1
|
Brajković A, Bićanić LA, Orehovački H, Prkačin I, Oliveira DRD, Mucalo I. Prescribers' approval rate of pharmacist-initiated interventions to optimise patients' clinical status of hypertension in the ambulatory care setting. Acta Pharm 2023; 73:723-734. [PMID: 38147475 DOI: 10.2478/acph-2023-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
This perspective, pre- and post-intervention study with a one-year follow-up primarily aimed to ascertain prescribers' approval rate of pharmacists' interventions and clinical status of hypertension following comprehensive medication management (CMM) intervention in the ambulatory care clinic. Between January 2018 and January 2022 overall 100 patients with hypertension and other comorbidities were referred to the CMM services at the Health Centre Zagreb - Centar (HCZC). Out of 275 interventions directed to prescribers, 73.1 % of interventions were approved, 12.4 % were rejected and 14.5 % were not reviewed. The percentage of patients with a blood pressure goal increased from 45 % at the initial consultation to 82.5 % at the patients' latest encounter (p < 0.001). The average number of drug therapy problems (DTPs) per patient totaled 3.53 ± 1.80, where 98 % of patients had one or more DTPs, 48 % had 4 or more DTPs, whereas 26 % had 5 or more DTPs. Sub-therapeutic dosage (32.6 %) and the need for additional drug therapy (30.9 %) were the two most commonly identified DTPs. These results reinforce the need to integrate pharmacy-led services in the primary care setting with the aim of improving patients' health outcomes.
Collapse
Affiliation(s)
- Andrea Brajković
- 1University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb Croatia
| | | | | | - Ingrid Prkačin
- 3Department of Internal Medicine School of Medicine, University of Zagreb, Merkur University Hospital Zagreb, Croatia
| | - Djenane Ramalho De Oliveira
- 4College of Pharmacy, Centre for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Iva Mucalo
- 1University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb Croatia
| |
Collapse
|
2
|
Orehovački H, Brajković A, Bićanić LA, Mucalo I. Polypharmacy - is there a cure for drug therapy problems? Croat Med J 2023; 64:295-300. [PMID: 37654043 PMCID: PMC10509682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
| | - Andrea Brajković
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | | | - Iva Mucalo
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
3
|
Affiliation(s)
| | - Andrea Brajković
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | | | - Iva Mucalo
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
4
|
Brajković A, Bićanić LA, Strgačić M, Orehovački H, Ramalho-de-Oliveira D, Mucalo I. The Impact of Pharmacist-Led Medication Management Services on the Quality of Life and Adverse Drug Reaction Occurrence. Pharmacy (Basel) 2022; 10:pharmacy10050102. [PMID: 36136835 PMCID: PMC9498323 DOI: 10.3390/pharmacy10050102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
The aim of this research was to assess the impact of comprehensive medication management (CMM) services on patients’ health-related quality of life (HRQoL) and frequency of adverse drug reactions (ADRs) in older patients with cardiovascular diseases (CVDs). A prospective, pre- and post-intervention study with a one-year follow-up was conducted at the Health Care Centre Zagreb—Centre (HCZC). The Euro-Quality of Life Questionnaire 5 Dimensions 5 Levels (EQ-5D-5L) was used to measure the HRQoL at baseline (initial visit at the HCZC) and 12 months following CMM services. The ADRs collected at the initial assessment of the CMM services and throughout follow-up consultations were analyzed according to the occurrence mechanism, seriousness, expectedness and distribution of the Preferred Term according to the System Organ Class. Following the CMM intervention, 65 patients reported significant improvement in dimensions “self-care” (p = 0.011) and “usual activities” (p = 0.003), whereas no significant change was found in the “mobility” (p = 0.203), “pain/discomfort” (p = 0.173) and “anxiety/depression” (p = 0.083) dimensions and the self-rated VAS scale (p = 0.781). A total of 596 suspected ADR reports were found, the majority at patients’ initial assessment (67.3%), with a mean ± SD of 9.2 ± 16.9 per patient. The CMM services significantly reduced the rate of suspected ADRs, namely 2.7 ± 1.7 ADRs per patient at the initial assessment vs. 1.0 ± 1.5 ADRs per patient at the last consultation (p < 0.001). The obtained results indicate that CMM services may improve patients’ HRQoL. Additionally, as CMM services diminished the proportion of ADRs following 1-year patient follow-up, they may serve as a viable solution for safety management.
