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Naga YS, Hamdy NA, Bassiouny AE, Selim M, ElHafeez SSA. Effect of medication therapy management services on medication-burden quality of life in hemodialysis patients. BMC Nephrol 2023; 24:277. [PMID: 37730586 PMCID: PMC10512485 DOI: 10.1186/s12882-023-03332-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Hemodialysis (HD) patients commonly receive polypharmacy leading to increased likelihood of drug related problems (DRPs) and poor quality of life. Medication Therapy Management (MTM) services discover and resolve DRPs and may specifically improve Medication-burden Quality of life (MBQoL) in HD patients. We aimed to assess the effect of MTM services on DRPs and MBQoL among HD patients. METHODS A prospective pre-post study was conducted on 104 patients in an HD unit in Alexandria, Egypt. MBQoL was assessed at baseline and after three months of MTM sessions, using the Arabic, validated version of the Patient Reported Outcomes Measure of Pharmaceutical Therapy (PROMPT) questionnaire. Cohen's d test and multiple linear regression were used to assess the effect size of MTM and the factors affecting MBQoL, respectively. DRPs, adverse events and adherence were also monitored. RESULTS MBQoL improved significantly after the implementation of MTM (Cohen's d=0.88, p < 0.01) with the largest effect size in the "medicine information and relation with healthcare providers" domain. DRPs decreased significantly after MTM implementation (11.97 ± 4.65 versus 7.63 ± 3.85 per patient, p<0.001). The mean adverse events per patient were also reduced (9.69 ± 4.12 versus 6.56 ± 3.77, p < 0.001). CONCLUSION Applying MTM services presents an opportunity to improve care for HD patients by improving MBQoL, decreasing DRPs and adverse events.
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Affiliation(s)
- Yasmine Salah Naga
- Internal Medicine department, Nephrology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Noha Alaa Hamdy
- Clinical Pharmacy and Pharmacy Practice department, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Amany El Bassiouny
- Clinical pharmacist, Al Moassat University Hospital, Alexandria University, Alexandria, Egypt
| | - Mohamed Selim
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Samar Samy Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Treciokiene I, Peceliuniene J, Wettermark B, Gulbinovic J, Taxis K. Hypertension management and drug-related problems. A case report of the 23-year history of Mr. Jonas. Explor Res Clin Soc Pharm 2023; 11:100313. [PMID: 37601158 PMCID: PMC10433230 DOI: 10.1016/j.rcsop.2023.100313] [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: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Arterial hypertension is a lifelong disease, which management is recognized as the most effective way to reduce cardiovascular mortality. Even though there is extensive evidence on the benefits of lifestyle modification and antihypertensive treatment, many patients with hypertension do not reach blood pressure targets. This paper aims to review the history of antihypertensive treatment of one patient and identify the drug related problems that occurred over the study period. In this case report, the patient's health record was studied, guidelines checked and a semi-structured interview conducted. Drug related problems were identified and possible pharmacist interventions were introduced. Drug related problems that could have contributed to the lack of hypertension control were adherence, side effects and disease-drug interaction. Identified pharmacists' interventions ranged from managing self-medication, to collaboration with general practitioner to change prescribing, and counselling the patient on medication use, including adherence. Even though the drug related problems were not that serious in the studied case, the patient could have valued from pharmacist intervention.
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Affiliation(s)
- Indre Treciokiene
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, Netherlands
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Jurate Peceliuniene
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
- Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Bjorn Wettermark
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, Netherlands
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Herledan C, Cerfon MA, Baudouin A, Larbre V, Lattard C, Poletto N, Ranchon F, Rioufol C. Impact of pharmaceutical care interventions on multidisciplinary care of older patients with cancer: A systematic review. J Geriatr Oncol 2023; 14:101450. [PMID: 36813686 DOI: 10.1016/j.jgo.2023.101450] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/22/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Optimizing medication use is a major issue in older patients with cancer and pharmacists are increasingly involved in their multidisciplinary care. The implementation of pharmaceutical care interventions must be supported by impact evaluations to enable their development and funding. This systematic review aims to synthesize evidence on the impact of pharmaceutical care interventions in older patients with cancer. MATERIALS AND METHODS A comprehensive search was performed in the PubMed/Medline, Embase, and Web of Science databases, for articles reporting evaluations of pharmaceutical care interventions for patients with cancer aged 65 years or older. RESULTS Eleven studies met the selection criteria. Most pharmacists were part of multidisciplinary geriatric oncology teams. Whether in outpatient or inpatient settings, interventions had common components, including patient interview, medication reconciliation, and comprehensive medication review to assess drug-related problems (DRPs). DRPs were identified in 95% of patients with 1.7 to 3 DRPs on average. Pharmacist recommendations resulted in a 20-40% reduction in the total number of DRPs and a 20-25% decrease in the prevalence of DRP. Prevalence of potentially inappropriate or omitted medications and their subsequent deprescribing or addition varied greatly between studies, notably depending on detection tools used. Clinical impact was insufficiently evaluated. Only one study reported a reduction of anticancer treatment toxicities following a joint pharmaceutical and geriatric assessment. A single economic evaluation calculated a potential net benefit of $3,864.23 per patient resulting from the intervention. DISCUSSION These encouraging results must be confirmed by more robust evaluations to support the involvement of pharmacists in multidisciplinary care of older patients with cancer.
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Affiliation(s)
- Chloé Herledan
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France.
| | - Marie-Anne Cerfon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France
| | - Amandine Baudouin
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France
| | - Virginie Larbre
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Claire Lattard
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Nicolas Poletto
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France
| | - Florence Ranchon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Catherine Rioufol
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
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Belayneh YM, Mamo T, Ahmed S, Kifle ZD. A retrospective study of drug related problems and contributing factors among type 2 diabetes mellitus patients on follow up at public health institutions of kemisse town, north east Ethiopia. Metabol Open 2021; 11:100098. [PMID: 34159307 PMCID: PMC8196223 DOI: 10.1016/j.metop.2021.100098] [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: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Drug related problems interfere with the desired treatment outcomes of type 2 Diabetes mellitus. This study was conducted to determine prevalence of drug related problems and associated factors among patients with type 2 Diabetes Mellitus in public health institutions of Kemisse town, northeast Ethiopia from May 01 to 30, 2019. METHODS Institution based retrospective cross sectional study was conducted among type 2 Diabetes Mellitus patents on follow up at public health institutions of Kemisse town, northeast Ethiopia. RESULT From the total of 156 patients included in the study, 126 (80.8%) patients have at least one drug related problem with a total of 149 drug related problems. The most prevalent drug related problems were need for additional drug therapy 60 (40.3%) followed by non-compliance 51 (34.2%) and unnecessary drug therapy 12 (8%). Identified causes of need for additional drug therapy were the need for prophylactic drug therapy (statins and antiplatelet), 83.3%; presence of untreated medical condition (Hypertension, diabetic nephropathy and diabetic foot ulcer), 11.7%; and the need for combination therapy for better efficacy, 5%. This study revealed that age ≥45 years (AOR = 5.59, 95% CI = 1.38-20.64, P = 0.016), presence of comorbid condition (AOR = 3.22, 95% CI = 1.75-13.47, P = 0.014 and emergency visit in the last one year (AOR = 5.08, 95% CI = 1.14-18.71, P = 0.033) were significantly associated with the occurrence of drug related problems. CONCLUSION A total of 149 drug related problems were identified in 80.8% of type 2 diabetes mellitus patients. The three most prevalent drug related problems were need for additional drug therapy 60 (40.3%) followed by non-compliance 51 (34.2%) and unnecessary drug therapy 12 (8%). Additionally, age ≥45 years (AOR = 5.59, P = 0.016), presence of comorbidity (AOR = 3.22, P = 0.014) and emergency visit in the last one year (AOR = 5.08, P = 0.033) were significantly associated with the occurrence of drug related problem.
