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Rodríguez-Ramallo H, Báez-Gutiérrez N, Villalba-Moreno Á, Jaramillo Ruiz D, Santos-Ramos B, Prado-Mel E, Sanchez-Fidalgo S. Reducing the drug burden of sedative and anticholinergic medications in older adults: a scoping review of explicit decision criteria. Arch Gerontol Geriatr 2024; 121:105365. [PMID: 38364710 DOI: 10.1016/j.archger.2024.105365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/27/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To describe the extent, characteristics, and knowledge gaps regarding explicit decision criteria for deprescribing drugs with anticholinergic or sedative properties (Ach/Sed) in older adults. DESIGN Scoping review. SETTING AND PARTICIPANTS Original studies, clinical trial protocols, grey literature, and Summaries of Product Characteristics. METHODS Searches targeting explicit decision criteria for deprescribing Ach/Sed were performed across MEDLINE, EMBASE, CINAHL, and Web of Science, including trial registries (clinicaltrials.gov, ICTRP, EU-CTR, ANZCTR) for pertinent articles, study protocols. Additionally, to encompass non-traditional or 'grey literature' sources, Google searches and relevant agency websites were explored, alongside the summary of product characteristics for Ach/Sed. RESULTS The initial literature search identified 8,192 unique data sources. After review, 188 original articles or books, 79 internet sources, and 127 SmPCs were included. Examining these sources for explicit criteria for 154 Ach/Sed, overall, 1,271 explicit criteria guidance for identifying clinical scenarios warranting deprescription of Ach/Sed across 145/154 Ach/Sed were identified. These criteria were identified mainly from qualitative research and Summaries of Product Characteristics. Additionally, 455 criteria-based recommendations suggesting approaches for tapering implementation across 76/154 Ach/Sed were identified, mostly from sources classified as expert opinions. Significant heterogeneity was found across the approaches for tapering Ach/Sed. CONCLUSIONS This scoping review provides a comprehensive overview of the literature providing guidance for clinical scenarios where Ach/Sed should be deprescribed and highlights the existing knowledge gaps regarding comprehensive guidance on tapering these drugs which warranties future research and development.
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Affiliation(s)
- Hector Rodríguez-Ramallo
- Pharmacy Department, Virgen del Rocío University Hospital, Seville, Spain; Clinical Unit of Pneumology and Thoracic Surgery, Institute of Biomedicine of Seville, Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | | | | | - Didiana Jaramillo Ruiz
- Pharmacy Department, Virgen del Rocío University Hospital, Seville, Spain; Andalusian Public Foundation for Health Research Management of Seville, Seville, Spain
| | | | - Elena Prado-Mel
- Pharmacy Department, Virgen del Rocío University Hospital, Seville, Spain
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Solh Dost L, Gastaldi G, Schneider MP. Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes. BMC Health Serv Res 2024; 24:620. [PMID: 38741070 DOI: 10.1186/s12913-024-10784-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/26/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients' perspectives of their medications from hospital to two months after discharge. METHODS Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted. RESULTS Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence. CONCLUSIONS The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients' difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients' needs, increase their safety, and standardize physicians', pharmacists', and nurses' roles and responsibilities.
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Affiliation(s)
- Léa Solh Dost
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
| | - Giacomo Gastaldi
- Division of Endocrinology, Diabetes, Hypertension and Nutrition, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
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Sawan M, Clough A, Mirzaei A, Widjaja GJ, Schneider C, Jeon YH, Chen T, Hilmer SN, Gnjidic D. The Carer Assessment of MedicaTion Management GuidanCe for People With Dementia at Hospital Discharge (CATCH) Tool: Exploratory Factor Analysis. Alzheimer Dis Assoc Disord 2024; 38:59-64. [PMID: 38300882 DOI: 10.1097/wad.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE The Carer Assessment of medicaTion management guidanCe for people with dementia at Hospital discharge (CATCH) tool was developed to examine the carer's experiences of medication management guidance delivery at discharge. This study explored its factor structure, characterized carers' experiences at discharge, and identified predictors of carer preparedness to manage medications at discharge. METHODS A cross-sectional survey of carers across Australia was distributed. Survey responses were analyzed descriptively, and exploratory factor and regression analyses were performed. RESULTS A total of 185 survey responses were completed. Exploratory factor analysis revealed 2 factors in the CATCH tool: (1) shared and supported decision-making in medication management (16 items loading 0.47 to 0.93); 2) provision of medication management guidance that is easy to understand (4 items loading (0.48 to 0.82). Internal consistency was acceptable (Cronbach alpha >0.8). Almost 18% of participants stated that they were not included in decisions about medications for people with dementia. The carer reported that the measure of how guidance is provided was positively related to their confidence in the management of medications postdischarge and satisfaction ( P < 0.05 for both). CONCLUSIONS The CATCH tool can give the patient and carer an opportunity to provide feedback on key elements of medication management guidance delivered at discharge.
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Affiliation(s)
| | | | | | | | | | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | | | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
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Ashkanani FZ, Rathbone AP, Lindsey L. The role of pharmacists in deprescribing benzodiazepines: A scoping review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100328. [PMID: 37743854 PMCID: PMC10511800 DOI: 10.1016/j.rcsop.2023.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/14/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Abstract
Background Polypharmacy can increase the risk of adverse drug events, hospitalisation, and unnecessary healthcare costs. Evidence indicates that discontinuing certain medications, such as benzodiazepines, can improve health outcomes, by resolving adverse drug effects. This scoping review aims to explore the pharmacists' role in deprescribing benzodiazepines. Method A scoping review has been conducted to distinguish and map the literature, discover research gaps, and focus on targeted areas for future studies and research. A systematic search strategy was conducted to identify relevant studies from PubMed, Medline, and EMBASE databases. The eligibility criteria involved studies that focused on the role of pharmacists in benzodiazepine deprescribing, quantitative and qualitative studies conducted in humans, full-text articles published in English. Results Twenty studies were identified, revealing three themes: 1) pharmacists' involvement in benzodiazepine deprescribing, 2) the impact of their involvement, and 3) obstacles impeding the process. Pharmacists involved in deprescribing procedures, mainly through completing medication reviews, collaborative work with other healthcare providers, and education. Pharmacists' involvement in benzodiazepine deprescribing intervention led to better health and economic outcomes. Withdrawal symptoms after medication discontinuation, dependence on medication, and lack of time and guidelines were identified in the literature as barriers to deprescribing. Conclusion Pharmacists' involvement in deprescribing benzodiazepines is crucial for optimizing medication therapy. This scoping review examines the pharmacists' role in benzodiazepine deprescribing. The findings contribute to enhancing healthcare outcomes and guiding future research in this area.
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Affiliation(s)
- Fatemah Zakariya Ashkanani
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, Tyne and Wear NE2 7RU, United Kingdom
| | - Adam Pattison Rathbone
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, Tyne and Wear NE2 7RU, United Kingdom
| | - Laura Lindsey
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, Tyne and Wear NE2 7RU, United Kingdom
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Prendergast C, Flood M, Murry LT, Clyne B, Fahey T, Moriarty F. Prescribing differences among older adults with differing health cover and socioeconomic status: a cohort study. BMC Geriatr 2023; 23:755. [PMID: 37978448 PMCID: PMC10656928 DOI: 10.1186/s12877-023-04441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION As health reforms move Ireland from a mixed public-private system toward universal healthcare, it is important to understand variations in prescribing practice for patients with differing health cover and socioeconomic status. This study aims to determine how prescribing patterns for patients aged ≥ 65 years in primary care in Ireland differ between patients with public and private health cover. METHODS This was an observational study using anonymised data collected as part of a larger study from 44 general practices in Ireland (2011-2018). Data were extracted from electronic records relating to demographics and prescribing for patients aged ≥ 65 years. The cohort was divided between those with public health cover (via the General Medical Services (GMS) scheme) and those without. Standardised rates of prescribing were calculated for pre-specified drug classes. We also analysed the number of medications, polypharmacy, and trends over time between groups, using multilevel linear regression adjusting for age and sex, and hospitalisations. RESULTS Overall, 42,456 individuals were included (56% female). Most were covered by the GMS scheme (62%, n = 26,490). The rate of prescribing in all drug classes was higher for GMS patients compared to non-GMS patients, with the greatest difference in benzodiazepine anxiolytics. The mean number of unique medications prescribed to GMS patients was 10.9 (SD 5.9), and 8.1 (SD 5.8) for non-GMS patients. The number of unique medications prescribed to both GMS and non-GMS cohorts increased over time. The increase was steeper in the GMS group where the mean number of medications prescribed increased by 0.67 medications/year. The rate of increase was 0.13 (95%CI 0.13, 0.14) medications/year lower for non-GMS patients, a statistically significant difference. CONCLUSION Our study found a significantly larger number of medications were prescribed to patients with public health cover, compared to those without. Increasing medication burden and polypharmacy among older adults may be accelerated for those of lower socioeconomic status. These findings may inform planning for moves towards universal health care, and this would provide an opportunity to evaluate the effect of expanding entitlement on prescribing and medications use.
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Affiliation(s)
- Ciaran Prendergast
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland
| | - Logan T Murry
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland.
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Correard F, Arcani R, Montaleytang M, Nakache J, Berard C, Couderc AL, Villani P, Daumas A. [Medication reconciliation: Interests and limits]. Rev Med Interne 2023; 44:479-486. [PMID: 36841717 DOI: 10.1016/j.revmed.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/22/2023] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
Admission to hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. The practice of medication reconciliation is securing for the patient because of the medication errors detected with significant clinical impact. Its implementation must comply with the recommendations of the French National Authority for Health (HAS) and its deployment is now integrated into the contract for improving the quality and efficiency of care (CAQES). However, although it allows to intercept medication errors, its impact on the length of hospitalization, the rate of readmission and/or death following discharge seems limited. Given the limited human resources to carry out this time-consuming activity, patient prioritization should be considered. Studies on the fate of patients and on the medico-economic issues are also necessary in order to make this activity sustainable.
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Affiliation(s)
- F Correard
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - R Arcani
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - M Montaleytang
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - J Nakache
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - C Berard
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - A L Couderc
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital Sainte Marguerite, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - P Villani
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France; Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital Sainte Marguerite, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - A Daumas
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France.
