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Kable A, Fraser S, Fullerton A, Hullick C, Palazzi K, Oldmeadow C, Pond CD, Searles A, Ling R, Bruce R, Murdoch W, Attia J. Evaluation of the Effect of a Safe Medication Strategy on Potentially Inappropriate Medications, Polypharmacy and Anticholinergic Burden for People with Dementia: An Intervention Study. Healthcare (Basel) 2023; 11:2771. [PMID: 37893845 PMCID: PMC10606387 DOI: 10.3390/healthcare11202771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
People with dementia (PWD) are at risk for medication-related harm due to their impaired cognition and frequently being prescribed many medications. This study evaluated a medication safety intervention (including pharmacist medication reconciliation and review) for PWD during an unplanned admission to hospital. This article reports the effect of the intervention on polypharmacy, potentially inappropriate medications (PIMs), and anticholinergic burden scores for PWD. A pre-post design using an intervention site and a control site was conducted in 2017-2019, in a regional area in New South Wales, Australia. Polypharmacy, PIMs, and anticholinergic burden were measured at admission, discharge, and three months after discharge. There were 628 participants including 289 at the control site and 339 at the intervention site. Polypharmacy was 95% at admission and 90% at discharge. PIMs at admission were 95-98% across timepoints and decreased significantly at discharge. The mean anticholinergic score decreased significantly between admission (2.40-3.15) and discharge (2.01-2.57). Reduced PIMs at discharge were correlated with reduced anticholinergic burden (rho = 0.48-0.55, p < 0.001). No significant differences were identified between the study and control sites for Polypharmacy, PIMs, and anticholinergic burden rates and scores. High rates of polypharmacy and PIMs in this study indicate a study population with multiple comorbidities. This intervention was feasible to implement but was limited due to difficulty recruiting participants and deaths during the study. Future multisite studies should be designed to recruit larger study samples to evaluate interventions for improving medication safety for PWD and improve outcomes for these vulnerable people.
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Affiliation(s)
- Ashley Kable
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Samantha Fraser
- Hunter New England Local Health District, Rankin Park, Newcastle, NSW 2287, Australia; (S.F.); (A.F.); (C.H.); (R.B.); (W.M.); (J.A.)
| | - Anne Fullerton
- Hunter New England Local Health District, Rankin Park, Newcastle, NSW 2287, Australia; (S.F.); (A.F.); (C.H.); (R.B.); (W.M.); (J.A.)
| | - Carolyn Hullick
- Hunter New England Local Health District, Rankin Park, Newcastle, NSW 2287, Australia; (S.F.); (A.F.); (C.H.); (R.B.); (W.M.); (J.A.)
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia; (K.P.); (C.O.); (A.S.); (R.L.)
| | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia; (K.P.); (C.O.); (A.S.); (R.L.)
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia; (K.P.); (C.O.); (A.S.); (R.L.)
| | - Constance Dimity Pond
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia;
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia; (K.P.); (C.O.); (A.S.); (R.L.)
| | - Rod Ling
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia; (K.P.); (C.O.); (A.S.); (R.L.)
| | - Remia Bruce
- Hunter New England Local Health District, Rankin Park, Newcastle, NSW 2287, Australia; (S.F.); (A.F.); (C.H.); (R.B.); (W.M.); (J.A.)
| | - Wendy Murdoch
- Hunter New England Local Health District, Rankin Park, Newcastle, NSW 2287, Australia; (S.F.); (A.F.); (C.H.); (R.B.); (W.M.); (J.A.)
| | - John Attia
- Hunter New England Local Health District, Rankin Park, Newcastle, NSW 2287, Australia; (S.F.); (A.F.); (C.H.); (R.B.); (W.M.); (J.A.)
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia; (K.P.); (C.O.); (A.S.); (R.L.)
