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Carollo M, Crisafulli S, Vitturi G, Besco M, Hinek D, Sartorio A, Tanara V, Spadacini G, Selleri M, Zanconato V, Fava C, Minuz P, Zamboni M, Trifirò G. Clinical impact of medication review and deprescribing in older inpatients: A systematic review and meta-analysis. J Am Geriatr Soc 2024. [PMID: 38822740 DOI: 10.1111/jgs.19035] [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: 02/17/2024] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Polypharmacy is a primary risk factor for the prescription of potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and ultimately, adverse drug reactions (ADRs). Medication review and deprescribing represent effective strategies to simplify therapeutic regimens, minimize risks, and reduce PIM prescriptions. This systematic review and meta-analysis of experimental and observational studies aimed to evaluate the impact of different medication review and deprescribing interventions in hospitalized older patients. METHODS Experimental and observational prospective cohort studies evaluating the clinical effects of medication review and deprescribing strategies in older hospitalized patients were searched in the bibliographic databases, PubMed, Embase, and Scopus, from inception until January 8, 2024. A narrative synthesis of the results was provided, along with a meta-analysis of dichotomous data (i.e., re-hospitalizations and mortality). RESULTS Overall, 21 randomized controlled trials, 7 non-randomized interventional studies, and 2 prospective cohort studies were included in the systematic review. Of these, 14 (46.7%) assessed medication appropriateness as the primary outcome, while the remaining evaluated clinical outcomes (e.g., length of hospital stay, hospital readmissions, emergency department visits, and incidence of ADRs) and/or quality of life. The meta-analysis revealed a slight but statistically significant 8% reduction in hospital readmissions (HR: 0.92; 95% CI: 0.85-0.99) following medication review and deprescribing, but no significant impact on mortality (HR: 0.98; 95% CI: 0.96-1.00). Of the 30 included studies, 21 were considered at high risk of bias, mostly due to potential deviations from intended interventions and randomization processes. The remaining nine studies had "some concerns" (eight studies) or were considered at "low" risk of bias (one study). CONCLUSION Medication review and deprescribing are associated with potential benefits in reducing hospital readmission rates among hospitalized older patients, particularly through the reduction of PIM prescriptions. The integration of thorough medication review and deprescribing protocols in hospital settings may improve post-discharge outcomes and reduce overall healthcare costs.
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Affiliation(s)
- Massimo Carollo
- Department of Diagnostics and Public Health, Clinical Pharmacology Unit, University of Verona, Verona, Italy
| | | | - Giacomo Vitturi
- Department of Diagnostics and Public Health, Clinical Pharmacology Unit, University of Verona, Verona, Italy
| | - Matilde Besco
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Damiano Hinek
- Department of Pharmacy, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Andrea Sartorio
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | - Valentina Tanara
- Department of Pharmacy, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giulia Spadacini
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Margherita Selleri
- Department of Diagnostics and Public Health, Clinical Pharmacology Unit, University of Verona, Verona, Italy
| | - Valentina Zanconato
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | - Cristiano Fava
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | - Pietro Minuz
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Surgery, Dentistry, Pediatric and Gynecology, Section of Geriatric Medicine, University of Verona, Verona, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, Clinical Pharmacology Unit, University of Verona, Verona, Italy
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease: the MIMeRiC randomized controlled trial. BMC Cardiovasc Disord 2021; 21:367. [PMID: 34334142 PMCID: PMC8327441 DOI: 10.1186/s12872-021-02178-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/23/2021] [Indexed: 01/22/2023] Open
Abstract
Background In the treatment of coronary heart disease, secondary prevention goals are still often unmet and poor adherence to prescribed drugs has been suggested as one of the reasons. We aimed to investigate whether pharmaceutical care by a pharmacist at the cardiology clinic trained in motivational interviewing improves clinical outcomes and patient adherence. Methods This was a prospective, randomized, controlled, outcomes-blinded trial designed to compare pharmaceutical care follow-up with standard care. After standard follow-up at the cardiology clinic, patients in the intervention group were seen by a clinical pharmacist two to five times as required over seven months. Pharmacists were trained to use motivational interviewing in the consultations and they tailored their support to each patient’s clinical needs and beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patient adherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the effects on patient adherence to other preventive drugs, systolic blood pressure, disease-specific quality of life, and healthcare use. Results 316 patients were included. The proportion of patients who reached the target for low-density lipoprotein cholesterol were 37.0% in the intervention group and 44.2% in the control group (P = .263). More intervention than control patients were adherent to cholesterol-lowering drugs (88 vs 77%; P = .033) and aspirin (97 vs 91%; P = .036) but not to beta-blocking agents or renin–angiotensin–aldosterone system inhibitors. Conclusions Our intervention had no positive effects on risk factors for CHD, but it increased patient adherence. Further investigation of the intervention process is needed to explore the difference in results between patient adherence and medication effects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful effect on patient health. Trial registration: ClinicalTrials.gov NCT02102503, 03/04/2014 retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02178-0.
