Impact of the Pharmacist Medication Review Services on Drug-Related Problems and Potentially Inappropriate Prescribing of Renally Cleared Medications in Residents of Aged Care Facilities

Gheewala, Pankti A.; Peterson, Gregory M.; Curtain, Colin; Nishtala, Prasad S.; Hannan, Paul J.; Castelino, Ronald L.

doi:10.1007/s40266-014-0208-y

Cited by 84 publications

(100 citation statements)

References 41 publications

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“…The START/STOPP criteria have been gaining prominence in Europe [10] and there are reports using the McLeod criteria [11], Priscus list [12] and even nationally developed classifications [13, 14]. However, few reports of pharmacist-led medication reviews focus on the identification of DRPs, and these have either used the Pharmaceutical Care Network Europe classification [15, 16] or the DOCUMENT classification [17]. The Dader method has been used in nursing homes [18] but, to our knowledge, no paper has yet described the nature of DRP detected using the Granada classification to guide pharmacist-led medication reviews [19, 20].…”

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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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

View full text Add to dashboard Cite

show abstract

“…Polypharmacy is common among older people with multiple chronic conditions. This situation is of particular concern as older people are more sensitive to drugs and adverse drug reactions (ADRs) than younger individuals [2, 4]. The changes in neurotransmitter substances that occur in people with dementia make this patient group especially vulnerable to the effects of drugs, including ADRs [1, 2, 5].…”

Section: Introductionmentioning

confidence: 99%

“…Drugs such as morphine and glibenclamide that have active metabolites may cause ADRs [10, 11]. Estimation of renal function is thus important when prescribing renally excreted drugs to older people to avoid inappropriate prescribing, which is defined as “a situation where risk from the adverse effects of a prescribed medication outweighs the desired clinical benefits of treating a particular condition” [4]. …”

Section: Introductionmentioning

confidence: 99%

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Inappropriate Prescription and Renal Function Among Older Patients with Cognitive Impairment

2016

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BackgroundOlder people are more sensitive to drugs and adverse drug reactions than younger people because of age-related physiological changes such as impaired renal function. As people with dementia are particularly vulnerable to the effects of drugs, it is especially important to evaluate the dosages of renally cleared medications in this group.ObjectiveThe aim of this study was to estimate the prevalence of impaired renal function and inappropriate prescriptions on the basis of renal function among older patients with dementia or cognitive impairment.MethodsThe medical records of 428 patients aged ≥65 years who were admitted to two hospitals in northern Sweden were reviewed and renally cleared medications were identified. The Cockcroft–Gault equation was used to evaluate renal function. Doses were evaluated according to the Geriatric Dosage Handbook.ResultsRenal function was impaired (estimated glomerular filtration rate <60 ml/min) in 65.4 % of the study population. Impaired renal function was associated with increasing age. Among 547 prescriptions identified as renally cleared medications, 9.1 % were inappropriate based on the patient’s renal function; 13.5 % of the 326 patients prescribed renally cleared medications had inappropriate prescriptions. Inappropriate prescriptions were more common among patients living in nursing homes.ConclusionsImpaired renal function is common and inappropriate prescription is prevalent among old people with cognitive impairment in northern Sweden. Continuous consideration of renal function is important when prescribing medications to this group.Electronic supplementary materialThe online version of this article (doi:10.1007/s40266-016-0408-8) contains supplementary material, which is available to authorized users.

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“…This medication review should be particularly focused on benzodiazepines, other psychotropic medications, and medicines that contribute to a high drug burden index (ie, those with anticholinergic or sedative properties). 6,[32][33][34] Other interventions to prevent falls have been multifactorial in nature and have addressed risk factors pertaining to the individual (eg, strength and balance training) as well as his or her ability to safely interact with the environment. A meta-analysis by Cameron et al 35 reported that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities.…”

Section: Nonpharmacologicalmentioning

confidence: 99%

Treatment of Osteoporosis in Australian Residential Aged Care Facilities: Update on Consensus Recommendations for Fracture Prevention

Duque

Lord

Mak

et al. 2016

Journal of the American Medical Directors Association

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Impact of the Pharmacist Medication Review Services on Drug-Related Problems and Potentially Inappropriate Prescribing of Renally Cleared Medications in Residents of Aged Care Facilities

Cited by 84 publications

References 41 publications

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

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

Inappropriate Prescription and Renal Function Among Older Patients with Cognitive Impairment

Treatment of Osteoporosis in Australian Residential Aged Care Facilities: Update on Consensus Recommendations for Fracture Prevention

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