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Affiliation(s)
- Yaschilal Muche Belayneh
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Teshome Mamo
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Solomon Ahmed
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Díaz Planelles I, Saurí Ferrer I, Trillo-Mata JL, Navarro-Pérez J. [Analysis of potentially inappropriate prescriptions according to the START criteria in nursing homes]. Rev Esp Geriatr Gerontol 2021; 56:195-202. [PMID: 34116800 DOI: 10.1016/j.regg.2021.03.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The potentially inappropriate prescription by omission of a drug is defined as the failure to prescribe drugs that are clinically indicated. The objective of this article is to describe and analyse the evolution of inappropriate prescriptions by omission in nursing homes of a health department. MATERIAL AND METHODS Retrospective observational descriptive study carried out in nursing homes of the Valencia-Clínico-Malvarrosa health department during the period 2016-2018. All institutionalized patients during this period were included. The prevalence of potentially inappropriate prescriptions by omission was assessed based on version 2 of the START criteria. The variables came from the electronic medical records of ambulatory care of the Conselleria de Sanitat (Abucasis). RESULTS 2251 different patients were selected, mean age of 79,53years, 69% women, and an average of 4,60 chronic drugs/resident. A total of 2647 inappropriate prescriptions by omission were identified during the study period, and the results were similar during these 3years. The most prevalent START criteria were those related to the musculoskeletal system and the cardiovascular system, and those related to analgesic consumption. The mean value of inappropriate prescriptions by omission prevalence for the period studied were 39.54%. CONCLUSION The results of our study confirm a high prevalence of potentially inappropriate prescriptions by omission in residents of nursing homes, and the maintenance of this prevalence during the 3years of the study.
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Affiliation(s)
| | - Inma Saurí Ferrer
- INCLIVA Instituto de Investigación Sanitaria. Hospital Clínico Universitario de Valencia, Valencia, España
| | - José Luis Trillo-Mata
- Servicio de Farmacia de Área de Salud, Departamento de Salud Clínico-Malvarrosa. Hospital Clínico Universitario de Valencia, Valencia, España
| | - Jorge Navarro-Pérez
- Universidad de Valencia, Valencia, España; INCLIVA Instituto de Investigación Sanitaria. Hospital Clínico Universitario de Valencia, Valencia, España; Dirección Médica Hospital Clínico Universitario de Valencia, Valencia, España; Centro de Investigación Biomédica en red Epidemiología y Salud Pública (CIBERESP), España
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Toukhy A, Fayed S, Sabry N, Shawki M. The Impact of an Established Pharmaceutical Care Pathway on Drug Related Problems in an Intensive Care Unit. Am J Med Sci 2021; 362:143-153. [PMID: 33745978 DOI: 10.1016/j.amjms.2021.03.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/19/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of drug related problems (DRPs) in intensive care units (ICU) is higher compared to any other wards in the hospital, requiring a structured pathway to ensure optimum detection of DRPs. The study aimed to evaluate the impact of implementing a pharmaceutical care pathway on the detection and management of DRPs in an ICU. METHODS The study was conducted in a general ICU and included three phases: tool preparation phase included the development of a core measures reference pathway and daily working scenario flow-charts, a control phase where the patient files and pharmacists' case assessment notes were retrospectively reviewed to detect the rate of DRPs before pathway implementation and a prospective phase similar to the control phase but with the implementation of the new pathway. The number and classification of DRPs and required core measures in the control and implementation phases were documented. RESULTS Using the new pathway, the detection of unmet core measures increased from 7.3% in the control phase to 99% in the implementation phase (p-value <0.001). The prevalence of unidentified DRPs/1000 patients' service days decreased from 98.1 in the control phase to 27.08 in the implementation phase (p-value <0.001). However, there was no significant difference between the phases regarding mortality rate and length of ICU stay. CONCLUSIONS The implementation of a unified pharmaceutical care pathway improved the detection of DRPs in ICU patients.
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Affiliation(s)
- Asia Toukhy
- Clinical Pharmacy Department, Al Haram Hospital, Giza, Egypt
| | - Said Fayed
- Anesthesia and Intensive Care Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Nirmeen Sabry
- Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Giza, Egypt.
| | - May Shawki
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Nabergoj Makovec U, Locatelli I, Kos M. Improved adherence with Medicines Use Review service in Slovenia: a randomized controlled trial. BMC Health Serv Res 2021; 21:266. [PMID: 33752647 PMCID: PMC7986462 DOI: 10.1186/s12913-021-06223-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/14/2020] [Accepted: 02/28/2021] [Indexed: 02/08/2023] Open
Abstract
Background Based on several existing patient-oriented activities, Medicines Use Review (MUR) service was standardized and officially adopted in Slovenia in 2015. Service aims to provide adherence support and ensure safe and effective medicines use. Therefore, the aim of the study was to evaluate the benefits of MUR in Slovenia, primarily the impact on medication adherence. Methods A randomised controlled trial was performed in community pharmacies to compare MUR with standard care. Patients were randomised into either the test (patients received MUR by a certified MUR provider at visit 1), or control group. The study primary outcome was self-reported adherence to multiple medications, assessed by electronic ©Morisky Widget MMAS-8 Software at the first visit (V1) and after 12 weeks (V2). A sub-analysis of intentional and unintentional non-adherence was performed. MUR impact was defined as the relative difference in ©MMAS-8 score after 12 weeks between the test and control group. A multiple linear regression model was used to predict MUR impact based on baseline adherence (low versus medium and high). Several secondary outcomes (e.g. evaluation of drug-related problems (DRPs)) were also assessed. Results Data from 153 (V1) and 140 (V2) patients were analysed. Baseline adherence was low, moderate and high in 17.6, 48.4 and 34.0% patients, respectively. In the low adherence subpopulation, test group patients showed a 1.20 point (95% CI = 0.16–2.25) increase in total ©MMAS-8 score (p = 0.025) compared to control group patients. A 0.84 point (95% CI = 0.05–1.63) increase was due to intentional non-adherence (p = 0.038), and a 0.36 point (95% CI = − 0.23-0.95) was due to unintentional non-adherence (p = 0.226). Additionally, statistically significant decrease in the proportion of patients with manifested DRPs (p < 0.001) and concerns regarding chronic medicines use (p = 0.029) were revealed. Conclusion MUR service in Slovenia improves low medication adherence and is effective in addressing DRPs and concerns regarding chronic medicines use. Trial registration ClinicalTrials.gov - NCT04417400; 4th June 2020; retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06223-8.
