A medication assessment tool to evaluate prescribers’ adherence to evidence-based guidelines in bipolar disorder

Application of MAT Methodology in the Evaluation of Prescribing Adherence to Clinical Practice Guidelines for Secondary Prevention of Coronary Heart Disease in Post-Acute Coronary Syndrome Patients in Kuwait

Quantification of prescribers’ adherence to evidence-based guidelines can be used as an outcome measure to assess the impact of services on the quality of medication use. Additionally, it can help in reducing inappropriate interventions and ensure that high-quality care is provided to patients. This study aimed to evaluate prescribing practices for secondary prevention of coronary heart disease (CHD) in post-acute coronary syndromes (ST-elevation myocardial infarction [STEMI] or non-ST elevation acute coronary syndrome [NSTEACS]) patients using two medication assessment tools (MATs) at secondary and tertiary health-care settings in Kuwait. Both MATs were developed and validated based on the relevant guidelines issued by the European Society of Cardiology and the American College of Cardiology/American Heart Association. A quantitative cross-sectional multicenter study was conducted on 460 patients’ medical records collected randomly from six health-care facilities in Kuwait. Application of MAT_STEMI on 232 patients’ medication records (with 85.9% applicability) resulted in intermediate overall adherence (69.8%; 95% CI: 67.6–72.0). Application of MAT_NSTEACS on 228 patients’ medication records (with applicability 83.2%) resulted in intermediate overall adherence (73.3%; 95% CI: 70.5–76.0). There was no significant difference between the percentages of overall adherence among patients managed post-NSTEACS compared to those managed post-STEMI (p = 0.05). Multivariable logistic regression analysis revealed that the overall adherence to the MAT_STEMI criteria was significantly higher among the specialized cardiac centers than among the general hospitals (OR: 1.6; 95% CI: 1.1–2.3; p = 0.02). The overall adherence to the MAT_NSTEACS criteria was found to be significantly lower among non-Kuwaitis than among Kuwaitis (OR: 0.6; 95% CI: 0.5–0.9; p = 0.01) and patients with a serum LDL ≥1.8 mmol/L than those with a serum LDL-C < 1.8 mmol/L (OR: 0.5; 95% CI: 0.4–0.7; p < 0.001). The present findings revealed that both MATs were useful tools in identifying the standard of clinical performances and highlighting areas for improvement regarding secondary prevention of CHD in post-acute coronary syndrome patients.

Development and validation of medication assessment tools to evaluate prescribing adherence to evidence-based guidelines for secondary prevention of coronary heart disease in post-acute coronary syndromes patients in Kuwait

Cardiovascular diseases are estimated to cause 46% of all mortalities in Kuwait. The aim of evidence-based clinical practice has led to an increased interest in the design of medication assessment tools (MATs) to identify deviations from evidence-based practice, and eventually provide the basis of consistent standardized prescribing. This study was designed to develop and validate MATs using quality standards extracted from international guidelines to evaluate prescribing practices in secondary prevention of coronary heart disease in patients with post-acute coronary syndrome (STEMI or NSTEACS]. International guidelines were reviewed to develop two MATs (MAT_STEMI and MAT_NSTEACS). Face and content validity of the developed tools was performed with three MAT experts and thirteen cardiologists. Two quantitative approaches were used to determine content validity: (i) Content Validity Ratio (CVR) and the average of CVR values; and (ii) Content validity index at item level (I-CVI) and scale-level of the tool (S-CVI/Ave) with the average approach. Criteria with a CVR<0.54 and I-CVI <70% were eliminated. Ultimately, feasibility testing of both MATs was performed on 66 patients’ records as a pilot study. The initial developed MAT_STEMI and MAT_NSTEACS consisted of eighteen and twelve medication-related criteria, respectively. Face validity resulted in dividing each MAT into five dimensions. In the MAT_STEMI, three criteria had CVR values < 0.54 and I-CVIs < 70%. Two criteria were eliminated and one was retained. This resulted in sixteen criteria with average CVR 0.85 and S-CVI/Ave 92.3%. In the MAT_NSTEACS, one criterion was eliminated. This resulted in eleven criteria with average CVR 0.93 and S-CVI/Ave 96.5%. The overall adherence scores to the MAT_STEMI and MAT_NSTEACS were 64.1% (95% CI: 57.8–69.9%) and 62.0% (95% CI: 53.4–69.9%), respectively. It was judged as intermediate adherence for both MATs. MAT_STEMI and MAT_NSTEACS were developed and validated to be utilized for optimizing medication therapy management and improving therapeutic interventions.

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middle-income countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed.Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments.Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.

Identifying potential prescribing safety indicators related to mental health disorders and medications: A systematic review

BACKGROUND

Prescribing errors and medication related harm may be common in patients with mental illness. However, there has been limited research focusing on the development and application of prescribing safety indicators (PSIs) for this population.

OBJECTIVE

Identify potential PSIs related to mental health (MH) medications and conditions.

METHODS

Seven electronic databases were searched (from 1990 to February 2019), including the bibliographies of included studies and of relevant review articles. Studies that developed, validated or updated a set of explicit medication-specific indicators or criteria that measured prescribing safety or quality were included, irrespective of whether they contained MH indicators or not. Studies were screened to extract all MH related indicators before two MH clinical pharmacists screened them to select potential PSIs based on established criteria. All indicators were categorised into prescribing problems and medication categories.

RESULTS

79 unique studies were included, 70 of which contained at least one MH related indicator. No studies were identified that focused on development of PSIs for patients with mental illness. A total of 1386 MH indicators were identified (average 20 (SD = 25.1) per study); 245 of these were considered potential PSIs. Among PSIs the most common prescribing problem was 'Potentially inappropriate prescribing considering diagnoses or conditions' (n = 91, 37.1%) and the lowest was 'omission' (n = 5, 2.0%). 'Antidepressant' was the most common PSI medication category (n = 85, 34.7%).

CONCLUSION

This is the first systematic review to identify a comprehensive list of MH related potential PSIs. This list should undergo further validation and could be used as a foundation for the development of new suites of PSIs applicable to patients with mental illness.