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Mortelmans L, Goossens E, De Cock AM, Petrovic M, van den Bemt P, Dilles T. The Development of Recommendations for Healthcare Providers to Support Patients Experiencing Medication Self-Management Problems. Healthcare (Basel) 2023; 11:healthcare11111545. [PMID: 37297685 DOI: 10.3390/healthcare11111545] [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: 04/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Medication self-management problems such as the inability to correctly obtain, understand, organize, administer or monitor medication can result in negative patient outcomes. However, supportive tools for healthcare providers to assist patients with medication self-management problems are lacking. This study aimed to develop recommendations for healthcare providers to support patients with polypharmacy who experience medication self-management problems. A three-phase study was conducted starting with (1) the mapping of medication self-management problems, followed by (2) a scoping review providing a list of relevant interventions and actions for each respective problem and (3) a three-round modified e-Delphi study with experts to reach consensus on the relevance and clarity of the recommended interventions and actions. The cut-off for consensus on the relevance and clarity of the recommendations was set at 80% expert agreement. Experts could propose additional recommendations based on their professional experience and expertise. The experts (n = 23) involved were healthcare professionals (i.e., nurses, pharmacists, and physicians) with specific expertise in medication management of patients with polypharmacy. Simultaneous with the second e-Delphi round, a panel of patients with polypharmacy (n = 8) evaluated the usefulness of recommendations. Results obtained from the patient panel were fed back to the panel of healthcare providers in the third e-Delphi round. Descriptive statistics were used for data analysis. Twenty medication self-management problems were identified. Based on the scoping review, a list of 66 recommendations for healthcare providers to support patients with the identified medication self-management problems was composed. At the end of the three-round e-Delphi study, the expert panel reached consensus on the relevance and clarity of 67 recommendations, clustered according to the six phases of the medication self-management model by Bailey et al. In conclusion, this study resulted in a guidance document including recommendations that can serve as a resource for healthcare providers to support patients with polypharmacy in case of medication self-management problems. Future research should focus on the evaluation of the feasibility and user-friendliness of the guide with recommendations in clinical practice.
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Affiliation(s)
- Laura Mortelmans
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
| | - Eva Goossens
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), 2610 Antwerp, Belgium
| | - Anne-Marie De Cock
- Department of Geriatrics, ZNA, 2020 Antwerp, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, 2610 Antwerp, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, 9000 Ghent, Belgium
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, 9000 Ghent, Belgium
| | - Patricia van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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Bourne RS, Ioannides CP, Gillies CS, Bull KM, Turton ECO, Bryden DC. Clinical frailty and polypharmacy in older emergency critical care patients: a single-centre retrospective case series. Eur J Hosp Pharm 2023; 30:136-141. [PMID: 34083221 PMCID: PMC10176984 DOI: 10.1136/ejhpharm-2020-002618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/17/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Admission of complex and frail patients to critical care units is common. Little is known about the relationship between clinical frailty and polypharmacy measures in critical care patients or how a critical care admission affects polypharmacy.We sought to: (1) Describe the extent and relationship between clinical frailty and polypharmacy in a cohort of older emergency general critical care patients, and to (2) Describe the effect of the critical care pathway on patient polypharmacy measures. METHODS A retrospective evaluation was undertaken in all patients ≥70 years of age, admitted as emergencies to the general critical care units of a single large UK academic hospital, over a 2-year period (March 2016 to February 2018) (n=762). Patient Clinical Frailty Scale (CFS) and polypharmacy measures on admission were described and association was tested. Medication changes and documentation on care transitions were analysed in a randomly selected convenience cohort of critical care survivors (n=77). RESULTS On admission patients had a median of 9 (5;12) medicines, of which a median of 3 (2;5) were high-risk medicines. Polypharmacy (5-9 medicines) and hyperpolypharmacy (≥10 medicines) occurred in 80.7% (615/762) and 43.2% (329/762) of patients, respectively. A degree of frailty was the standard (median CFS 4 (3;5)) with 45.7% (348/762) CFS 4-5 and 20% (153/762) CFS ≥6. The patient median CFS increased by 1 with polypharmacy classification increments (p<0.001). In the survivor cohort, a median of 6 (4;8) and 5 (4;8) medication changes occurred on critical care and hospital discharges, respectively. A minority of patients had detailed medication continuity plans on care transitions. CONCLUSIONS Polypharmacy and frailty were very common in this UK single-centre cohort of older emergency critical care patients. There was a significant association between the degree of polypharmacy and frailty score. The critical care pathway created extensive changes in patient medication therapy. Medication changes on care transitions often lacked detailed documentation.
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Affiliation(s)
- Richard S Bourne
- Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christopher P Ioannides
- Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Kathryn M Bull
- Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Elin C O Turton
- Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Daniele C Bryden
- Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Wirth K, Bähler C, Boes S, Näpflin M, Huber CA, Blozik E. Opioid prescriptions after knee replacement: a retrospective study of pathways and prognostic factors in the Swiss healthcare setting. BMJ Open 2023; 13:e067542. [PMID: 36889828 PMCID: PMC10008278 DOI: 10.1136/bmjopen-2022-067542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES The optimal use of opioids after knee replacement (KR) remains to be determined, given the growing evidence that opioids are no more effective than other analgesics and that their adverse effects can impair quality of life. Therefore, the objective is to examine opioid prescriptions after KR. DESIGN In this retrospective study, we used descriptive statistics and estimated the association of prognostic factors using generalised negative binomial models. SETTING The study is based on anonymised claims data of patients with mandatory health insurance at Helsana, a leading Swiss health insurance. PARTICIPANTS Overall, 9122 patients undergoing KR between 2015 and 2018 were identified. PRIMARY AND SECONDARY OUTCOME MEASURES Based on reimbursed bills, we calculated the dosage (morphine equivalent dose, MED) and the episode length (acute: <90 days; subacute: ≥90 to <120 days or <10 claims; chronic: ≥90 days and ≥10 claims or ≥120 days). The incidence rate ratios (IRRs) for postoperative opioids were calculated. RESULTS Of all patients, 3445 (37.8%) received opioids in the postoperative year. A large majority had acute episodes (3067, 89.0%), 2211 (65.0%) had peak MED levels above 100 mg/day and most patients received opioids in the first 10 postoperative weeks (2881, 31.6%). Increasing age (66-75 and >75 vs 18-65) was associated with decreased IRR (0.776 (95% CI 0.7 to 0.859); 0.723 (95% CI 0.649 to 0.805)), whereas preoperative non-opioid analgesics and opioids were associated with higher IRR (1.271 (95% CI 1.155 to 1.399); 3.977 (95% CI 4.409 to 3.591)). CONCLUSION The high opioid demand is unexpected given that current recommendations advise using opioids only when other pain therapies are ineffective. To ensure medication safety, it is important to consider alternative treatment options and ensure that benefits outweigh potential risks.
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Affiliation(s)
- Kevin Wirth
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Caroline Bähler
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Markus Näpflin
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Carola A Huber
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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de Godoi Rezende Costa Molino C, Rübel L, Mantegazza N, Bischoff-Ferrari HA, Freystaetter G. Association of polypharmacy with cognitive impairment in older trauma patients: a cross-sectional study. Eur J Hosp Pharm 2023:ejhpharm-2022-003645. [PMID: 36882299 DOI: 10.1136/ejhpharm-2022-003645] [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: 12/05/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Few if any studies have been conducted to date on the association between polypharmacy and cognitive impairment among older trauma patients. Therefore, we investigated whether polypharmacy is associated with cognitive impairment in trauma patients aged ≥70 years. METHODS This is a cross-sectional study of patients aged ≥70 years hospitalised due to a trauma-related injury. Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score ≤24 points. Medications were coded according to the Anatomical Therapeutic Chemical classification. Three exposures were examined: polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and number of medications. Separate logistic regression models adjusted for age, sex, body mass index (BMI), education, smoking, independent living, frailty, multimorbidity, depression, and type of trauma were used to test the association between the three exposures and cognitive impairment. RESULTS A total of 198 patients were included (mean age 80.2; 64.7% women and 35.4% men), of which 148 (74.8%) had polypharmacy and 63 (31.8%) had excessive polypharmacy. The prevalence of cognitive impairment was 34.3% overall, 37.2% in the polypharmacy group and 50.8% in the excessive polypharmacy group. More than 80% of participants were taking at least one analgesic. Overall, polypharmacy was not statistically significantly associated with cognitive impairment (odds ratio (OR) 1.20 [95% confidence interval (CI) 0.46 to 3.11]). However, patients in the excessive polypharmacy group were more than two times more likely to have cognitive impairment (OR 2.88 [95% CI 1.31 to 6.37]) even after adjustments for relevant confounders. Similarly, the number of medications was associated with greater odds of cognitive impairment (OR 1.15 [95% CI 1.04 to 1.28]) after adjustments for the same relevant confounders. CONCLUSION Cognitive impairment is common among older trauma patients, particularly among those in the excessive polypharmacy group. Polypharmacy was not associated with cognitive impairment. Excessive polypharmacy and number of medications, on the other hand, were associated with greater odds of cognitive impairment in older trauma patients.
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Affiliation(s)
- Caroline de Godoi Rezende Costa Molino
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lisa Rübel
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
| | - Noemi Mantegazza
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Aging Medicine, City Hospital, Zurich, Waid, Zurich, Switzerland
| | - Gregor Freystaetter
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Aging Medicine, City Hospital, Zurich, Waid, Zurich, Switzerland
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11
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Vaghasiya MR, Poon SK, Gunja N, Penm J. The Impact of an Electronic Medication Management System on Medication Deviations on Admission and Discharge from Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1879. [PMID: 36767245 PMCID: PMC9915082 DOI: 10.3390/ijerph20031879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Medication errors at transition of care remain a concerning issue. In recent times, the use of integrated electronic medication management systems (EMMS) has caused a reduction in medication errors, but its effectiveness in reducing medication deviations at transition of care has not been studied in hospital-wide settings in Australia. The aim of this study is to assess medication deviations, such as omissions and mismatches, pre-EMMS and post-EMMS implementation at transition of care across a hospital. In this study, patient records were reviewed retrospectively to identify medication deviations (medication omissions and medication mismatches) at admission and discharge from hospital. A total of 400 patient records were reviewed (200 patients in the pre-EMMS and 200 patients in the post-EMMS group). Out of 400 patients, 112 in the pre-EMMS group and 134 patients in post-EMMS group met the inclusion criteria and were included in the analysis. A total of 105 out of 246 patients (42.7%) had any medication deviations on their medications. In the pre-EMMS group, 59 out of 112 (52.7%) patients had any deviations on their medications compared to 46 out of 134 patients (34.3%) from the post-EMMS group (p = 0.004). The proportion of patients with medication omitted from inpatient orders was 36.6% in the pre-EMMS cohort vs. 22.4% in the post-EMMS cohort (p = 0.014). Additionally, the proportion of patients with mismatches in medications on the inpatient charts compared to their medication history was 4.5% in the pre-EMMS group compared to 0% in the post-EMMS group (p = 0.019). Similarly, the proportion of patients with medications omitted from their discharge summary was 23.2% in the pre-EMMS group vs. 12.7% in the post-EMMS group (p = 0.03). Our study demonstrates a reduction in medication deviations after the implementation of the EMMS in hospital settings.
