Drug‐related problems identified during medication review before and after the introduction of a clinical decision support system

Verdoorn, Sanne; Kwint, Henk-Frans; Hoogland, Petra; Gussekloo, Jacobijn; Bouvy, Marcel L.

doi:10.1111/jcpt.12637

Cited by 28 publications

(18 citation statements)

References 34 publications

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“…A possible explanation might be that more potential DRPs were identified by adding the computer‐assisted evidence based explicit criteria to the assessment by the pharmacist. Another explanation might be the use of a standardized patient questionnaire to inventory the drug utilization experience of patients instead of a patient interview by pharmacists with relatively little experience with performing patient‐interviews in the context of a medication review in the study of Geurts et al The comparable rate of resolved DRPs in our study despite the higher number of potential DRPs per patient, might be explained by: (i) a shorter follow‐up time in our study; and (ii) the fact that DRPs identified by clinical decision support are considered to be less relevant by physicians and patients …”

Section: Discussionmentioning

confidence: 73%

“…Tools used to perform a medication review can be based on implicit or explicit criteria (or a combination). Explicit criteria are evidence based and/or guideline based criteria to identify inappropriate medication, whereas implicit criteria are criteria to identify DRPs based on knowledge of the healthcare practitioner that performs the medication review . Examples of explicit criteria are the Beers and START (screening tool to alert doctors to the right treatment) and STOPP (Screening Tool of Older Persons potentially inappropriate Prescriptions) criteria .…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of medication review on the number of drug‐related problems in patients visiting the outpatient cardiology clinic: A randomized controlled trial

Huiskes

Ende

Kruijtbosch

et al. 2019

Brit J Clinical Pharma

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Aims:To assess the effectiveness of medication review on the number of drugrelated problems (DRPs) in outpatient cardiology patients. Methods:In this randomized controlled trial, a computer-assisted and pharmacist-led medication review with patient involvement (questionnaire and telephone call with pharmacist) was conducted in intervention patients prior to their visit to the cardiologist. The control group received usual care. Adult outpatient cardiology patients without support concerning the administration of medication, without a medication review in the past 6 months and who gave permission to access their electronic medication record were included. The primary outcome measure was the number of DRPs 1 month after the visit. Secondary outcome measures concerned the type of DRP and the type of medication involved in the DRPs. Results:In total, 75 patients (mean [standard deviation, SD] age 66.0 [12.5] years, 41% female) were included. Intervention (n = 90) and control group (n = 85) were comparable at baseline. The mean (SD) number of drugs used per patient was 7.9 (3.9). After 1 month, the mean (SD) number of DRPs was 0.3 (0.7) and 0.8 (1.0) and the median (range) number of DRPs was 0 (0-4) and 0 (0-4) in the intervention group and control group, respectively (P < .001). In the intervention group, 74% of the DRPs identified at T0 were solved at T1 vs 14% in the control group. Conclusion: This randomized controlled trial suggests that a pharmacist-led medication review in patients with a scheduled visit to the outpatient cardiology clinic decreases the number of DRPs. K E Y W O R D S clinical pharmacology, drug development, drug safety, drug utilization, prescribing, quality use of medicines, randomised controlled trial PI statement: The authors confirm that the Principal Investigator for this paper is Bartholomeus Johannes Fredericus van den Bemt. Acquisition of data: H.T.E., M.M. and V.M.M.M.Statistical analysis an interpretation of data:

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Effectiveness of medication review on the number of drug‐related problems in patients visiting the outpatient cardiology clinic: A randomized controlled trial

Huiskes

Ende

Kruijtbosch

et al. 2019

Brit J Clinical Pharma

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“…The most frequently cited causes of preventable ADRs included failure to recognise previously documented allergic reaction to the causative drug, drug-drug interactions overlooked, and inappropriate selection of medication and/or dosage for patients' clinical condition (e.g., comorbidity, age) [23,27,31,43]. Several initiatives have been performed to potentially reduce preventable medication harm in the primary care setting, including pharmacists-led medication review [75][76][77][78], clinical decision support (CDS) embedded in information system [79,80], educational intervention [81,82], and nurse-led medication monitoring, particularly in long-term care facilities [83][84][85].…”