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Affiliation(s)
- Urška Nabergoj Makovec
- Department of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Askerceva cesta 7, 1000, Ljubljana, Slovenia
| | - Igor Locatelli
- Department of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Askerceva cesta 7, 1000, Ljubljana, Slovenia
| | - Mitja Kos
- Department of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Askerceva cesta 7, 1000, Ljubljana, Slovenia.
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Babu T, Mathew Panachiyil G, Sebastian J, Dhati Ravi M. Prescribing patterns and drug-related problems (DRPs) in transfusion-dependent paediatric thalassemia patients: A prospective interventional study from a tertiary care hospital in India. Int J Pediatr Adolesc Med 2021; 8:35-38. [PMID: 33718575 PMCID: PMC7922838 DOI: 10.1016/j.ijpam.2020.01.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/17/2019] [Accepted: 01/06/2020] [Indexed: 11/04/2022]
Abstract
Background Each year nearly 10,000 children with thalassaemia major are born in India, but among them, very few are optimally managed mainly in urban regions even though the Government of India has incorporated their care and treatment in the 12th Five-Year Plan. Data on prescribing patterns and drug-related problems (DRPs) in paediatric thalassaemia patients in India are limited. Methods In this prospective interventional study, the medications prescribed were recorded after reviewing the treatment charts, thalassaemia register, thalassaemia card, nurses’ notes, as well as discharge summaries. When DRPs and/or medication errors were identified, the same was discussed with the concerned health care professionals and suitable suggestions were made at the earliest. Results Out of the enrolled 54 patients, only 94% (n = 51) of the patients received iron chelation therapy with deferasirox and/or deferiprone, Folic acid tablet was prescribed for 100% of the patients (n = 54). Five percent of patients (n = 3) had undergone splenectomy and was prescribed with amoxicillin prophylactically. There were a total of 16 DRPs and 15 medication errors were identified and suitable measurements were taken to solve these problems. Conclusions The prescribing patterns, DRPs and medication errors in transfusion-dependent paediatric thalassaemia patients were discussed in this study. Our study was effective in identifying and solving the DRPs and medication problems that occurred in thalassaemia patients.
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Affiliation(s)
- Tirin Babu
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka, 570015, India
| | - George Mathew Panachiyil
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka, 570015, India
| | - Juny Sebastian
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka, 570015, India
| | - Mandyam Dhati Ravi
- Department of Paediatrics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, 570015, India
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Chiarelli MT, Antoniazzi S, Cortesi L, Pasina L, Novella A, Venturini F, Nobili A, Mannucci PM. Pharmacist-driven medication recognition/ reconciliation in older medical patients. Eur J Intern Med 2021; 83:39-44. [PMID: 32773274 DOI: 10.1016/j.ejim.2020.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In older medical patients polypharmacy is often associated with poor prescription appropriateness and harmful drug-drug interactions. An effort that jointly involved hospital pharmacists and clinicians attending multimorbid older patients acutely admitted to medical wards was implemented for medication recognition and reconciliation aided by the use of a computerized support system. METHODS Six internal medicine wards enrolled consecutively 90 acutely admitted multimorbid patients aged 75 years or more taking 5 or more different drugs. Two hospital pharmacists carried out the recognition of medications taken at hospital ward admission, and interacted with the clinicians in a process of drug reconciliation, using also the computerized support system to evaluate drug related problems, prescription inappropriateness or drug-drug interactions. The process was repeated at hospital discharge. RESULTS Among a total number of 911 drugs prescribed to 90 older medical patients at ward admission, the pharmacists identified during their recognition/reconciliation 455 drug-related problems, mainly due to prescription of medications inappropriate for older multimorbid patients and clinically harmful drug-drug interactions. When these drug-related problems were identified by the pharmacist, the attending clinicians accepted and implemented the suggestions for changes for approximately two thirds of the discrepancies, thereby leading to deprescribing the implicated drugs or at least to their closer monitoring. CONCLUSIONS This interventional prospective study based upon the integrated expertise of hospital pharmacists and clinicians confirms that drug-related problems are frequent in multimorbid older patients acutely admitted to hospital medical wards, and demonstrates afresh the feasibility and mutual acceptance of a trajectory of recognition/reconciliation based upon an integrated collaboration between hospital pharmacists and ward clinicians in the process of medication optimization.
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Affiliation(s)
- Maria Teresa Chiarelli
- Hospital Pharmacy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Antoniazzi
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Cortesi
- Laboratorio di Valutazione della Qualita' delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156 Milan, Italy
| | - Luca Pasina
- Laboratorio di Valutazione della Qualita' delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156 Milan, Italy
| | - Alessio Novella
- Laboratorio di Valutazione della Qualita' delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156 Milan, Italy
| | - Francesca Venturini
- Hospital Pharmacy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Nobili
- Laboratorio di Valutazione della Qualita' delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156 Milan, Italy.
| | - Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
BACKGROUND Residents at nursing homes (NHs) are at particular risk for drug related harm. Regular medication reviews using explicit criteria for pharmacological inappropriateness and classification of drug related problems (DRPs) have recently been introduced as measures to improve the quality of medication use and for making the treatment more uniform across different institutions. Knowledge about variation in DRPs between NHs is scarce. To explore if increased attention towards more appropriate drug treatment in NHs have led to more uniform treatment, we have analyzed variations between different nursing homes' drug use and DRPs. METHODS Cross-sectional medication review study including 2465 long-term care residents at 41 NHs in Oslo, Norway. Regular drug use was retrieved from the patients' medical records. DRPs were identified by using STOPP/START and NORGEP criteria and a drug-drug interactions database. NHs were grouped in quartiles based on average levels of drug use. The upper and lower quartiles were compared using independent samples t-test and associations between drug use and DRPs were tested by logistic regression. RESULTS Patients' mean age was 85.9 years, 74.2% were women. Mean numbers of regular drugs per patient was 6.8 and varied between NHs from 4.8 to 9.3. The proportion of patients within each NH using psychotropic and analgesic drugs varied largely: antipsychotics from three to 50%, benzodiazepines from 24 to 99%, antidepressants from nine to 75%, anti-dementia drugs from no use to 42%, opioids from no use to 65% and paracetamol from 16 to 74%. Mean DRPs per patient was 2.0 and varied between NHs from 0.5 to 3.4. The quartiles of NHs with highest and lowest mean drugs per patient (7.7 vs. 5.7, p < 0.001) had comparable mean number of DRPs per patient (2.2 vs. 1.8, p = 0.2). Using more drugs and the use of opioids, antipsychotics, benzodiazepines and antidepressants were associated with more DRPs. CONCLUSIONS The use of psychotropic and analgesic drugs was high and varied substantially between different NHs. Even if the use of more drugs, opioids and psychotropic drugs was associated with DRPs, no difference was found in DRPs between the NHs with highest vs. lowest drug use.
