Drug-related problems in institutionalized, polymedicated elderly patients: opportunities for pharmacist intervention

Silva, Cristina; Ramalho, Célia; Luz, Isabel; Monteiro, Joaquim; Fresco, Paula

doi:10.1007/s11096-014-0063-2

Cited by 71 publications

(107 citation statements)

References 23 publications

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“…The most common DRPs in both stages were “Unnecessary drug treatment,” (20.2 and 40.1%), “Adverse drug event, non‐allergic” (18.5 and 13.2%), and “Effect of drug treatment not optimal” (17.8 and 11.0%; Table ). This result resembles that of Silva et al and Delgado Silveira et al , although “Unnecessary drug treatment” was less frequently reported by these authors.…”

Section: Discussionsupporting

confidence: 89%

“…The prevalence of DRP classification in these results (Table ) is similar to that of previous studies, indicating that unnecessary drug prescriptions often lead to DRPs in the elderly in Taiwan, similar to other countries. This is likely because the elderly often suffer from multiple simultaneous chronic diseases, and require visits to multiple departments, leading to multi‐drug therapies, potentially inappropriate duplication or combinations of drugs, and drug–drug interactions.…”

Section: Discussionsupporting

confidence: 89%

“…Numerous studies have noted that elderly patients are at increased risk of DRPs during the medication use process, which can lead to adverse clinical outcomes . This may be related to polypharmacy, pharmacokinetics/pharmacodynamics, and cognitive and functional alterations among elderly people .…”

Section: Discussionmentioning

confidence: 99%

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Cross‐sectional investigation of drug‐related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud

Wang

Yeh

et al. 2016

Pharmacoepidemiology and Drug

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Cross‐sectional investigation of drug‐related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud

Wang

Yeh

et al. 2016

Pharmacoepidemiology and Drug

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“…Similarly to our study, Silva et al used STOPP/START on a sample of institutionalized elderly and found a higher proportion of misprescribed PIM compared to the underprescribed cases: 76.82 % were STOPP criteria and 23.18 % were START criteria in their study [25]. The most prevalent examples were different nevertheless, as in our study the institutionalized elderly were mostly exposed to the high use of NSAIDs and to the underuse of antihypertensive therapy.…”

Section: Discussionsupporting

confidence: 79%

Potentially inappropriate medications in elderly ambulatory and institutionalized patients: an observational study

Primejdie

Bojiţă

Popa

2016

BMC Pharmacol Toxicol

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BackgroundThe elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care. Information about Romanian prescribing practices among the elderly and potential medication associated- risks is lacking. The objective of this study was to identify and compare the most frequent potentially inappropriate medications (PIM) recommended to ambulatory and institutionalized Romanian elderly, through an observational retrospective design.MethodsAll reimbursed medications prescribed to a sample of ambulatory elderly accessing two community pharmacies and all medications recommended to a group of institutionalized elderly (urban facilities, Romania, same month) were analyzed. The STOPP/START criteria and the PRISCUS list were used for PIM identification and for classification as misprescribed, underprescribed or overprescribed -subtypes.ResultsThe analysis involved 345 prescriptions recommended to ambulatory elderly and 91 medical files available for the institutionalized patients. The ambulatory elderly had a mean age of 74.8 years old and were daily exposed to a median number of 3 prescribed medications. The institutionalized elderly were older (mean age 80.77) received 8 medications daily and 69 % of them were functionally dependent. Cardiovascular and neuropsychiatric indications were the most frequent: 64.34 % and 18.55 % of the ambulatory prescriptions, 93.40 % and 41.75 % of the institutionalized patients’ medical files. 159 PIM were identified on 34.49 % of the ambulatory prescriptions. 82.41 % of the institutionalized patients’ medical files contained 140 PIM. The potential underprescribing of cardiovascular therapies was the most frequent PIM category on the ambulatory prescriptions (55.34 % of all PIM), while for the institutionalized patients’ medical files, the misprescribed and overprescribed PIM were those predominantly represented (62.14 % and 27.14 % of all PIM). In both subgroups of data, NSAIDs (56.66 % of ambulatory prescriptions and 35.63 % of institutionalized patients’ data) and benzodiazepines (26.66 % of ambulatory prescriptions and 24.13 % of institutionalized patient’s data) were predominantly misprescribed. Anticholinergics were rarely used (0.62 % of total PIM from ambulatory prescriptions, 2.14 % of total PIM from institutionalized patients’ data).ConclusionsThe PIM identified in both elderly groups suggested potential risks for the occurrence of adverse events specific to the elderly population. Larger studies, both observational and interventional, are needed to ensure a safer therapeutic approach.

