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Ravi P, Pfaff K, Ralph J, Cruz E, Bellaire M, Fontanin G. Nurse-pharmacist collaborations for promoting medication safety among community-dwelling adults: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100079. [PMID: 38745597 PMCID: PMC11080473 DOI: 10.1016/j.ijnsa.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/23/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Despite good evidence that supports improved clinical health outcomes and the cost effectiveness of nurse-pharmacist collaboration for promoting medication safety among adults in acute care settings, there is limited research in community settings. Objective This scoping review examines, maps, and identifies gaps in the existing literature on nurse-pharmacist collaboration to augment medication safety among community-dwelling adults. Design Setting(s): Community setting. Participants This review consists of 3,464 participants across 23 studies. Methods We used the enhanced Arksey and O'Malley framework by Levac and colleagues. Studies from MEDLINE, CINAHL, ProQuest, Scopus, and PubMed databases implementing medication safety through nurse-pharmacist collaboration for community-dwelling adults were included. We extracted data according to country of origin, intervention, and relevance to the current review. Results Twenty-three studies were included in this review. Nurse-pharmacist collaborations in community settings are still evolving and are in a nascent form. Five sub-themes emerged from literature review of collaboration between nurses and pharmacists in community settings for medication safety. They are creating new opportunities to address gaps in community medication safety, enabling complementary interprofessional roles in medication safety, facilitating of efficient and cost-effective measures for medication safety, diverse nature of assessments done by nurses and pharmacists, and incohesive teams due to poor collaborative practices. Conclusions Nurse-pharmacist collaborations in community settings improved disease management, prevented adverse drug events, and reduced hospitalizations. They resulted in early identification and correction of medication safety related issues, reduced wait periods to see general practitioners, and enhanced chronic disease self-management skills among community-dwelling adults. There is a need to improve existing systems and policies through research for sustaining such collaborations especially in community settings.
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Affiliation(s)
- Padma Ravi
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Kathryn Pfaff
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Jody Ralph
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Edward Cruz
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | | | - Gemma Fontanin
- Faculty of Nursing, University of Windsor, Windsor, Canada
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Nightingale G, Scopelliti EM, Casten R, Woloshin M, Xiao S, Kelley M, Chang AM, Hollander JE, Leiby BE, Peterson AM, Pizzi LT, Rising KL, White N, Rovner B. Polypharmacy and Potentially Inappropriate Medication Use in Older Blacks with Diabetes Mellitus Presenting to the Emergency Department. J Aging Health 2021; 34:499-507. [PMID: 34517775 DOI: 10.1177/08982643211045546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: Medication-related problems in older Blacks with diabetes mellitus (DM) are not well established. Objectives: To describe the frequency of medication-related problems in older Blacks with DM presenting to the emergency department (ED). Methods: The study was a cross-sectional analysis of baseline data from a randomized controlled trial evaluating Blacks aged ≥60 years of age presenting to the ED. Polypharmacy, potentially inappropriate medication (PIM) use, and anticholinergic score were evaluated. Results: Of 168 patients (median age = 68, range 60-92), most (n = 164, 98%) were taking ≥5 medications, and 67 (39.9%) were taking a PIM. A majority (n = 124, 74%) were taking a medication with an anticholinergic score ≥1. Number of medications was correlated with number of PIMs (r = .22, p = .004) and anticholinergic score (r = .50, p < .001). Conclusion: Polypharmacy and PIM use was common in older Blacks with DM.
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Affiliation(s)
- Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Emily M Scopelliti
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Robin Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Monica Woloshin
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Shu Xiao
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Megan Kelley
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna Marie Chang
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Judd E Hollander
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew M Peterson
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura T Pizzi
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Kristin L Rising
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Neva White
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry Rovner
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
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Casten R, Rovner B, Chang AM, Hollander JE, Kelley M, Leiby B, Nightingale G, Pizzi L, White N, Rising K. A randomized clinical trial of a collaborative home-based diabetes intervention to reduce emergency department visits and hospitalizations in black individuals with diabetes. Contemp Clin Trials 2020; 95:106069. [PMID: 32561466 DOI: 10.1016/j.cct.2020.106069] [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: 01/09/2020] [Revised: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 01/22/2023]
Abstract
The prevalence of diabetes mellitus (DM) in black individuals (blacks) is twice that of white individuals (whites), and blacks are more likely to have worse glycemic control, less optimal medication regimens, and higher levels of mistrust in the medical system. These three factors account for higher rates of acute medical care use in blacks with DM. To address this disparity, we developed DM I-TEAM (Diabetes Interprofessional Team to Enhance Adherence to Medical Care), a home-based multidisciplinary behavioral intervention that integrates care from a community health worker (CHW), the participant's primary care physician (PCP), a DM nurse educator, and a clinical pharmacist. Treatment is delivered during 9 sessions over 1 year, and includes diabetes education and goal setting, telehealth visits with participants' PCP and a DM nurse educator, and comprehensive medication reviews by a pharmacist. We describe the rationale and methods for a randomized controlled trial to test the efficacy of DM I-TEAM to reduce emergency department (ED) visits and hospitalizations. We are enrolling 200 blacks with DM during an ED visit. Participants are randomized to DM I-TEAM or Usual Medical Care (UMC). Follow-up assessments are conducted at 6 and 12 months. The primary outcome is the number of ED visits and hospitalizations over 12 months, and is measured by participant self-report and medical record review. Secondary outcomes include hemoglobin A1c (HbA1c), number of potentially inappropriate medications (PIMs), and trust in health care.