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Affiliation(s)
- Milan R. Vaghasiya
- Faculty of Engineering, The University of Sydney, Camperdown, NSW 2006, Australia
- Digital Health Solutions, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
| | - Simon K. Poon
- Faculty of Engineering, The University of Sydney, Camperdown, NSW 2006, Australia
- Digital Health Solutions, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
| | - Naren Gunja
- Digital Health Solutions, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
- Faculty of Medicine & Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Jonathan Penm
- Faculty of Medicine & Health, School of Pharmacy, The University of Sydney, Camperdown, NSW 2006, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW 2031, Australia
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12
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Yahya F, Nazar H, Hadi MA. Role of primary care pharmacists in the post-hospital discharge care of patients: a scoping review protocol. J Pharm Policy Pract 2022; 15:75. [PMID: 36309737 DOI: 10.1186/s40545-022-00473-5] [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: 07/25/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence has shown that there is a significant problem with medication safety when patients are transferred between settings. The role of community pharmacists and hospital pharmacists in facilitating transition of care has been well-researched. However, with the developing role of pharmacists in general practice as part of a multi-disciplinary team, little is known about their role in improving transition of care when patients move from secondary to primary care. The key objective of this scoping review is to understand the nature and extent of the role of primary care pharmacists for patients recently discharged from secondary care. METHODS This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping review underpinned by the Arksey and O'Malley methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR) guidelines. The following electronic databases will be systematically searched: MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and NICE Evidence. Reference lists of included full texts will be searched for relevant papers, in addition to grey literature which includes websites of relevant professional organisations. Primary studies, published in the English language that involved a primary care pharmacist-led intervention post-hospital discharge will be included. Two independent reviewers will screen studies against eligibility criteria and use a piloted data extraction form to extract data related to the review questions. The data will be presented in tabular form and assessed for key themes to identify gaps and inform future research. DISCUSSION This scoping review will map current evidence surrounding the role of primary care pharmacists in the post-hospital discharge care of patients. Findings will inform ongoing research to support safer transfer-of-care post-hospital discharge and identify ways in which collaboration between healthcare professionals can be improved. This review anticipates guiding the inclusion of patient and public involvement (PPI) at the consultation stage to validate and build on the findings.
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Affiliation(s)
- Faiza Yahya
- Our Health Partnership, First Floor, 1856 Pershore Road, Cotteridge, Birmingham, B30 3AS, UK.
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK
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13
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Johansen JS, Halvorsen KH, Svendsen K, Havnes K, Robinson EG, Wetting HL, Haustreis S, Småbrekke L, Kamycheva E, Garcia BH. Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) - a randomized controlled trial. BMC Health Serv Res 2022; 22:1290. [PMID: 36289541 PMCID: PMC9597977 DOI: 10.1186/s12913-022-08648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Suboptimal medication use contributes to a substantial proportion of hospitalizations and emergency department visits in older adults. We designed a clinical pharmacist intervention to optimize medication therapy in older hospitalized patients. Based on the integrated medicine management (IMM) model, the 5-step IMMENSE intervention comprise medication reconciliation, medication review, reconciled medication list upon discharge, patient counselling, and post discharge communication with primary care. The objective of this study was to evaluate the effects of the intervention on healthcare use and mortality. Methods A non-blinded parallel group randomized controlled trial was conducted in two internal medicine wards at the University Hospital of North Norway. Acutely admitted patients ≥ 70 years were randomized 1:1 to intervention or standard care (control). The primary outcome was the rate of emergency medical visits (readmissions and emergency department visits) 12 months after discharge. Results Of the 1510 patients assessed for eligibility, 662 patients were asked to participate, and 516 were enrolled. After withdrawal of consent and deaths in hospital, the modified intention-to-treat population comprised 480 patients with a mean age of 83.1 years (SD: 6.3); 244 intervention patients and 236 control patients. The number of emergency medical visits in the intervention and control group was 497 and 499, respectively, and no statistically significant difference was observed in rate of the primary outcome between the groups [adjusted incidence rate ratio of 1.02 (95% CI: 0.82–1.27)]. No statistically significant differences between groups were observed for any of the secondary outcomes, neither in subgroups, nor for the per-protocol population. Conclusions We did not observe any statistical significant effects of the IMMENSE intervention on the rate of emergency medical visits or any other secondary outcomes after 12 months in hospitalized older adults included in this study. Trial registration The trial was registered in clinicaltrials.gov on 28/06/2016, before enrolment started (NCT02816086). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08648-1.
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Affiliation(s)
- Jeanette Schultz Johansen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjell H. Halvorsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kristian Svendsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjerstin Havnes
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Surgery, Cancer and Women’s Health Clinic, The University Hospital of North Norway, Tromsø, Norway
| | | | - Hilde Ljones Wetting
- grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
| | | | - Lars Småbrekke
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elena Kamycheva
- Nøste Private Healthcare Centre, Lier, Norway ,grid.412244.50000 0004 4689 5540Department of Geriatric Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Beate Hennie Garcia
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
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14
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Zeschick N, Gollnick J, Muth J, Hörbrand F, Killian P, Krombholz W, Donner-Banzhoff N, Kühlein T, Sebastião M. [Prescribing behavior of Bavarian general practitioners at the inpatient-outpatient interface within the context of the Bavarian active substance agreement-qualitative results of the WirtMed Study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:900-908. [PMID: 35838813 PMCID: PMC9436878 DOI: 10.1007/s00103-022-03563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
Hintergrund und Ziel Zur transparenten Steuerung der Arzneimittelausgaben im Rahmen des Wirtschaftlichkeitsgebots (§ 12 Fünftes Buch Sozialgesetzbuch (SGB V)) hat die Kassenärztliche Vereinigung Bayerns im Jahr 2014 die Wirkstoffvereinbarung (WSV) eingeführt. Diese hat die Richtgrößensystematik abgelöst. Mit Bezug auf die Rolle der WSV werden im Artikel die Gründe der Hausärzt*innen (HÄ) für oder gegen eine Weiterverordnung von Arzneimitteln aus dem Krankenhaus beschrieben. Material und Methode In einem qualitativen Studiendesign wurden im Zeitraum 11/2019 bis 03/2020 mit bayerischen HÄ Einzelinterviews (n = 18) und 2 Fokusgruppen (n = 10) durchgeführt und nach der qualitativen Inhaltsanalyse ausgewertet. Ergebnisse Mit der Einführung der WSV nahmen die Regresssorgen der HÄ insgesamt ab. Große Bedeutung bei Verordnungen haben – vor der Wirtschaftlichkeit – die patient*innenorientierte Versorgung und fachliche Richtigkeit von Therapieentscheidungen. Mit der Entlassmedikation ergeben sich wirtschaftliche Herausforderungen, besonders mit dem Leitsubstanzziel der oralen Antikoagulation, den Generikazielen bei Antidiabetika und bei Therapeutika für das Herz-Kreislauf-System. Allgemein kritisiert werden Rabattverträge, die oft zu Umstellungen von Arzneimitteln führen. Vereinzelt wird von einer „Vormachtstellung“ der Klinikärzt*innen berichtet, die dem hausärztlichen wirtschaftlichen Handeln entgegenstehen. Es fehlt laut HÄ eine sektorenübergreifende Kostenverantwortung. Diskussion Ein reibungsloser Schnittstellenübergang ist aus Sicht der HÄ trotz des Rahmenvertrags Entlassmanagement und der neuen Steuerungssystematik der WSV im ambulanten Sektor noch nicht vorhanden. Für eine wirtschaftliche Arzneimittelversorgung bedarf es weiterhin einer sektorenübergreifenden, aber auch bundesländerübergreifenden politischen Diskussion. Zusatzmaterial online Im Onlinematerial sind vertiefende Informationen zu der Methodik (Onlinematerial 1: Interview- und Fokusgruppenleitfaden) sowie zur Auswertung (Onlinematerial 2: Kategoriensystem) dieser Studie (10.1007/s00103-022-03563-6) verfügbar.
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Affiliation(s)
- Nikoletta Zeschick
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Julia Gollnick
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps Universität Marburg, Marburg, Deutschland
| | - Julia Muth
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps Universität Marburg, Marburg, Deutschland
| | | | - Peter Killian
- Kassenärztliche Vereinigung Bayerns, München, Deutschland
| | | | - Norbert Donner-Banzhoff
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps Universität Marburg, Marburg, Deutschland
| | - Thomas Kühlein
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Maria Sebastião
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland.
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15
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Wang J, Feng Z, Dong Z, Li W, Chen C, Gu Z, Wei A, Feng D. Does Having a Usual Primary Care Provider Reduce Polypharmacy Behaviors of Patients With Chronic Disease? A Retrospective Study in Hubei Province, China. Front Pharmacol 2022; 12:802097. [PMID: 35126137 PMCID: PMC8815858 DOI: 10.3389/fphar.2021.802097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Within China's hierarchical medical system, many patients seek medical care in different hospitals independently without integrated management. As a result, multi-hospital visiting is associated with fragmented service utilization and increased incidence of polypharmacy behaviors, especially for patients with chronic disease. It has been confirmed that factors from the perspective of patients may cause polypharmacy behaviors in Chinese community patients; whether having a usual primary care provider for chronic disease patients could reduce the polypharmacy behaviors and the effect size remains unanswered, and that is what our study aimed to answer. Methods: Our study adopted a cluster sampling method to select 1,196 patients with hypertension or diabetes and measured some information about them. The propensity score weighting method was adopted to eliminate the influence of confounding bias, and then a multivariate logistic regression model was conducted to test the relationship between having a usual primary care provider and polypharmacy behaviors. Results: Patients without usual primary care providers were significantly correlated with polypharmacy behaviors (OR = 2.40, 95%CI: 1.74–3.32, p < 0.001), and the corresponding marginal effect is 0.09 (95%CI: 0.06–0.12). Patients who suffer from two kinds of diseases (OR = 3.05, 95%CI: 1.87–5.10, p < 0.001), with more than three kinds of diseases (OR = 21.03, 95%CI: 12.83–35.65, p < 0.001), with disease history of 20 years and above (OR = 1.66, 95%CI: 1.14–2.42, p = 0.008), who communicate frequently with doctors (OR = 3.14, 95%CI: 1.62–6.19, p < 0.001), alcoholic patients (OR = 2.14, 95%CI: 1.08–4.19, p = 0.027), who used to have meat-based food (OR = 1.42, 95%CI: 1.00–2.00, p = 0.049), and have vegetarian-based diet (OR = 1.42, 95%CI: 1.00–2.00, p = 0.049) are more likely to have polypharmacy behaviors, while patients aged between 65 and 75 years (OR = 0.50, 95%CI: 0.33–0.77, p = 0.020), used to be brain workers (OR = 0.67, 95%CI: 0.45–0.99, p = 0.048), with disease history between 10 and 20 years (OR = 0.56, 95%CI: 0.37–0.83, p = 0.005), have had adverse drug reactions (OR = 0.64, 95%CI: 0.45–0.93, p = 0.019), and participated in medical insurance for urban and rural residents (OR = 0.35, 95%CI: 0.21–0.58, p < 0.001) were less likely to have polypharmacy behaviors. Conclusion: The results suggest that having a usual primary care provider may reduce the incidence of having polypharmacy behaviors; we can take intervention measures to promote establishing a long-term relationship between patients and primary care providers.