Collapse
Affiliation(s)
- Andrea Brajković
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Lucija Ana Bićanić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Marija Strgačić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Djenane Ramalho-de-Oliveira
- Centre for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Iva Mucalo
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
| |
Collapse
|
5
|
Mucalo I, Brajković A, Strgačić M, Ramalho-de-Oliveira D, Ribarić E, Bobinac A. Budget Impact Analysis of Pharmacist-Led Medication Management in Cardiovascular and Type 2 Diabetic Patients. Healthcare (Basel) 2022; 10:healthcare10040722. [PMID: 35455900 PMCID: PMC9027851 DOI: 10.3390/healthcare10040722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022] Open
Abstract
The paper aims to identify and measure the costs and savings associated with the delivery of Comprehensive Medication Management (CMM) services in Croatia in patients diagnosed with hypertension accompanied by at least one additional established cardiovascular disease (CVD) and/or type 2 diabetes mellitus (DMT2) who use five or more medicines daily. The budget impact analysis (BIA) employed in this study compares the total costs of CMM to the cost reductions expected from CMM. The cost reductions (or savings) are based on the reduced incidence of unwanted clinical events and healthcare service utilisation rates due to CMM. The BIA model is populated by data on medication therapy costs, labour, and training from the pilot CMM intervention introduced in Zagreb’s main Health Centre, while relevant international published sources were used to estimate the utilisation, incidence, and unwanted clinical events rates. Total direct costs, including pharmacists’ labour and training (EUR 2,667,098) and the increase in the cost of prescribed medication (EUR 5,182,864) amounted to EUR 7,849,962 for 3 years, rendering the cost per treated patient per year EUR 57. CMM is expected to reduce the utilisation rates of healthcare services and the incidence of unwanted clinical events, leading to a total 3-year reduction in healthcare costs of EUR 7,787,765. Given the total CMM costs of EUR 7,849,962, CMM’s 3-year budget impact equals EUR 92,869, rendering per treated patient an incremental cost of CMM EUR 0.67. Hence, CMM appears to be an affordable intervention for addressing medication mismanagement and irrational drug use.
Collapse
Affiliation(s)
- Iva Mucalo
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia;
- Correspondence: ; Tel.: +38-51-6394-802
| | - Andrea Brajković
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia;
| | - Marija Strgačić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia;
| | - Djenane Ramalho-de-Oliveira
- College of Pharmacy, Centre for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil;
| | - Elizabeta Ribarić
- Center for Health Economics and Pharmacoeconomics (CHEP), Faculty of Economics and Business, University of Rijeka, 51 000 Rijeka, Croatia; (E.R.); (A.B.)
| | - Ana Bobinac
- Center for Health Economics and Pharmacoeconomics (CHEP), Faculty of Economics and Business, University of Rijeka, 51 000 Rijeka, Croatia; (E.R.); (A.B.)
| |
Collapse
|
6
|
Brajković A, Bosnar L, do Nascimento MMG, Prkačin I, Balenović A, Ramalho de Oliveira D, Mucalo I. Healthcare Utilisation and Clinical Outcomes in Older Cardiovascular Patients Receiving Comprehensive Medication Management Services: A Nonrandomised Clinical Study. Int J Environ Res Public Health 2022; 19:ijerph19052781. [PMID: 35270472 PMCID: PMC8910212 DOI: 10.3390/ijerph19052781] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
The objective of this study was to evaluate the impact of comprehensive medication management (CMM) services on healthcare utilisation and cardiovascular risk factors among older patients with established cardiovascular diseases (CVDs). This quasi-experimental study that was performed at the Croatian primary care ambulatory clinic included patients aged 65 to 80 years. Patients were divided into intervention (65 patients) and control groups (68 patients) and were followed-up for one year. Pharmacists provided face-to-face consultations to patients from the intervention group. Groups were compared with regards to the clinical parameters (blood pressure, HbA1c, LDL, TC) and healthcare utilisation (hospital admission, emergency visits, unplanned GP visits). The CMM intervention significantly improved systolic blood pressure (p = 0.038), diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison with the control group. Patients included in CMM services had statistically and clinically lower systolic (−9.02 mmHg, p < 0.001) and diastolic blood pressure (−4.99 mmHg, p < 0.001) at the end of the study. The number of hospital admissions and unplanned GPs visits were 3.35 (95% CI 1.16−10.00) and 2.34 (95% CI 1.52−3.57) times higher in the control group compared to the intervention group, respectively. This study demonstrated that pharmacists providing CMM services can significantly contribute to better clinical outcomes and lower healthcare utilisation, thus potentially contributing to total healthcare savings.