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Affiliation(s)
- Malin Johansson Östbring
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden. .,Pharmaceutical Department, Region Kalmar County, Building 2, floor 2, County Council Hospital, 391 85, Kalmar, Sweden.
| | - Tommy Eriksson
- Department of Biomedical Science, and Biofilm - Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Building 2, floor 2, County Council Hospital, 391 85, Kalmar, Sweden
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3
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Kurteva S, Tamblyn R, Khosrow-Khavar F, Meguerditchian AN. Postoperative duration of opioid use and acute healthcare services use in cancer patients hospitalized for thoracic surgery. J Surg Oncol 2021; 124:431-440. [PMID: 33893741 DOI: 10.1002/jso.26504] [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] [Received: 10/28/2020] [Revised: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative pain control is an important cancer care component. However, opioid consumption has resulted in a surge of adverse events, with thoracic surgery patients having the highest rate of persistent use. The effect of opioid duration post-discharge and the risk of increased acute healthcare use in this population remains unclear. METHODS A prospective cohort of non-metastatic cancer patients was assembled from an academic health center in Montreal (Canada). Clinical data linked to administrative claims from the universal healthcare program was used to determine the association between time-varying opioid patterns and emergency department (ED) visits/re-admissions/death 3 months following thoracic surgery. RESULTS Of the 610 patients, 77% had at least one opioid dispensed post-discharge. Compared to non-opioid users, <15 days of use was associated with a 42% decreased risk of acute healthcare events, adjusted HR 0.58, 95% CI (0.40-0.85); longer durations were not associated with an increased risk. Compared to short-term use (<15 days), use of >30 days was associated with a 72% increased risk of the outcome, aHR: 1.72, 95% CI (1.01-2.93). CONCLUSION There was a variation in the risk of acute healthcare use associated with postsurgical opioid use. Findings from this study may be used to inform postoperative prescribing practices.
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Affiliation(s)
- Siyana Kurteva
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Farzin Khosrow-Khavar
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ari N Meguerditchian
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.,St. Mary's Research Institute, Montreal, Quebec, Canada
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4
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Hellström L, Eriksson T, Bondesson Å. Prospective observational study of medication reviews in internal medicine wards: evaluation of drug-related problems. Eur J Hosp Pharm 2020; 28:e128-e133. [PMID: 33199398 DOI: 10.1136/ejhpharm-2020-002492] [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] [Received: 08/13/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from the medication reconciliation process. There is a need also to describe the medication review process. OBJECTIVE To describe the frequency and types of drug-related problems (DRPs) identified during medication reviews and to evaluate the actions of the pharmacists and the physicians regarding the identified DRPs. METHOD Structured medication reviews were conducted by a multi-professional team on top of standard care for 719 patients in two internal medicine wards in a Swedish University Hospital. The medication reviews were studied retrospectively to classify DRPs and actions taken. RESULTS A total of 573 (80%) of patients had at least one actual DRP; an average of three DRPs per patient and in total 2164. Wrong drug and adverse drug reaction were the most common types of DRPs. The most frequent medication groups involved in DRPs were drugs for the cardiovascular system and the nervous system and the most frequent substances were warfarin, digoxin, furosemide and paracetamol. The 10 most common medications accounted for 27% of the actual DRPs. Of the identified DRPs, a total of 1740 (80%) were acted on. The three most common types of adjustments made were withdrawal of drug therapy, change of drug therapy and initiation of drug therapy. When the pharmacist suggested an adjustment, the physician implemented 88% (1037/1174) of the recommendations. CONCLUSION DRPs are common among elderly patients who are admitted to hospital. Systematic identification of high-risk medications and common DRP types enables targeting of prioritised patients for medication reviews.
