adjusted RP chronic diseases, diabetes RP 1.55 (95%IC 1.04-1.94), diabetes/hypertension RP 1.6 (95%CI 1.09-1.23) and polypharmacy RP 1.61 (95%IC 1.41-1.85), respectively. CONCLUSION Medication errors are known to compromise patient safety. This has led to the suggestion that medication reconciliation an entry point into the systems health, ongoing care coordination and a person focused approach for people and their families.
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Affiliation(s)
- Hellen Lilliane da Cruz
- Graduated, Pharmacy, MSc, Departamento de Farmácia, Universidade Federal
dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Flávia Karla da Cruz Mota
- Especialist, Nursing and Family Health Especialization, Secretaria
Municipal de Saúde, Prefeitura de Diamantina, Diamantina, MG, Brazil
| | - Lorena Ulhôa Araújo
- Doctor, Pharmaceutical Sciences, Professor, Departamento de farmácia,
Universidade Federal dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Emerson Cotta Bodevan
- PhD, Estatistic, Professor, Departamento de Matemática, Universidade
Federal dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Sérgio Ricardo Stuckert Seixas
- PhD, Farmacology, Professor, Departamento de Farmácia, Universidade
Federal dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Delba Fonseca Santos
- PhD, Collective Health, Professor, Departamento de Farmácia,
Universidade Federal dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
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Abstract
BACKGROUND Older people have a higher risk of drug-related problems (DRPs). However, little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care. METHODS The Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi-MV) study is a general practitioner (GP)-based cluster-randomized controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in the primary care setting in Germany. Medication reviews of 446 study participants were conducted by pharmacists based on a comprehensive baseline assessment that included a computer-based home medication assessment. ClinicalTrials.gov Identifier: NCT01401582. RESULTS A total of 1,077 DRPs were documented. In 414 study participants (93%), at least one DRP was detected by a pharmacist. The most frequent DRPs were administration and compliance problems (60%), drug interactions (17%), and problems with inappropriate drug choice (15%). The number of DRPs was significantly associated with the total number of drugs taken and with a formal diagnosis of a mental or behavioral disorder. CONCLUSIONS Degree of cognitive impairment (MMSE defined) and formal diagnosis of dementia were not risk factors for an increased number of DRPs. However, the total number of drug taken and the presence of a diagnosis of mental and behavioral disorders were associated with an increased total number of DRPs.
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Dhalwani NN, Fahami R, Sathanapally H, Seidu S, Davies MJ, Khunti K. Association between polypharmacy and falls in older adults: a longitudinal study from England. BMJ Open 2017; 7:e016358. [PMID: 29042378 PMCID: PMC5652576 DOI: 10.1136/bmjopen-2017-016358] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Assess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England. DESIGN Longitudinal cohort study. SETTING The English Longitudinal Study of Ageing waves 6 and 7. PARTICIPANTS 5213 adults aged 60 or older. MAIN OUTCOME MEASURES Rates, incidence rate ratio (IRR) and 95% CI for falls in people with and without polypharmacy. RESULTS A total of 5213 participants contributed 10 502 person-years of follow-up, with a median follow-up of 2.02 years (IQR 1.9-2.1 years). Of the 1611 participants with polypharmacy, 569 reported at least one fall within the past 2 years (rate: 175 per 1000 person-years, 95% CI 161 to 190), and of the 3602 participants without polypharmacy 875 reported at least one fall (rate: 121 per 1000 person-years, 95% CI 113 to 129). The rate of falls was 21% higher in people with polypharmacy compared with people without polypharmacy (adjusted IRR 1.21, 95% CI 1.11 to 1.31). Using ≥4 drugs threshold the rate of falls was 18% higher in people with polypharmacy compared with people without (adjusted IRR 1.18, 95% CI 1.08 to 1.28), whereas using ≥10 drugs threshold polypharmacy was associated with a 50% higher rate of falls (adjusted IRR 1.50, 95% CI 1.34 to 1.67). CONCLUSIONS We found almost one-third of the total population using five or more drugs, which was significantly associated with 21% increased rate of falls over a 2-year period. Further exploration of the effects of these complex drug combinations in the real world with a detailed standardised assessment of polypharmacy is greatly required along with pragmatic studies in primary care, which will help inform whether the threshold for a detailed medication review should be lowered.