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia;
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van Nuland M, Butterhoff M, Verwijmeren K, Berger F, Hogervorst VM, de Jonghe A, van der Linden PD. Assessment of drug-related problems at the emergency department in older patients living with frailty: pharmacist-led medication reviews within a geriatric care team. BMC Geriatr 2023; 23:215. [PMID: 37016324 PMCID: PMC10074685 DOI: 10.1186/s12877-023-03942-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Older patients are vulnerable to experiencing drug related problems (DRPs), which may result in emergency department (ED) visits. However, it is not standard practice to conduct medications reviews during ED visit. The aim of this study was to assess the number of DRPs in older patients living with frailty at the ED, identified through pharmacist-led medication reviews within a geriatric care team, and to determine the acceptance rate of pharmacists' recommendations among hospital physicians and general practitioners or elderly care specialists. METHODS A retrospective observational study was performed in patients ≥ 70 years living with frailty at the ED at Tergooi Medical Center. Pharmacist-led medication reviews were conducted to identify and classify DRPs as part of a larger geriatric assessment. The acceptance rate of given recommendations was determined during follow-up. RESULTS A total of 356 ED visits were included. The mean (standard deviation, SD) age of patients was 83 (6.8) years. About 76% of patients had at least one DRP. In total, 548 DRPs were identified with a mean of 1.5 DRP (SD 1.3) per patient. The acceptance rate of medication recommendations in admitted patients was 55%, and 32% among general practitioners/elderly care specialists in discharged patients. CONCLUSIONS Pharmacist-led medication reviews as part of a geriatric care team identified DRPs in 76% of older patients living with frailty at the ED. The acceptance rate was substantially higher in admitted patients compared to discharged patients.
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Affiliation(s)
- Merel van Nuland
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands.
| | - Madelon Butterhoff
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Karin Verwijmeren
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Florine Berger
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | | | | | - Paul D van der Linden
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
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3
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Bülow C, Clausen SS, Lundh A, Christensen M. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev 2023; 1:CD008986. [PMID: 36688482 PMCID: PMC9869657 DOI: 10.1002/14651858.cd008986.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND A medication review can be defined as a structured evaluation of a patient's medication conducted by healthcare professionals with the aim of optimising medication use and improving health outcomes. Optimising medication therapy though medication reviews may benefit hospitalised patients. OBJECTIVES We examined the effects of medication review interventions in hospitalised adult patients compared to standard care or to other types of medication reviews on all-cause mortality, hospital readmissions, emergency department contacts and health-related quality of life. SEARCH METHODS In this Cochrane Review update, we searched for new published and unpublished trials using the following electronic databases from 1 January 2014 to 17 January 2022 without language restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). To identify additional trials, we searched the reference lists of included trials and other publications by lead trial authors, and contacted experts. SELECTION CRITERIA We included randomised trials of medication reviews delivered by healthcare professionals for hospitalised adult patients. We excluded trials including outpatients and paediatric patients. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data and assessed risk of bias. We contacted trial authors for data clarification and relevant unpublished data. We calculated risk ratios (RRs) for dichotomous data and mean differences (MDs) or standardised mean differences (SMDs) for continuous data (with 95% confidence intervals (CIs)). We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the overall certainty of the evidence. MAIN RESULTS In this updated review, we included a total of 25 trials (15,076 participants), of which 15 were new trials (11,501 participants). Follow-up ranged from 1 to 20 months. We found that medication reviews in hospitalised adults may have little to no effect on mortality (RR 0.96, 95% CI 0.87 to 1.05; 18 trials, 10,108 participants; low-certainty evidence); likely reduce hospital readmissions (RR 0.93, 95% CI 0.89 to 0.98; 17 trials, 9561 participants; moderate-certainty evidence); may reduce emergency department contacts (RR 0.84, 95% CI 0.68 to 1.03; 8 trials, 3527 participants; low-certainty evidence) and have very uncertain effects on health-related quality of life (SMD 0.10, 95% CI -0.10 to 0.30; 4 trials, 392 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Medication reviews in hospitalised adult patients likely reduce hospital readmissions and may reduce emergency department contacts. The evidence suggests that mediation reviews may have little to no effect on mortality, while the effect on health-related quality of life is very uncertain. Almost all trials included elderly polypharmacy patients, which limits the generalisability of the results beyond this population.
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Affiliation(s)
- Cille Bülow
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Stine Søndersted Clausen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikkel Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research (CCTR), Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Doherty AS, Adamson G, Mallett J, Darcy C, Friel A, Scott MG, Miller EFR. Minding the gap-an examination of a pharmacist case management medicines optimisation intervention for older people in intermediate care settings. Res Social Adm Pharm 2022; 18:3669-3679. [DOI: 10.1016/j.sapharm.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/14/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
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5
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Ong CEC, Yong H, Qiu H, Velu K, Choa PH. Preparing for the silver boom: A falls prevention tool for older adults in the emergency department. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:109-112. [PMID: 35224607 DOI: 10.47102/annals-acadmedsg.2021173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Geriatric falls presenting to the emergency department (ED) are rising due to our rapidly ageing population. As part of a group of geriatric-focused emergency medicine practitioners, we describe a multidisciplinary falls prevention tool using the acronym.