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Affiliation(s)
- Lina Hellström
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden .,Biofilm - Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Åsa Bondesson
- Department of Medicines Management and Informatics, Skåne County Council, Kristianstad, Sweden
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5
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Linkens AEMJH, Milosevic V, van der Kuy PHM, Damen-Hendriks VH, Mestres Gonzalvo C, Hurkens KPGM. Medication-related hospital admissions and readmissions in older patients: an overview of literature. Int J Clin Pharm 2020; 42:1243-1251. [PMID: 32472324 PMCID: PMC7522062 DOI: 10.1007/s11096-020-01040-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 04/16/2020] [Indexed: 01/26/2023]
Abstract
Background The number of medication related hospital admissions and readmissions are increasing over the years due to the ageing population. Medication related hospital admissions and readmissions lead to decreased quality of life and high healthcare costs. Aim of the review To assess what is currently known about medication related hospital admissions, medication related hospital readmissions, their risk factors, and possible interventions which reduce medication related hospital readmissions. Method We searched PubMed for articles about the topic medication related hospital admissions and readmissions. Overall 54 studies were selected for the overview of literature. Results Between the different selected studies there was much heterogeneity in definitions for medication related admission and readmissions, in study population and the way studies were performed. Multiple risk factors are found in the studies for example: polypharmacy, comorbidities, therapy non adherence, cognitive impairment, depending living situation, high risk medications and higher age. Different interventions are studied to reduce the number of medication related readmission, some of these interventions may reduce the readmissions like the participation of a pharmacist, education programmes and transition-of-care interventions and the use of digital assistance in the form of Clinical Decision Support Systems. However the methods and the results of these interventions show heterogeneity in the different researches. Conclusion There is much heterogeneity in incidence and definitions for both medication related hospital admissions and readmissions. Some risk factors are known for medication related admissions and readmissions such as polypharmacy, older age and additional diseases. Known interventions that could possibly lead to a decrease in medication related hospital readmissions are spare being the involvement of a pharmacist, education programs and transition-care interventions the most mentioned ones although controversial results have been reported. More research is needed to gather more information on this topic.
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Affiliation(s)
- A E M J H Linkens
- Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - V Milosevic
- Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, PO box 5500, 6130 MB, Sittard, The Netherlands
| | - P H M van der Kuy
- Department of Clinical Pharmacy, Erasmus Medical Centre, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - V H Damen-Hendriks
- Department of Internal Medicine, Zuyderland Medical Centre, PO box 5500, 6130 MB, Sittard, Geleen, The Netherlands
| | - C Mestres Gonzalvo
- Department of Clinical Pharmacy, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - K P G M Hurkens
- Department of Internal Medicine, Zuyderland Medical Centre, PO box 5500, 6130 MB, Sittard, Geleen, The Netherlands
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de Lorenzo-Pinto A, García-Sánchez R, Herranz A, Miguens I, Sanjurjo-Sáez M. Promoting clinical pharmacy services through advanced medication review in the emergency department. Eur J Hosp Pharm 2020; 27:73-77. [PMID: 32133132 DOI: 10.1136/ejhpharm-2018-001599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 11/04/2022] Open
Abstract
Objectives To determine if an advanced medication review carried out in the emergency department (ED) increases the number of pharmacotherapy recommendations (PR) and the severity of the detected prescribing errors. Methods We designed an analytic observational prospective cohort study with preintervention assessment (PRE) and postintervention assessment (POST). In PRE, prescription review was done by pharmacists located in the pharmacy department; they took into account only the information provided by the computerised physician order entry system. In POST, pharmacists were physically present in the ED and performed an advanced medication review. The main variables were number of PR and the severity of detected prescribing errors according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index. Clinical variables were number of calls to physicians on duty during the first 48 hours of admission, readmissions at 30 days, visits to the ED at 30 days, inhospital mortality and length of stay. Results The study population comprised 102 patients (51 in PRE and 51 in POST). In PRE, the number of PR per patient was 1.1; in POST, this value increased by 53% (1.7 PR per patient; P=0.014), especially in the case of PR related to home medications. The severity of prescribing errors was higher in POST (P=0.004). There was a trend towards better results for all clinical outcomes in POST although statistical significance was not reached. Conclusions An advanced medication review in the ED increases the number of PR and the severity of the detected prescribing errors.