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“…Literature describing interventions in institutionalised elderly patients, where a medication review focusses on the identification of DRP, is very scarce and the few published studies have used different DRP classifications, making comparisons very difficult [6]. In Portugal, only three studies have been found evaluating DRPs in nursing homes, two of them focussing on the detection of PIM, either using the STOPP/START criteria [7] or Beers criteria [8]. The third study focussed on the use of the medication regimen complexity index, which measures the number of medicines and dosages, but not the quality of pharmacotherapy or its outcome [9].…”

Section: Introductionmentioning

confidence: 99%

Drug-Related Problems Identified in a Sample of Portuguese Institutionalised Elderly Patients and Pharmacists’ Interventions to Improve Safety and Effectiveness of Medicines

Costa

Silvestre

Periquito

et al. 2016

Drugs - Real World Outcomes

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BackgroundCurrently, people live longer but often with poor quality of life. The decrease in healthy life-years is partly attributable to the institution of polypharmacy to treat various comorbidities.ObjectivesThe objectives of the study were to determine the prevalence and nature of drug-related problems (DRPs) in polypharmacy elderly patients residing in nursing homes and to test the acceptability of a pharmacist’s intervention.MethodsAn exposure cohort was constituted in three Portuguese nursing homes, where all polypharmacy (five or more medicines) elderly patients (≥65 years of age) were analysed and then a random stratified sample was extracted to be subject to an intervention. Clinical and therapeutic data were collected and analysed for DRPs and classified according to the II Granada Consensus, by a pharmacist-led team. The intervention was the formulation of a pharmacist’s recommendations to prescribers addressing clinically relevant DRPs, along with suggestions for therapy changes.ResultsThe initial sample included 126 elderly patients taking 1332 medicines, where 2109 DRPs were identified. The exposure cohort included 63 patients, with comparable baseline data (p > 0.005). Manifest DRPs occurred in 31.7 % of the intervention group (mainly quantitative ineffectiveness–DRP 4), whereas potential DRPs were identified in 100 % of patients (mainly non-quantitative unsafe–DRP 5). Amongst the DRPs identified, 584 (56.7 %) were reported to prescribers (all types of DRPs) and 113 (11 %) to nurses (only non-quantitative ineffectiveness–DRP 3). A total of 539 pharmacist recommendations were presented to physicians, corresponding to 62 letters sent by mail, each including an average of 8.7 recommendations to solve DRPs present in intervention group (IG) patients. There was a high non-response rate (n = 34 letters; 54.8 %; containing 367 pharmacist recommendations; 68.1 %) and amongst recommendations receiving feedback, only 8.7 % of pharmacist recommendations made were accepted (n = 15). Positive responses were significantly associated with a lower number of recommendations made, whereas a higher number of recommendations increased the odds of no response (p < 0.001).ConclusionA pharmacist-led medication review proved useful in identifying DRPs in elderly polypharmacy nursing home residents. Stronger bonds must be developed between healthcare professionals to increase patient safety in the vulnerable institutionalised elderly population.

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Drug-related problems in institutionalized, polymedicated elderly patients: opportunities for pharmacist intervention

Abstract: These results reinforce the need for the implementation of pharmaceutical care services to institutionalized elderly, necessary to improve medicines efficacy and safety, better clinical outcomes and cost reduction.

Cited by 71 publications

References 23 publications

Cross‐sectional investigation of drug‐related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud

Cross‐sectional investigation of drug‐related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud

Potentially inappropriate medications in elderly ambulatory and institutionalized patients: an observational study

Drug-Related Problems Identified in a Sample of Portuguese Institutionalised Elderly Patients and Pharmacists’ Interventions to Improve Safety and Effectiveness of Medicines

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