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Falconer N, Snoswell C, Morris C, Barras M. The right time and place: the need for seven‐day pharmacist service models. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nazanin Falconer
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Centaine Snoswell
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Christopher Morris
- Department of Internal Medicine Princess Alexandra Hospital Metro South Health Brisbane Australia
| | - Michael Barras
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
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7
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Implementation of a multi-interventional approach to improve medication safety in older hospitalized patients: feasibility and impact on 30-day rehospitalization rate. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:543-553. [PMID: 34742917 DOI: 10.1016/j.pharma.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/20/2022]
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8
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Bambach K, Southerland LT. Applying Geriatric Principles to Transitions of Care in the Emergency Department. Emerg Med Clin North Am 2021; 39:429-442. [PMID: 33863470 DOI: 10.1016/j.emc.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Each emergency department (ED) visit represents a crucial transition of care for older adults. Systems, provider, and patient factors are barriers to safe transitions and can contribute to morbidity and mortality in older adults. Safe transitions from ED to inpatient, ED to skilled nursing facility, or ED back to the community require a holistic approach, such as the 4-Ms model-what matters (patient goals of care), medication, mentation, and mobility-along with safety and social support. Clear written and verbal communication with patients, caregivers, and other members of the interdisciplinary team is paramount in ensuring successful care transitions.
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Affiliation(s)
- Kimberly Bambach
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 376 West 10th Avenue, Columbus, OH 43210, USA. https://twitter.com/kimbambach
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 376 West 10th Avenue, Columbus, OH 43210, USA.
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9
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Kable A, Hullick C, Palazzi K, Oldmeadow C, Searles A, Ling R, Pond D, Fullerton A, Fraser S, Bruce R, Murdoch W, Attia J. Evaluation of a safe medication strategy intervention for people with dementia with an unplanned admission: Results from the Safe Medication Strategy Dementia Study. Australas J Ageing 2020; 40:356-365. [PMID: 33166034 DOI: 10.1111/ajag.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/24/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate whether a safe medication strategy compared with usual care, provided to people with dementia during an unplanned admission, reduces readmissions to hospital and re-presentation to emergency departments within three months. METHODS A prospective, controlled pre-/post-trial conducted at two regional hospitals in New South Wales, Australia. RESULTS No treatment effect was seen for time to first re-presentation or readmission within three months (P = .3). Compliance with six strategies applicable for all participants in the intervention phase was 58%. There was no treatment effect for secondary outcomes including dose administration aid use, home medicines review (HMR) requests by general practitioners and completed HMRs; however, they were significantly higher at the intervention site in both phases. CONCLUSION A bundle of care to improve medication safety in people with dementia did not reduce re-presentations or readmissions within three months.
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Affiliation(s)
- Ashley Kable
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Carolyn Hullick
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | | | - Andrew Searles
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Rod Ling
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Dimity Pond
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Anne Fullerton
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Samantha Fraser
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Remia Bruce
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Wendy Murdoch
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - John Attia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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10
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Welch S, Currey E, Doran E, Harding A, Roman C, Taylor S, Thomas A, Munro C. Standard of practice in emergency medicine for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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11
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Mizokami F, Mizuno T, Kanamori K, Oyama S, Nagamatsu T, Lee JK, Kobayashi T. Clinical medication review type III of polypharmacy reduced unplanned hospitalizations in older adults: A meta‐analysis of randomized clinical trials. Geriatr Gerontol Int 2019; 19:1275-1281. [DOI: 10.1111/ggi.13796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 08/22/2019] [Accepted: 09/26/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Fumihiro Mizokami
- Department of PharmacyNational Center for Geriatrics and Gerontology Obu Japan
| | - Tomohiro Mizuno
- Analytical PharmacologyMeijo University Graduate School of Pharmacy Nagoya Japan
- Center for Innovation in Clinical Pharmacy Education and ResearchMeijo University Nagoya Japan
| | - Koichiro Kanamori