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Affiliation(s)
- Robin Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas, Jefferson University, United States of America.
| | - Barry Rovner
- Departments of Neurology, Psychiatry, and Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Anna Marie Chang
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Judd E Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Megan Kelley
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Benjamin Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Ginah Nightingale
- Jefferson College of Pharmacy at Thomas Jefferson University, United States of America
| | - Laura Pizzi
- Center for Health Outcomes, Policy, and Economics, Ernest Mario School of Pharmacy, Rutgers University, United States of America
| | - Neva White
- Center for Urban Health, Thomas Jefferson University Hospital, United States of America
| | - Kristin Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
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Santos NSD, Marengo LL, Moraes FDS, Barberato Filho S. Interventions to reduce the prescription of inappropriate medicines in older patients. Rev Saude Publica 2019; 53:7. [PMID: 30726488 PMCID: PMC6390643 DOI: 10.11606/s1518-8787.2019053000781] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/06/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE: Identify and critically evaluate systematic reviews addressing the effectiveness of interventions to reduce the number of prescriptions of potentially inappropriate medication to older patients. METHODS: This is an overview of systematic reviews. The studies were searched and selected from Medline, Cochrane Library, Embase, CINAHL, Virtual Health Library, and Web of Science databases, combining the terms aged, prescriptions, inappropriate prescribing and potentially inappropriate medication list with their entry terms and other related descriptors, published by June 2017. This study included systematic reviews with or without meta-analysis that addressed the effectiveness of any intervention or combined interventions to reduce the number of prescriptions of potentially inappropriate medications to older patients, without restriction in terms of design, language or date of publication of primary studies. AMSTAR – A MeaSurement Tool to Assess systematic Reviews – was used to evaluate the methodological quality of selected systematic reviews. Study selection and the methodological quality evaluation were performed by two independent evaluators, who resolved any divergence by consensus. The main findings were grouped into thematic categories, defined after a content analysis and discussed qualitatively as narrative synthesis. RESULTS: This study analyzed 24 systematic reviews. In terms of study design and methodological quality evaluation, most were systematic reviews of randomized controlled clinical trials and studies of moderate quality, respectively. The interventions were analyzed in five thematic categories: medication review services, pharmaceutical interventions, computerized systems, educational interventions, and others. The interventions analyzed showed good results and most of them helped reduce the number of prescriptions of potentially inappropriate medication to older patients. CONCLUSIONS: The systematic reviews included in this overview showed potential benefits of different interventions. However, it was not possible to determine the most effective intervention. Combined interventions are likely to provide better results than isolated interventions.
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Affiliation(s)
| | - Lívia Luize Marengo
- Universidade de Sorocaba. Programa de Pós-Graduação em Ciências Farmacêuticas. Sorocaba, SP, Brasil
| | - Fabio da Silva Moraes
- Universidade de Sorocaba. Programa de Pós-Graduação em Ciências Farmacêuticas. Sorocaba, SP, Brasil
| | - Silvio Barberato Filho
- Universidade de Sorocaba. Programa de Pós-Graduação em Ciências Farmacêuticas. Sorocaba, SP, Brasil
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Shade MY, Berger AM, Chaperon C, Haynatzki G, Sobeski L, Yates B. Factors Associated With Potentially Inappropriate Medication Use in Rural, Community-Dwelling Older Adults. J Gerontol Nurs 2017; 43:21-30. [DOI: 10.3928/00989134-20170406-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/10/2017] [Indexed: 11/20/2022]
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Parsons C. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem. Ther Adv Drug Saf 2017; 8:31-46. [PMID: 28203365 PMCID: PMC5298466 DOI: 10.1177/2042098616670798] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Multimorbidity and polypharmacy are increasingly prevalent across healthcare systems and settings as global demographic trends shift towards increased proportions of older people in populations. Numerous studies have demonstrated an association between polypharmacy and potentially inappropriate prescribing (PIP), and have reported high prevalence of PIP across settings of care in Europe and North America and, as a consequence, increased risk of adverse drug reactions, healthcare utilization, morbidity and mortality. These studies have not focused specifically on people with dementia, despite the high risk of adverse drug reactions and PIP in this patient cohort. This narrative review considers the evidence currently available in the area, including studies examining prevalence of PIP in older people with dementia, how appropriateness of prescribing is assessed, the medications most commonly implicated, the clinical consequences, and research priorities to optimize prescribing for this vulnerable patient group. Although there has been a considerable research effort to develop criteria to assess medication appropriateness in older people in recent years, the majority of tools do not focus on people with dementia. Of the limited number of tools available, most focus on the advanced stages of dementia in which life expectancy is limited. The development of tools to assess medication appropriateness in people with mild to moderate dementia or across the full spectrum of disease severity represents an important gap in the research literature and is beginning to attract research interest, with recent studies considering the medication regimen as a whole, or misprescribing, overprescribing or underprescribing of certain medications/medication classes, including anticholinergics, psychotropics, antibiotics and analgesics. Further work is required in development and validation of criteria to assess prescribing appropriateness in this vulnerable patient population, to determine prevalence of PIP in large cohorts of people with the full spectrum of dementia variants and severities, and to examine the impact of PIP on health outcomes.