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Affiliation(s)
- Jia Wang
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhongxin Dong
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Wanping Li
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chaoyi Chen
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhichun Gu
- Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Anhua Wei
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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16
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Grande KJ, Dalton R, Moyer NA, Arwood MJ, Nguyen KA, Sumfest J, Ashcraft KC, Cooper-DeHoff RM. Assessment of a Manual Method versus an Automated, Probability-Based Algorithm to Identify Patients at High Risk for Pharmacogenomic Adverse Drug Outcomes in a University-Based Health Insurance Program. J Pers Med 2022; 12:jpm12020161. [PMID: 35207649 PMCID: PMC8878761 DOI: 10.3390/jpm12020161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 12/21/2022] Open
Abstract
We compared patient cohorts selected for pharmacogenomic testing using a manual method or automated algorithm in a university-based health insurance network. The medication list was compiled from claims data during 4th quarter 2018. The manual method selected patients by number of medications by the health system’s list of medications for pharmacogenomic testing. The automated method used YouScript’s pharmacogenetic interaction probability (PIP) algorithm to select patients based on the probability that testing would result in detection of one or more clinically significant pharmacogenetic interactions. A total of 6916 patients were included. Patient cohorts selected by each method differed substantially, including size (manual n = 218, automated n = 286) and overlap (n = 41). The automated method was over twice as likely to identify patients where testing may reveal a clinically significant pharmacogenetic interaction than the manual method (62% vs. 29%, p < 0.0001). The manual method captured more patients with significant drug–drug or multi-drug interactions (80.3% vs. 40.2%, respectively, p < 0.0001), higher average number of significant drug interactions per patient (3.3 vs. 1.1, p < 0.0001), and higher average number of unique medications per patient (9.8 vs. 7.4, p < 0.0001). It is possible to identify a cohort of patients who would likely benefit from pharmacogenomic testing using manual or automated methods.
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Affiliation(s)
| | - Rachel Dalton
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (R.D.); (K.A.N.)
| | | | | | - Khoa A. Nguyen
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (R.D.); (K.A.N.)
| | - Jill Sumfest
- GatorCare, University of Florida, Gainesville, FL 32610, USA;
| | | | - Rhonda M. Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (R.D.); (K.A.N.)
- Division of Cardiology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Correspondence: ; Tel.: +1-352-359-2658
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Carracedo-Martínez E, Vázquez-Mourelle R, Figueiras A, Piñeiro-Lamas M. Impact on In- and Outpatient Hospital Drug Prescriptions of Including a More Expensive Me-Too Antidepressant in a Hospital Drug Formulary: a Controlled Longitudinal Study. Pharmacoepidemiol Drug Saf 2021; 31:556-565. [PMID: 34965012 DOI: 10.1002/pds.5405] [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: 04/09/2021] [Revised: 11/08/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The effect of the inclusion of a more expensive me-too medicine in a hospital drug formulary (HDF) on both in- and out-of-hospital utilization, and the contextual factors which influence this type of induction is rarely studied. Accordingly, this work aimed to quantify the effect of the decision of a hospital of including a more expensive me-too antidepressant in its HDF. METHODS A controlled longitudinal study was carried out in a Regional Health Service of Spain. We performed a segmented regression analysis with control group. We used the following dependent variables: defined daily doses (DDD) per 1000 inhabitants per day, DDD per 100 bed days, and cost per DDD. RESULTS At a hospital level, the modification in the formulary led to utilization changes: (1) an increase in immediate consumption of the newly included me-too drug; and, (2) an annual 25.96% [95%CI: 2.96%-48.95%] decrease in the adjusted trend of the already existing parent antidepressant. The adjusted trend of the cost per DDD of the sum of all medications in the therapeutic group increased by 20.03% annually [95%CI:3.24%-36.82%]. In the out-of-hospital setting utilization changes were: (1) the adjusted trend of the newly included me-too drug rose by 12.14% annually [95%CI:4.97%-19.30%]; and, (2) that of the parent drug underwent a negative change in trend of 4.18% annually [95%CI: 0.00%-8.36%]. CONCLUSIONS The inclusion of a more expensive me-too drug in the HDF led to increased consumption of this more expensive me-too drug both in- and out-of-hospital. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Eduardo Carracedo-Martínez
- Santiago de Compostela Health Area. Galician Health Service (Servizo Galego de Saúde - SERGAS). Spanish National Health System, Spain
| | - Raquel Vázquez-Mourelle
- Deputy Directorate-General Galician Health Service (Servicio Gallego de Salud SERGAS), Galicia Regional Authority, Santiago de Compostela, Galicia, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP).,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP).,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
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Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity. Drugs Aging 2021; 39:59-73. [PMID: 34877629 PMCID: PMC8752546 DOI: 10.1007/s40266-021-00904-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) instrument is used to evaluate the appropriateness of medication in older people. STOPP/START criteria have been converted into software algorithms and implemented in a clinical decision support system (CDSS) to facilitate their use in clinical practice. OBJECTIVE Our objective was to determine the frequency of CDSS-generated STOPP/START signals and their subsequent acceptance by a pharmacotherapy team in a hospital setting. DESIGN AND METHODS Hospitalised older patients with polypharmacy and multimorbidity allocated to the intervention arm of the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial underwent a CDSS-assisted structured medication review in four European hospitals. We evaluated the frequency of CDSS-generated STOPP/START signals and the subsequent acceptance of these signals by a trained pharmacotherapy team consisting of a physician and pharmacist after evaluation of clinical applicability to the individual patient, prior to discussing pharmacotherapy optimisation recommendations with the patient and attending physicians. Multivariate linear regression analysis was used to investigate potential patient-related (e.g. age, number of co-morbidities and medications) and setting-related (e.g. ward type, country of inclusion) determinants for acceptance of STOPP and START signals. RESULTS In 819/826 (99%) of the patients, at least one STOPP/START signal was generated using a set of 110 algorithms based on STOPP/START v2 criteria. Overall, 39% of the 5080 signals were accepted by the pharmacotherapy team. There was a high variability in the frequency and the subsequent acceptance of the individual STOPP/START criteria. The acceptance ranged from 2.5 to 75.8% for the top ten most frequently generated STOPP and START signals. The signal to stop a drug without a clinical indication was most frequently generated (28%), with more than half of the signals accepted (54%). No difference in mean acceptance of STOPP versus START signals was found. In multivariate analysis, most patient-related determinants did not predict acceptance, although the acceptance of START signals increased in patients with one or more hospital admissions (+ 7.9; 95% confidence interval [CI] 1.6-14.1) or one or more falls in the previous year (+ 7.1; 95% CI 0.7-13.4). A higher number of co-morbidities was associated with lower acceptance of STOPP (- 11.8%; 95% CI - 19.2 to - 4.5) and START (- 11.0%; 95% CI - 19.4 to - 2.6) signals for patients with more than nine and between seven and nine co-morbidities, respectively. For setting-related determinants, the acceptance differed significantly between the participating trial sites. Compared with Switzerland, the acceptance was higher in Ireland (STOPP: + 26.8%; 95% CI 16.8-36.7; START: + 31.1%; 95% CI 18.2-44.0) and in the Netherlands (STOPP: + 14.7%; 95% CI 7.8-21.7). Admission to a surgical ward was positively associated with acceptance of STOPP signals (+ 10.3%; 95% CI 3.8-16.8). CONCLUSION The involvement of an expert team in translating population-based CDSS signals to individual patients is essential, as more than half of the signals for potential overuse, underuse, and misuse were not deemed clinically appropriate in a hospital setting. Patient-related potential determinants were poor predictors of acceptance. Future research investigating factors that affect patients' and physicians' agreement with medication changes recommended by expert teams may provide further insight for implementation in clinical practice. REGISTRATION ClinicalTrials.gov Identifier: NCT02986425.
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Marques Cavalcante-Santos L, Carvalho Silvestre C, Andrade Macêdo L, Mônica Machado Pimentel D, Dias de Oliveira-Filho A, Manias E, Pereira de Lyra D. Written communication about the use of medications in medical records in a Brazilian hospital. Int J Clin Pract 2021; 75:e14990. [PMID: 34710266 DOI: 10.1111/ijcp.14990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated. AIM To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge. METHOD A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non-conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe. RESULTS This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified. CONCLUSION Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.
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Affiliation(s)
- Lincoln Marques Cavalcante-Santos
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Carina Carvalho Silvestre
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Luana Andrade Macêdo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | | | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
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20
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Cornelissen N, Karapinar-Çarkit F, Heer SEND, Uitvlugt EB, Hugtenburg JG, van den Bemt PMLA, van den Bemt BJF, Bekker CL. Application of intervention mapping to develop and evaluate a pharmaceutical discharge letter to improve information transfer between hospital and community pharmacists. Res Social Adm Pharm 2021; 18:3297-3302. [PMID: 34690086 DOI: 10.1016/j.sapharm.2021.10.001] [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: 05/20/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Insufficient information transfer is a major barrier in the transition from hospital to home. This study describes the systematic development and evaluation of an intervention to improve medication information transfer between hospital and community pharmacists. OBJECTIVE To develop and evaluate an intervention to improve the medication information transfer between hospital and community pharmacists based on patients', community and hospital pharmacists' needs. METHODS The intervention development and evaluation was guided by the six-step Intervention Mapping (IM) approach: (1) needs assessment to identify determinants of the problem, with a scoping review and focus groups with patients and healthcare providers, (2) formulation of intervention objectives with an expert group, (3) inventory of communication models to design the intervention, (4) using literature review and qualitative research with pharmacists and patients to develop the intervention (5) pilot-testing of the intervention in two hospitals, and (6) a qualitative evaluation of the intervention as part of a multicenter before-after study with hospital and community pharmacists. RESULTS Barriers in the information transfer are mainly time and content related. The intervention was designed to target a complete, accurate and timely medication information transfer between hospital and community pharmacists. A pharmaceutical discharge letter was developed to improve medication information transfer. Hospital and community pharmacists were positive about the usability, content, and comprehensiveness of the pharmaceutical discharge letter, which gave community pharmacists sufficient knowledge about in-hospital medication changes. However, hospital pharmacists reported that it was time-consuming to draft the discharge letter and not always feasible to send it on time. The intervention showed that pharmacists are positive about the usability, content and comprehensiveness. CONCLUSION This study developed an intervention systematically to improve medication information transfer, consisting of a discharge letter to be used by hospital and community pharmacists supporting continuity of care.
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Affiliation(s)
- Nicky Cornelissen
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
| | - Selma En-Nasery-de Heer
- Amsterdam UMC, Location Vumc, Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Elien B Uitvlugt
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
| | - Jacqueline G Hugtenburg
- Amsterdam UMC, Location Vumc, Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Patricia M L A van den Bemt
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy. University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Pharmacy, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands.
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands.