- Analytical PharmacologyMeijo University Graduate School of Pharmacy Nagoya Japan
| | - Sakiko Oyama
- Analytical PharmacologyMeijo University Graduate School of Pharmacy Nagoya Japan
| | - Tadashi Nagamatsu
- Analytical PharmacologyMeijo University Graduate School of Pharmacy Nagoya Japan
| | - Jeannie K Lee
- Department of Pharmacy Practice & ScienceUniversity of Arizona College of Pharmacy Tucson Arizona USA
| | - Tomoharu Kobayashi
- Department of PharmacyNational Center for Geriatrics and Gerontology Obu Japan
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Roseleur J, Partington A, Karnon J. Evaluations of healthcare delivery models in Australia: a scoping review protocol. JBI Evid Synth 2019; 18:128-134. [PMID: 31356574 DOI: 10.11124/jbisrir-d-19-00094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this review is to identify and describe the evidence base of published primary, comparative healthcare delivery model evaluations that require the employment of additional healthcare practitioners undertaken in Australia. INTRODUCTION In Australia, formal processes are utilized in assessing the value of new pharmaceuticals and medical services, which inform decisions on whether to list new items on the Pharmaceutical Benefits Schedule and Medicare Benefits Schedule, respectively. There are no formal processes to aid in decision making on the funding of new, evaluated healthcare delivery models. This imbalance undervalues the available evidence on healthcare delivery models, leading to the sub-optimal allocation of resources between new health technologies and new healthcare delivery models within the Australian health system. INCLUSION CRITERIA Eligible studies will evaluate healthcare delivery models that require the employment of additional healthcare practitioners (either to replace existing practitioners of another type or to provide new services). Studies must include a comparator to evaluate a condition of interest being treated using alternative healthcare delivery models, or no treatment, and will involve observation of outcomes over a similar period of time. Studies in any Australian setting will be included. Interventions aimed at primary preventions will be excluded. METHODS PubMed, Embase and CINAHL will be searched for articles published from 2008. One reviewer will review titles, and then two reviewers will independently review abstracts to identify eligible studies. One reviewer will extract data on study characteristics and design. The results of the data extraction will be presented in a table with examples of case studies.
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Affiliation(s)
- Jacqueline Roseleur
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Andrew Partington
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Macquarie University Centre for the Health Economy, Macquarie University, Sydney, Australia
| | - Jonathan Karnon
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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13
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Lamkin L, Lindsey S, Weant K, Shoff H, Pinkston C. Implications of the presence of an emergency medicine pharmacist during critical care trauma patient resuscitation. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lynn Lamkin
- Department of Pharmacy University of Louisville Hospital Louisville Kentucky
| | - Savannah Lindsey
- Department of Pharmacy University of Louisville Hospital Louisville Kentucky
| | - Kyle Weant
- Department of Pharmacy Medical University of South Carolina Charleston South Carolina
| | - Hugh Shoff
- University of Louisville School of Medicine Department of Emergency Medicine Louisville Kentucky
| | - Christina Pinkston
- School of Public Health and Information Sciences University of Louisville Louisville Kentucky
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14
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Welch S. Pharmacy research in the emergency medicine environment. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Schepel L, Lehtonen L, Airaksinen M, Ojala R, Ahonen J, Lapatto-Reiniluoto O. Medication reconciliation and review for older emergency patients requires improvement in Finland. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2019; 30:19-31. [PMID: 30103352 PMCID: PMC6294607 DOI: 10.3233/jrs-180030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: 10–30% of hospital stays by older patients are drug-related. The admission phase is important for identifying drug-related problems, but taking an incorrect medication history often leads to medication errors. OBJECTIVES: To enhance medication history recording and identify drug-related problems (DRPs) of older patients admitted to emergency departments (EDs). METHODS: DRPs were identified by pharmacists-led medication reconciliation and review procedures in two EDs in Finland; Helsinki University Hospital (HUS), and Kuopio University Hospital (KUH). One-hundred-and-fifty patients aged ≥65-years, living at home and using ≥6 medicines were studied. RESULTS: 100% of patients (N = 75) in HUS and 99% in KUH (N = 75), had discrepancies in their admission-medication chart recorded by the nurse or physician. Associations between admission-diagnosis and drug-related problems were found in 12 patients (16%) in HUS and 22 patients (29%) in KUH. Of these, high-alert medications (e.g. antithrombotics, cytostatics, opioids) were linked to eight patients (11%) in HUS and six patients (8%) in KUH. Other acute DRPs were identified in 19 patients (25%) in HUS and 54 patients (72%) in KUH. Furthermore, 67 patients (89%) in HUS and all patients in KUH had non-acute DRPs. CONCLUSIONS: Medication reconciliation and review at admission of older ED patients requires improvement in Finland.
