Effectiveness of Pharmacists' Comprehensive Assessment of Medication Profiles in Dementia Patients

Abstract

In Japan the prevalence of dementia has increased considerably, and pharmacists are involved in addressing these patients' medication-related problems. Here, we determined whether pharmacists' comprehensive assessment of medication proˆles could reduce the burden of dementia patients' medication-related problems. In this historical cohort study 120 community pharmacies were randomly selected, and participating pharmacists completed questionnaires concerning comprehensive assessment of patient medication proˆles, using a``start'' questionnaire for patients prescribed medication prior to or during the study period and a``follow-up'' questionnaire for patients who subsequently visited pharmacies for prescriptions. Numbers and details of problems and solutions implemented by pharmacists and identiˆed in the start and follow-up questionnaires were compared. Changes in start and follow-up scores were also compared between patients whose problems were identiˆed by pharmacists (identiˆed group) and those whose problems were not (nonidentiˆed group). Data were collected for 349 patients issued medication by 60 pharmacies. The most common medication-related problems identiˆed in the start survey were key person's understanding of donepezil (60 cases) and other dementia treatments (60 cases), and adherence to treatment (53 cases). Solutions implemented by pharmacists included gathering information regarding drug administration and dementia awareness from the key person and providing pharmaceutical counseling and instruction. Subsequently, problems related to understanding of dementia treatment, understanding donepezil, and adherence were resolved by 70.0％, 65.0％, and 58.5％, respectively. Pharmacists' comprehensive assessment of medication proˆles could eŠectively solve dementia patients' medication-related problems.

Medication compliance in Singaporean patients with Alzheimer’s disease

“…A multidisciplinary approach in educating patients and their caregivers about the importance of treatment and medication use is crucial, and the involvement of pharmacists should be considered, as it has been shown to improve compliance to medications. (41)…”

Community Pharmacists’ Knowledge Regarding Donepezil Averse Effects and Self-Care Recommendations for Insomnia for Persons with AD

“…Maintaining continuous pharmacological treatment of patients with Alzheimer’s disease can be difficult because of low persistence of treatment with AChEIs due to perceived medication inefficacy, unrealistic treatment expectations, and/or GI AEs [ 23 , 24 , 25 , 26 ]. Medication education and pharmacist-counseling have been associated with improved adherence and treatment persistence with AChEIs [ 27 , 28 , 29 ]. Inappropriate medications among community-dwelling persons with AD are relatively common including over-the-counter first-generation antihistamines with central anticholinergic AEs that can negatively impact cognition [ 30 , 31 ].…”

“…Community pharmacists play a role in dispensing AChEIs but also providing medication-related information, especially important for those with filling a medication for the first time. Inadequate pharmacist knowledge regarding donepezil GI AEs can potentially result in patient distress or early discontinuation [ 27 , 29 ], or to lack of understanding on how to potentially decrease AEs (e.g., taking medication with food, dividing daily dose and taking separately). Patients or caregivers should be informed that these AEs are usually transient and improve with continuous medication use [ 4 ].…”

“…Patients or caregivers should be informed that these AEs are usually transient and improve with continuous medication use [ 4 ]. Lack of knowledge regarding donepezil AEs could reduce effectiveness of pharmacist counseling, negatively impacting adherence or treatment persistence [ 27 , 28 , 29 ].…”

Impact of interventions by a community pharmacist on care burden for people with dementia: development and randomized feasibility trial of an intervention protocol

“…It has been suggested that community pharmacists can optimize pharmacotherapy for BPSD by sharing patient information with their general practitioners [ 25 ]. A prospective cohort study previously conducted by the authors suggests that enhancing the collection of patient information by community pharmacists may help to reduce the burden of caregiving [ 26 ]. In addition, assessing the effectiveness of community pharmacists by monitoring caregiver burden has been initiated [ 27 ].…”