Medication‐Related Problems in Outpatients With Decompensated Cirrhosis: Opportunities for Harm Prevention

Hayward, Kelly L.; Patel, Preya; Valery, Patricia C.; Horsfall, Leigh; Li, Catherine Y.; Wright, Penny L.; Tallis, Caroline; Stuart, Katherine; Irvine, Katharine M.; Cottrell, Neil; Martin, Jennifer H.; Powell, Elizabeth E.

doi:10.1002/hep4.1334

Cited by 40 publications

(90 citation statements)

References 30 publications

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“…Medication‐related problems are very common in patients with cirrhosis. A recent single‐centre trial showed that more than half of medication‐related problems could be resolved by a pharmacist‐led medication review . These results are promising and the guidance we developed can support pharmacists.…”

Section: Discussionmentioning

confidence: 82%

“…A recent single-centre trial showed that more than half of medication-related problems could be resolved by a pharmacist-led medication review. 5 These results are promising and the guidance we developed can support pharmacists. However, for large-scale implementation of pharmacists-led medication reviews in these patients, there are still some barriers to overcome as we demonstrated in this study.…”

Section: Implications For Practice and Future Researchmentioning

confidence: 87%

“…A Dutch study showed that almost 2/3 of patients with liver cirrhosis used potentially unsafe drugs . In addition, a recent study among 57 patients with cirrhosis identified a median of 6 medication‐related problems per patient . Almost 60% of these problems could be resolved during a pharmacist‐led medication review.…”

Section: Introductionmentioning

confidence: 99%

“…4 In addition, a recent study among 57 patients with cirrhosis identified a median of 6 medication-related problems per patient. 5 Almost 60% of these problems could be resolved during a pharmacistled medication review. This suggests that pharmacists, as medication experts, could play a key role in preventing and resolving medicationrelated problems in this vulnerable patient group.…”

Section: Introductionmentioning

confidence: 99%

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Medication safety in patients with hepatic impairment: A survey of community pharmacists' knowledge level and their practice in caring for these patients

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Abadier

Boer

et al. 2020

Brit J Clinical Pharma

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Aims To study community pharmacists' level of knowledge on medication safety in patients with hepatic impairment and their practice in caring for these patients. Methods Pharmacists from Dutch community pharmacies (n = 1545) were invited to participate in an online survey. The survey consisted of 27 questions covering 2 main topics: knowledge and current practice. The level of knowledge was measured by a 6‐item knowledge test. Multiple linear regression was used to identify predictors of correctly answered responses. Results In total, 338 pharmacists (22%) completed the questionnaire. The mean knowledge score was 2.8 (standard deviation 1.6). Only 30.3% of respondents were able to appropriately advise on use of analgesics in severe cirrhosis. Postgraduate education on hepatic impairment, knowledge of recently developed practical guidance, and fewer years of practice were associated with a higher level of knowledge. In total, 70.4% indicated to evaluate medication safety in a patient with hepatic impairment at least once weekly. In the past 6 months, 83.3% of respondents consulted a prescriber about a patient with hepatic impairment. Frequently encountered barriers in practice were insufficient knowledge on the topic and a lack of essential patient information (i.e. diagnosis and severity of the impairment). Conclusion Community pharmacists regularly evaluate the safety of medication in patients with hepatic impairment, yet their level of knowledge was insufficient and additional education is needed. Pharmacists experienced several difficulties in providing pharmaceutical care. If these issues are resolved, pharmacists can play a more active role in ensuring medication safety in their patients with hepatic impairment.

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Section: Discussionmentioning

confidence: 82%

Section: Implications For Practice and Future Researchmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Medication safety in patients with hepatic impairment: A survey of community pharmacists' knowledge level and their practice in caring for these patients

Weersink

Abadier

Boer

et al. 2020

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Until now, no such intervention studies have been performed in patients with cirrhosis. (6) In this issue of Hepatology Communications, Hayward and colleagues (7) discuss the results of their randomized controlled trial of pharmacist-led, patientoriented, medication education intervention and its association between MRPs and patient outcomes. They documented at least two or more MRPs for all patients, with a median of 6 MRPs per patient.…”

Section: See Article On Page 620mentioning

confidence: 99%

First Do No Harm: Medication‐Related Problems Among Patients With Cirrhosis

Aye

Volk

2019

Hepatol Commun

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Appropriate and Potentially Inappropriate Medication Use in Decompensated Cirrhosis

2021

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Background and Aims Patients with decompensated cirrhosis are prescribed numerous medications. Data are limited as to whether patients are receiving medications they need and avoiding those they do not. We examined a large national claims database (2010‐2015) to characterize the complete medication profile as well as the factors associated with appropriate and potentially inappropriate medication use in 12,621 patients with decompensated cirrhosis. Approach and Results Clinical guidelines and existing literature were used to determine appropriate and potentially inappropriate medications in decompensated cirrhosis. The total medication days’ supply was calculated from pharmacy data and divided by the follow‐up period for each decompensation. Ascites was the most common (86.5%), followed by hepatic encephalopathy (HE; 37.8%), variceal bleeding (VB; 17.5%), hepatorenal syndrome (6.3%), and spontaneous bacterial peritonitis (SBP; 6.1%). For patients with ascites, 55.8% filled a diuretic. For patients with HE, 32.4% and 63.3% filled rifaximin and lactulose, respectively. After VB, 60.3% of patients filled a nonselective beta blocker, and after an episode of SBP, 48.0% of patients filled an antibiotic for prophylaxis. The minority (4.5%‐17.3%) had enough medication to cover >50% follow‐up days. Potentially inappropriate medication use was common: 53.2% filled an opiate, 46.0% proton pump inhibitors, 14.2% benzodiazepines, and 10.1% nonsteroidal anti‐inflammatory drugs. Disease severity markers were associated with more appropriate mediation use but not consistently associated with less inappropriate medication use. Conclusions Patients with decompensated cirrhosis are not filling indicated medications as often or as long as is recommended and are also filling medications that are potentially harmful. Future steps include integrating pharmacy records with medical records to obtain a complete medication list and counseling on medication use with patients at each visit.

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Medication‐Related Problems in Outpatients With Decompensated Cirrhosis: Opportunities for Harm Prevention

Cited by 40 publications

References 30 publications

Medication safety in patients with hepatic impairment: A survey of community pharmacists' knowledge level and their practice in caring for these patients

Medication safety in patients with hepatic impairment: A survey of community pharmacists' knowledge level and their practice in caring for these patients

First Do No Harm: Medication‐Related Problems Among Patients With Cirrhosis

Appropriate and Potentially Inappropriate Medication Use in Decompensated Cirrhosis

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