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Affiliation(s)
- Amura Francesca Fog
- Nursing Home Agency, Oslo Municipality, Norway
- General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo, Postbox 1130 Blinderen, N-0318 Oslo, Norway
| | - Ibrahimu Mdala
- General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo, Postbox 1130 Blinderen, N-0318 Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit for Aging and Health, Vestfold County Hospital HF, Toensberg and Oslo University Hospital, Oslo, Norway
| | - Jørund Straand
- General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo, Postbox 1130 Blinderen, N-0318 Oslo, Norway
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Hailu BY, Berhe DF, Gudina EK, Gidey K, Getachew M. Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions. BMC Geriatr 2020; 20:13. [PMID: 31931723 PMCID: PMC6958579 DOI: 10.1186/s12877-020-1413-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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: 08/06/2019] [Accepted: 01/03/2020] [Indexed: 01/09/2023] Open
Abstract
Background Geriatric patients are at high risk of Drug Related Problems (DRPs) due to multi- morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients often excluded from premarketing trials that can further increase the occurrence of DRPs. This study aimed to identify drug related problems and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimization. Methods A prospective interventional study was conducted among geriatric patients admitted to medical and surgical wards of Jimma University Medical Center from April to July 2017. Clinical pharmacists reviewed patients drug therapy, identified drug related problems and provided interventions. Data were analyzed by using SPSS statistical software version 20.0. Descriptive statistics were performed to determine the proportion of drug related problems. Logistic regression analyses were performed to identify the determinants of drug related problems. Results A total of 200 geriatric patients were included in the study. The mean age of the participants was 67.3 years (SD7.3). About 82% of the patients had at least one drug related problems. A total of 380 drug related problems were identified and 670 interventions were provided. For the clinical pharmacist interventions, the prescriber acceptance rate was 91.7%. Significant determinants for drug related problems were polypharmacy (adjusted odds ratio [AOR] = 4.350, 95% C.I: 1.212–9.260, p = 0.020) and number of comorbidities (AOR = 1.588, 95% C.I: 1.029–2.450, p = 0.037). Conclusions Drug related problems were substantially high among geriatric inpatients. Patients with polypharmacy and co-morbidities had a much higher chance of developing DRPs. Hence, special attention is needed to prevent the occurrence of DRPs in these patients. Moreover, clinical pharmacists’ intervention was found to reduce DRPs in geriatric inpatients. The prescriber acceptance rate of clinical pharmacists’ intervention was also substantially high.
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Affiliation(s)
- Berhane Yohannes Hailu
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Derebew Fikadu Berhe
- Department of Pharmacology and Toxicology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mestawet Getachew
- Department of clinical pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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12
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Sutherland A, Phipps DL, Tomlin S, Ashcroft DM. Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review. BMC Pediatr 2019; 19:486. [PMID: 31829142 PMCID: PMC6905106 DOI: 10.1186/s12887-019-1875-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Problems arising from medicines usage are recognised as a key patient safety issue. Children are a particular concern, given that they are more likely than adults to experience medication-related harm. While previous reviews have provided an estimate of prevalence in this population, these predate recent developments in the delivery of paediatric care. Hence, there is a need for an updated, focussed and critical review of the prevalence and nature of drug-related problems in hospitalised children in the UK, in order to support the development and targeting of interventions to improve medication safety. METHODS Nine electronic databases (Medline, Embase, CINAHL, PsychInfo, IPA, Scopus, HMIC, BNI, The Cochrane library and clinical trial databases) were searched from January 1999 to April 2019. Studies were included if they were based in the UK, reported on the frequency of adverse drug reactions (ADRs), adverse drug events (ADEs) or medication errors (MEs) affecting hospitalised children. Quality appraisal of the studies was also conducted. RESULTS In all, 26 studies were included. There were no studies which specifically reported prevalence of adverse drug events. Two adverse drug reaction studies reported a median prevalence of 25.6% of patients (IQR 21.8-29.9); 79.2% of reactions warranted withdrawal of medication. Sixteen studies reported on prescribing errors (median prevalence 6.5%; IQR 4.7-13.3); of which, the median rate of dose prescribing errors was 11.1% (IQR 2.9-13). Ten studies reported on administration errors with a median prevalence of 16.3% (IQR 6.4-23). Administration technique errors represented 53% (IQR 52.7-67.4) of these errors. Errors detected during medicines reconciliation at hospital admission affected 43% of patients, 23% (Range 20.1-46) of prescribed medication; 70.3% (Range 50-78) were classified as potentially harmful. Medication errors detected during reconciliation on discharge from hospital affected 33% of patients and 19.7% of medicines, with 22% considered potentially harmful. No studies examined the prevalence of monitoring or dispensing errors. CONCLUSIONS Children are commonly affected by drug-related problems throughout their hospital journey. Given the high prevalence and risk of patient harm,, there is a need for a deeper theoretical understanding of paediatric medication systems to enable more effective interventions to be developed to improve patient safety.
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Affiliation(s)
- Adam Sutherland
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT UK
- Pharmacy Department, Royal Manchester Children’s Hospital, Manchester Universities NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Denham L. Phipps
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Stephen Tomlin
- Pharmacy Department, Great Ormond Street Hospital, Holborn, London, WC1N 3JH UK
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
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Abstract
Objective: To derive findings from different studies done on drug related hospital admissions and comprehensively express the incidence and preventability of drug related hospital admissions; identify the common types of drug related problems that caused hospital admission, and identify factors associated with drug related hospital admission. Methods: Literatures that assessed hospitalization due to drug related problems were searched online using Pub Med and Google Scholar databases. The relevant reference lists of retrieved articles were also searched manually on Google. Prospective and retrospective studies conducted anywhere in the world on drug related hospitalization, published from January 2012 to January 2017 as an original article and written in English language were included. Result: The prevalence of drug related hospital admission varies from 1.3% to 41.3% with the average rate of 15.4%. Among hospitalized patients 2.7% were died due to drug-related problems (DRPs). Drugs that were frequently reported as causing drug related admission were antithrombotic drugs, antihypertensive drugs, analgesics, anti-diabetics, antipsychotics, and anti-neoplastic drugs. Poly pharmacy, old age and female sex were mentioned as determinants for drug related hospitalization by a number of studies. About one third of drug related hospital admissions were definitely preventable and more than 40% were also potentially preventable. Conclusion: Drug related problems contribute for more than 15% of hospital admissions. Higher risk of admission due to DRPs was observed in patients who were on poly pharmacy and those who were old. As most of drug related hospital admissions were preventable an emphasis should be given for preventive strategies to avoid complications and costs associated with admission.
