Effect of a Multifaceted Clinical Pharmacist Intervention on Medication Safety After Hospitalization in Persons Prescribed High-risk Medications

Gurwitz, Jerry H.; Kapoor, Alok; Garber, Lawrence; Mazor, Kathleen M.; Wagner, Joann L.; Cutrona, Sarah L.; Singh, Sonal; Kanaan, Abir O.; Donovan, Jennifer L.; Crawford, Sybil L.; Anzuoni, Kathryn; Konola, Timothy J.; Zhou, Yanhua; Field, Terry S.

doi:10.1001/jamainternmed.2020.9285

Cited by 44 publications

(39 citation statements)

References 40 publications

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“…These results are also well supported by the studies of Wang et al and Rodriguez et al [ 42 , 53 ]. Review findings reported pharmacists regularly monitored the records of patients admitted to ICUs, reviewed their prescriptions and lab reports, managed their medication errors and did interventions to balance their electrolytes and these findings were supported by the literature [ 54 , 55 , 56 , 57 , 58 , 59 ].…”

Section: Discussionmentioning

confidence: 83%

Interventions and Impact of Pharmacist-Delivered Services for People Infected with COVID-19: A Systematic Review

et al. 2022

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Pharmacists are essential members of the healthcare team. The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has led pharmacists to undertake additional clinical roles. We aim to conduct a systematic review on the interventions and impact of pharmacist-delivered services in managing COVID-19 patients. We searched PubMed, Embase, Scopus, CINAHL plus, International Pharmaceutical Abstracts, and Web of Science from 1 December 2019 (the first case of COVID-19 emerged) to 13 January 2022 to retrieve the articles. Cochrane handbook and PRISMA guidelines were followed respectively to perform and report the review. The pharmacist-led interventions were reported following the Descriptive Elements of Pharmacist Intervention Characterization Tool (DEPICT) version 2. The protocol of systematic review was registered on PROSPERO (CRD42021277128). Studies quality was assessed with the modified NOS scale. In total, 7 observational studies were identified from 10,838 studies. Identification of dosage errors (n = 6 studies), regimen modifications (n = 5), removal of obsolete/duplicate medications (n = 5), identification and management of adverse drug reactions (n = 4), drug interactions prevention (n = 2), and physicians acceptance rate (n = 3) of therapy-related services delivered in-person or via tele-pharmacy were among the pharmacist-delivered services. Common interventions delivered by pharmacists also included optimizing the use of antibacterial, antivirals, and anticoagulants in COVID-19 infected patients. The acceptance of pharmacist-delivered services by physicians was high (88.5–95.5%). Included studies have described pharmacists’ beneficial role in managing patients with COVID-19 including detection, resolution, and prevention of medication-related problems, with physicians demonstrating high trust in pharmacists’ advice. Future research should assess the feasibility and scalability of such roles in real-world settings.

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Section: Discussionmentioning

confidence: 83%

Interventions and Impact of Pharmacist-Delivered Services for People Infected with COVID-19: A Systematic Review

et al. 2022

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“…Eleven of the included studies were individually randomised [ 24–34 ], and eight studies were cluster-randomised [ 35–42 ]. Eight of the studies were conducted in the United States [ 24 , 28–30 , 33 , 35 , 38 , 40 ], eight in Europe [ 25–27 , 31 , 37 , 41 , 42 ] and two in Australia [ 36 , 39 ] and one in New Zealand [ 32 ]. The sample size ranged from 81 to 3,904 participants, and the mean age between 67 and 85 years.…”