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Affiliation(s)
- Lotta Schepel
- HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland.,Specialization Programme of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Lasse Lehtonen
- Helsinki University Hospital and University of Helsinki, Finland
| | - Marja Airaksinen
- Specialization Programme of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland.,Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Raimo Ojala
- KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital, Finland
| | - Jouni Ahonen
- KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital, Finland
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Southerland LT, Pearson S, Hullick C, Carpenter CR, Arendts G. Safe to send home? Discharge risk assessment in the emergency department. Emerg Med Australas 2019; 31:266-270. [DOI: 10.1111/1742-6723.13250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lauren T Southerland
- Department of Emergency MedicineThe Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Scott Pearson
- Department of Emergency MedicineChristchurch Hospital Christchurch New Zealand
| | - Carolyn Hullick
- Faculty of HealthThe University of Newcastle Newcastle New South Wales Australia
- Hunter Medical Research Institute Newcastle New South Wales Australia
| | | | - Glenn Arendts
- School of MedicineThe University of Western Australia Perth Western Australia Australia
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17
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Comparison of Potentially Inappropriate Medications for People with Dementia at Admission and Discharge during An Unplanned Admission to Hospital: Results from the SMS Dementia Study. Healthcare (Basel) 2019; 7:healthcare7010008. [PMID: 30634548 PMCID: PMC6473531 DOI: 10.3390/healthcare7010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 11/16/2022] Open
Abstract
People with dementia (PWD) and cognitive impairment are particularly vulnerable to medication problems, and unplanned admission to hospital presents an opportunity to address polypharmacy, potentially inappropriate medications (PIMs) and anticholinergic burden. This study aimed to compare PIMS and other medication data for PWD to determine whether these changed during hospitalization. Medications documented in patient’s records at admission and discharge were evaluated for PWD recruited to phase one of a prospective quasi-experimental pre/post-controlled trial that was conducted at two regional hospitals in NSW, Australia. The study sample included PWD or cognitive impairment having an unplanned admission to hospital. Data were collected using a purpose developed audit tool for medications and PIMs, and a Modified Anticholinergic Burden Scale. Total participants were 277, and results determined that the cognitive status of PWD is not always detected during an unplanned admission. This may make them more vulnerable to medication problems and poor outcomes. Polypharmacy and PIMS for PWD were high at admission and significantly reduced at discharge. However, PWD should be routinely identified as high risk at admission; and there is potential to further reduce polypharmacy and PIMs during admission to hospital, particularly psychotropic medications at discharge. Future studies should focus on evaluating targeted interventions designed to increase medication safety for PWD.
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Clark RM, Rice LW, Del Carmen MG. Thirty-day unplanned hospital readmission in ovarian cancer patients undergoing primary or interval cytoreductive surgery: systematic literature review. Gynecol Oncol 2018; 150:370-377. [PMID: 29929923 DOI: 10.1016/j.ygyno.2018.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Thirty-day readmission rate has been proposed as metric of quality and remains an ongoing clinical concern in the primary treatment of patients with advanced-stage ovarian epithelial ovarian cancer. We conducted a review of the literature to identify rates, risk factors, and predictors for 30-day readmission in this population. METHODS A 10-year period MEDLINE (PubMed) search of English literature studies published between January 01, 2008-January 01, 2018 was performed to identify appropriate studies for review. RESULTS Thirty -day readmission rates for ovarian cancer patients undergoing primary treatment ranged from 2.5-19.3%. Neoadjuvant chemotherapy and interval cytoreductive surgery (NACT-ICS) surgery was associated with lower readmission rates, when compared to primary debulking surgery (PDS). The most frequently reported adverse events resulting in readmission include inpatient management of ileus/small bowel obstruction, wound-related complications, and thromboembolic events. Readmission predictors included the presence of other medical comorbidities, re-operation, and major complications occurring after initial hospital discharge. Some studies reported lower rates of readmission and survival in patients treated by NACT-ICS. CONCLUSIONS Policies and programs should be designed to measure short- and long-term outcomes in this patient population to avoid bias in assigning patients to NACT-ICS to maintain low 30-day readmission rates.
