Healthcare professionals’ agreement on clinical relevance of drug-related problems among elderly patients

Bech, Christine Flagstad; Frederiksen, Tine; Villesen, C; Højsted, Jette; Nielsen, Per Peetz; Kjeldsen, Lene Juel; Nørgaard, Lotte Stig; Christrup, Lona Louring

doi:10.1007/s11096-017-0572-x

Cited by 6 publications

(7 citation statements)

References 22 publications

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“…The moderate degree of consensus among experts was determined with the narrow confidence intervals of Fleiss' kappa coefficients when assessing the impact of DRPs on effectiveness reduction, safety reduction, and cost increase. This consensus degree was higher than that of previous studies, which had a low consensus level [30,31]. This was because we only differentiated each aspect into two levels (influence or no influence), whereas others differentiated more levels.…”

Section: Discussioncontrasting

confidence: 63%

Drug-Related Problems in Prescribing for Pediatric Outpatients in Vietnam

Nguyen

Quach

et al. 2021

Healthcare

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Background: Our study was conducted to determine the prevalence of drug-related problems (DRPs) in outpatient prescriptions, the impact of DRPs on treatment efficacy, safety, and cost, and the determinants of DRPs in prescribing for pediatric outpatients in Vietnam. Methods: A retrospective cross-sectional study was conducted on pediatric outpatients at a pediatric hospital in Can Tho, Vietnam. DRPs were classified according to the Pharmaceutical Care Network Europe classification (PCNE) of 2020. The study determined prevalence of DRPs and their impacts on efficacy, safety, and cost. Multivariate regression was used to identify the determinants of DRPs. Results: The study included 4339 patients (mean age 4.3, 55.8% male), with a total of 3994 DRPs, averaging 0.92 DRP/prescription. The proportion of prescriptions with at least one DRP was 65.7%. DRPs included inappropriate drug selection (35.6%), wrong time of dosing relative to meals (35.6%), inappropriate dosage form (9.3%), inappropriate indication (7.1%), and drug-drug interactions (0.3%). The consensus of experts was average when evaluating each aspect of efficiency reduction, safety reduction, and treatment cost increase, with Fleiss’ coefficients of 0.558, 0.511, and 0.541, respectively (p < 0.001). Regarding prescriptions, 50.1% were assessed as reducing safety. The figures for increased costs and decreased treatment effectiveness were 29.0% and 23.9%, respectively. Patients who were ≤ 2 years old were more likely to have DRPs than patients aged 2 to 6 years old (OR = 0.696; 95% CI = 0.599–0.809) and patients aged over 6 years old (OR = 0.801; 95% CI = 0.672–0.955). Patients who had respiratory system disease were more likely to have DRPs than patients suffering from other diseases (OR = 0.715; 95% CI = 0.607–0.843). Patients with comorbidities were less likely to have DRPs than patients with no comorbidities (OR = 1.421; 95% CI = 1.219–1.655). Patients prescribed ≥ 5 drugs were more likely to have DRPs than patients who took fewer drugs (OR = 3.677; 95% CI = 2.907–4.650). Conclusion: The proportion of prescriptions in at least one DRP was quite high. Further studies should evaluate clinical significance and appropriate interventions, such as providing drug information and consulting doctors about DRPs.

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Section: Discussioncontrasting

confidence: 63%

Drug-Related Problems in Prescribing for Pediatric Outpatients in Vietnam

Nguyen

Quach

et al. 2021

Healthcare

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“…These results were in line with Bech et al reported that the panelists agreed moderately in their drug-related problems (DRP) assessments of higher clinical relevance ( κ = 0.5). 12 However, our findings were in contrast to those reported by Bosma et al where the agreement between raters was poor for both the severity error or DRP and the value for service (weighted κ = 0.3 and κ = 0.2; respectively). 36 Similarly, poor overall agreement on the severity of DRP was found among panelists assessing pharmacists’ interventions in elderly patients with chronic non-cancer pain ( κ = 0.12) 12 and patients with rheumatic conditions (κ =0.29).…”

Section: Discussioncontrasting

confidence: 99%

“… 12 However, our findings were in contrast to those reported by Bosma et al where the agreement between raters was poor for both the severity error or DRP and the value for service (weighted κ = 0.3 and κ = 0.2; respectively). 36 Similarly, poor overall agreement on the severity of DRP was found among panelists assessing pharmacists’ interventions in elderly patients with chronic non-cancer pain ( κ = 0.12) 12 and patients with rheumatic conditions (κ =0.29). 14 Unlike in our study in which the reviewers were clinical pharmacists, these studies involved different professionals in the rating process including an internal medicine specialist, 36 a rheumatologist 14 or a general practitioner.…”