Collapse
Affiliation(s)
- Andrea Brajković
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia;
| | - Lorena Bosnar
- Health Care Centre Zagreb–Centre, 10000 Zagreb, Croatia;
| | - Mariana Martins Gonzaga do Nascimento
- College of Pharmacy, Centre for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte, Belo Horizonte 31270-901, Brazil; (M.M.G.d.N.); (D.R.d.O.)
| | - Ingrid Prkačin
- Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, 10000 Zagreb, Croatia;
| | | | - Djenane Ramalho de Oliveira
- College of Pharmacy, Centre for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte, Belo Horizonte 31270-901, Brazil; (M.M.G.d.N.); (D.R.d.O.)
| | - Iva Mucalo
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia;
- Correspondence:
| |
Collapse
|
7
|
Šola KF, Mucalo I, Brajković A, Jukić I, Verbanac D, Vladimir Knežević S. Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience. J Int Med Res 2020; 48:300060520928791. [PMID: 32493090 PMCID: PMC7273786 DOI: 10.1177/0300060520928791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/30/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. METHOD We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. RESULTS Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2-16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. CONCLUSION The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.
Collapse
Affiliation(s)
| | - Iva Mucalo
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Andrea Brajković
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Ivona Jukić
- Community Pharmacy Mandis Pharm, Zagreb, Croatia
| | - Donatella Verbanac
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | | |
Collapse
|
8
|
Mucalo I, Hadžiabdić MO, Brajković A, Lukić S, Marić P, Marinović I, Bačić-Vrca V. Potentially inappropriate medicines in elderly hospitalised patients according to the EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. Eur J Clin Pharmacol 2017; 73:991-999. [PMID: 28405697 DOI: 10.1007/s00228-017-2246-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to measure the prevalence of potentially inappropriate medications (PIMs) by using the EU(7)-PIM list, STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) version 2 criteria and the new comprehensive protocol. METHODS This prospective study involved a sample of 276 consecutive elderly patients discharged from the university teaching hospital. Age, gender, diagnoses, medication history and medicines at discharge were recorded. The main outcome measure was the prevalence of PIMs according to each set of criteria: EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. RESULTS The median patient age (range) was 74 (65-92) years. The median number of prescribed medications was 7 (1-17). STOPP identified 393 PIMs affecting 190 patients (69%), EU(7)-PIM list identified 330 PIMs in 184 patients (66.7%) whilst the comprehensive protocol identified 134 PIMs in 102 patients (37%). STOPP version 2 criteria identified significantly more PIMs per patient than the other two protocols (p < 0.001). Gender (p = 0.002), glomerular filtration rate (p = 0.039) and number of comorbidities (p = 0.001) were associated with the proportion of PIMs for the STOPP version 2 criteria only. CONCLUSION A very high PIM prevalence at discharge was reported suggesting the urgent need for actions to reduce them. STOPP version 2 criteria identified significantly more PIMs than the EU(7)-PIM list and the comprehensive protocol and was found as a more sensitive tool for PIM detection.
Collapse
Affiliation(s)
- Iva Mucalo
- Centre for Applied Pharmacy, University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia.
| | - Maja Ortner Hadžiabdić
- Centre for Applied Pharmacy, University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia
| | - Andrea Brajković
- Centre for Applied Pharmacy, University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia
| | - Sonja Lukić
- University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia
| | - Patricia Marić
- University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia
| | - Ivana Marinović
- Department of Clinical Pharmacy, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
| | - Vesna Bačić-Vrca
- Centre for Applied Pharmacy, University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia.,Department of Clinical Pharmacy, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
| |
Collapse
|