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Affiliation(s)
- Rachel M Clark
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Laurel W Rice
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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Bach QN, Peasah SK, Barber E. Review of the Role of the Pharmacist in Reducing Hospital Readmissions. J Pharm Pract 2018; 32:617-624. [DOI: 10.1177/0897190018765500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hospital readmissions remain a public health concern despite progress in reducing and preventing its occurrence. Among strategies that have been implemented to reduce readmission most involves medication management. Our objective was to evaluate the effectiveness of interventions involving pharmacists to reduce hospital readmissions. PubMed and Google Scholar were searched for primary literature from January 1990 to July 2016 with search terms such as “hospital readmission,” and “Pharmacist,” or “Pharmacy,” or “medications.” Studies with an abstract in English which highlighted a pharmacist involvement based on the type of intervention, country of origin, type of study, and findings were summarized. The outcomes of these interventions to reduce hospital readmissions were mixed. Of the 29 studies, 16 (55%) showed a statistically significant reduction in readmissions ranging from 3.3% to 30%. Most of the interventions focused mainly on patient education postdischarge (8) or in addition to medication reconciliation predischarge (9). There were no studies from Africa or Asia but mainly from the United States (72%). Although multiple factors contribute to hospital readmission, this review highlights the important role pharmacists can play singularly and as part of interdisciplinary teams. Most effective interventions often involved medication review and patient education postdischarge.
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Affiliation(s)
- Quyen N. Bach
- Phoebe Putney Memorial Hospital, Mercer College of Pharmacy, Mercer University, Atlanta, GA, USA
| | - Samuel K. Peasah
- Center for Clinical Outcomes Research and Education (CCORE), Mercer College of Pharmacy, Mercer University, Atlanta, GA, USA
| | - Elizabeth Barber
- Phoebe Putney Memorial Hospital, Mercer College of Pharmacy, Mercer University, Atlanta, GA, USA
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Khalil H, Bell B, Chambers H, Sheikh A, Avery AJ. Professional, structural and organisational interventions in primary care for reducing medication errors. Cochrane Database Syst Rev 2017; 10:CD003942. [PMID: 28977687 PMCID: PMC6485628 DOI: 10.1002/14651858.cd003942.pub3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Medication-related adverse events in primary care represent an important cause of hospital admissions and mortality. Adverse events could result from people experiencing adverse drug reactions (not usually preventable) or could be due to medication errors (usually preventable). OBJECTIVES To determine the effectiveness of professional, organisational and structural interventions compared to standard care to reduce preventable medication errors by primary healthcare professionals that lead to hospital admissions, emergency department visits, and mortality in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two trial registries on 4 October 2016, together with reference checking, citation searching and contact with study authors to identify additional studies. We also searched several sources of grey literature. SELECTION CRITERIA We included randomised trials in which healthcare professionals provided community-based medical services. We also included interventions in outpatient clinics attached to a hospital where people are seen by healthcare professionals but are not admitted to hospital. We only included interventions that aimed to reduce medication errors leading to hospital admissions, emergency department visits, or mortality. We included all participants, irrespective of age, who were prescribed medication by a primary healthcare professional. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data. Each of the outcomes (hospital admissions, emergency department visits, and mortality), are reported in natural units (i.e. number of participants with an event per total number of participants at follow-up). We presented all outcomes as risk ratios (RRs) with 95% confidence intervals (CIs). We used the GRADE tool to assess the certainty of evidence. MAIN RESULTS We included 30 studies (169,969 participants) in the review addressing various interventions to prevent medication errors; four studies addressed professional interventions (8266 participants) and 26 studies described organisational interventions (161,703 participants). We did not find any studies addressing structural interventions. Professional interventions included the use of health information technology to identify people at risk of medication problems, computer-generated care suggested and actioned by a physician, electronic notification systems about dose changes, drug interventions and follow-up, and educational interventions on drug use aimed at physicians to improve drug prescriptions. Organisational interventions included medication reviews by pharmacists, nurses or physicians, clinician-led clinics, and home visits by clinicians.There is a great deal of diversity in types of professionals involved and where the studies occurred. However, most (61%) of the interventions were conducted by pharmacists or a combination of pharmacists and medical doctors. The studies took place in many different countries; 65% took place in either the USA or the UK. They all ranged from three months to 4.7 years of follow-up, they all took place in primary care settings such as general practice, outpatients' clinics, patients' homes and aged-care facilities. The participants in the studies were adults taking medications and the interventions were undertaken by healthcare professionals including pharmacists, nurses or physicians. There was also evidence of potential bias in some studies, with only 18 studies reporting adequate concealment of allocation and only 12 studies reporting appropriate protection from contamination, both of which may have influenced the overall effect estimate and the