Section: Discussioncontrasting

confidence: 99%

“…10 , 11 A more recent study, showed poor overall agreement on the severity of clinical pharmacist interventions by other different health care providers in the team. 12 A study on asthmatic patients’ management reported that physicians favored increased pharmacist involvement after reviewing their interventions. 13 Similarly, rheumatologists’ agreement on variety of clinical pharmacists’ interventions has led to encouraging trust in clinical pharmacists.…”

Section: Introductionmentioning

confidence: 99%

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Levels of agreement among clinical pharmacists on the impact of pharmaceutical interventions in Oman: A retrospective analysis

Al-Maqbali¹,

Taqi²,

Al-Hamadani³

et al. 2022

PHARMPRACT

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Objectives: Disagreement between health care providers on medication-related interventions can affect clinical outcomes. We aimed to study the outcomes and significance of clinical pharmacists' interventions and evaluate the levels of agreement between different clinical pharmacists on the impact of pharmaceutical interventions. Methodology: A retrospective study was conducted at a tertiary care hospital in Oman. The study included all documented interventions by clinical pharmacists for all categories of admitted patients that met the inclusion criteria. Results: The originator clinical pharmacists interjected to improve the efficacy of treatment in (58%, n=1740) of the interventions, followed by toxicity reduction (24%). The level of agreement in the clinical significance resulted in substantial Scotts' kappa (k) between the originator and the first reviewer, the first and second reviewers, and the second reviewer and supervisor (86%; k=0.77; P<.001), (77%; k=0.63; P<.001), (84%; k=0.77; P<.001), respectively. In terms of grading of clinical significance, the originator clinical pharmacists recorded moderate significance in 50% of the interventions, followed by major (30%), not applicable (8.4%), and minor (7.3%). The level of agreement in the clinical significance resulted in substantial Scotts' k between the originator and the first reviewer, and between the second reviewer and supervisor (82%; k=0.72; P<.001), (84%; k=0.77; P<.001), respectively. The level of agreement between the first and second reviewer was fair (55%; k=0.28; p<0.001). Conclusion: Clinical pharmacists' interventions have a crucial impact on patient safety, improving efficacy and reducing toxicities. Overall, there was a substantial agreement among clinical pharmacists on the clinical significance and grading of the interventions..

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“…According to Bech et al, DRPs with higher clinical relevance require medical consultation or hospital admission, while DRPs with lower clinical relevance can be solved by other health professionals and do not require medical attention, e.g., by pharmacist-provided patient counseling on the correct use of the medicine (23). In this study, most pharmacotherapy problems with higher clinical relevance were those related to prescriptions errors, which required medical consultation to solve them.…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapy problems in cardiology patients 30 days post discharge from a tertiary hospital in Brazil: a randomized controlled trial

Bonetti

Bagatim

Bottacin

et al. 2019

Clinics

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OBJECTIVES:This is a randomized controlled trial that aims to evaluate the impact of pharmacist-led discharge counseling on reducing pharmacotherapy problems in the 30-day postdischarge period of cardiology patients from a tertiary hospital in Brazil.METHODS:At discharge, two cardiovascular pharmacy residents performed a medication counseling session with the intervention group, and the follow-up was performed by telephone (3 and 15 days after discharge). The number of pharmacotherapy problems was evaluated during a pharmacist-led ambulatory consultation 30 days after discharge.RESULTS:A total of 66 and 67 patients were randomized to the intervention and control groups, respectively, but only 51 patients were analyzed in each group, all with similar baseline characteristics. The intervention group had significantly fewer pharmacotherapy problems compared to the control (p<0.001), and 100% of the patients had at least one problem. We observed five problems significantly more frequently in the control group: “incorrect time of taking” (p=0.003), “use higher dose of medication” (p=0.007), “use lower dose of medication” (p=0.014), “restart discontinued medication” (p=0.011), and “underdosing prescription” (p=0.009). Simvastatin, enalapril, carvedilol, and atorvastatin were the medications more associated with pharmacotherapy problems.CONCLUSIONS:We concluded that pharmacist-led discharge counseling should be an indispensable service, as patients exhibited less pharmacotherapy problems in the 30-day postdischarge period, especially related to drug administration and adherence.

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Healthcare professionals’ agreement on clinical relevance of drug-related problems among elderly patients

Cited by 6 publications

References 22 publications

Drug-Related Problems in Prescribing for Pediatric Outpatients in Vietnam

Drug-Related Problems in Prescribing for Pediatric Outpatients in Vietnam

Levels of agreement among clinical pharmacists on the impact of pharmaceutical interventions in Oman: A retrospective analysis

Pharmacotherapy problems in cardiology patients 30 days post discharge from a tertiary hospital in Brazil: a randomized controlled trial

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