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Affiliation(s)
- Mohammed Biset Ayalew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
| | - Ousman Abubeker Abdela
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
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Abramsson L, Gustafsson M. Prevalence of drug-related problems using STOPP/START and medication reviews in elderly patients with dementia. Res Social Adm Pharm 2020; 16:308-14. [PMID: 31176652 DOI: 10.1016/j.sapharm.2019.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) are common among elderly patients with dementia. STOPP/START is an explicit tool that has been used to detect DRPs among elderly patients. OBJECTIVES The objective of this study was to compare prevalence and type of DRPs identified by STOPP/START with DRPs identified by clinical pharmacists among the same population. Secondary objectives were to investigate factors associated with the use of DRPs using the two methods. METHOD Extracts from medical records were used to identify DRPs in 212 patients by using STOPP/START. The patients were ≥65 years of age with dementia or cognitive impairment. An earlier study was performed in the same study population in 2012-2014, where DRPs were identified by clinical pharmacists in order to decrease the number of rehospitalizations. RESULTS STOPP/START identified DRPs in 72.2% of the patients compared with 66.0% identified by the clinical pharmacists. The numbers of DRPs identified by the different methods were 326 and 310, respectively. Different types of DRPs were identified with the different tools. STOPP/START mainly identified DRPs in the categories "ineffective/inappropriate drug" and "needs additional drug therapy", whereas the clinical pharmacists identified DRPs in several categories. CONCLUSION Even though STOPP/START was able to identify a similar number of DRPs compared with DRPs identified by clinical pharmacists, STOPP/START failed to identify DRPs in several important categories. To cover all DRPs, STOPP/START might be used as a complement to implicit criteria.
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15
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Mifsud EM, Wirth F, Camilleri L, Azzopardi LM, Serracino-Inglott A. Pharmacist-led medicine use review in community pharmacy for patients on warfarin. Int J Clin Pharm 2019; 41:741-750. [PMID: 31006832 DOI: 10.1007/s11096-019-00824-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/09/2018] [Accepted: 04/10/2019] [Indexed: 01/03/2023]
Abstract
Background Medicine use review by pharmacists has the potential to improve anticoagulation therapy management in patients on warfarin. Objective To develop, implement and evaluate a pharmacist-led medication use review service for patients on warfarin. Setting Six community pharmacies in Malta. Method Patients (N = 100) aged 18 or older and on warfarin were recruited through pre-selected community-pharmacies. These patients were then invited to attend two sessions: a review session (t1) and a follow-up session after 2 months (t2). During the medication use review session, medication reconciliation was performed (a) to detect drug-related problems using the DOCUMENT classification system, (b) to develop an individualised care plan for each patient and (c) to recommend an action for each identified problem for physician, pharmacist or patient consideration. At t2, the degree of acceptance of the recommendations was determined by assessing the number of drug-related problems for which action was taken to address the problem. International normalisation ration (INR) control was evaluated by calculating the percentage Time in Therapeutic Range (TTR) at t1 and t2 using the Rosendaal linear interpolation method. Main outcome measures Frequency and type of drug-related problems detected; percentage of accepted recommendations; and INR control. Results A total of 481 drug-related problems were identified; 40% (n = 190) were related to warfarin treatment. Need for monitoring (30%; n = 145), lack of compliance (20%; n = 97) and need for patient education (19%; n = 90) were the top three problems identified. There was a significant correlation between frequency of the problems and number of chronic medications (Spearman Correlation 0.583, p < 0.001), number of comorbidities (Spearman Correlation 0.327, p = 0.001) and older age (Spearman Correlation 0.285, p = 0.04). A total of 475 recommendations were followed-up; 49% (n = 234) were referred for consideration by the physician. The percentage of recommendations accepted (84%; n = 397) was significantly higher than the percentage of recommendations not accepted (16%; n = 78) (p < 0.001). The time in therapeutic range improved significantly from 68.7% at t1 to 79.8% at t2 (p = 0.01). Conclusions The high percentage of accepted recommendations and the improvement in INR control indicate that a pharmacist-led medication use review service in community pharmacy contributes to improving anticoagulation therapy management in patients on warfarin.
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Affiliation(s)
- Elena M Mifsud
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | - Francesca Wirth
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - Lilian M Azzopardi
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Perlman A, Horwitz E, Hirsh-Raccah B, Aldouby-Bier G, Fisher Negev T, Hochberg-Klein S, Kalish Y, Muszkat M. Clinical pharmacist led hospital-wide direct oral anticoagulant stewardship program. Isr J Health Policy Res 2019; 8:19. [PMID: 30709417 PMCID: PMC6357500 DOI: 10.1186/s13584-019-0285-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 05/22/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction In the past decade, direct-acting oral anticoagulants (DOAC) have been introduced to medical practice for several indications, with a wide range of dosing regimens. As both over- and under-dosing might lead to life-threatening events, development of methods promoting safe and effective utilization of these agents is imperative. The Hadassah Clinical Pharmacy team initiated a hospital-wide program, for monitoring and promoting safe and effective prescription of DOAC during hospitalization. This study describes the types of drug related problems addressed and the program’s performance in terms of consultation rates and physician acceptance. Methods Electronic medical records throughout the hospital were screened for DOAC orders. All DOAC orders were assessed by a clinical pharmacist for potentially-inappropriate prescribing. When potentially-inappropriate prescribing or a drug-related problem was identified, the clinical pharmacist provided consultation on management options. In specific cases, additional guidance was provided by coagulation and pharmacology specialists. Data on patient characteristics, clinical pharmacist consultations, and physician response was retrospectively retrieved for the first six months of 2017. Characteristics of patients with and without consultations were compared, consultations were categorized by the recommended management of the drug related problem, and physician acceptance rates were evaluated by category. Results During the evaluated period, 585 patients with DOAC orders were identified. Patients were evenly distributed by gender, and age averaged 78 years. Most patients received apixaban (75%) followed by rivaroxaban (14%) and dabigatran (11%), and most (63%) received “reduced dose” regimens. Clinical pharmacists provided 258 consultations for 210 patients, regarding anticoagulation management, such that more than one in three patients on DOAC had potentially inappropriate prescribing or drug related problems. Consultations included alerts regarding potentially inappropriate DOAC doses and recommendations to increase (29%) or decrease (5%) the dose, potentially inappropriate concomitant antiplatelet agents (20%), need for DOAC level monitoring (23%), and alerts regarding other drug related problems (23%). More than 70% of recommendations were accepted by the attending physician. Conclusion Due to the complexity of DOAC management, potentially-inappropriate prescribing and drug related problems are common. Multidisciplinary collaborative projects including review and consultation by clinical pharmacists are an effective method of improving management of patients on DOAC. Trial registration Retrospectively registered at clinicaltrials.gov, NCT03527615.
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Affiliation(s)
- Amichai Perlman
- Department of Pharmacy, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Department of Medicine, Hadassah Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel.,Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ehud Horwitz
- Department of Pharmacy, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Department of Medicine, Hadassah Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
| | - Bruria Hirsh-Raccah
- Department of Pharmacy, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Department of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gefen Aldouby-Bier
- Department of Pharmacy, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Department of Orthopedics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tamar Fisher Negev
- Department of Pharmacy, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sarit Hochberg-Klein
- Department of Pharmacy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Muszkat
- Department of Medicine, Hadassah Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel.
