A Descriptive Quantitative Analysis on the Extent of Polypharmacy in Recipients of Ontario Primary Care Team Pharmacist-Led Medication Reviews

Abstract

Pharmacist-led medication reviews have been shown to improve medication management, reducing the adverse effects of polypharmacy among older adults. This paper quantitatively examines the medications, medication discrepancies and drug therapy problems of recipients in primary care. A convenience sample of 16 primary care team pharmacists in Ontario, Canada contributed data for patients with whom they conducted a medication review over a prior four-week period. Data were uploaded using electronic data capture forms and descriptive analyses were completed. Two hundred and thirty-seven patients (on average, 67.9 years old) were included in the study, taking an average of 9.2 prescription medications ( ± 4.7). Majority of these patients (83.5%) were categorized as polypharmacy patients taking at least five or more prescribed drugs per day. Just over half of the patients were classified as having a low level of medication complexity (52.3%). Pharmacists identified 2.1 medication discrepancies ( ± 3.9) and 3.6 drug therapy problems per patient ( ± 2.8). Half these patients had more than one medication discrepancy and almost every patient had a drug therapy problem identified. Medication reviews conducted by pharmacists in primary care teams minimized medication discrepancies and addressed drug therapy problems to improve medication management and reduce adverse events that may result from polypharmacy.

The Evolving Role and Impact of Integrating Pharmacists into Primary Care Teams: Experience from Ontario, Canada

“…When DRPs were identified by the PCT pharmacist, a positive clinical outcome was realized for approximately 80% of patients, upon 2-year follow-up [ 32 ]. These findings are comparable to findings across FHTs in Ontario that found the most common DRPs were additional drug therapy needed (22.6%), inappropriate dosage (14.1%), and receiving a drug with no indication (13.1%) [ 6 ]. In the province of Quebec, one study reported that pharmacists detected 300 DRPs (an average of 7.2 per patient) and that the most common DRP was ‘drug use without indication’ (27%); physicians accepted nearly 90% of the recommendations made by PCT pharmacists [ 9 ].…”

“…Research conducted across Ontario FHTs showed that medication reviews conducted by pharmacists are able to reduce medication discrepancies and rectify DRPs [ 6 ]. In this study, among a sample of 237 patients, 16 pharmacists found that patients were on an average of 9.2 prescription medications, and identified an average of 2.1 medication discrepancies and 3.6 DRPs per patient [ 6 ]. Pharmacists identified more than one medication discrepancy per patient and that almost every patient had a drug therapy problem.…”

“…Although pharmacists are the most accessible and visited healthcare professionals in the world, the contributions that pharmacists make to interdisciplinary healthcare settings often remain overlooked [ 1 , 2 , 3 ]. It is known that poor communication and connectivity between healthcare professionals can fragment patient care, is a significant contributor to the development of drug-related problems (DRPs), and results in poorer health outcomes and experiences [ 4 , 5 , 6 ]. Moreover, since most prescribing of medications occurs in primary care, defined as a “whole-of-society approach to health and well-being” that addresses the broader determinants of health [ 7 ], pharmacists have an integral role in providing education and information about the appropriate and safe use of medications to patients, as well as to other healthcare professionals [ 8 ].…”

Drug-Related Problems of Patients in Primary Health Care Institutions: A Systematic Review

“…After preliminary screening, 250 articles needed to be further screened. Twenty-seven articles (Patel et al, 2005;Gisev et al, 2009;Gomez et al, 2009;Hooper et al, 2009;Zhao, 2012;Roth et al, 2013;Lenander et al, 2014;Nadir et al, 2014;Tan et al, 2014;Mendonca et al, 2016;Okumura et al, 2016;Rodis et al, 2017;Schwartz et al, 2017;Benson et al, 2018;Vande Griend et al, 2018;Yang et al, 2018;Hazen et al, 2019;Khera et al, 2019;Neves et al, 2019;Santos et al, 2019;Zhang et al, 2020a;Zhang et al, 2020b;Chung et al, 2020;Gerard et al, 2020;Puspitasari et al, 2020;Samir Abdin et al, 2020;Troncoso-Marino et al, 2020) were finally included (there were only 26 studies because one of the studies was reported in two articles) (Zhang et al, 2020a;Zhang et al, 2020b). The process of study selection is shown in Figure 1.…”

“…Among the included studies, 61.54% (n 16) were from developed countries, including six from America (Patel et al, 2005;Roth et al, 2013;Rodis et al, 2017;Schwartz et al, 2017;Vande Griend et al, 2018;Chung et al, 2020), three from Canada (Khera et al, 2019;Gerard et al, 2020;Samir Abdin et al, 2020), three from Australia (Gisev et al, 2009;Tan et al, 2014;Benson et al, 2018), two from Spain (Gomez et al, 2009;Troncoso-Marino et al, 2020), one from the Netherlands (Hazen et al, 2019), and one from Sweden (Lenander et al, 2014); 38.46% (n 10) were from developing countries, including four from Brazil (Mendonca et al, 2016;Okumura et al, 2016;Neves et al, 2019;Santos et al, 2019), three from China (Zhao, 2012;Yang et al, 2018;Zhang et al, 2020a;Zhang et al, 2020b), two from Qatar (Hooper et al, 2009;Nadir et al, 2014), and one from Indonesia (Puspitasari et al, 2020). According to the types of study design reported by the authors, there were six prospective studies (Hooper et al, 2009;Roth et al, 2013;Rodis et al, 2017;Benson et al, 2018;Yang et al, 2018;Zhang et al, 2020a;Zhang et al, 2020b), five cross-sectional studies (Zhao, 2012;Nadir et al, 2014;Okumura et al, 2016;Hazen et al, 2019;…”