Drug-related problems (DRPs) identified from geriatric medication safety review clinics

Chan, Ding‐Cheng; Chen, Jen‐Hau; Kuo, Hsu-Ko; We, Chiung-Jung; Lu, I-Shu; Chiu, Lee-Shu; Wu, Shwu-Chong

doi:10.1016/j.archger.2011.02.005

Cited by 63 publications

(69 citation statements)

References 21 publications

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“…This reflects the typical focus areas of rational pharmacotherapy in the elderly and in polypharmacy patients [9,54,55] and is similar to other studies classifying DRPs with the PCNE classification [9,56,57]. The typical approach has to be changed in more than just the timing when performing medication review in the acute ward setting.…”

Section: Interventionsmentioning

confidence: 72%

Clinical pharmacist service in the acute ward

Nielsen

Andersen

Rasmussen³

et al. 2013

Int J Clin Pharm

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Background The majority of hospitalised patients have drug-related problems. Clinical pharmacist services including medication history, medication reconciliation and medication review may reduce the number of drug-related problems. Acute and emergency hospital services have changed considerably during the past decade in Denmark, and the new fast-paced workflows pose new challenges for the provision of clinical pharmacist service. Objective To describe and evaluate a method for a clinical pharmacist service that is relevant and fit the workflow of the medical care in the acute ward. Setting Acute wards at three Danish hospitals. Methods The clinical pharmacist intervention comprised medication history, medication reconciliation, medication review, medical record entries and entry of prescription templates into the electronic medication module. Drug-related problems were categorised using The PCNE Classification V6.2. Inter-rater agreement analysis was used to validate the tool. Acceptance rates were measured as the physicians' approval of prescription templates and according to outcome in the PCNE classification. Main outcome measure Acceptance rate of the clinical pharmacists' interventions through the described method and inter-rater agreement using the PCNE classification for drug-related problems. Results During 17 months, 188 patients were included in this study (average age 72 years and 55 % women). The clinical pharmacists found drug-related problems in 85 % of the patients. In the 1,724 prescriptions, 538 drug-related problems were identified. The overall acceptance rate by the physicians for the proposed interventions was 76 % (95 % CI 74-78 %). There was a substantial inter-rater agreement when using the PCNE classification system. Conclusion The methods for a clinical pharmacist service in the acute ward in this study have been demonstrated to be relevant and timely. The method received a high acceptance rate, regardless of no need for oral communication, and a substantial inter-rater agreement when classifying the drug-related problems.

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Section: Interventionsmentioning

confidence: 72%

Clinical pharmacist service in the acute ward

Nielsen

Andersen

Rasmussen³

et al. 2013

Int J Clin Pharm

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“…Drug therapy can effectively improve quality of life and treat, prevent, or alleviate the symptoms of a disease, but undesirable reactions and DRPs are common in geriatrics [2]. This is likely due to the fact that geriatrics often have multiple comorbidities and are therefore prescribed multiple medications [3]. However, age-related physiological changes in geriatrics may alter the pharmacokinetic and pharmacodynamic properties of drugs [3], and all pharmacokinetic steps may be affected in the elderly.…”

Section: Introductionmentioning

confidence: 99%

“…Yet, Beijer and de Blaey (2002) reported that the majority of adverse drug reactions in the elderly can be prevented [3].…”

Section: Research Articlementioning

confidence: 99%

“…This is likely due to the fact that geriatrics often have multiple comorbidities and are therefore prescribed multiple medications [3]. However, age-related physiological changes in geriatrics may alter the pharmacokinetic and pharmacodynamic properties of drugs [3], and all pharmacokinetic steps may be affected in the elderly. Most of the organ systems in the elderly are more susceptible; hence, the adverse effect of drugs may be magnified.…”

Section: Introductionmentioning

confidence: 99%

“…The studies conducted by Bero (1991), Roughead (1998), and Cooper (1999) showed that 15-22% of hospitalized elderly patients were admitted because of DRPs [3]. A study by Blix et al showed that about 81% of patients admitted to the hospital experienced DRP s, with an average of 2.1 clinically relevant DRPs per patient [5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pharmacist Involvement to Decrease Drug-Related Problems Among Geriatric Patients in Indonesian Primary Health Centers