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Mestres C, Hernandez M, Agustí A, Puerta L, Llagostera B, Amorós P. Development of a pharmaceutical care program in progressive stages in geriatric institutions. BMC Geriatr 2018; 18:316. [PMID: 30567496 PMCID: PMC6300022 DOI: 10.1186/s12877-018-1002-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/06/2018] [Accepted: 12/03/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To introduce and manage a Pharmaceutical care programs in geriatric care institutions presents difficulties such as reduced pharmacy service staff, complexity of the patients or lack of integration of the pharmacist in the health care team. This work describes the evolution of the implementations of a program of pharmaceutical care centered in drug related problems (DRP) in a group of geriatric institutions of different levels of complexity. METHODS Setting: Long-term and subacute care hospitals (HSS) and Health care teams attending nursing homes (EARs). PARTICIPANTS Patients attended in HSS and EARs during different periods between 2010 and 2016. INTERVENTIONS The program was developed in different stages, in which pharmacists made interventions of increasing complexity. RESULTS Between 2010 and 2013, the approach was only to improve the prescription of non-appropriate drugs for the elderly, which was reduced from 19 to 14.5%. Subsequent steps included detection of drug-related problems (DRP), systematization of treatment revisions, recording of pharmacist interventions, improvements in the classification of interventions and the creation of a web-based database for recording in a more efficient way. During these years, there was an increase in the number of patients included in pharmaceutical care activities and thus the number of pharmacist interventions (3872 in 2014 vs 5903 in 2016). In 2016, mean age in 2016: 83.2 years old. Mean number of medicines/patient: 8.4 ± 3.3, and mean interventions/patient: 1.62. Degree of acceptance of the interventions by physicians improved (68.6% in 2016 vs 45.5% in 2012), even though there is still much work to do. The Medication Appropriateness Index (MAI) showed that when the interventions were accepted, there was an important improvement. HSS mean MAI values pre-intervention: 2.52, post-intervention 0.80. In EARs: 5 pre and 1.39 post. In both cases p < 0.0001. CONCLUSIONS Approaching the deployment of activities in a progressive way has made us more efficient and able to confront and solve the problems that have arisen. Even though there has been a very restricted increase in the staff and budget, we are able to implement a DRP detection programme with guaranties of quality.
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Affiliation(s)
- Conxita Mestres
- School of Health Sciences Blanquerna, University Ramon Llull, Padilla 326, 08025 Barcelona, Spain
| | | | - Anna Agustí
- Pharmacy Department, HSS Mutuam Girona, Girona, Spain
| | - Laura Puerta
- Pharmacy Department, HSS Mutuam Güell, Barcelona, Spain
| | | | - Patricia Amorós
- Pharmacy Department, Centre Residencial La Creueta, Sabadell, Spain
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Ayele Y, Melaku K, Dechasa M, Ayalew MB, Horsa BA. Assessment of drug related problems among type 2 diabetes mellitus patients with hypertension in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. BMC Res Notes 2018; 11:728. [PMID: 30314443 PMCID: PMC6186051 DOI: 10.1186/s13104-018-3838-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022] Open
Abstract
Objective This study was conducted to assess magnitude and pattern of drug related problems among patients with type 2 diabetes mellitus (T2DM) and hypertension. Results This study identified 364 drug related problems (DRPs) across the three categories of drug related problems, giving an average of 1.8 DRPs per patient. The effect of drug treatment being not optimal 179 (49.2%), untreated indication and symptoms 77 (21.1%), unnecessary drug-treatment 39 (10.7%) and adverse drug reactions 69 (19%) were the most frequent categories of DRPs identified. In general, high prevalence of drug-related problems was identified among patients with T2DM hypertension. The effect of drug treatment being not optimal, untreated indication and symptoms, unnecessary drug-treatment and adverse drug reactions were the most frequent categories of drug related problems identified. Therefore, the clinicians should work to improve patient care through prevention and resolving drug related problems since it can affect the quality of the care significantly.
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Affiliation(s)
- Yohanes Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O.Box 235, Harar, Ethiopia.
| | - Kibkab Melaku
- Hiwot Fana Specialized University Hospital, Harar, Ethiopia
| | - Mesay Dechasa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O.Box 235, Harar, Ethiopia
| | - Mohammed Biset Ayalew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Boressa Adugna Horsa
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Flamme-Obry F, Belaiche S, Hazzan M, Ramdan N, Noël C, Odou P, Décaudin B. [Clinical pharmacist and medication reconciliation in kidney transplantation]. Nephrol Ther 2018; 14:91-98. [PMID: 29477279 DOI: 10.1016/j.nephro.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Drug related problems (DRP) can lead to severe consequences in kidney recipients. The aim of the study was to assess the impact of the clinical pharmacist interventions on the incidence of DRP. METHOD The number of DRP were evaluated according to 3periods: Without intervention, with medication reconciliation at admission, and with medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge. RESULTS Patients concerned were mainly men, 55years old (median age), stage3 of CKD, transplanted for less than 3months or more than 1year, with cardiovascular risk factors and receiving an average of 9drugs/day. Among the DRP, 20% were avoidable and severe in most cases. In period1, 27.7% patients had at least 1DRP, in period2, 21.3% patients had at least 1DRP, and in period3, 17.4% of patients had at least 1DRP (P=0.03). One hundred and ten patients had medication reconciliation at admission with a mean of 0.6unintentional discrepancies per patient (omission in 81% of cases). The main drugs involved concerned the digestive-metabolic (24.5%), cardiovascular (23%), and nervous (23%) system. Sixty-eight interviews at discharge were realized and revealed self-medication habits. CONCLUSION Our study shows that medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge can help to reduce DRP in kidney recipients. Further studies are needed to confirm our results.
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Affiliation(s)
| | - Stéphanie Belaiche
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France.
| | - Marc Hazzan
- Service de néphrologie, CHRU de Lille, 59000 Lille, France; Inserm U995, Lille Inflammation Research International Center (LIRIC), University Lille, 59000 Lille, France
| | - Nassima Ramdan
- EA 2694, santé publique : épidémiologie et qualité des soins, CHRU de Lille, University Lille, 59000 Lille, France
| | - Christian Noël
- Service de néphrologie, CHRU de Lille, 59000 Lille, France; Inserm U995, Lille Inflammation Research International Center (LIRIC), University Lille, 59000 Lille, France
| | - Pascal Odou
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France
| | - Bertrand Décaudin
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France
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Ong KY, Chung WL, Mamun K, Chen LL. Project Octo-Pills - A practice model engaging community pharmacists in the care of patients from a tertiary hospital. Res Social Adm Pharm 2017; 14:792-794. [PMID: 29054693 DOI: 10.1016/j.sapharm.2017.10.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
Even while pharmacy practice evolves to a more patient-centric mode of practice, local hospitals, due to high patient load as well as space and resource constraints, find it challenging to conduct thorough medication review and physical medication reconciliation for all patients. In light of this, optimizing the local current healthcare system to involve community pharmacists in the care of patients from public hospitals could potentially better cater to the healthcare needs of the older population. Due to easy accessibility, community pharmacies are often the first point of contact in the healthcare system. Project Octo-Pills aims to engage community pharmacists in the collaborative care of patients from a tertiary hospital, providing patients with quality medication reconciliation and review services from a more convenient location within their neighborhood. This paper describes the model for this pilot initiative.
