Drug-related problems in community-dwelling primary care patients screened positive for dementia

Abstract

Background:Older people have a higher risk of drug-related problems (DRPs). However, little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care.Methods:The Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi-MV) study is a general practitioner (GP)-based cluster-randomized controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in the primary care setting in Germany. Medication reviews of 446 study participants were conducted by pharmacists based on a comprehensive baseline assessment that included a computer-based home medication assessment. ClinicalTrials.gov Identifier: NCT01401582.Results:A total of 1,077 DRPs were documented. In 414 study participants (93%), at least one DRP was detected by a pharmacist. The most frequent DRPs were administration and compliance problems (60%), drug interactions (17%), and problems with inappropriate drug choice (15%). The number of DRPs was significantly associated with the total number of drugs taken and with a formal diagnosis of a mental or behavioral disorder.Conclusions:Degree of cognitive impairment (MMSE defined) and formal diagnosis of dementia were not risk factors for an increased number of DRPs. However, the total number of drug taken and the presence of a diagnosis of mental and behavioral disorders were associated with an increased total number of DRPs.

Adverse drug reactions in primary care: a scoping review

“…Of these, 17 were excluded due to having: an irrelevant setting that is not primary care, irrelevant interventions that were only addressing medication errors instead of reporting on drug related adverse events and describing only qualitative aspects of medication safety. The final search yielded a total of 19 citations for inclusion in this review, with two abstracts and 17 full papers [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. A protocol detailing the methodology for the current review was followed [23].…”

“…28, 42]. Overall, the incidence of ADR reported in the studies ranged between 6% and up to 80% in some cases [29,44].…”

“…A total of nine studies out of the 19 included studies addressed specific classes of medications such as; antituberculosis drugs [29], anti-epileptics [31,40], antipsychotics, antidepressants and mood stabilisers [32], antibiotics [33,39], insulin and oral diabetic medications [35], biologicals [37], and anticholinergic drugs including dementia medications [44]. The remainder of the studies covered other classes of medications such as beta blockers, antiplatelets, analgesics, benzodiazepines, musculoskeletal drugs, stimulants, lipid modifying agents, selective serotonin reuptake inhibitors and skin preparations.…”

“…However, the majority of the authors cited patient factors as the cause of ADRs such as advanced age, lack of patients' education and patients' comorbidities [4, 26, 28-31, 34-38, 40, 42]. Some studies mentioned drug related causes such as prescribers' errors, inconsistent consultation notes, incomplete physical examination, inappropriate follow up and monitoring errors as causes of ADRs [26,27,35,36,38,41,44]. Drug specific causes such as drug administration, dispensing errors, drug interactions and look alike medications were also mentioned by three studies [27,30,35,43].Allergic reactions were cited as the cause of ADRs in one study by Shehab et al [39] Iatrogenic causes was also cited by one study amongst other causes [42].…”

Knowledge on Alzheimer's Disease among Public Hospitals and Health Clinics Pharmacists in the State of Selangor, Malaysia

“…The role of pharmacists in management of AD is increasingly recognized, which includes recognizing early symptoms of AD, referring AD patients to seek for timely diagnosis and treatment, identifying potential ADRs of pharmacological treatment, and educating and providing counseling to the AD patients and caregivers. For example, findings from a study on multi-disciplinary dementia care services conducted in Germany revealed that pharmacists are adapt in identifying problems related to drug administration, adherence, and drug interaction among patients with dementia (Wucherer et al, 2017 ). Meanwhile, in the United Kingdom, a trial targeting people with dementia initiated on anti-psychotics demonstrated that pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia because of the increased risk of ADRs (Child et al, 2012 ).…”