A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes

Halvorsen, Kjell H.; Stadeløkken, Torunn; García, Beate Hennie

doi:10.3390/pharmacy7040148

Cited by 19 publications

(9 citation statements)

References 26 publications

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“…For this reason, the Spanish Society of Primary Care Pharmacists (SEFAP), based on Milton et al [ 65 ], recommends reviewing medication every 6 months for NH residents with polypharmacy, and at least once a year for the rest of institutionalised people. Furthermore, other authors concluded that it is necessary to integrate the pharmacist into NH in interdisciplinary collaboration with doctors and nurses to identify, solve and prevent DRP [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

Díez

Cadenas

Susperregui

et al. 2022

IJERPH

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At present, 19.2% of the Spanish population is aged 65 or older. Polypharmacy is a frequent condition among the elderly, especially in those living in nursing homes, which is associated with adverse outcomes, such as adverse drug events or drug-drug interactions. This study aimed to assess the pattern of polypharmacy in a nursing home in Leon, one of Spain’s most ageing regions, and its relationship with different drug-related problems. A descriptive, observational, and cross-sectional study design was used; 222 residents were involved in this study. Data on drug use were collected from medical charts. Information was screened with the software CheckTheMeds, BOT PLUS and Drug-Reax. Residents were on a median of 7 medicines. Polypharmacy and inappropriate medications were present in 78.8% and 96.8% of residents, respectively. Drug-related problems were present in almost all the populations evaluated. Drug-drug interactions were very common in participants (81.1%), being severe/moderate in 24.7%. A high prevalence of polypharmacy and drug-related problems in the nursing home population assessed has been observed. A significantly higher risk of suffering drug-drug interactions was revealed for increasing polypharmacy and anticholinergic risk. A regular evaluation of drug prescribing in nursing home residents is necessary to minimize drug-related problems risk.

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Section: Discussionmentioning

confidence: 99%

Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

Díez

Cadenas

Susperregui

et al. 2022

IJERPH

View full text Add to dashboard Cite

show abstract

“…Further, the study documented that the rates of DRPs varied up to seven-fold (from 0.5 to 3.4) between the NHs. To the best of our knowledge, only two medication review studies have previously reported variation in DPRs between NHs: one in two urban NHs, from 3.0 to 5.5 mean DRPs per patient [ 20 ] and another study in four rural NHs, from 2.7 to 5.6 mean DRPs per patient [ 30 ]. The mean of 2.0 DRPs per patient found in the total cohort is below those previously reported in Norway [ 2 , 3 , 13 ], probably because we reported DRPs agreed upon by the team, not all DRPs suggested by the pharmacist.…”

Section: Discussionmentioning

confidence: 99%

“…It is an important limitation that we have only recorded the DRPs that were accepted by the physicians, without recording all the DRPs that were initially suggested by the pharmacists. Hence, we do not know how the physicians' acceptance rates varied between the different NHs and how appropriate their rejections were [30]. Some doctors may have experienced suggestions to change their treatment as a threat and criticism towards their own prescribing practice.…”

Section: Strengths and Limitationsmentioning

confidence: 96%

Variation between nursing homes in drug use and in drug-related problems

et al. 2020

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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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“…nervous system ADRs in drugs affecting the cardiovascular system). This underlines the complexity of geriatric patient treatment and the need for interdisciplinary medication reviews that include an assessment of drug-related problems, such as drug-drug interactions, potentially inappropriate medication, as well as ADRs [ 25 , 26 ]. In routine care, however, potential additive effects are often not taken into account.…”

Section: Discussionmentioning

confidence: 99%

Considering additive effects of polypharmacy

Lexow

Wernecke

Schmid

et al. 2020

Wien Klin Wochenschr

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Summary Background Potential additive effects of polypharmacy are rarely considered in adverse events of geriatric patients living in long-term care facilities. Our aim, therefore, was to identify adverse events in this setting and to assess plausible concomitant drug causes. Methods A cross-sectional observational study was performed in three facilities as follows: (i) adverse event identification: we structurally identified adverse events using nurses’ interviews and chart review. (ii) Analysis of the concomitantly administered drugs per patient was performed in two ways: (ii.a) a review of summary of product characteristics for listed adverse drug reactions to identify possible causing drugs and (ii.b) a causality assessment according to Naranjo algorithm. Results (i) We found 424 adverse events with a median of 4 per patient (range 1–14) in 103 of the 104 enrolled patients (99%). (ii.a) We identified a median of 3 drugs (range 0–11) with actually occurring adverse events listed as an adverse drug reaction in the summary of product characteristics. (ii.b) Causality was classified in 198 (46.9%) of adverse events as “doubtful,” in 218 (51.2%) as “possible,” in 7 (1.7%) as “probable,” and in 1 (0.2%) adverse event as a “definitive” cause of the administered drugs. In 340 (80.2%) of all identified adverse events several drugs simultaneously reached the highest respective Naranjo score. Conclusion Patients in long-term facilities frequently suffer from many adverse events. Concomitantly administered drugs have to be frequently considered as plausible causes for adverse events. These additive effects of drugs should be more focused in patient care and research.

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A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes

Cited by 19 publications

References 26 publications

Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

Variation between nursing homes in drug use and in drug-related problems

Considering additive effects of polypharmacy

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