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Affiliation(s)
- Kheng Yong Ong
- Department of Pharmacy, Singapore General Hospital, Singapore.
| | | | - Kaysar Mamun
- Department of Geriatric Medicine, Singapore General Hospital, Singapore
| | - Li Li Chen
- Department of Pharmacy, Singapore General Hospital, Singapore
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Degu A, Njogu P, Weru I, Karimi P. Assessment of drug therapy problems among patients with cervical cancer at Kenyatta National Hospital, Kenya. Gynecol Oncol Res Pract 2017; 4:15. [PMID: 29075505 PMCID: PMC5648473 DOI: 10.1186/s40661-017-0054-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/13/2017] [Indexed: 02/07/2023]
Abstract
Background Although cervical cancer is preventable, it is still the second leading cause of cancer deaths among women in the world. Further, it is estimated that around 5–10% of hospital admissions are due to drug related problems (DRPs), of which 50% are avoidable. In cancer therapy, there is an immense potential for DRPs due to the high toxicity of most chemotherapeutic regimens. Hence, this study sought to assess DRPs among patients with cervical cancer at Kenyatta National Hospital (KNH). Methods A cross-sectional study was conducted at the oncology units of KNH. A total of 81 study participants were recruited through simple random sampling. Data were collected from medical records and interviewing patients. The appropriateness of medical therapy was evaluated by comparing with National Compressive Cancer Network and European Society for Medical Oncology practice guideline of cervical cancer treatment protocol. The degree of adherence was determined using eight-item Morisky medication adherence scale. The likelihood of drug interaction was assessed using Medscape, Micromedex and Epocrates drug interaction checkers. The data were entered in Microsoft Excel and analysed using statistical software STATA version 13.0. Descriptive statistics such as mean, percent and frequency were used to summarise patients’ characteristics. Univariable and multivariable binary logistic regression were used to investigate the potential predictors of DRPs. Result A total of 215 DRPs were identified from 76 patients, translating to a prevalence of 93.8% and a mean of 2.65 ± 1.22 DRPs. The predominant proportion of DRPs (48.2%) was identified in patients who had been treated with chemoradiation regimens. Adverse drug reactions 56(69.1%) and drug interactions 38(46.9%) were the most prevalent DRPs. Majority (67.9%) of the study population were adherent to their treatment regimens. Forgetfulness 18(69.2%), expensive medications 4(15.4%) and side effects of medications 4(15.4%) were the main reasons for medication non-adherence. Patients with advanced stage cervical cancer were 15.4 times (AOR = 15.4, 95% CI = 1.3–185.87, p = 0.031) more likely to have DRPs as compared to patients with early stage disease. Conclusion Adverse drug reactions, drug interactions, and need of additional drug therapy were the most common DRPs identified among cervical cancer patients. Advanced stage cervical cancer was the only predictor of DRPs.
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Affiliation(s)
- Amsalu Degu
- Department of Pharmaceutics and Pharmacy Practice, University of Nairobi, College of Health Sciences, School of Pharmacy, P.O. Box 19676-00202, Nairobi, Kenya
| | - Peter Njogu
- Department of Pharmaceutical Chemistry, University of Nairobi, College of Health Sciences, School of Pharmacy, Nairobi, 19676-00202 Kenya
| | - Irene Weru
- Kenyatta National Hospital, Division of Pharmacy, Nairobi, 20723-00202 Kenya
| | - Peter Karimi
- Department of Pharmaceutics and Pharmacy Practice, University of Nairobi, College of Health Sciences, School of Pharmacy, P.O. Box 19676-00202, Nairobi, Kenya
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Jazbar J, Locatelli I, Horvat N, Kos M. Clinically relevant potential drug-drug interactions among outpatients: A nationwide database study. Res Social Adm Pharm 2017; 14:572-580. [PMID: 28716467 DOI: 10.1016/j.sapharm.2017.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 01/06/2017] [Revised: 06/06/2017] [Accepted: 07/10/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Adverse drug events due to drug-drug interactions (DDIs) represent a considerable public health burden, also in Slovenia. A better understanding of the most frequently occurring potential DDIs may enable safer pharmacotherapy and minimize drug-related problems. OBJECTIVES The aim of this study was to evaluate the prevalence and predictors of potential DDIs among outpatients in Slovenia. METHODS An analysis of potential DDIs was performed using health claims data on prescription drugs from a nationwide database. The Lexi-Interact Module was used as the reference source of interactions. The influence of patient-specific predictors on the risk of potential clinically relevant DDIs was evaluated using logistic regression model. RESULTS The study population included 1,179,803 outpatients who received 15,811,979 prescriptions. The total number of potential DDI cases identified was 3,974,994, of which 15.6% were potentially clinically relevant. Altogether, 9.3% (N = 191,213) of the total population in Slovenia is exposed to clinically relevant potential DDIs, and the proportion is higher among women and the elderly. After adjustment for cofactors, higher number of medications and older age are associated with higher odds of clinically relevant potential DDIs. The burden of DDIs is highest with drug combinations that increase risk of bleeding, enhance CNS depression or anticholinergic effects or cause cardiovascular complications. CONCLUSION The current study revealed that 1 in 10 individuals in the total Slovenian population is exposed to clinically relevant potential DDIs yearly. Taking into account the literature based conservative estimate that approximately 1% of potential DDIs result in negative health outcomes, roughly 1800 individuals in Slovenia experience an adverse health outcome each year as a result of clinically relevant potential interactions alone.
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Affiliation(s)
- Janja Jazbar
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Igor Locatelli
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Nejc Horvat
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Mitja Kos
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia.
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23
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Panda A, Pradhan S, Mohapatra G, Mohapatra J. Drug-related problems associated with self-medication and medication guided by prescription: A pharmacy-based survey. Indian J Pharmacol 2017; 48:515-521. [PMID: 27721536 PMCID: PMC5051244 DOI: 10.4103/0253-7613.190728] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objective of this study is to identify and compare the nature of the drug-related problems (DRPs) associated with self-medication and non-self-medication (drug use guided by a prescription). MATERIALS AND METHODS The cross-sectional, observational study was conducted on 1100 adult participants at a convenience sample of six retail private pharmacy counters. The data collection form was based on the Pharmaceutical Care Network Europe version 6.2 classification for DRPs. Descriptive statistics was used to represent the prevalence of DRPs. Chi-square test was used to find out the association between the type of medication and DRPs. Odds ratio (OR) with confidence interval (CI) was computed to find the factors determining the occurrence of DRPs. P < 0.05 was considered to be statistically significant. Data were analyzed using SPSS version 16.0. RESULTS The prevalence of self-medication was 18.72%. The prevalence of DRPs was 17.36%. In the self-medication group, the prevalence of DRPs was high (40.78%) as compared to the non-self-medication group (11.97%). DRP related to inappropriate drug dosing was observed in 44.83% and 40.45% subjects in self-medication and non-self-medication group, respectively (P < 0.001). The subjects in the self-medication group were about 5 times likely to have a DRP (OR: 5.06, CI: 3.59-7.14, P < 0.001). CONCLUSIONS Self-medication is associated with a higher risk of various DRPs. Since retail pharmacy outlet is often the first point of contact between the patient and the health care system in a developing country, interventions like drug information activities at the retail pharmacy is likely to bring down the DRPs associated with self-medication.