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Affiliation(s)
- Ana de Lorenzo-Pinto
- Pharmacy Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Raquel García-Sánchez
- Pharmacy Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz
- Pharmacy Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Iria Miguens
- Emergency Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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7
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Caleres G, Modig S, Midlöv P, Chalmers J, Bondesson Å. Medication Discrepancies in Discharge Summaries and Associated Risk Factors for Elderly Patients with Many Drugs. Drugs Real World Outcomes 2019; 7:53-62. [PMID: 31834621 PMCID: PMC7060975 DOI: 10.1007/s40801-019-00176-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background and Objective Elderly patients are at high risk for medication errors in care transitions. The discharge summary aims to counteract drug-related problems due to insufficient information transfer in care transitions, hence the accuracy of its medication information is of utmost importance. The purpose of this study was to describe the medication discrepancy rate and associated risk factors in discharge summaries for elderly patients. Methods Pharmacists collected random samples of discharge summaries from ten hospitals in southern Sweden. Medication discrepancies, organisational, and patient- and care-specific factors were noted. Patients aged ≥ 75 years with five or more drugs were further included. Descriptive and logistic regression analyses were performed. Results Discharge summaries for a total of 933 patients were included. Average age was 83.1 years, and 515 patients (55%) were women. Medication discrepancies were noted for 353 patients (38%) (mean 0.87 discrepancies per discharged patient, 95% confidence interval 0.76–0.98). Unintentional addition of a drug was the most common discrepancy type. Central nervous system drugs/analgesics were most commonly affected. Major risk factors for the presence of discrepancies were multi-dose drug dispensing (adjusted odds ratio 3.42, 95% confidence interval 2.48–4.74), an increasing number of drugs in the discharge summary (adjusted odds ratio 1.09, 95% confidence interval 1.05–1.13) and discharge from departments of surgery (adjusted odds ratio 2.96, 95% confidence interval 1.55–5.66). By contrast, an increasing number of drug changes reduced the odds of a discrepancy (adjusted odds ratio 0.93, 95% confidence interval 0.88–0.99). Conclusions Medication discrepancies were common. In addition, we identified certain circumstances in which greater vigilance may be of considerable value for increased medication safety for elderly patients in care transitions.
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Affiliation(s)
- Gabriella Caleres
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, 20213, Malmö, Sweden.
| | - Sara Modig
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, 20213, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, Kristianstad, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, 20213, Malmö, Sweden
| | - John Chalmers
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Åsa Bondesson
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, 20213, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, Kristianstad, Sweden
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8
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An inventory of collaborative medication reviews for older adults - evolution of practices. BMC Geriatr 2019; 19:321. [PMID: 31752700 PMCID: PMC6873748 DOI: 10.1186/s12877-019-1317-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/15/2019] [Indexed: 12/04/2022] Open
Abstract
Background Collaborative medication review (CMR) practices for older adults are evolving in many countries. Development has been under way in Finland for over a decade, but no inventory of evolved practices has been conducted. The aim of this study was to identify and describe CMR practices in Finland after 10 years of developement. Methods An inventory of CMR practices was conducted using a snowballing approach and an open call in the Finnish Medicines Agency’s website in 2015. Data were quantitatively analysed using descriptive statistics and qualitatively by inductive thematic content analysis. Clyne et al’s medication review typology was applied for evaluating comprehensiveness of the practices. Results In total, 43 practices were identified, of which 22 (51%) were designed for older adults in primary care. The majority (n = 30, 70%) of the practices were clinical CMRs, with 18 (42%) of them being in routine use. A checklist with criteria was used in 19 (44%) of the practices to identify patients with polypharmacy (n = 6), falls (n = 5), and renal dysfunction (n = 5) as the most common criteria for CMR. Patients were involved in 32 (74%) of the practices, mostly as a source of information via interview (n = 27, 63%). A medication care plan was discussed with the patient in 17 practices (40%), and it was established systematically as usual care to all or selected patient groups in 11 (26%) of the practices. All or selected patients’ medication lists were reconciled in 15 practices (35%). Nearly half of the practices (n = 19, 44%) lacked explicit methods for following up effects of medication changes. When reported, the effects were followed up as a routine control (n = 9, 21%) or in a follow-up appointment (n = 6, 14%). Conclusions Different MRs in varying settings were available and in routine use, the majority being comprehensive CMRs designed for primary outpatient care and for older adults. Even though practices might benefit from national standardization, flexibility in their customization according to context, medical and patient needs, and available resources is important.