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Affiliation(s)
- Nafeesa N Dhalwani
- Department of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Radia Fahami
- Department of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Harini Sathanapally
- Department of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Sam Seidu
- Department of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Department of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
- Leicester Biomedical Research Centre, Leicester, UK
| | - Kamlesh Khunti
- Department of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
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Alves-Conceição V, Silva DTD, Santana VLD, Santos EGD, Santos LMC, Lyra DPD. Evaluation of pharmacotherapy complexity in residents of long-term care facilities: a cross-sectional descriptive study. BMC Pharmacol Toxicol 2017; 18:59. [PMID: 28743294 PMCID: PMC5526292 DOI: 10.1186/s40360-017-0164-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/27/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Polypharmacy is a reality in long-term care facilities. However, number of medications used by the patient should not be the only predictor of a complex pharmacotherapy. Although the level of complexity of pharmacotherapy is considered an important factor that may lead to side effects, there are few studies in this field. The aim of this study was to evaluate the complexity of pharmacotherapy in residents of three long-term care facilities. METHODS A cross-sectional study was performed to evaluate the complexity of pharmacotherapy using the protocols laid out in the Medication Regimen Complexity Index instrument in three long-term care facilities in northeastern Brazil. As a secondary result, potential drug interactions, potentially inappropriate medications, medication duplication, and polypharmacy were evaluated. After the assessment, the association among these variables and the Medication Regimen Complexity Index was performed. RESULTS In this study, there was a higher prevalence of women (64.4%) with a high mean age among the study population of 81.8 (±9.7) years. The complexity of pharmacotherapy obtained a mean of 15.1 points (±9.8), with a minimum of 2 and a maximum of 59. The highest levels of complexity were associated with dose frequency, with a mean of 5.5 (±3.6), followed by additional instructions of use averaging 4.9 (±3.7) and by the dosage forms averaging 4.6 (±3.0). CONCLUSIONS The present study evaluated some factors that complicate the pharmacotherapy of geriatric patients. Although polypharmacy was implicated as a factor directly related to complexity, other indicators such as drug interactions, potentially inappropriate medications, and therapeutic duplication can also make the use of pharmacotherapy in such patients more difficult.
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Affiliation(s)
- Vanessa Alves-Conceição
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, SE, Brazil; Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| | - Daniel Tenório da Silva
- Group of Studies in Geriatrics and Gerontology, College of Pharmacy, Federal University of Vale do São Francisco, Petrolina, Brazil
| | - Vanessa Lima de Santana
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, SE, Brazil; Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| | - Edileide Guimarães Dos Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, SE, Brazil; Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| | - Lincoln Marques Cavalcante Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, SE, Brazil; Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, SE, Brazil; Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil.
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Bethi Y, Shewade DG, Dutta TK, Gitanjali B. Prevalence and predictors of potential drug-drug interactions in patients of internal medicine wards of a tertiary care hospital in India. Eur J Hosp Pharm 2017; 25:317-321. [PMID: 31157049 DOI: 10.1136/ejhpharm-2017-001272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 11/03/2022] Open
Abstract
Background Drug-drug interactions are a major source of adverse drug events (ADEs). Polypharmacy, age and the number of comorbid conditions are important predictors of adverse drug interactions. ADEs account for up to 5% of hospital admissions per year and an increase in the length of hospital stay. Objective To find the prevalence and predictors of potential drug-drug interactions (pDDIs) in patients admitted to the wards of an internal medicine department of a tertiary care hospital. Method Patients admitted to internal medicine wards with prescriptions having more than one drug were selected. Demographic details including age, gender, number of comorbid conditions, number of drugs prescribed and the disease for which the patient was admitted were recorded in a case record form. Interactions were checked using Micromedex DrugReax software. Results A total of 939 patients were recruited for this study based on inclusion criteria. 433 prescriptions (46%) had one or more pDDIs, with a range of 1-13 drug interactions per prescription. A total of 1395 drug interactions were found, with 866 moderate drug interactions (62%), 435 major interactions (31.1%) and 89 minor interactions (6.3%). During the study period only three contraindicated drug combinations (0.2%) were recorded. A significant association (p<0.01) was found between the number of pDDIs and predictors, age and number of drugs. Conclusion A total of 433 prescriptions (46%) had one or more pDDIs. Older patients and those prescribed >6 drugs are at major risk for occurrence of pDDIs. Moderate severity interactions were the highest number followed by major severity interactions.