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21
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Daliri S, Kooij MJ, Scholte Op Reimer WJM, Ter Riet G, Jepma P, Verweij L, Peters RJG, Buurman BM, Karapinar-Çarkit F. Effects of a transitional care programme on medication adherence in an older cardiac population: A randomized clinical trial. Br J Clin Pharmacol 2021; 88:965-982. [PMID: 34410011 DOI: 10.1111/bcp.15044] [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: 04/18/2021] [Revised: 07/21/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS Medication non-adherence post-discharge is common among patients, especially those suffering from chronic medical conditions, and contributes to hospital admissions and mortality. This study aimed to evaluate the effect of the Cardiac Care Bridge (CCB) intervention on medication adherence post-discharge. METHODS We performed a secondary analysis of the CCB randomized single-blind trial, a study in patients ≥70 years, at high risk of functional loss and admitted to cardiology departments in six hospitals. In this multi-component intervention study, community nurses performed medication reconciliation and observed medication-related problems (MRPs) during post-discharge home visits, and pharmacists provided recommendations to resolve MRPs. Adherence to high-risk medications was measured using the proportion of days covered (PDC), using pharmacy refill data. Furthermore, MRPs were assessed in the intervention group. RESULTS For 198 (64.7%) of 306 CCB patients, data were available on adherence (mean age: 82 years; 58.9% of patients used a multidose drug dispensing [MDD] system). The mean PDC before admission was 92.3% in the intervention group (n = 99) and 88.5% in the control group (n = 99), decreasing to 85.2% and 84.1% post-discharge, respectively (unadjusted difference: -2.6% (95% CI -9.8 to 4.6, P = .473); adjusted difference -3.3 (95% CI -10.3 to 3.7, P = .353)). Post-hoc analysis indicated that a modest beneficial intervention effect may be restricted to MDD non-users (Pinteraction = .085). In total, 77.0% of the patients had at least one MRP post-discharge. CONCLUSIONS Our findings indicate that a multi-component intervention, including several components targeting medication adherence in older cardiac patients discharged from hospital back home, did not benefit their medication adherence levels. A modest positive effect on adherence may potentially exist in those patients not using an MDD system. This finding needs replication.
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Affiliation(s)
- Sara Daliri
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.,Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marcel J Kooij
- Community pharmacy, Service Apotheek Koning, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, The Netherlands
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Patricia Jepma
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lotte Verweij
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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22
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Benipal H, Holbrook A, Paterson JM, Douketis J, Foster G, Ma J, Thabane L. Derivation and validation of predictors of oral anticoagulant-related adverse events in seniors transitioning from hospital to home. Thromb Res 2021; 206:18-28. [PMID: 34391064 DOI: 10.1016/j.thromres.2021.07.016] [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: 05/19/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Oral anticoagulant (OAC)-related adverse events are high post-hospitalization. We planned to develop and validate a prediction model for OAC-related harm within 30 days of hospitalization. METHODS We undertook a population-based study of adults aged ≥66 years who were discharged from hospital on an OAC from September 2010 to March 2015 in Ontario, Canada. The primary outcome was a composite of time to first hospitalization or emergency department visit for a hemorrhagic or thromboembolic event, or mortality within 30 days of hospital discharge. Cox proportional hazards regression was used to build the model. RESULTS We included 120,721 patients of which 5423 experienced the outcome. Most patients were aged ≥75 years (59.5%) and were female (55.6%). Sixty percent of the cohort had a follow-up visit with a healthcare provider within 7 days of discharge. Patients discharged on a direct acting OAC versus warfarin (apixaban: Hazard Ratio [HR] 0.82, 95% confidence interval [CI] 0.71-0.94; dabigatran: HR 0.73, 95% CI 0.63-0.84; rivaroxaban: HR 0.79, 95% CI 0.71-0.88), were prevalent users of the dispensed OAC versus incident users (HR 0.82, 95% CI 0.69-0.96), had a joint replacement in the past 35 days (HR 0.40, 95% CI 0.33-0.50) or major surgery during index hospital stay (HR 0.69, 95% CI 0.60-0.80) had a lower risk for the outcome. The Cox model was stable with acceptable discrimination but poor goodness-of-fit. CONCLUSIONS A model for OAC-related harm in the early post-discharge period was developed. External validation studies are required to understand the model's poor calibration.
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Affiliation(s)
- Harsukh Benipal
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada.
| | - Anne Holbrook
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada; Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, SJHH G623, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
| | - J Michael Paterson
- ICES, G1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada.
| | - James Douketis
- Division of Hematology and Thromboembolism, Department of Medicine, HSC-3V50, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Research Institute C5-121, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
| | - Gary Foster
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada; Biostatistics Unit, St Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
| | - Jinhui Ma
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada.
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada; Biostatistics Unit, St Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
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Habib B, Buckeridge D, Bustillo M, Marquez SN, Thakur M, Tran T, Weir DL, Tamblyn R. Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge. JAMIA Open 2021; 4:ooab050. [PMID: 34345805 PMCID: PMC8325487 DOI: 10.1093/jamiaopen/ooab050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
Objective The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM’s potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events. Materials and Methods We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care). Patients were followed for 30 days post-discharge, during which app use was recorded. Pharmacy claims data were used to measure adherence to medication changes made at discharge, and physician billing data were used to identify emergency department visits and hospital readmissions during follow-up. Results Forty-nine patients were eligible for inclusion in the study at hospital discharge (23 intervention, 26 control). In the 30 days of post-discharge, 15 (65.2%) intervention patients used the SAM app. During this period, intervention patients adhered to a larger proportion of medication changes (83.7%) than control patients (77.8%), including newly prescribed medications (72.7% vs 61.7%) and dose changes (90.9% vs 81.8%). A smaller proportion of intervention patients (8.7%) were readmitted to hospital during follow-up than control patients (15.4%). Conclusion The high uptake of SAM among intervention patients supports the feasibility of a larger trial. Results also suggest that SAM has the potential to enhance adherence to medication changes and reduce the risk of downstream adverse events. This hypothesis needs to be tested in a larger trial. Trial registration Clinicaltrials.gov, registration number NCT04676165.
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Affiliation(s)
- Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - David Buckeridge
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | | | - Manish Thakur
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - Thai Tran
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - Daniala L Weir
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University Health Center, Montreal, Canada
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Migliazza K, Bähler C, Liedtke D, Signorell A, Boes S, Blozik E. Potentially inappropriate medications and medication combinations before, during and after hospitalizations: an analysis of pathways and determinants in the Swiss healthcare setting. BMC Health Serv Res 2021; 21:522. [PMID: 34049550 PMCID: PMC8164287 DOI: 10.1186/s12913-021-06550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background A hospitalization phase represents a challenge to medication safety especially for multimorbid patients as acute medical needs might interact with pre-existing medications or evoke adverse drug effects. This project aimed to examine the prevalence and risk factors of potentially inappropriate medications (PIMs) and medication combinations (PIMCs) in the context of hospitalizations. Methods Analyses are based on claims data of patients (≥65 years) with basic mandatory health insurance at the Helsana Group, and on data from the Hirslanden Swiss Hospital Group. We assessed PIMs and PIMCs of patients who were hospitalized in 2013 at three different time points (quarter prior, during, after hospitalization). PIMs were identified using the PRISCUS list, whereas PIMCs were derived from compendium.ch. Zero-inflated Poisson regression models were applied to determine risk factors of PIMs and PIMCs. Results Throughout the observation period, more than 80% of patients had at least one PIM, ranging from 49.7% in the pre-hospitalization, 53.6% in the hospitalization to 48.2% in the post-hospitalization period. PIMCs were found in 46.6% of patients prior to hospitalization, in 21.3% during hospitalization, and in 25.0% of patients after discharge. Additional medication prescriptions compared to the preceding period and increasing age were the main risk factors, whereas managed care was associated with a decrease in PIMs and PIMCs. Conclusion We conclude that a patient’s hospitalization offers the possibility to increase medication safety. Nevertheless, the prevalence of PIMs and PIMCs is relatively high in the study population. Therefore, our results indicate a need for interventions to increase medication safety in the Swiss healthcare setting.
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Affiliation(s)
- Kevin Migliazza
- Department of Health Sciences, Helsana Group, Zürich, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Caroline Bähler
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | | | - Andri Signorell
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zürich, Switzerland. .,Institute of Primary Care, University of Zürich, Zürich, Switzerland.
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Whitman A, Erdeljac P, Jones C, Pillarella N, Nightingale G. Managing Polypharmacy in Older Adults with Cancer Across Different Healthcare Settings. DRUG HEALTHCARE AND PATIENT SAFETY 2021; 13:101-116. [PMID: 33953612 PMCID: PMC8092848 DOI: 10.2147/dhps.s255893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022]
Abstract
The care of older patients with cancer is becoming increasingly complex. Common challenges for this population include management of comorbidities, safe transitions of care, and appropriate medication use. In particular, polypharmacy-generally defined as the regular use of five or more medications-and inappropriate medication use can lead to adverse effects and poor outcomes in older adults with cancer, including falls, hospital readmissions, cognitive impairment, poor adherence to essential medications, chemotherapy toxicity, and increased mortality. Managing polypharmacy across different cancer care settings is often challenging. Providers face barriers to safe and successful medication management that may include lack of time, absence of reimbursement, underappreciation of the scale of polypharmacy-related harm, lack of ownership of deprescribing efforts, and poor communication across care settings. Existing literature on managing inappropriate medication use and polypharmacy in older adults with cancer has often focused on ideal state settings in which resources are plentiful and time is purposefully allocated for medication interventions. This paper presents a narrative, rather than a systematic review, of studies published in the past decade that provided detailed information on medication management and polypharmacy across cancer care settings. This review aims to also summarize different healthcare provider roles in taking action against inappropriate medication use and polypharmacy in older adults with cancer.
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Affiliation(s)
- Andrew Whitman
- Department of Pharmacy, University of Virginia Health, Charlottesville, VA, USA
| | - Paige Erdeljac
- Department of Pharmacy, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Caroline Jones
- Department of Pharmacy, University of Virginia Health, Charlottesville, VA, USA
| | - Nicole Pillarella
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
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Montaleytang M, Correard F, Spiteri C, Boutier P, Gayet S, Honore S, Villani P, Daumas A. Medication reconciliation in the geriatric unit: impact on the maintenance of post-hospitalization prescriptions. Int J Clin Pharm 2021; 43:1183-1190. [PMID: 33464484 DOI: 10.1007/s11096-021-01229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022]
Abstract
Background Medication reconciliation prevents medication errors at care transition points. This process improves communication with general practitioners regarding the reasons for therapeutic changes, allowing those changes to be maintained after hospital discharge. Objective To investigate the impact of medication reconciliation in geriatrics on the sustainability of therapeutic optimization after hospital discharge. Setting This study was conducted in a geriatric unit in a University Hospital Centre in France. Method This was a retrospective study. For 6 months, all patients over 65 years who underwent the process of medication reconciliation performed by a clinical hospital pharmacist and a physician at admission and discharge, were included. A comparison between drug prescriptions at hospital discharge and the first prescription made outside the hospital was made to identify any differences. Main outcome measure The main outcome measures were the provision of the results of the medication reconciliation performed in the hospital to the relevant general practitioner, the subsequent acceptance of that information, the type of medication discrepancies one month after discharge and the therapeutic classes affected by the modifications. Results Among the 112 patients, medication reconciliation allowed us to identify and correct 87 unintentional discrepancies at admission (88% corrected) and 54 at discharge (92% corrected). Patients were discharged to homes or nursing homes (61%), geriatric rehabilitation units (38%) or psychiatric clinics (1%). A general practitioner wrote the first prescription renewal a mean of 36 ± 23 days after discharge, having been made aware of the medication reconciliation in only 24% of the cases (received and taken into account). The impact was a decrease in the number of patients with at least one discrepancy. Twenty-five percent of general practitioners who were aware about the medication reconciliation process accepted all therapeutic changes, while only 7% of those who were not informed did so (p = 0.02). The number of medication discrepancies observed was correlated with the number of medications for which prescriptions were renewed (p < 0.01). Conclusion Medication reconciliation involving therapeutic optimization and the justification of changes is essential to ensure the safety of the prescriptions written for patients. However, its impact after discharge is hampered by the fact that the results are often not received or taken into account by general practitioners. Taking medication reconciliation into account was associated with a significant increase in prescriptions that maintained therapeutic changes made in the hospital, confirming the positive impact of communication between care providers on therapeutic optimization.