overall pooled estimate. Professional interventionsProfessional interventions probably make little or no difference to the number of hospital admissions (risk ratio (RR) 1.24, 95% confidence interval (CI) 0.79 to 1.96; 2 studies, 3889 participants; moderate-certainty evidence). Professional interventions make little or no difference to the number of participants admitted to hospital (adjusted RR 0.99, 95% CI 0.92 to 1.06; 1 study, 3661 participants; high-certainty evidence). Professional interventions may make little or no difference to the number of emergency department visits (adjusted RR 0.71, 95% CI 0.50 to 1.02; 2 studies, 1067 participants; low-certainty evidence). Professional interventions probably make little or no difference to mortality in the study population (adjusted RR 0.98, 95% CI 0.82 to 1.17; 1 study, 3538 participants; moderate-certainty evidence). Organisational interventionsOverall, it is uncertain whether organisational interventions reduce the number of hospital admissions (adjusted RR 0.85, 95% CI 0.71 to 1.03; 11 studies, 6203 participants; very low-certainty evidence). Overall, organisational interventions may make little difference to the total number of people admitted to hospital in favour of the intervention group compared with the control group (adjusted RR 0.92, 95% CI 0.86 to 0.99; 13 studies, 152,237 participants; low-certainty evidence. Overall, it is uncertain whether organisational interventions reduce the number of emergency department visits in favour of the intervention group compared with the control group (adjusted RR 0.75, 95% CI 0.49 to 1.15; 5 studies, 1819 participants; very low-certainty evidence. Overall, it is uncertain whether organisational interventions reduce mortality in favour of the intervention group (adjusted RR 0.94, 95% CI 0.85 to 1.03; 12 studies, 154,962 participants; very low-certainty evidence. AUTHORS' CONCLUSIONS Based on moderate- and low-certainty evidence, interventions in primary care for reducing preventable medication errors probably make little or no difference to the number of people admitted to hospital or the number of hospitalisations, emergency department visits, or mortality. The variation in heterogeneity in the pooled estimates means that our results should be treated cautiously as the interventions may not have worked consistently across all studies due to differences in how the interventions were provided, background practice, and culture or delivery of the interventions. Larger studies addressing both professional and organisational interventions are needed before evidence-based recommendations can be made. We did not identify any structural interventions and only four studies used professional interventions, and so more work needs to be done with these types of interventions. There is a need for high-quality studies describing the interventions in more detail and testing patient-related outcomes.
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Affiliation(s)
- Hanan Khalil
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, PO Box 973, Moe, Victoria, Australia, 3825
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Arendts G, Burkett E, Hullick C, Carpenter CR, Nagaraj G, Visvanathan R. Frailty, thy name is…. Emerg Med Australas 2017; 29:712-716. [PMID: 28971594 DOI: 10.1111/1742-6723.12869] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Glenn Arendts
- Department of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Ellen Burkett
- Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Carolyn Hullick
- Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Guruprasad Nagaraj
- Emergency Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Renuka Visvanathan
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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The utility of a medical admissions pharmacist in a hospital in Australia. Int J Clin Pharm 2017; 39:403-407. [DOI: 10.1007/s11096-017-0438-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
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Lim LM, McStea M, Chung WW, Nor Azmi N, Abdul Aziz SA, Alwi S, Kamarulzaman A, Kamaruzzaman SB, Chua SS, Rajasuriar R. Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia. PLoS One 2017; 12:e0173466. [PMID: 28273128 PMCID: PMC5342241 DOI: 10.1371/journal.pone.0173466] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/22/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Polypharmacy has been associated with increased morbidity and mortality in the older population. OBJECTIVES The aim of this study was to determine the prevalence, risk factors and health outcomes associated with polypharmacy in a cohort of urban community-dwelling older adults receiving chronic medications in Malaysia. METHODS This was a baseline study in the Malaysian Elders Longitudinal Research cohort. The inclusion criteria were individuals aged ≥55years and taking at least one medication chronically (≥3 months). Participants were interviewed using a structured questionnaire during home visits where medications taken were reviewed. Health outcomes assessed were frequency of falls, functional disability, potential inappropriate medication use (PIMs), potential drug-drug interactions (PDDIs), healthcare utilisation and quality of life (QoL). Risk factors and health outcomes associated with polypharmacy (≥5 medications including dietary supplements) were determined using multivariate regression models. RESULTS A total of 1256 participants were included with a median (interquartile range) age of 69(63-74) years. The prevalence of polypharmacy was 45.9% while supplement users made up 56.9% of the cohort. The risk factors associated with increasing medication use were increasing age, Indian ethnicity, male, having a higher number of comorbidities specifically those diagnosed with cardiovascular, endocrine and gastrointestinal disorders, as well as supplement use. Health outcomes significantly associated with polypharmacy were PIMS, PDDIs and increased healthcare utilisation. CONCLUSION A significant proportion of older adults on chronic medications were exposed to polypharmacy and use of dietary supplements contributed significantly to this. Medication reviews are warranted to reduce significant polypharmacy related issues in the older population.