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Affiliation(s)
- Yugandhar Bethi
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Deepak Gopal Shewade
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Tarun Kumar Dutta
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Batmanabane Gitanjali
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Marino A, Capogrosso-Sansone A, Tuccori M, Bini G, Calsolaro V, Mantarro S, Convertino I, Pasqualetti G, Orsitto E, Santini M, Monzani F, Blandizzi C. Expected and actual adverse drug-drug interactions in elderly patients accessing the emergency department: data from the ANCESTRAL-ED study. Expert Opin Drug Saf 2017; 15:45-50. [PMID: 27875918 DOI: 10.1080/14740338.2016.1221400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study was aimed at evaluating the frequency and describing the adverse drug-drug interactions (DDIs) recorded among elderly patients accessing the emergency department (ED). METHODS Patients aged ≥65 years, accessing the ED of Pisa University Hospital (Italy) from 1 January 2015 to 31 December 2015 within the ANCESTRAL-ED program, were included in this study. 'Expected' DDIs were assessed using Thomson Micromedex®. Each ED admission (discharge diagnosis) consistent with the signs and symptoms of an expected DDI for each patient was classified as an 'actual' DDI. RESULTS Throughout the study period, 3473 patients (3812 ED admissions, 58% females, mean age: 80.3) were recorded. The total number of expected DDIs was 12,578 (67 contraindicated; 3334 major; 8878 moderate; 299 minor) detected in 2147 (62%) patients. Overall 464 expected DDIs were found to be consistent with the ED admission in 194 patients (representing 9% of patients with expected DDIs). CONCLUSIONS More than one half of elderly patients admitted to ED presented at least one expected DDI at the time of ED presentation. However, 9% of the expected DDIs were identified as actual DDIs, based on the consistency of the expected event with the ED discharge diagnosis.
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Affiliation(s)
- A Marino
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - A Capogrosso-Sansone
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - M Tuccori
- b Unit of Adverse Drug Reaction Monitoring , University Hospital of Pisa , Pisa , Italy
| | - G Bini
- c Geriatric Unit, Department of Clinical and Experimental Medicine , University Hospital of Pisa , Pisa , Italy
| | - V Calsolaro
- c Geriatric Unit, Department of Clinical and Experimental Medicine , University Hospital of Pisa , Pisa , Italy
| | - S Mantarro
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - I Convertino
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - G Pasqualetti
- c Geriatric Unit, Department of Clinical and Experimental Medicine , University Hospital of Pisa , Pisa , Italy
| | - E Orsitto
- d Emergency Department , University Hospital of Pisa , Pisa , Italy
| | - M Santini
- d Emergency Department , University Hospital of Pisa , Pisa , Italy
| | - F Monzani
- c Geriatric Unit, Department of Clinical and Experimental Medicine , University Hospital of Pisa , Pisa , Italy
| | - C Blandizzi
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
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Lim LM, McStea M, Chung WW, Nor Azmi N, Abdul Aziz SA, Alwi S, Kamarulzaman A, Kamaruzzaman SB, Chua SS, Rajasuriar R. Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia. PLoS One 2017; 12:e0173466. [PMID: 28273128 PMCID: PMC5342241 DOI: 10.1371/journal.pone.0173466] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/22/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Polypharmacy has been associated with increased morbidity and mortality in the older population. OBJECTIVES The aim of this study was to determine the prevalence, risk factors and health outcomes associated with polypharmacy in a cohort of urban community-dwelling older adults receiving chronic medications in Malaysia. METHODS This was a baseline study in the Malaysian Elders Longitudinal Research cohort. The inclusion criteria were individuals aged ≥55years and taking at least one medication chronically (≥3 months). Participants were interviewed using a structured questionnaire during home visits where medications taken were reviewed. Health outcomes assessed were frequency of falls, functional disability, potential inappropriate medication use (PIMs), potential drug-drug interactions (PDDIs), healthcare utilisation and quality of life (QoL). Risk factors and health outcomes associated with polypharmacy (≥5 medications including dietary supplements) were determined using multivariate regression models. RESULTS A total of 1256 participants were included with a median (interquartile range) age of 69(63-74) years. The prevalence of polypharmacy was 45.9% while supplement users made up 56.9% of the cohort. The risk factors associated with increasing medication use were increasing age, Indian ethnicity, male, having a higher number of comorbidities specifically those diagnosed with cardiovascular, endocrine and gastrointestinal disorders, as well as supplement use. Health outcomes significantly associated with polypharmacy were PIMS, PDDIs and increased healthcare utilisation. CONCLUSION A significant proportion of older adults on chronic medications were exposed to polypharmacy and use of dietary supplements contributed significantly to this. Medication reviews are warranted to reduce significant polypharmacy related issues in the older population.