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Affiliation(s)
- Maeva Montaleytang
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Florian Correard
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Charlotte Spiteri
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Philippe Boutier
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Stéphane Gayet
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Stéphane Honore
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Patrick Villani
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Aurélie Daumas
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France.
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Capiau A, Foubert K, Van der Linden L, Walgraeve K, Hias J, Spinewine A, Sennesael AL, Petrovic M, Somers A. Medication Counselling in Older Patients Prior to Hospital Discharge: A Systematic Review. Drugs Aging 2020; 37:635-655. [PMID: 32643062 DOI: 10.1007/s40266-020-00780-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Older patients are regularly exposed to multiple medication changes during a hospital stay and are more likely to experience problems understanding these changes. Medication counselling is often proposed as an important component of seamless care to ensure appropriate medication use after hospital discharge. OBJECTIVES The purpose of this systematic review was to describe the components of medication counselling in older patients (aged ≥ 65 years) prior to hospital discharge and to review the effectiveness of such counselling on reported clinical outcomes. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology (PROSPERO CRD42019116036), a systematic search of MEDLINE, EMBASE and CINAHL was conducted. The QualSyst Assessment Tool was used to assess bias. The impact of medication counselling on different outcomes was described and stratified by intervention content. RESULTS Twenty-nine studies were included. Fifteen different components of medication counselling were identified. Discussing the dose and dosage of patients' medications (19/29; 65.5%), providing a paper-based medication list (19/29; 65.5%) and explaining the indications of the prescribed medications (17/29; 58.6%) were the most frequently encountered components during the counselling session. Twelve different clinical outcomes were investigated in the 29 studies. A positive effect of medication counselling on medication adherence and medication knowledge was found more frequently, compared to its impact on hard outcomes such as hospital readmissions and mortality. Yet, evidence remains inconclusive regarding clinical benefit, owing to study design heterogeneity and different intervention components. Statistically significant results were more frequently observed when counselling was provided as part of a comprehensive intervention before discharge. CONCLUSIONS Substantial heterogeneity between the included studies was found for the components of medication counselling and the reported outcomes. Study findings suggest that medication counselling should be part of multifaceted interventions, but the evidence concerning clinical outcomes remains inconclusive.
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Affiliation(s)
- Andreas Capiau
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium. .,Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
| | - Katrien Foubert
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Lorenz Van der Linden
- Department of Pharmacy, University Hospitals Leuven, Leuven, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Julie Hias
- Department of Pharmacy, University Hospitals Leuven, Leuven, Belgium
| | - Anne Spinewine
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Brussels, Belgium.,Department of Pharmacy, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Anne-Laure Sennesael
- Department of Pharmacy, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Annemie Somers
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.,Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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28
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Nilsen MK, Olsen RM, Sletvold H. Kan organisering av omsorgsboliger for eldre påvirke praksis i forbindelse med legemidler som gis ved behov? TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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29
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Hambrook M, Peterson S, Gorman S, Becotte G, Burrows A. Medication management surrounding transitions of care: A qualitative assessment of community pharmacists' preferences (MEMO TOC). Can Pharm J (Ott) 2020; 153:301-307. [PMID: 33110471 DOI: 10.1177/1715163520947444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Multiple medication changes during hospitalization increase the risk of errors upon discharge. Community pharmacists may face barriers to providing pharmaceutical care because of the lack of clinical information and communication from hospitals. Studies implementing handover to community pharmacists upon hospital discharge reported improved patient outcomes, but interventions were time-consuming. Methods One-on-one interviews and a focus group were conducted to identify community pharmacists' barriers to providing care to patients recently discharged from hospital and to determine their preferences for hospital discharge prescriptions. Transcripts were qualitatively analyzed using an inductive semantic approach. Results Four one-on-one interviews and an 8-participant focus group were conducted. Participants described barriers to providing care to discharged patients, including lack of communication, incomplete prescriptions, and limited clinical information. Participants identified that the most valuable information to include comprised laboratory values, hospital contact information and annotation of medication changes. These items would improve their abilities to provide timely and high-quality pharmaceutical care. Interpretation Our results were similar to prior literature identifying a lack of communication and clinical information as barriers to providing care to recently discharged patients. Unexpectedly, study participants did not rate medication indication as a strongly preferred information item. Conclusions Hospital discharge prescriptions lack information, which makes it challenging for community pharmacists to provide pharmaceutical care. Discharge prescriptions should include additional clinical information. Can Pharm J (Ott) 2020;153:xx-xx.
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Affiliation(s)
- Miranda Hambrook
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
| | - Shaylee Peterson
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
| | - Sean Gorman
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
| | - Greg Becotte
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
| | - Andrea Burrows
- Interior Health Authority, Kelowna General Hospital (Hambrook).,Clinical Quality & Research, (Gorman) Kelowna.,Royal Inland Hospital (Peterson, Burrows), Kamloops.,Kipp-Mallery Pharmacy (Becotte), Kamloops, BC
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30
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Aggarwal P, Woolford SJ, Patel HP. Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice. Geriatrics (Basel) 2020; 5:E85. [PMID: 33126470 PMCID: PMC7709573 DOI: 10.3390/geriatrics5040085] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022] Open
Abstract
Multi-morbidity and polypharmacy are common in older people and pose a challenge for health and social care systems, especially in the context of global population ageing. They are complex and interrelated concepts in the care of older people that require early detection and patient-centred shared decision making underpinned by multi-disciplinary team-led comprehensive geriatric assessment (CGA) across all health and social care settings. Personalised care plans need to remain responsive and adaptable to the needs and wishes of the patient, enabling the individual to maintain their independence. In this review, we aim to give an up-to-date account of the recognition and management of multi-morbidity and polypharmacy in the older person.
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Affiliation(s)
- Pritti Aggarwal
- Southampton City Clinical Commissioning Group, Southampton SO16 4GX, UK;
- Living Well Partnership, Southampton SO19 9GH, UK
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton SO17 1BJ, UK
| | - Stephen J. Woolford
- Medicine for Older People, University Hospital Southampton NHS FT, Southampton SO16 6YD, UK;
| | - Harnish P. Patel
- Medicine for Older People, University Hospital Southampton NHS FT, Southampton SO16 6YD, UK;
- Academic Geriatric Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS FT, Southampton SO16 6YD, UK
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31
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Should Hospital Admission Be Used as an Opportunity for Deprescribing in Older Adults? Can J Hosp Pharm 2020; 73:294-297. [PMID: 33100363 PMCID: PMC7556391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Benipal H, Holbrook A, Paterson JM, Douketis J, Foster G, Thabane L. Predictors of oral anticoagulant-associated adverse events in seniors transitioning from hospital to home: a retrospective cohort study protocol. BMJ Open 2020; 10:e036537. [PMID: 32963065 PMCID: PMC7509956 DOI: 10.1136/bmjopen-2019-036537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Oral anticoagulants (OACs) are widely prescribed in older adults. High OAC-related adverse event rates in the early period following hospital discharge argue for an analysis to identify predictors. Our objective is to identify and validate clinical and continuity of care variables among seniors discharged from hospital on an OAC, which are independently associated with OAC-related adverse events within 30 days. METHODS AND ANALYSIS We propose a population-based retrospective cohort study of all adults aged 66 years or older who were discharged from hospital on an OAC from September 2010 to March 2015 in Ontario, Canada. The primary outcome is a composite of the first hospitalisation or emergency department visit for a haemorrhage or thromboembolic event or mortality within 30 days of hospital discharge. A Cox proportional hazards model will be used to determine the association between the composite outcome and a set of prespecified covariates. A split sample method will be adopted to validate the variables associated with OAC-related adverse events. ETHICS AND DISSEMINATION The use of data in this project was authorised under section 45 of Ontario's Personal Health Information Protection Act, which does not require review by a research ethics board. Results will be disseminated via peer-reviewed publications and presentations at conferences and will determine intervention targets to improve OAC management in upcoming randomised trials. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT02777047; Pre-results.
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Affiliation(s)
- Harsukh Benipal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anne Holbrook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Division of Clinical Pharmacology & Toxicology, McMaster University, Hamilton, Ontario, Canada
| | - J Michael Paterson
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - James Douketis
- Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Saint Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Saint Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Weir DL, Motulsky A, Abrahamowicz M, Lee TC, Morgan S, Buckeridge DL, Tamblyn R. Failure to follow medication changes made at hospital discharge is associated with adverse events in 30 days. Health Serv Res 2020; 55:512-523. [PMID: 32434274 PMCID: PMC7376001 DOI: 10.1111/1475-6773.13292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/02/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the hypothesis that nonadherence to medication changes made at hospital discharge is associated with an increased risk of adverse events in the 30 days postdischarge. STUDY SETTING Patients admitted to hospitals in Montreal, Quebec, between 2014 and 2016. STUDY DESIGN Prospective cohort study. DATA COLLECTION Nonadherence to medication changes was measured by comparing medications dispensed in the community with those prescribed at hospital discharge. Patient, health system, and drug regimen-level covariates were measured using medical services and pharmacy claims data as well as data abstracted from the patient's hospital chart. Multivariable Cox models were used to determine the association between nonadherence to medication changes and the risk of adverse events. PRINCIPAL FINDINGS Among 2655 patients who met our inclusion criteria, mean age was 69.5 years (SD 14.7) and 1581 (60%) were males. Almost half of patients (n = 1161, 44%) were nonadherent to at least one medication change, and 860 (32%) were readmitted to hospital, visited the emergency department, or died in the 30 days postdischarge. Patients who were not adherent to any of their medication changes had a 35% higher risk of adverse events compared to those who were adherent to all medication changes (1.41 vs 1.27 events/100 person-days, adjusted hazard ratio: 1.35, 95% CI: 1.06-1.71). CONCLUSIONS Almost half of all patients were not adherent to some or all changes made to their medications at hospital discharge. Nonadherence to all changes was associated with an increased risk of adverse events. Interventions addressing barriers to adherence should be considered moving forward.
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Affiliation(s)
- Daniala L Weir
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Todd C Lee
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Steven Morgan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David L Buckeridge
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
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Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England. Br J Gen Pract 2020; 70:e399-e405. [PMID: 32253190 PMCID: PMC7141815 DOI: 10.3399/bjgp20x709385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022] Open
Abstract
Background Little is known about the impact of hospitalisation on prescribing in UK clinical practice. Aim To investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs). Design and setting A retrospective cohort analysis set in primary and secondary care in England. Method Changes in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission. Results Emergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients. Conclusion Perceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.