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Skjøt-Arkil H, Lundby C, Kjeldsen LJ, Skovgårds DM, Almarsdóttir AB, Kjølhede T, Duedahl TH, Pottegård A, Graabaek T. Multifaceted Pharmacist-led Interventions in the Hospital Setting: A Systematic Review. Basic Clin Pharmacol Toxicol 2018; 123:363-379. [PMID: 29723934 DOI: 10.1111/bcpt.13030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/19/2018] [Indexed: 11/30/2022]
Abstract
Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist-led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed articles published from 2006 to 1 March 2018. Controlled trials concerning hospitalized patients in any setting receiving patient-related multifaceted pharmacist-led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two independent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi-centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient-reported outcome (n = 7) and cost-effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharmacist-led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient-reported outcome and cost-effectiveness.
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Affiliation(s)
- Helene Skjøt-Arkil
- Emergency Department, Hospital of Southern Jutland, Aabenraa, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Carina Lundby
- Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark
| | | | | | | | - Tue Kjølhede
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Tina Hoff Duedahl
- Telepsychiatric Centre, The Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Anton Pottegård
- Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Trine Graabaek
- Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark
- Department of Quality, Hospital of South West Jutland, Esbjerg, Denmark
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10
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Al-Hashar A, Al-Zakwani I, Eriksson T, Sarakbi A, Al-Zadjali B, Al Mubaihsi S, Al Za'abi M. Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use. Int J Clin Pharm 2018; 40:1154-1164. [PMID: 29754251 DOI: 10.1007/s11096-018-0650-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
Abstract
Background Adverse drug events from preventable medication errors can result in patient morbidity and mortality, and in cost to the healthcare system. Medication reconciliation can improve communication and reduce medication errors at transitions in care. Objective Evaluate the impact of medication reconciliation and counselling intervention delivered by a pharmacist for medical patients on clinical outcomes 30 days after discharge. Setting Sultan Qaboos University Hospital, Muscat, Oman. Methods A randomized controlled study comparing standard care with an intervention delivered by a pharmacist and comprising medication reconciliation on admission and discharge, a medication review, a bedside medication counselling, and a take-home medication list. Medication discrepancies during hospitalization were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records and telephone interviews. Main outcome measures Rates of preventable adverse drug events as primary outcome and healthcare resource utilization as secondary outcome at 30 days post discharge. Results A total of 587 patients were recruited (56 ± 17 years, 57% female); 286 randomized to intervention; 301 in the standard care group. In intervention arm, 74 (26%) patients had at least one discrepancy on admission and 100 (35%) on discharge. Rates of preventable adverse drug events were significantly lower in intervention arm compared to standard care arm (9.1 vs. 16%, p = 0.009). No significant difference was found in healthcare resource use. Conclusion The implementation of an intervention comprising medication reconciliation and counselling by a pharmacist has significantly reduced the rate of preventable ADEs 30 days post discharge, compared to the standard care. The effect of the intervention on healthcare resource use was insignificant. Pharmacists should be included in decentralized, patient-centred roles. The findings should be interpreted in the context of the study's limitations.
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Affiliation(s)
- Amna Al-Hashar
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman.
| | - Ibrahim Al-Zakwani
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Tommy Eriksson
- Department of Biomedical Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Alaa Sarakbi
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Badriya Al-Zadjali
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Saif Al Mubaihsi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al Za'abi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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11
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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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12
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Cheema E, Alhomoud FK, Kinsara ASALD, Alsiddik J, Barnawi MH, Al-Muwallad MA, Abed SA, Elrggal ME, Mohamed MMA. The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2018; 13:e0193510. [PMID: 29590146 PMCID: PMC5873985 DOI: 10.1371/journal.pone.0193510] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 02/13/2018] [Indexed: 11/18/2022] Open
Abstract
Background Adverse drug events (ADEs) impose a major clinical and cost burden on acute hospital services. It has been reported that medicines reconciliation provided by pharmacists is effective in minimizing the chances of hospital admissions related to adverse drug events. Objective To update the previous assessment of pharmacist-led medication reconciliation by restricting the review to randomized controlled trials (RCTs) only. Methods Six major online databases were sifted up to 30 December 2016, without inception date (Embase, Medline Ovid, PubMed, BioMed Central, Web of Science and Scopus) to assess the effect of pharmacist-led interventions on medication discrepancies, preventable adverse drug events, potential adverse drug events and healthcare utilization. The Cochrane tool was applied to evaluate the chances of bias. Meta-analysis was carried out using a random effects model. Results From 720 articles identified on initial searching, 18 RCTs (6,038 patients) were included. The quality of the included studies was variable. Pharmacists-led interventions led to an important decrease in favour of the intervention group, with a pooled risk ratio of 42% RR 0.58 (95% CI 0.49 to 0.67) P<0.00001 in medication discrepancy. Reductions in healthcare utilization by 22% RR 0.78 (95% CI 0.61 to 1.00) P = 0.05, potential ADEs by10% RR 0.90 (95% CI 0.78 to 1.03) P = 0.65 and preventable ADEs by 27% RR 0.73 (0.22 to 2.40) P = 0.60 were not considerable. Conclusion Pharmacists-led interventions were effective in reducing medication discrepancies. However, these interventions did not lead to a significant reduction in potential and preventable ADEs and healthcare utilization.