Section: Resultsmentioning

confidence: 99%

Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis

et al. 2022

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Background our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods Design systematic review and meta-analysis. Data sources Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome. Study records title/abstract and full-text screening by two reviewers. Risk of bias Cochrane Collaboration revised tool. Data synthesis results reported separately for different settings and sufficiently comparable studies meta-analysed. Results forty-nine heterogeneous studies were included. Community meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85–1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70–1.27, I2 = 37%, 3 s) for number of injurious fallers and in a rate ratio (RaR) of 0.89 (0.69–1.14, I2 = 0%, 2 s) for injurious falls. Hospital meta-analyses assessing medication reviews resulted in an RR = 0.97 (0.74–1.28, I2 = 15%, 2 s) and in an RR = 0.50 (0.07–3.50, I2 = 72% %, 2 s) for number of fallers after and during admission, respectively. Long-term care meta-analyses investigating medication reviews or deprescribing plans resulted in an RR = 0.86 (0.72–1.02, I2 = 0%, 5 s) for number of fallers and in an RaR = 0.93 (0.64–1.35, I2 = 92%, 7 s) for number of falls. Conclusions the heterogeneity of the interventions precluded us to estimate the exact effect of medication review and deprescribing as a single intervention. For future studies, more comparability is warranted. These interventions should not be implemented as a stand-alone strategy in falls prevention but included in multimodal strategies due to the multifactorial nature of falls. PROSPERO registration number: CRD42020218231

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“…Patients scheduled for readmission were less likely to be unscheduled readmission, which may have resulted in a lower rate of unscheduled readmissions in the no suggestions group. Cochrane review suggested that it is uncertain whether interventions for polypharmacy and medication reviews reduces hospital admissions, quality of life, or mortality [ 9 , 27 ], and subsequent randomized clinical trial also did not demonstrate that clinical pharmacist intervention can reduce adverse drug-related incidents or clinically important medication errors during the posthospitalization [ 28 ]. Whereas, the other randomized clinical trial suggested that clinical pharmacist intervention including follow-up after discharge can reduce the number of emergency department visits and hospital readmissions [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of pharmacist intervention for deprescribing potentially inappropriate medications: a prospective observational study

Kondo

Shimizu

Sumiyoshi

et al. 2022

J Pharm Health Care Sci

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Background Potentially inappropriate medications (PIMs) and polypharmacy in older adults lead to increase the risk of adverse drug events. This study aimed to evaluate the effectiveness of pharmacist intervention combining the criteria for detecting PIMs with the deprescribing algorithm on correcting PIMs, reducing the number of medications, and readmissions. Methods A prospective observational study was conducted at a Japanese University Hospital enrolling new inpatients aged ≥65 years prescribed ≥1 daily medication. Pharmacists detected PIMs based on the criteria combined the screening tool of older persons’ potentially inappropriate prescriptions criteria version 2 with the screening tool for older persons’ appropriate prescriptions for Japanese, examined changes using the deprescribing algorithm, and suggested changes to the physician. The proportion of patients whose number of medications was reduced at discharge and the rate of readmissions within 30 and 90 days were compared between patients without PIMs (without PIMs group), patients who were not suggested to change PIMs (no suggestions group), and patients who were suggested to change PIMs (suggested group). Results The study enrolled 544 patients (median age 75.0 years, 54.4% males, median number of medications 6.0/patient). The number of patients with PIMs was 240 (44.1%), and 304 patients had no PIMs (without PIMs group). Among the patients with PIMs, 125 (52.1%) patients received pharmacist suggestions to change ≥1 PIMs (suggested group), and 115 patients received no suggestions for change (no suggestions group). The total number of PIMs was 432, of which changes were suggested for 189 (43.8%). Of these 189 cases, 172 (91.0%) were changed. The proportion of patients whose number of medications was reduced was significantly higher in the suggested group than in the without PIMs group and the no suggestions group [56.8% (71/125) vs. 26.6% (81/304) and 19.1% (22/115), respectively; P < 0.001 in both comparisons]. There were no significant differences in the rates of readmissions within 30 and 90 days among the three groups. Conclusions Pharmacist intervention combining the criteria for detecting PIMs with the deprescribing algorithm was effective for correcting PIMs and may be associated with a reduction in the number of medications.

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Effect of a Multifaceted Clinical Pharmacist Intervention on Medication Safety After Hospitalization in Persons Prescribed High-risk Medications

Cited by 44 publications

References 40 publications

Interventions and Impact of Pharmacist-Delivered Services for People Infected with COVID-19: A Systematic Review

Interventions and Impact of Pharmacist-Delivered Services for People Infected with COVID-19: A Systematic Review

Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis

Effectiveness of pharmacist intervention for deprescribing potentially inappropriate medications: a prospective observational study

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