Feasibility, acceptability and potential effectiveness of an                     information technology-based, pharmacist-led intervention to prevent an increase                     in anticholinergic and sedative load among older community-dwelling                     individuals

Meer, Helene G van der; Wouters, Hans; Teichert, Martina; Griens, Fabiënne; Pavlovic, Jugoslav; Pont, Lisa G.; Taxis, Katja

doi:10.1177/2042098618805881

Cited by 11 publications

(20 citation statements)

References 25 publications

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“…Ideally, the information on FRIDs should be integrated in the pharmacy information system as has been done for the DBI. 43 As a start, pharmacists should ask older individuals frequently about fall history and record their responses. We recommend integrating a fall alert in the pharmacy information system for individuals who have experienced a fall before.…”

Section: Discussionmentioning

confidence: 99%

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Using pharmacy dispensing data to predict falls in older individuals

Gemmeke

Koster

Pajouheshnia

et al. 2020

Brit J Clinical Pharma

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Aims: Associations between individual medication use and falling in older individuals are well-documented. However, a comprehensive risk score that takes into account overall medication use and that can be used in daily pharmacy practice is lacking. We, therefore, aimed to determine whether pharmacy dispensing records can be used to predict falls. Methods: A retrospective cohort study was conducted using pharmacy dispensing data and self-reported falls among 3454 Dutch individuals aged ≥65 years. Two different methods were used to classify medication exposure for each person: the drug burden index (DBI) for cumulative anticholinergic and sedative medication exposure as well as exposure to fall risk-increasing drugs (FRIDs). Multinomial regression analyses, adjusted for age and sex, were conducted to investigate the association between medication exposure and falling classified as nonfalling, single falling and recurrent falling. The predictive performances of the DBI and FRIDs exposure were estimated by the polytomous discrimination index (PDI). Results: There were 521 single fallers (15%) and 485 recurrent fallers (14%). We found significant associations between a DBI ≥1 and single falling (adjusted odds ratio: 1.30 [95% confidence interval {CI}: 1.02-1.66]) and recurrent falling (adjusted odds ratio: 1.60 [95%CI: 1.25-2.04]). The PDI of the DBI model was 0.41 (95%CI: 0.39-0.42) and the PDI of the FRIDs model was 0.45 (95%CI: 0.43-0.47), indicating poor discrimination between fallers and nonfallers. Conclusion: The study shows significant associations between medication use and falling. However, the medication-based models were insufficient and other factors should be included to develop a risk score for pharmacy practice. K E Y W O R D S dispensing records, drug burden index, elderly, fall risk-increasing drugs, falling, risk prediction The authors confirm that the Principal Investigator for this paper is Marcel Bouvy and that he had direct clinical responsibility for participants.

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Section: Discussionmentioning

confidence: 99%

“…Evaluating the medication use in these individuals should be a priority for them. Ideally, the information on FRIDs should be integrated in the pharmacy information system as has been done for the DBI 43 . As a start, pharmacists should ask older individuals frequently about fall history and record their responses.…”

Section: Discussionmentioning

confidence: 99%

Using pharmacy dispensing data to predict falls in older individuals

Gemmeke

Koster

Pajouheshnia

et al. 2020

Brit J Clinical Pharma

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“…Despite this, 90% of patients report they are willing to have a medication deprescribed 34. Some of the most successful deprescribing initiatives described in the literature have incorporated clinical pharmacists and targeted specific medications 35 36…”

Section: Discussionmentioning

confidence: 99%

Pharmacist-led intervention to improve medication use in older inpatients using the Drug Burden Index: a study protocol for a before/after intervention with a retrospective control group and multiple case analysis

et al. 2020

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IntroductionPolypharmacy and potentially inappropriate medication use is common in older adults and is associated with adverse outcomes such as falls and hospitalisations.Methods and analysisThis study is a pharmacist-led medication optimisation initiative using an electronic tool (the Drug Burden Index (DBI) Calculator) in four hospital sites in the Canadian province of Nova Scotia. The study aims to enrol 160 participants between the preintervention and intervention groups. The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT 2013 checklist) was used to develop the protocol for this prospective interventional implementation study. A preintervention retrospective control cohort and a multiple case study analysis will also be used to assess the effect of intervention implementation. Statistical analysis will involve change in DBI scores and assessment of clinical outcomes, such as rehospitalisation and mortality using appropriate statistical tests including t-test, χ2, analysis of variance and unadjusted and adjusted regression methods.Ethics and disseminationEthics approval has been granted by the Nova Scotia Health Authority Research Ethics Board. The findings of this study will be published in peer-reviewed journals and presented at local, national and international conferences.Trial registration numberNCT03698487.

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“…Lastly, 'experienced intervention burden' stands for the amount of effort that is required to participate in the intervention. Acceptability usually looks at the introduction of a new device/technology 15,38,39 or innovative ways to improve service delivery. [40][41][42][43] Acceptability assessment can take place 'before' the implementation of the healthcare intervention; during the intervention period, 'concurrent assessment, ' or after the implementation, 'post-intervention. '…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Acceptability of a Prime Vendor System in Public Healthcare Facilities in Tanzania

Kuwawenaruwa

Tediosi

Metta

et al. 2020

Int J Health Policy Manag

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Background: Pharmaceutical supply chain management in low- and middle-income countries has received substantial attention to address the shortage of medicines at peripheral facilities. The focus has been on health system interventions, including the establishment of public-private partnerships (PPPs). In 2014, the United Republic of Tanzania began implementing the Jazia prime vendor system (Jazia PVS) with a contracted private wholesale supplier to complement the national medicines supply chain in public facilities. Few studies have investigated the acceptability of such a prime vendor system. This study analyses factors that contributed to the acceptability of Jazia PVS introduced in Tanzania. We used qualitative analytical methods to study experiences of Jazia PVS implementers in 4 districts in mid-2018. Methods: Data were drawn from 14 focus group discussions (FGDs), 7 group discussions (GDs) and 30 in-depth interviews (IDIs) with a range of actors involved in Jazia PVS. The study analysed 7 acceptability dimensions as defined in the acceptability framework by Sekhon et al. Framework analysis was adopted to summarise the results using a deductive and an inductive approach. Results: The findings show that participants’ acceptability of Jazia PVS was influenced by the increased availability of essential medicines at the facilities, higher order fulfilment rates, and timely delivery of the consignment. Furthermore, acceptability was also influenced by the good reputation of the prime vendor, close collaboration with district managers, and participants’ understanding that the prime vendor was meant to complement the existing supply chain. Intervention coherence, experienced opportunity cost and intervention burden, affective attitude and self-efficacy were also important in explaining the acceptability of the Jazia PVS. Conclusion: In conclusion, the most critical factor contributing to the acceptability of the Jazia PVS was the perceived effectiveness of the system in achieving its intended purpose. Districts purchasing directly from the prime vendor have a policy based on the possibility to increase availability of essential medicines at peripheral facilities in a low income setting; however, it is crucial to select a reputable and competent vendor, as well as to abide by the contractual agreements.

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Feasibility, acceptability and potential effectiveness of an information technology-based, pharmacist-led intervention to prevent an increase in anticholinergic and sedative load among older community-dwelling individuals

Cited by 11 publications

References 25 publications

Using pharmacy dispensing data to predict falls in older individuals

Using pharmacy dispensing data to predict falls in older individuals

Pharmacist-led intervention to improve medication use in older inpatients using the Drug Burden Index: a study protocol for a before/after intervention with a retrospective control group and multiple case analysis

Acceptability of a Prime Vendor System in Public Healthcare Facilities in Tanzania

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