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Affiliation(s)
- Abinash Panda
- Department of Pharmacology, MKCG Medical College, Berhampur, Odisha, India
| | - Supriya Pradhan
- Department of Pharmacology, MKCG Medical College, Berhampur, Odisha, India
| | | | - Jigyansa Mohapatra
- Department of Pharmacology, S.C.B. Medical College, Cuttack, Odisha, India
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Shareef J, Fernandes J, Samaga L. Assessment of clinical pharmacist interventions in drug therapy in patients with diabetes mellitus in a tertiary care teaching hospital. Diabetes Metab Syndr 2016; 10:82-87. [PMID: 26642888 DOI: 10.1016/j.dsx.2015.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/27/2015] [Indexed: 11/27/2022]
Abstract
AIM To assess the impact of clinical pharmacist interventions in drug therapy in hospitalized patients with diabetes mellitus. METHODS A Prospective interventional study was carried out in the medicine wards of a tertiary care teaching hospital over a period of 10 months from September 2013 to June 2014. The drug therapy details of the patients were collected from inpatient case records in the respective clinical wards. Clinical pharmacist reviewed the drug therapy, identified the drug related problems during ward rounds and discussed with the physicians and suitable suggestions was provided which had been documented. RESULTS A total of 189 drug therapy problems were identified from 151 patient case records. The number of drug related problems was found to more in males than females. Drug related problems were commonly seen in patients aged between 61 and 70 years of age. The most common drug related problems was found to be drug use without indication (17.98%) followed by improper drug selection (16.40%). The most frequent suggestions by the clinical pharmacist were on cessation of drug (30.68%). The acceptance rate of suggestions and the changes in drug therapy was found to be high (58.20%). The majority of the level of significance of drug related problems was seen to have moderate significance in grade. CONCLUSION Involvement of clinical pharmacist as a member of healthcare team during ward rounds in hospitalized patients with diabetes mellitus helps in identification and prevention of drug related problems which will helps to rationalize drug therapy, achieve better therapeutic outcomes and improved patient care.
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Affiliation(s)
- Javedh Shareef
- Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Paneer, Mangalore, Karnataka, India.
| | - Jennifer Fernandes
- NGSM Institute of Pharmaceutical Sciences, Paneer, Mangalore, Karnataka, India.
| | - Laxminarayana Samaga
- Department of General Medicine, KS Hegde Medical Academy & Hospital, Deralakatte, Mangalore, Karnataka, India.
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25
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Abu Farha R, Basheti I, Abu Al Ruz H, Alsaleh A, AbuRuz S. Assessment of drug-related problems and their impact on blood pressure control in patients with hypertension. Eur J Hosp Pharm 2015; 23:126-130. [PMID: 31156832 DOI: 10.1136/ejhpharm-2015-000712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/04/2015] [Revised: 09/16/2015] [Accepted: 09/25/2015] [Indexed: 11/04/2022] Open
Abstract
Objectives Hypertension is among the leading causes of cardiovascular disease worldwide. No previous studies have examined specifically the types of drug-related problems (DRPs) in patients with hypertension, and how these problems affect blood pressure control. So, the primary aim of this study was to investigate the prevalence and nature of DRPs in outpatients with hypertension and reveal any associations between DRPs and blood pressure control in these patients. Methods This was a cross-sectional correlation study. A total of 200 patients who fulfilled the inclusion criteria were recruited through outpatient clinics. Patients' data were assessed to identify DRPs using a systematic evidence-based approach. Results Two hundred participants were recruited in this cross-sectional study. About half of the participants (48.5%) had uncontrolled hypertension. The average number of DRPs was 6.31±2.63. The main identified DRPs affecting blood pressure control included patients' lack of knowledge about their medications, lack of adherence to their medications, suboptimal efficacy of medications prescribed and the need for additional monitoring. Logistic regression analysis was performed to identify the most important predictors, and significant associations were found between poor blood pressure control and the above-identified variables except for knowledge about medication (p≤0.05). Conclusion The number of DRPs among patients with hypertension is relatively high. These DRPs were associated with poor blood pressure control. The implementation of clinical pharmacy services for all patients with hypertension is strongly recommended.
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Affiliation(s)
- Rana Abu Farha
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Iman Basheti
- Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Science University, Amman, Jordan
| | | | - Akram Alsaleh
- Department of Internal Medicine, Faculty of medicine, University of Jordan, Amman, Jordan
| | - Salah AbuRuz
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan.,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, National Guards Health Affairs, Riyadh, Saudi Arabia
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Gangwar SS, Monisha N, Nachiya J, Narasingarao K, Parimalakrishnan S, Singh SP. Impact of medication and psychological behaviour assessment by community pharmacists in type 2 diabetes mellitus patients after hospital stay. Afr Health Sci 2014; 14:539-50. [PMID: 25352870 DOI: 10.4314/ahs.v14i3.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Drug related problem (DRPs) is a key factor which will affect the outcome of therapy and safety. OBJECTIVE To assess the DRPs in type 2 diabetes mellitus (T2DM) patients and psychological aspects of patients by community pharmacists to observe the rate of DRP. METHODS Prospective randomized controlled intervention study involved T2DM patients and conducted in two community pharmacies at Kanpur from January 2012 to December 2012. The assessment of DRPs was based on the PCNE. Changes in glycosylated hemoglobin (HBA1c), low density lipoproteins (LDL), blood pressure(BP), foot examinations, changes medical and medication utilization were studied. Using as control group, received usual care, and interventional group provided, intervened with use of the standard treatment guidelines (STG). Researcher provided the knowledge to community pharmacists and patients. Baseline and interventional data were collected at 0,3,6,9 and 12 months. RESULTS Over the 12 month study, participants' average HBA1C reduced from 8.9% at initial visit to 7.5%. During this time, the eye examination rate was raised from 31% to 48%, and the foot examination rate was raised from 35% to 50%. CONCLUSION The intervention of pharmacists showed little influence on any of the intermediate health outcomes in T2DM.
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Affiliation(s)
- Sudhir Singh Gangwar
- Department of Pharmaceutical Sciences, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - N Monisha
- Department of Pharmacy, Annamalai University, Annamalai Nagar, Tamil Nadu, India
| | - Jainaf Nachiya
- Department of Pharmacy, Annamalai University, Annamalai Nagar, Tamil Nadu, India
| | | | - S Parimalakrishnan
- Department of Pharmacy, Annamalai University, Annamalai Nagar, Tamil Nadu, India
| | - Seo Pratap Singh
- Department of Pharmacology, GSVM Medical College, Kanpur, Uttar Pradesh, India
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