Prevalence of Potential Medication Problems Among Dually Eligible Older Adults in Medicaid Waiver Services

Alkema, Gretchen E.; Wilber, Kathleen H.; Simmons, W. June; Enguídanos, Susan; Frey, Dennee

doi:10.1345/aph.1k270

Cited by 28 publications

(16 citation statements)

References 21 publications

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“…The proportion of patients with actual medication duplication in our study was lower than that reported in a study done in Australia (20%)[5], and in a study in California among elderly patients where 24.2% had unnecessary therapeutic duplication [11]. The populations in those studies were different from our study population.…”

Section: Discussioncontrasting

confidence: 87%

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Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

Kalyango

Hall

Karamagi

2012

BMC Health Serv Res

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BackgroundChronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda.MethodsA cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data.ResultsOverall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37).ConclusionsPatients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

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Section: Discussioncontrasting

confidence: 87%

“…Studies that have looked at home management of medicines found inappropriate practices in 10-57% of patients [5,7,8]. The factors that were associated with these practices included: gender, age, confusion between trade and generic names [9], education level [10] and number of medicines [11]. …”

Section: Introductionmentioning

confidence: 99%

Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

Kalyango

Hall

Karamagi

2012

BMC Health Serv Res

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“…The higher number of medication-related problems documented in our study compared to previous studies may be due to a several factors. 21, 23,24 First, previous assessments of medication use often target patients with specific chronic conditions or pre-defined quality indicators. We examined medication-related problems across all chronic and acute diseases, taking into account the whole person.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Quality of Medication Use in Older Adults: Findings From a Longitudinal Study

Roth

Esserman

Ivey

et al. 2011

The American Journal of Geriatric Pharmacotherapy

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BACKGROUND The quality of medication use in older adults is suboptimal with a large percentage of individuals not receiving recommended care. Most efforts to evaluate the quality of medication use target high-risk drugs, appropriate treatment of prevalent chronic disease states, or a set of predefined quality indicators of medication use, rather than the patient. It is also suggested that racial differences in the quality of medication use may exist in older adults. OBJECTIVE To determine the prevalence, number, and types of medication-related problems in older adults, examining the impact of race on quality medication use. METHODS A prospective cohort study involving in-home interviews and medical record reviews of 200 community-residing older adults stratified by race (100 blacks, 100 whites) conducted three times over 1 year. No intervention to address medication-related problems was performed. The quality of medication use was reported as medication-related problems by clinical pharmacists. KEY RESULTS Mean age was 78.3 (whites) and 75.5 (blacks), with the majority being female. Although whites used more medications than blacks (11.6 versus 9.7; p < 0.01), blacks had more medication-related problems per person than whites (6.2 versus 4.9; p < 0.01). All patients had at least one medication-related problem; common problems at baseline, 6 months, and 12 months for both whites and blacks were undertreatment, suboptimal drug use, suboptimal dosing, nonadherence, and less costly alternative available. Blacks had significantly higher rates of nonadherence than whites (68% versus 42%; p < 0.01). Over the 12-month study, the number of medication-related problems not only persisted but increased (adjusted p=0.0168). CONCLUSIONS Medication-related problems are prevalent in both black and white older adults and persist over one-year. Blacks had more medication-related problems than whites, including higher rates of nonadherence. These findings require further study to better understand racial disparities in the quality of medication use in older adults and the impact of race on specific medication-related problems.

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“…28 In a study of potential medication-related problems in dually eligible older adults in a Medicaid waiver management program, 49% were found to have at least one potential medication-related problem, with the most prevalent problem being therapeutic duplication, which occurred in 24% of individuals. 29 . A large pharmaceutical care registry between of patients cared for by pharmacists working in ambulatory care clinics and community pharmacy settings found that 30% of older adults had at least one drug therapy problem, with the most common problems being additional drug therapy needed (30%), too low dosage (23%), and nonadherence (18%).…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in the Quality of Medication Use in Older Adults: Baseline Findings from a Longitudinal Study

et al. 2009

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Prevalence of Potential Medication Problems Among Dually Eligible Older Adults in Medicaid Waiver Services

Cited by 28 publications

References 21 publications

Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

Racial Disparities in Quality of Medication Use in Older Adults: Findings From a Longitudinal Study

Racial Disparities in the Quality of Medication Use in Older Adults: Baseline Findings from a Longitudinal Study

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