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Affiliation(s)
- Li Min Lim
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Megan McStea
- The Malaysian Elders Longitudinal Research (MELOR) Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Wen Wei Chung
- Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nuruljannah Nor Azmi
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Azdiah Abdul Aziz
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Faculty of Pharmacy, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Syireen Alwi
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- The Malaysian Elders Longitudinal Research (MELOR) Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siew Siang Chua
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Peter Doherty Institute for Infection and Immunity, Melbourne University, Melbourne, Australia
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Prevalence of drug interactions in elderly patients with multimorbidity in primary care. Int J Clin Pharm 2017; 39:343-353. [DOI: 10.1007/s11096-017-0439-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/10/2017] [Indexed: 01/29/2023]
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Humphries TL, Carroll N, Chester EA, Magid D, Rocho B. Evaluation of an Electronic Critical Drug Interaction Program Coupled with Active Pharmacist Intervention. Ann Pharmacother 2016; 41:1979-85. [DOI: 10.1345/aph.1k349] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Failure to detect significant drug interactions may result in adverse outcomes. While proper screening and management of drug interactions can prevent the majority of adverse events, studies indicate that current practice is suboptimal. In the last quarter of 2001, physicians and pharmacists in Kaiser Permanente Colorado, a group model health maintenance organization, developed an electronic critical drug interaction alert program (CDIX). Electronic screening was coupled with active intervention to prevent dispensing of critically interacting drug combinations. Objective: To assess the impact of CDIX on the co-dispensing ol critically interacting drug combinations. Methods: A physician and team of outpatient pharmacists and clinical pharmacy staff developed a condensed list of critical drug interactions (8 drug combinations) to be included in the evaluation of CDIX. Monthly electronic outpatient pharmacy data were collected 20 months before and 37 months after CDIX implementation, with no lag period following implementation. Univariate analyses were completed to compare baseline subject characteristics of the pre- and post-CDIX groups using χ2 and Wilcoxon Rank Sum tests. Interrupted time series analysis was used to estimate changes in the rates of critical drug interactions. Results: Three hundred sixty-seven instances of co-dispensing were observed in 348 subjects during the pre-CDIX period and 256 instances of co-dispensing were observed in 248 subjects during the post-CDIX period. Following CDIX implementation, the overall rate of co-dispensing dropped abruptly from 21.3 to 14.7 per 10,000 prescriptions, representing a relative decrease in co-dispensing of 31% from the month before CDIX implementation (p = 0.0125). Significant reductions in co-dispensing were noted for 7 of the 8 drug class combinations. Conclusions: Employing an intervention system that limits electronic alerts regarding drug interactions to those deemed critical but that also requires pharmacist intervention and collaboration with the prescriber decreases the number of critical drug interactions dispensed.
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Affiliation(s)
- Tammy L Humphries
- Pharmacy Department, Kaiser Permanente Colorado, School of Pharmacy, University of Colorado, Aurora, CO
| | | | - Elizabeth A Chester
- Pharmacy Department, Kaiser Permanente Colorado, School of Pharmacy, University of Colorado
| | - David Magid
- Clinical Research Unit, Kaiser Permanente Colorado
| | - Bob Rocho
- Pharmacy Department, Kaiser Permanente Colorado
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Westerlund LT, Björk HT. Pharmaceutical Care in Community Pharmacies: Practice and Research in Sweden. Ann Pharmacother 2016; 40:1162-9. [PMID: 16735653 DOI: 10.1345/aph.1g680] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To describe the organization and delivery of community pharmacy and medical care, as well as pharmaceutical care practice and research, in Sweden. Findings: The Swedish retail pharmacy system of 800 community pharmacies and nearly 80 hospital pharmacies is unique in that it is organized into one single, government-owned chain, known as Apoteket AB. The pharmacy staff consists of pharmacists, prescriptionists, and pharmacy technicians. Some activities related to pharmaceutical care have been directed toward specific patient groups during annual theme campaigns. In the past few years, there has been a growing emphasis on the identification, resolution, and documentation of drug-related problems (DRPs) in Swedish pharmacy practice. A classification system for documenting DRPs and pharmacy interventions was developed in 1995 and incorporated into the software of all community pharmacies in 2001. A national DRP database (SWE-DRP) was established in 2004 to collect and analyze DRPs and interventions on a nationwide basis. Recently, a new counseling technique composed of key questions to facilitate the detection of DRPs has been tested successfully. Patient medication profiles are kept in 160 pharmacies, and a new national register of drugs dispensed to patients became available in 2006. Most pharmaceutical care studies in Sweden have focused on DRPs and resulting pharmacy interventions. Discussion: Swedish community pharmacy DRP work is in the international forefront but there is a potential for further developing cognitive services, given the beneficial organization of the country's pharmacies into one single pharmacy chain. The introduction of patient medication profiles has been both late and slow and has only had a marginal effect on pharmaceutical care practice so far. The universities do not appear to have any desire to influence the practice of pharmacy and could potentially take on a more active role in preparing pharmacy students for patient-oriented services. Current threats to pharmaceutical care practice and research include organizational changes, budget cuts, and reduced manpower of Apoteket AB. Conclusions: The identification, resolution, and documentation of DRPs are central to community pharmacy practice in Sweden, resulting in a number of research studies. A national DRP database, patient medication profiles, and a new national register of drugs dispensed to patients provide opportunities for growth in pharmaceutical care practice and research in the country.
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Melo DOD, Storpirtis S, Ribeiro E. Does hospital admission provide an opportunity for improving pharmacotherapy among elderly inpatients? BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000300005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Eliane Ribeiro
- University of São Paulo, Brazil; University of São Paulo, Brazil
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