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Affiliation(s)
- Ejaz Cheema
- Department of Clinical and Pharmacy Practice, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia
- Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, United Kingdom
- * E-mail:
| | - Farah Kais Alhomoud
- Department of Clinical and Pharmacy Practice, School of Clinical Pharmacy, University of Dammam, Dammam, Saudi Arabia
| | - Amnah Shams AL-Deen Kinsara
- Department of Clinical and Pharmacy Practice, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia
| | - Jomanah Alsiddik
- Department of Clinical and Pharmacy Practice, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia
| | - Marwah Hassan Barnawi
- Department of Clinical and Pharmacy Practice, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia
| | - Morooj Abdullah Al-Muwallad
- Department of Clinical and Pharmacy Practice, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia
| | - Shatha Abdulbaset Abed
- Department of Clinical and Pharmacy Practice, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia
| | - Mahmoud E. Elrggal
- Department of Clinical and Pharmacy Practice, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia
| | - Mahmoud M. A. Mohamed
- Department of Clinical and Pharmacy Practice, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia
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13
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Protocol for a Randomized Controlled Trial Investigating Effects on Clinical Outcomes, Adherence, and Quality of Life. JMIR Res Protoc 2018; 7:e57. [PMID: 29463490 PMCID: PMC5840476 DOI: 10.2196/resprot.8659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preventive treatment goals for blood pressure and cholesterol levels continue to be unmet for many coronary patients. The effect of drug treatment depends on both its appropriateness and the patients' adherence to the treatment regimen. There is a need for adherence interventions that have a measurable effect on clinical outcomes. OBJECTIVE This study aims to evaluate the effects on treatment goals of an intervention designed to improve patient adherence and treatment quality in secondary prevention of coronary heart disease. A protocol for the prespecified process evaluation of the trial is published separately. METHODS The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a prospective, randomized, outcomes-blinded trial designed to compare individualized follow-up by a clinical pharmacist using motivational interviewing (MI) and medication review with standard follow-up. Patients were randomized to 2 groups after stratification according to their beliefs about medicines. After standard follow-up at the cardiology clinic, patients in the intervention group are seen individually by a clinical pharmacist 2 to 5 times as required over 7 months, at the clinic. The pharmacist reviews each patient's medication and uses MI to manage any problems with prescribing and adherence. The primary study outcome is the proportion of patients who have reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. Secondary outcomes are the effects on patient adherence, systolic blood pressure, disease-specific quality of life, and health care use. RESULTS The protocol for this study was approved by the Regional Ethics Committee, Linköping, in 2013. Enrollment started in October 2013 and ended in December 2016 when 417 patients had been included. Follow-up data collection will conclude in March 2018. Publication of the primary and secondary outcome results from the MIMeRiC trial is anticipated in 2019. CONCLUSIONS The MIMeRiC trial will assess the effectiveness of an intervention involving medication reviews and individualized support. The results will inform the continued development of support for this large group of patients who use preventive medicines for lifelong treatment. The design of this adherence intervention is based on a theoretical framework and is the first trial of an intervention that uses beliefs about medicines to individualize the intervention protocol. TRIAL REGISTRATION ClinicalTrials.gov NCT02102503; https://clinicaltrials.gov/ct2/show/NCT02102503 (Archived by WebCite at http://www.webcitation.org/6x7iUDohy).