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Affiliation(s)
- Carole Parsons
- Queen’s University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
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Riordan DO, Walsh KA, Galvin R, Sinnott C, Kearney PM, Byrne S. The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review. SAGE Open Med 2016; 4:2050312116652568. [PMID: 27354917 PMCID: PMC4910534 DOI: 10.1177/2050312116652568] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/04/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing among community-dwelling older adults receiving primary care to identify the components of a successful intervention. DATA SOURCES An electronic search of the literature was conducted using the following databases from inception to December 2015: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid), Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science, ScienceDirect, ClinicalTrials.gov, metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in Great Britain, Ireland and North America). REVIEW METHODS Studies were included if they were randomised controlled trials or quasi-randomised studies involving a pharmacist-led intervention compared to usual/routine care which aimed to reduce potentially inappropriate prescribing in older adults in primary care. Methodological quality of the included studies was independently assessed. RESULTS A comprehensive literature search was conducted which identified 2193 studies following removal of duplicates. Five studies met the inclusion criteria. Four studies involved a pharmacist conducting a medication review and providing feedback to patients or their family physician. One randomised controlled trial evaluated the effect of a computerised tool that alerted pharmacists when elderly patients were newly prescribed potentially inappropriate medications. Four studies were associated with an improvement in prescribing appropriateness. CONCLUSION Overall, this review demonstrates that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. However, the quality of evidence is low. The role of a pharmacist working as part of a multidisciplinary primary care team requires further investigation to optimise prescribing in this group of patients.
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Affiliation(s)
- David O Riordan
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Kieran A Walsh
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Rose Galvin
- Department of Clinical Therapies, Health Research Institute, University of Limerick, Limerick, Republic of Ireland
| | - Carol Sinnott
- Department of General Practice, University College Cork, Cork, Republic of Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Republic of Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
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Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol 2015; 71:1415-27. [PMID: 26407687 DOI: 10.1007/s00228-015-1954-4] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Potentially inappropriate prescribing (PIP) is one of the main risk factors for adverse drug events (ADEs) in older people. PURPOSE This systematic literature review aims to determine prevalence and type of PIP in community-dwelling older people across Europe, as well as identifying risk factors for PIP. METHODS The PubMed and Web of Science database were searched systematically for relevant manuscripts (January 1, 2000-December 31, 2014). Manuscripts were included if the study design was observational, the study participants were community-dwelling older patients in Europe, and if a published screening method for PIP was used. Studies that focused on specific pathologies or that focused on merely one inappropriate prescribing issue were excluded. Data analysis was performed using R statistics. RESULTS Fifty-two manuscripts were included, describing 82 different sample screenings with an estimated overall PIP prevalence of 22.6 % (CI 19.2-26.7 %; range 0.0-98.0 %). Ten of the sample screenings were based on the Beers 1997 criteria, 19 on the Beers 2003 criteria, 14 on STOPP criteria (2008 version), 8 on START-criteria (2008 version), and 7 on the PRISCUS list. The 24 remaining sample screenings were carried out using compilations of screening methods or used country-specific lists such as the Laroche criteria. It appears that only PIP prevalence calculated from insurance data significantly differs from the other data collection method categories. Furthermore, risk factors most often positively associated with PIP prevalence were polypharmacy, poor functional status, and depression. Drug groups most often involved in PIP were anxiolytics (ATC-code: N05B), antidepressants (N06A), and nonsteroidal anti-inflammatory and anti-rheumatic products (M01A). CONCLUSION PIP prevalence in European community-dwelling older adults is high and depends partially on the data collection method used. Polypharmacy, poor functional status, and depression were identified as the most common risk factors for PIP.
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Affiliation(s)
- Eline Tommelein
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal medicine, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Annemie Somers
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.,Department of Pharmacy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Pieter Colin
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.,Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
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