Section: Plos Onementioning

confidence: 99%

Prevalence of adverse drug reactions in the primary care setting: A systematic review and meta-analysis

et al. 2021

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Background Adverse drug reactions (ADRs) represent a major cause of iatrogenic morbidity and mortality in patient care. While a substantial body of work has been undertaken to characterise ADRs in the hospital setting, the overall burden of ADRs in the primary care remains unclear. Objectives To investigate the prevalence of ADRs in the primary care setting and factors affecting the heterogeneity of the estimates. Methods Studies were identified through searching of Medline, Embase, CINAHL and IPA databases. We included observational studies that reported information on the prevalence of ADRs in patients receiving primary care. Disease and treatment specific studies were excluded. Quality of the included studies were assessed using Smyth ADRs adapted scale. A random-effects model was used to calculate the pooled estimate. Potential source of heterogeneity, including age groups, ADRs definitions, ADRs detection methods, study setting, quality of the studies, and sample size, were investigated using sub-group analysis and meta-regression. Results Thirty-three studies with a total study population of 1,568,164 individuals were included. The pooled prevalence of ADRs in the primary care setting was 8.32% (95% CI, 7.82, 8.83). The percentage of preventable ADRs ranged from 12.35–37.96%, with the pooled estimate of 22.96% (95% CI, 7.82, 38.09). Cardiovascular system drugs were the most commonly implicated medication class. Methods of ADRs detection, age group, setting, and sample size contributed significantly to the heterogeneity of the estimates. Conclusion ADRs constitute a significant health problem in the primary care setting. Further research should focus on examining whether ADRs affect subsequent clinical outcomes, particularly in high-risk therapeutic areas. This information may better inform strategies to reduce the burden of ADRs in the primary care setting.

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“…3 43 This stresses the importance of DRP detection before dispensing the product to the patient, thereby promoting the minimisation of harms resulting from the medication process, 8 28 since computer system alerts issued for MO revision do not seem sufficient to guarantee the effectiveness of the pharmaceutical interventions. 44 A strength of the present study is the extended period of observation that allows the exclusion of the seasonality bias due to changing diseases characteristic throughout Open access the year. A major feature of the study was to perform MO review in all patients admitted to all departments of a general hospital, thus providing a better insight into the size and extent of DRP in a health facility as a whole than is provided by a study in particular populations or in specialised departments.…”

Section: Open Accessmentioning

confidence: 99%

Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort

et al. 2020

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ObjectivesTo evaluate the incidence and types of drug-related problems (DRP) in a general teaching hospital and to evaluate the acceptability of pharmaceutical interventions by the medical team.DesignProspective cohort study during 2 years.SettingConducted in a Brazilian University Hospital.ParticipantsThe patient cohort consisted of 9303 patients with a total of 12 286 hospitalisation episodes.Primary outcome measuresDRP detected by pharmacists’ review of 100% medication orders using Pharmaceutical Care Network Europe 6.2 classification.ResultsPatients with a mean age of 52.6±17.7 years and 50.9% females. A total of 3373 DRP in 1903 hospital episodes were identified, corresponding to a cumulative incidence of 15.5%. ‘Treatment ineffectiveness’ (11.5%) and ‘Treatment costs’ (5.90%) were the most common DRP and ‘Drug use process’ (18.4%) and ‘Treatment duration’ (31.0%) the main causes of DRP. The medicines involved most often involved in DRP were anti-infectives (36.0%), mainly cephalosporins (20.2%), antiulcer (38.6%), analgesics/antipyretics (61.2%), propulsives (51.2%), opioids (38.5%) and antiemetics (57.4%). From 1939 pharmaceutical interventions, at least, 21.4% were not approved by the medical team.ConclusionDRP detected by 100% medication order review by hospital pharmacists occur in a significant proportion of hospital episodes, the most frequent being related to treatment effectiveness and treatment costs. The medications mostly involved were cephalosporins, penicillins, antidyspeptics, analgesics, antipyretics, opioids and antiemetics. Pharmaceutical interventions had low acceptability by the medical staff.

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Drug‐related problems identified during medication review before and after the introduction of a clinical decision support system

Abstract: The introduction of CDSS to medication review software generated additional DRPs with a lower resolution rate. Structural assessment including a patient interview elicited the most relevant DRPs. Further development of CDSS with more specific alerts is needed to be clinical relevant.

Cited by 28 publications

References 34 publications

Effectiveness of medication review on the number of drug‐related problems in patients visiting the outpatient cardiology clinic: A randomized controlled trial

Effectiveness of medication review on the number of drug‐related problems in patients visiting the outpatient cardiology clinic: A randomized controlled trial

Prevalence of adverse drug reactions in the primary care setting: A systematic review and meta-analysis

Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort

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