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Affiliation(s)
- Malin Johansson Östbring
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden.,eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden.,Department of Clinical and Molecular Medicine, Norweigan University of Sciences and Technology, Trondheim, Norway
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden
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14
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Intervention Development and Protocol for the Process Evaluation. JMIR Res Protoc 2018; 7:e21. [PMID: 29382630 PMCID: PMC5811650 DOI: 10.2196/resprot.8660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/24/2017] [Accepted: 11/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Trials of complex interventions are often criticized for being difficult to interpret because the effects of apparently similar interventions vary across studies dependent on context, targeted groups, and the delivery of the intervention. The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a randomized controlled trial (RCT) of an intervention aimed at improving pharmacological secondary prevention. Guidelines for the development and evaluation of complex interventions have recently highlighted the need for better reporting of the development of interventions, including descriptions of how the intervention is assumed to work, how this theory informed the process evaluation, and how the process evaluation relates to the outcome evaluation. OBJECTIVE This paper aims to describe how the intervention was designed and developed. The aim of the process evaluation is to better understand how and why the intervention in the MIMeRiC trial was effective or not effective. METHODS The research questions for evaluating the process are based on the conceptual model of change processes assumed in the intervention and will be analyzed by qualitative and quantitative methods. Quantitative data are used to evaluate the medication review in terms of drug-related problems, to describe how patients' beliefs about medicines are affected by the intervention, and to evaluate the quality of motivational interviewing. Qualitative data will be used to analyze whether patients experienced the intervention as intended, how cardiologists experienced the collaboration and intervention, and how the intervention affected patients' overall experience of care after coronary heart disease. RESULTS The development and piloting of the intervention are described in relation to the theoretical framework. Data for the process evaluation will be collected until March 2018. Some process evaluation questions will be analyzed before, and others will be analyzed after the outcomes of the MIMeRiC RCT are known. CONCLUSIONS This paper describes the framework for the design of the intervention tested in the MIMeRiC trial, development of the intervention from the pilot stage to the complete trial intervention, and the framework and methods for the process evaluation. Providing the protocol of the process evaluation allows prespecification of the processes that will be evaluated, because we hypothesize that they will determine the outcomes of the MIMeRiC trial. This protocol also constitutes a contribution to the new field of process evaluations as made explicit in health services research and clinical trials of complex interventions.
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Affiliation(s)
- Malin Johansson Östbring
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden.,eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden.,Department of Clinical and Molecular Medicine, Norwegian University of Sciences and Technology, Trondheim, Norway
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden
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15
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Clinical Outcomes Used in Clinical Pharmacy Intervention Studies in Secondary Care. PHARMACY 2017; 5:pharmacy5020028. [PMID: 28970440 PMCID: PMC5597153 DOI: 10.3390/pharmacy5020028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/30/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022] Open
Abstract
The objective was to investigate type, frequency and result of clinical outcomes used in studies to assess the effect of clinical pharmacy interventions in inpatient care. The literature search using Pubmed.gov was performed for the period up to 2013 using the search phrases: “Intervention(s)” and “pharmacist(s)” and “controlled” and “outcome(s)” or “effect(s)”. Primary research studies in English of controlled, clinical pharmacy intervention studies, including outcome evaluation, were selected. Titles, abstracts and full-text papers were assessed individually by two reviewers, and inclusion was determined by consensus. In total, 37 publications were included in the review. The publications presented similar intervention elements but differed in study design. A large variety of outcome measures (135) had been used to evaluate the effect of the interventions; most frequently clinical measures/assessments by physician and health care service use. No apparent pattern was established among primary outcome measures with significant effect in favour of the intervention, but positive effect was most frequently related to studies that included power calculations and sufficient inclusion of patients (73% vs. 25%). This review emphasizes the importance of considering the relevance of outcomes selected to assess clinical pharmacy interventions and the importance of conducting a proper power calculation.
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16
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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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17
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Gutiérrez Valencia M, Martínez Velilla N, Lacalle Fabo E, Beobide Telleria I, Larrayoz Sola B, Tosato M. Interventions to optimize pharmacologic treatment in hospitalized older adults: A systematic review. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2016.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Mekonnen AB, McLachlan AJ, Brien JAE. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open 2016; 6:e010003. [PMID: 26908524 PMCID: PMC4769405 DOI: 10.1136/bmjopen-2015-010003] [Citation(s) in RCA: 284] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Pharmacists play a role in providing medication reconciliation. However, data on effectiveness on patients' clinical outcomes appear inconclusive. Thus, the aim of this study was to systematically investigate the effect of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions. DESIGN Systematic review and meta-analysis. METHODS We searched PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO from inception to December 2014. Included studies were all published studies in English that compared the effectiveness of pharmacist-led medication reconciliation interventions to usual care, aimed at improving medication reconciliation programmes. Meta-analysis was carried out using a random effects model, and subgroup analysis was conducted to determine the sources of heterogeneity. RESULTS 17 studies involving 21,342 adult patients were included. Eight studies were randomised controlled trials (RCTs). Most studies targeted multiple transitions and compared comprehensive medication reconciliation programmes including telephone follow-up/home visit, patient counselling or both, during the first 30 days of follow-up. The pooled relative risks showed a more substantial reduction of 67%, 28% and 19% in adverse drug event-related hospital revisits (RR 0.33; 95% CI 0.20 to 0.53), emergency department (ED) visits (RR 0.72; 95% CI 0.57 to 0.92) and hospital readmissions (RR 0.81; 95% CI 0.70 to 0.95) in the intervention group than in the usual care group, respectively. The pooled data on mortality (RR 1.05; 95% CI 0.95 to 1.16) and composite readmission and/or ED visit (RR 0.95; 95% CI 0.90 to 1.00) did not differ among the groups. There was significant heterogeneity in the results related to readmissions and ED visits, however. Subgroup analyses based on study design and outcome timing did not show statistically significant results. CONCLUSION Pharmacist-led medication reconciliation programmes are effective at improving post-hospital healthcare utilisation. This review supports the implementation of pharmacist-led medication reconciliation programmes that include some component aimed at improving medication safety.