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Weir DL, Lee TC, McDonald EG, Motulsky A, Abrahamowicz M, Morgan S, Buckeridge D, Tamblyn R. Both New and Chronic Potentially Inappropriate Medications Continued at Hospital Discharge Are Associated With Increased Risk of Adverse Events. J Am Geriatr Soc 2020; 68:1184-1192. [PMID: 32232988 PMCID: PMC7687123 DOI: 10.1111/jgs.16413] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Admission to hospital provides the opportunity to review patient medications; however, the extent to which the safety of drug regimens changes after hospitalization is unclear. OBJECTIVE To estimate the number of potentially inappropriate medications (PIMs) prescribed to patients at hospital discharge and their association with the risk of adverse events 30 days after discharge. DESIGN Prospective cohort study. SETTING Tertiary care hospitals within the McGill University Health Centre Network in Montreal, Quebec, Canada. PARTICIPANTS Patients from internal medicine, cardiac, and thoracic surgery, aged 65 years and older, admitted between October 2014 and November 2016. MEASURES Abstracted chart data were linked to provincial health databases. PIMs were identified using AGS (American Geriatrics Society) Beers Criteria®, STOPP, and Choosing Wisely statements. Multivariable logistic regression and Cox models were used to assess the association between PIMs and adverse events. RESULTS Of 2,402 included patients, 1,381 (57%) were male; median age was 76 years (interquartile range [IQR] = 70‐82 years); and eight discharge medications were prescribed (IQR = 2‐8). A total of 1,576 (66%) patients were prescribed at least one PIM at discharge; 1,176 (49%) continued a PIM from prior to admission, and 755 (31%) were prescribed at least one new PIM. In the 30 days after discharge, 218 (9%) experienced an adverse drug event (ADE) and 862 (36%) visited the emergency department (ED), were rehospitalized, or died. After adjustment, each additional new PIM and continued community PIM were respectively associated with a 21% (odds ratio [OR] = 1.21; 95% confidence interval [CI] = 1.01‐1.45) and a 10% (OR = 1.10; 95% CI = 1.01‐1.21) increased odds of ADEs. They were also respectively associated with a 13% (hazard ratio [HR] = 1.13; 95% CI = 1.03‐1.26) and a 5% (HR = 1.05; 95% CI = 1.00‐1.10) increased risk of ED visits, rehospitalization, and death. CONCLUSIONS Two in three hospitalized patients were prescribed a PIM at discharge, and increasing numbers of PIMs were associated with an increased risk of ADEs and all‐cause adverse events. Improving hospital prescribing practices may reduce the frequency of PIMs and associated adverse events. J Am Geriatr Soc 68:1184–1192, 2020. See related editorial by Donna M. Fick in this issue.
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Affiliation(s)
- Daniala L Weir
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Todd C Lee
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Emily G McDonald
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Aude Motulsky
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Steven Morgan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Buckeridge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
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Sawan M, Reeve E, Turner J, Todd A, Steinman MA, Petrovic M, Gnjidic D. A systems approach to identifying the challenges of implementing deprescribing in older adults across different health-care settings and countries: a narrative review. Expert Rev Clin Pharmacol 2020; 13:233-245. [PMID: 32056451 DOI: 10.1080/17512433.2020.1730812] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: There is increasing recognition of the need for deprescribing of inappropriate medications in older adults. However, efforts to encourage implementation of deprescribing in clinical practice have resulted in mixed results across settings and countries.Area covered: Searches were conducted in PubMed, Embase, and Google Scholar in June 2019. Reference lists, citation checking, and personal reference libraries were also utilized. Studies capturing the main challenges of, and opportunities for, implementing deprescribing into clinical practice across selected health-care settings internationally, and international deprescribing-orientated policies were included and summarized in this narrative review.Expert opinion: Deprescribing intervention studies are inherently heterogeneous because of the complexity of interventions employed and often do not reflect the real-world. Further research investigating enhanced implementation of deprescribing into clinical practice and across health-care settings is required. Process evaluations in deprescribing intervention studies are needed to determine the contextual factors that are important to the translation of the interventions in the real-world. Deprescribing interventions may need to be individually tailored to target the unique barriers and opportunities to deprescribing in different clinical settings. Introduction of national policies to encourage deprescribing may be beneficial, but need to be evaluated to determine if there are any unintended consequences.
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Affiliation(s)
- Mouna Sawan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, St Leonards, Australia
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Adelaide, Australia.,Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Justin Turner
- Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Adam Todd
- School of Pharmacy, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, Australia
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Weir DL, Motulsky A, Abrahamowicz M, Lee TC, Morgan S, Buckeridge DL, Tamblyn R. Challenges at Care Transitions: Failure to Follow Medication Changes Made at Hospital Discharge. Am J Med 2019; 132:1216-1224.e5. [PMID: 31145881 DOI: 10.1016/j.amjmed.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND In-hospital medication reconciliation has not demonstrated reductions in adverse health outcomes, possibly because patients do not follow the changes made to their preadmission medications. Our objective was to determine the incidence of and variables associated with failure to follow newly prescribed therapies, discontinued medications, and dose changes. METHODS A prospective cohort study of patients admitted to hospitals in Montreal, Quebec between 2014 and 2016 was conducted. Failure to follow medication changes 30 days post discharge was measured by comparing prescribed and dispensed medications. Multivariable logistic regression was used to determine characteristics associated with failure to follow changes. RESULTS Among 2655 patients, mean age was 69.5 years (SD 14.7), and 1581 (60%) were males. There were 10,068 medication changes made at hospital discharge and 24% were not followed in the 30 days post discharge. Thirty percent of dose modifications were filled at the incorrect dose, 27% of new medications were not filled, and 12% of discontinued medications were filled. A number of factors increased the risk of failure to follow medication changes, including increasing out-of-pocket medication costs (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI], 1.07-1.18), discharge to long-term care facility (aOR 2.29; 95% CI, 1.63-3.08), and not having medications dispensed prior to admission (aOR 4.67; 95% CI, 3.75-5.90). CONCLUSION One in 4 hospital medication changes was not followed post discharge. Health policy aimed at eliminating out-of-pocket medication costs and investigation of factors influencing failure to follow changes for those not dispensed medications prior to admission and for long-term care residents are important next steps to address this issue.
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Affiliation(s)
- Daniala L Weir
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Que, Canada.
| | - Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Que, Canada; Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Que, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Research Institute of the McGill University Health Centre, Montreal, Que, Canada
| | - Todd C Lee
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Department of Medicine, McGill University, Montreal, Que, Canada
| | - Steven Morgan
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - David L Buckeridge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Que, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Que, Canada
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Krause O, Glaubitz S, Hager K, Schleef T, Wiese B, Junius-Walker U. Post-discharge adjustment of medication in geriatric patients : A prospective cohort study. Z Gerontol Geriatr 2019; 53:663-670. [PMID: 31440831 DOI: 10.1007/s00391-019-01601-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known to what extent general practitioners (GP) change hospital discharge medications in older patients. OBJECTIVE This prospective cohort study aimed to analyze medication changes at the interface between hospital and community in terms of quality, quantity and type of drugs. METHODS A total of 121 out of 248 consecutively enrolled patients admitted to an acute geriatric hospital unit participated in the study. Medication regimens were recorded at admission and discharge and 4 weeks after hospital discharge the general practitioners in charge were contacted to provide the current medication charts. Changes in the extent of polypharmacy, in the type of drugs using anatomical therapeutic chemical classification (ATC) codes and potentially inappropriate medications (PIM) were analyzed. RESULTS Medication charts could be obtained for 98 participants in primary care. Only 21% of these patients remained on the original discharge medication. Overall, the average number of medications rose from hospital admission (6.58 SD ± 3.45) to discharge (6.96 SD ± 3.49) and again post-discharge in general practice (7.22 SD ± 3.68). The rates of patients on excessive polypharmacy (≥10 drugs) and on PIM were only temporarily reduced during hospital stay. The GPs stopped anti-infective drugs (ATC-J) and prescribed more antirheumatic drugs (ATC-M). Although no significant net changes occurred in other ATC groups, a substantial number of drugs were interchanged regarding the subgroups. CONCLUSION The study found that GPs extensively adjusted geriatric discharge medications. Whereas some changes may be necessary due to alterations in patients' state of health, a thorough communication between hospital doctors and GPs may level off different prescribing cultures and contribute to consistency in medication across sectors.
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Affiliation(s)
- Olaf Krause
- Center for Medicine of the Elderly, DIAKOVERE Henriettenstift, Schwemannstr. 19, 30559, Hannover, Germany. .,Institute for General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Stefanie Glaubitz
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Department of Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Klaus Hager
- Center for Medicine of the Elderly, DIAKOVERE Henriettenstift, Schwemannstr. 19, 30559, Hannover, Germany
| | - Tanja Schleef
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Birgitt Wiese
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ulrike Junius-Walker
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Gimenes FRE, Baysari M, Walter S, Moreira LA, de Carvalho REFL, Miasso AI, Faleiros F, Westbrook J. Are patients with a nasally placed feeding tube at risk of potential drug-drug interactions? A multicentre cross-sectional study. PLoS One 2019; 14:e0220248. [PMID: 31365563 PMCID: PMC6668811 DOI: 10.1371/journal.pone.0220248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/11/2019] [Indexed: 12/05/2022] Open
Abstract
Aims The primary aims were to determine the rate of potential drug-drug interactions (pDDIs) in patients with nasally placed feeding tubes (NPFT) and the factors significantly associated with pDDIs. The secondary aim was to assess the change in pDDIs for patients between admission and discharge. Material and methods This multicentre study applied a cross-sectional design and was conducted in six Brazilian hospitals, from October 2016 to July 2018. Data from patients with NPFT were collected through electronic forms. All regular medications prescribed were recorded. Medications were classified according to the World Health Organization (WHO) Anatomical Therapeutic Chemical code. Drug-drug interaction screening software was used to screen patients’ medications for pDDIs. Negative binomial regression was used to account for the over dispersed nature of the pDDI count. Since the number of pDDIs was closely related to the number of prescribed medications, we modelled the rate of pDDIs with the count of pDDIs as the numerator and the number of prescribed medications as the denominator; six variables were considered for inclusion: time (admission or discharge), patient age, patient gender, age-adjusted Charlson Comorbidity Index (CCI) score, type of prescription (electronic or handwritten) and patient care complexity. To account for correlation within the two time points (admission and discharge) for each patient a generalised estimating equations approach was used to adjust the standard error estimates. To test the change in pDDI rate between admission and discharge a full model of six variables was fitted to generate an adjusted estimate. Results In this study, 327 patients were included. At least one pDDI was found in more than 91% of patients on admission and discharge and most of these pDDIs were classified as major severity. Three factors were significantly associated with the rate of pDDIs per medication: patient age, patient care complexity and prescription type (handwritten vs electronic). There was no evidence of a difference in pDDI rate between admission and discharge. Conclusion Patients with a NPFT are at high risk of pDDIs. Drug interaction screening tools and computerized clinical decision support systems could be effective risk mitigation strategies for this patient group.