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Affiliation(s)
- Li Min Lim
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Megan McStea
- The Malaysian Elders Longitudinal Research (MELOR) Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Wen Wei Chung
- Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nuruljannah Nor Azmi
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Azdiah Abdul Aziz
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Faculty of Pharmacy, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Syireen Alwi
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- The Malaysian Elders Longitudinal Research (MELOR) Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siew Siang Chua
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Peter Doherty Institute for Infection and Immunity, Melbourne University, Melbourne, Australia
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Huiskes VJB, Burger DM, van den Ende CHM, van den Bemt BJF. Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials. BMC FAMILY PRACTICE 2017; 18:5. [PMID: 28095780 PMCID: PMC5240219 DOI: 10.1186/s12875-016-0577-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 12/26/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND Medication review is often recommended to optimize medication use. In clinical practice it is mostly operationalized as an intervention without co-interventions during a short term intervention period. However, most systematic reviews also included co-interventions and prolonged medication optimization interventions. Furthermore, most systematic reviews focused on specific patient groups (e.g. polypharmacy, elderly, hospitalized) and/or on specific outcome measures (e.g. hospital admissions and mortality). Therefore, the objective of this study is to assess the effectiveness of medication review as an isolated short-term intervention, irrespective of the patient population and the outcome measures used. METHODS A literature search was performed in MEDLINE, EMBASE and Web of Science from their inception through September 2015. Randomized controlled trials (RCTs) with medication review as isolated short term intervention (<3 months) were included. There were no restrictions with regard to patient characteristics and outcome measures. One reviewer extracted and a second checked data. The risk of bias of studies was evaluated independently by two reviewers. A best evidence synthesis was conducted for every outcome measure used in more than one trial. In case of binary variables a meta-analysis was performed in addition to the best evidence synthesis, to quantify the effect. RESULTS Thirty-one RCTs were included in this systematic review (55% low risk of bias). A best evidence synthesis was conducted for 22 outcome measures. No effect of medication review was found on clinical outcomes (mortality, hospital admissions/healthcare use, the number of patients falling, physical and cognitive functioning), except a decrease in the number of falls per patient. However, in a sensitivity analysis using a more stringent threshold for risk of bias, the conclusion for the effect on the number of falls changed to inconclusive. Furthermore no effect was found on quality of life and evidence was inconclusive about the effect on economical outcome measures. However, an effect was found on most drug-related problems: medication review resulted in a decrease in the number of drug-related problems, more changes in medication, more drugs with dosage decrease and a greater decrease or smaller increase of the number of drugs. CONCLUSIONS An isolated medication review during a short term intervention period has an effect on most drug-related outcomes, minimal effect on clinical outcomes and no effect on quality of life. No conclusion can be drawn about the effect on economical outcome measures. Therefore, it should be considered to stop performing cross-sectional medication reviews as standard care.
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Affiliation(s)
| | - David Marinus Burger
- Department of Pharmacy, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | | | - Bartholomeus Johannes Fredericus van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574 NA Ubbergen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, Maastricht, Peter Debyelaan 15, 6229 HX Maastricht, The Netherlands
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Fitzgerald C, Welch S, Taylor S, Harding A, Graudins L, Lawrence D, Roman C, Curry E, Doran E, Abbott L, Morrow M, Guidone D, Heward S, Wilkinson L. SHPA Standards of Practice in Emergency Medicine Pharmacy Practice. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/jppr.1144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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