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Affiliation(s)
- Alemayehu B Mekonnen
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, Australia
| | - Jo-anne E Brien
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, St Vincent's Hospital Clinical School, University of New South Wales, Sydney, Australia
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19
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[Interventions to optimize pharmacologic treatment in hospitalized older adults: a systematic review]. Rev Clin Esp 2016; 216:205-21. [PMID: 26899140 DOI: 10.1016/j.rce.2016.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To summarise the evidence on interventions aimed at optimising the drug treatment of hospitalised elderly patients. MATERIAL AND METHODS We conducted a search in the main medical literature databases, selecting prospective studies of hospitalised patients older than 65 years who underwent interventions aimed at optimising drug treatment, decreasing polypharmacy and improving the medication appropriateness, health outcomes and exploitation of the healthcare system. RESULTS We selected 18 studies whose interventions consisted of medication reviews, detection of predefined drugs as potentially inappropriate for the elderly, counselling from a specialised geriatric team, the use of a computer support system for prescriptions and specific training for the nursing team. Up to 14 studies assessed the medication appropriateness, 13 of which showed an improvement in one or more of the parameters. Seven studies measured the impact of the intervention on polypharmacy, but only one improved the outcomes compared with the control. Seven other studies analysed mortality, but none of them showed a reduction in that rate. Only 1 of 6 studies showed a reduction in the number of hospital readmissions, and 1 of 4 studies showed a reduction in the number of emergency department visits. CONCLUSIONS Despite the heterogeneity of the analysed interventions and variables, we obtained better results in the process variables (especially in medication appropriateness) than in those that measured health outcomes, which had greater variability.
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20
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Lehnbom EC, Stewart MJ, Manias E, Westbrook JI. Impact of Medication Reconciliation and Review on Clinical Outcomes. Ann Pharmacother 2014; 48:1298-312. [DOI: 10.1177/1060028014543485] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the evidence regarding the effectiveness of medication reconciliation and review and to improve clinical outcomes in hospitals, the community, and aged care facilities. Data Source: This systematic review was undertaken in concordance with the PRISMA statement. Electronic databases, including MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for relevant articles published between January 2000 and March 2014. Study Selection and Data Extraction: Randomized and nonrandomized studies rating the severity of medication discrepancies and medication-related problems identified during medication reconciliation and/or review were considered for inclusion. Data were extracted independently by 2 authors using a data collection form. Data Synthesis: Of the 5292 articles identified, 83 articles met the inclusion criteria. Medication reconciliation identified unintentional medication discrepancies in 3.4% to 98.2% of patients. There is limited evidence of the potential of these discrepancies to cause harm. Medication reviews identified medication-related problems or possible adverse drug reactions in 17.2% to 94.0% of patients. The studies reported conflicting findings regarding the impact of medication review on length of stays, readmissions, and mortality. Conclusions: The evidence demonstrates that medication reconciliation has the potential to identify many medication discrepancies and reduce potential harm, but the impact on clinical outcomes is less clear. Similarly, medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Overall, there is limited evidence that medication reconciliation and medication review processes, as currently performed, significantly improve clinical outcomes, such as reductions in hospital readmissions.
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Affiliation(s)
- Elin C. Lehnbom
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
| | - Michael J. Stewart
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
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21
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Eriksson T. Results from a project to develop systematic patient focused clinical pharmacy services. The Lund Integrated Medicines Management model. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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