Suryani¹,

Bahtiar

Andrajati

2017

Asian J Pharm Clin Res

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Objective:The studies have demonstrated that older people often suffer from multiple diseases and are thus prescribed many different drugs. Therefore, drug-related problems (DRPs) are common in the elderly. The main objectives of this study were to reduce the number of DRPs in the elderly through pharmacist involvement and to analyze differences after pharmacist recommendations. Methods:In a quasi-experimental study, 12 primary health centers were selected and randomly divided into two groups (six in each group). In the first group, the physicians received pharmacist recommendations verbally through discussions, and in the second group, the physicians received recommendations through letters. DRPs were analyzed from all older inpatients' medical records 1 month before and 1 month after the pharmacist recommendations. The main outcome being measured was the incidence of DRPs, classified into problems, and causes according to the Indonesian translated version of Pharmaceutical Care Network Europe, Version 6.2 (PCNE V 6.2). The problems were identified based on journal articles and other relevant literature.Results: A total of 205 patients were analyzed before pharmacist intervention (Group 1: 121; Group 2: 84) and 202 patients after the intervention (Group 1: 108; Group 2: 94). The most common problem in these elderly patients was that they suffered from toxic effects. The most common cause was inappropriate drug selection. The number of DRPs and causes were decreased significantly through the discussions (Wilcoxon signed-rank test, problems p=0.027, causes p=0.028). DRPs were also significantly decreased through the recommendation letters (paired t-test, number of problems p=0.003, and causes p=0.004). Discussion with physicians seemed more effective and decreased more problems (p=0.001) and causes (p=0.002). Through discussions, the decrease in a number of problems was 20.83±8.931, and the decrease in the number of causes was 25.33±11.431 versus the recommendation letter, at 4.17±1.941 and 5.17±2.483, respectively. Conclusion:Pharmacist involvement decreased DRPs among older inpatients. Discussing DRPs with the physicians treating the patients is more effective than giving recommendations in writing only. The PCNE V 6.2 DRP classification system is useful for documenting DRPs among the elderly as it can help pharmacists develop plans to reduce DRPs.

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Evaluation of clinical pharmacy priority scoring methods in an adult medicine residency clinic

Krasniak

Szymaniak

Conn

et al. 2019

J Am Coll Clin Pharm

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Background: Patients with higher clinical pharmacy priority (CP2) scores are more likely to receive a medication recommendation from a pharmacist to resolve an identified medication related problem (MRP) in a family medicine clinic.Objective: The objective of this study was to compare a modified CP2 score to the original CP2 score in an adult medicine residency clinic and assess whether a modified CP2 score more appropriately captured patients in need of recommendations from a clinical pharmacist.Methods: A convenience sample of patients scheduled for visits in an adult medicine clinic had a comprehensive medication review (CMR) performed. All patients had the original CP2 score and modified CP2 score calculated retrospectively. Both versions of the CP2 scores were compared using Pearson correlation. The relationship between a recommendation from a pharmacist and each CP2 score was evaluated using Pearson correlation and t test.Results: In total, 148 patients who received a CMR by a clinical pharmacist were included in the retrospective chart review. Overall, there was a strong positive correlation between the CP2 score and the modified CP2 score (correlation coefficient (r) 0.968, P < 0.001); thus, as the CP2 scores increase, the modified CP2 score increases.Patients with higher CP2 and modified CP2 scores were more likely to receive a recommendation from a pharmacist (P < 0.001 and P < 0.001, respectively). There was a moderate correlation between both scores and number of recommendations made (CP2: r = 0.436 [P < 0.001], modified CP2: r = 0.456 [P < 0.001]) which did not differ significantly. Conclusions:The CP2 score and the modified CP2 score were both associated with pharmacist recommendations in an adult medicine clinic. Refinement of the CP2 score did not better capture patients in an adult medicine residency clinic with a recommendation from a clinical pharmacist. K E Y W O R D Shealth care systems, health services research, medication therapy management, pharmacists, pharmacy service, hospital

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Drug-related problems (DRPs) identified from geriatric medication safety review clinics

Cited by 63 publications

References 21 publications

Clinical pharmacist service in the acute ward

Clinical pharmacist service in the acute ward

Pharmacist Involvement to Decrease Drug-Related Problems Among Geriatric Patients in Indonesian Primary Health Centers

Evaluation of clinical pharmacy priority scoring methods in an adult medicine residency clinic

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