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Affiliation(s)
- Fernanda Raphael Escobar Gimenes
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Melissa Baysari
- Centre for Health Systems and Safety Research, Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Scott Walter
- Centre for Health Systems and Safety Research, Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Leticia Alves Moreira
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | - Adriana Inocenti Miasso
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Faleiros
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
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Redmond P, McDowell R, Grimes TC, Boland F, McDonnell R, Hughes C, Fahey T. Unintended discontinuation of medication following hospitalisation: a retrospective cohort study. BMJ Open 2019; 9:e024747. [PMID: 31167862 PMCID: PMC6561421 DOI: 10.1136/bmjopen-2018-024747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 03/01/2019] [Accepted: 05/01/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Whether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice. DESIGN Retrospective cohort study between 2012 and 2015. SETTING Electronic records and hospital supplied discharge notifications in 44 Irish general practices. PARTICIPANTS 20 488 patients aged 65 years or more prescribed long-term medication for chronic conditions. PRIMARY AND SECONDARY OUTCOMES Discontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient's general practitioner (GP) prescribing record at 6 months follow-up. RESULTS In patients admitted to hospital, medication discontinuity ranged from 6%-11% in the 6 months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95% CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95% CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95% CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95% CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95% CI (1.68 to 5.25), p<0.01). CONCLUSION Discontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary.
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Affiliation(s)
- Patrick Redmond
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Ronald McDowell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Public Health, Queen’s University, Cancer Epidemiology and Health Services Group, Belfast, UK
| | | | - Fiona Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronan McDonnell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel Hughes
- School of Pharmacy, Queens University Belfast, Belfast, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Daliri S, Bekker CL, Buurman BM, Scholte op Reimer WJM, van den Bemt BJF, Karapinar – Çarkit F. Barriers and facilitators with medication use during the transition from hospital to home: a qualitative study among patients. BMC Health Serv Res 2019; 19:204. [PMID: 30925880 PMCID: PMC6441233 DOI: 10.1186/s12913-019-4028-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During transitions from hospital to home, up to half of all patients experience medication-related problems, such as adverse drug events. To reduce these problems, knowledge of patient experiences with medication use during this transition is needed. This study aims to identify the perspectives of patients on barriers and facilitators with medication use, during the transition from hospital to home. METHODS A qualitative study was conducted in 2017 among patients discharged from two hospitals using a semi-structured interview guide. Patients were asked to identify all barriers they experienced with medication use during transitions from hospital to home, and facilitators needed to overcome those barriers. Data were analyzed following thematic content analysis and visualized using an "Ishikawa" diagram. RESULTS In total, three focus groups were conducted with 19 patients (mean age: 70.8 (SD 9.3) years, 63% female). Three barriers were identified; lack of personalized care in the care continuum, insufficient information transfer (e.g. regarding changes in pharmacotherapy), and problems in care organization (e.g. medication substitution). Facilitators to overcome these barriers included a personal medication-counselor in the care continuum to guide patients with medication use and overcome communication barriers, and post-discharge follow-up care (e.g. home visits from healthcare providers). CONCLUSIONS During transitions from hospital to home patients experience individual-, healthcare provider- and organization level barriers. Future research should focus on personal-medication counselors in the care continuum and post-discharge follow-up care as it may overcome communication, emotional, information and organization barriers with medication use.
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Affiliation(s)
- Sara Daliri
- Faculty of Health, ACHIEVE Center of Expertise, Amsterdam University of Applied Sciences, Amsterdam, 1105 BD the Netherlands
- Department of Clinical Pharmacy, OLVG hospital, Amsterdam, 1061AE The Netherlands
| | - Charlotte L. Bekker
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, 6574 NA The Netherlands
- Department of Clinical Pharmacy, Division of Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht, 3584 CX The Netherlands
| | - Bianca M. Buurman
- Faculty of Health, ACHIEVE Center of Expertise, Amsterdam University of Applied Sciences, Amsterdam, 1105 BD the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, 1105 AZ the Netherlands
| | - Wilma J. M. Scholte op Reimer
- Faculty of Health, ACHIEVE Center of Expertise, Amsterdam University of Applied Sciences, Amsterdam, 1105 BD the Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, 1105 AZ The Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, 6574 NA The Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, 6525 GA The Netherlands
- Department of Pharmacy, University Medical Centre Maastricht, Maastricht, 6229 HX The Netherlands
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Daliri S, Hugtenburg JG, ter Riet G, van den Bemt BJF, Buurman BM, Scholte op Reimer WJM, van Buul-Gast MC, Karapinar-Çarkit F. The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before-After prospective study. PLoS One 2019; 14:e0213593. [PMID: 30861042 PMCID: PMC6413946 DOI: 10.1371/journal.pone.0213593] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/25/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medication-related problems are common after hospitalization, for example when changes in patients' medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge. METHODS A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient's own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data. RESULTS We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38-0.86, adjusted odds ratio 0.50; 95% CI 0.31-0.79). CONCLUSIONS A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.
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Affiliation(s)
- Sara Daliri
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, the Netherlands
- Community Pharmacy Westwijk, Amsterdam, the Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, the Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Pharmacy, University Medical Centre Maastricht, the Netherlands
| | - Bianca M. Buurman
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Wilma J. M. Scholte op Reimer
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
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Chan WWT, Dahri K, Partovi N, Egan G, Yousefi V. Evaluation of Collaborative Medication Reviews for High-Risk Older Adults. Can J Hosp Pharm 2018; 71:356-363. [PMID: 30626981 PMCID: PMC6306190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite the widespread use of medication reviews, many older adults are still exposed to the risks of polypharmacy. OBJECTIVES To quantify and describe the drug therapy problems identified and interventions undertaken by pharmacists before and after implementation (on July 1, 2015) of collaborative medication review for high-risk older adult patients (> 80 years of age). METHODS A retrospective single-centre pre-post cohort study was conducted between July 1, 2014, and July 31, 2016, to characterize the impact of collaborative medication reviews-consisting of a thorough medication review by a pharmacist and care conferences with the hospitalist and family physician-on prescribing patterns in an Acute Care for Elders unit. A standardized template was used to conduct medication reviews for the post-implementation group, whereas a chart review was conducted for the pre-implementation group. The primary outcomes were the number of drug therapy problems identified by the clinical pharmacists and the associated interventions by the pharmacists, which were categorized as clinical or compliance interventions. Secondary outcomes included the number of medications at discharge, the rate of hospital readmission within 30 days, and the length of hospital stay. RESULTS A total of 137 patients were identified for inclusion in either the pre-implementation group (n = 70) or the post-implementation group (n = 67). After implementation of collaborative medication reviews, there were statistically significant increases in the mean number of drug therapy problems identified (p < 0.001), the mean number of interventions undertaken (p = 0.004), and the median length of hospital stay (p < 0.001). There was no difference between the 2 groups in the number of medications at discharge, the proportion of patients taking more than 5 medications at discharge, or readmission within 30 days. CONCLUSION At the study institution, implementation of a quality improvement program that included pharmacist-led medication reviews and collaborative care conferences involving community and hospital care providers helped to improve documentation by clinical pharmacists of potential medication-related problems and led to more interventions to optimize patients' medication regimens.
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Affiliation(s)
- Winnie W T Chan
- , BSc, BSc(Pharm), ACPR, is a Clinical Pharmacist with Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia
| | - Karen Dahri
- , BSc, BSc(Pharm), PharmD, ACPR, is a Clinical Pharmacy and Research Specialist with Pharmaceutical Sciences, Vancouver General Hospital, and an Assistant Professor (Partner) with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Nilufar Partovi
- , BSc(Pharm), PharmD, FCSHP, is a Clinical Coordinator with Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia
| | - Gregory Egan
- , BSc(Pharm), PharmD, ACPR, is a Clinical Pharmacy Specialist with Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia
| | - Vandad Yousefi
- , MD, CCFP, FHM, is a Hospitalist with the Department of Family Practice, Vancouver General Hospital, Vancouver, British Columbia
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Mc Colgan R, Dalton DM, O’Sullivan HP, Sproule JA. The prescription of lidocaine patches in osteoarthritis—a complete audit cycle. Ir J Med Sci 2018; 188:525-530. [DOI: 10.1007/s11845-018-1878-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/23/2018] [Indexed: 12/31/2022]
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Rouch L, Farbos F, Cool C, McCambridge C, Hein C, Elmalem S, Rolland Y, Vellas B, Cestac P. Hospitalization Drug Regimen Changes in Geriatric Patients and Adherence to Modifications by General Practitioners in Primary Care. J Nutr Health Aging 2018; 22:328-334. [PMID: 29484345 DOI: 10.1007/s12603-017-0940-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved. DESIGN Observational prospective cohort study. SETTING Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital. PARTICIPANTS 206 subjects with a mean age of 85 years. MEASUREMENTS Changes in drug regimen undertaken during hospitalization were collected with the associated justifications. Adherence at one month by GPs to treatment modifications was assessed as well as modifications implemented in primary care with their rationale in case of non-adherence. Community pharmacists' and GPs' opinions about quality of communication and information transfer at hospital-general practice interface were investigated. RESULTS 5.5 ± 2.8 drug regimen changes were done per patient during hospitalization. The rate of adherence by GPs to treatment modifications suggested at discharge from hospital was 83%. In most cases, non-adherence by GPs to treatment modifications done during hospitalization was due to dosage adjustments, symptoms resolution but also worsening of symptoms. The last of which was particularly true for psychotropic drugs. All GPs received their patients' discharge letters but the timely dissemination still needs to be improved. Only 6.6% of community pharmacists were informed of treatment modifications done during their patients' hospitalization. CONCLUSION Our findings showed a successful rate of adherence by GPs to treatment modifications suggested at discharge from hospital, due to the fact that optimization was done in a collaborative way between geriatricians and hospital pharmacists and that justifications for drug regimen changes were systematically provided in discharge letters. Communication processes at the interface between secondary and primary care, particularly with community pharmacists, must be strengthened to improve seamless care.
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Affiliation(s)
- L Rouch
- Laure Rouch,Toulouse University Hospital, Department of Pharmacy, France,
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Brühwiler LD, Hersberger KE, Lutters M. Hospital discharge: What are the problems, information needs and objectives of community pharmacists? A mixed method approach. Pharm Pract (Granada) 2017; 15:1046. [PMID: 28943987 PMCID: PMC5597803 DOI: 10.18549/pharmpract.2017.03.1046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 08/22/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists' needs to perform these tasks are not well known. OBJECTIVE This study aims to a) Identify community pharmacists' current problems and roles at hospital discharge, b) Assess their information needs, specifically the availability and usefulness of information, and c) Gain insight into pharmacists' objectives and ideas for discharge optimisation. METHODS A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies. RESULTS The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient's care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation. There were 194 questionnaires returned (response rate 14.4%). The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather) badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for "off-label" medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services. CONCLUSION Surveyed Swiss community pharmacists rarely receive sufficient information along with discharge prescriptions, although it would be needed for medication reconciliation. According to the pharmacist's opinions, appropriate pharmaceutical care is therefore impeded.
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Affiliation(s)
- Lea D Brühwiler
- Clinical pharmacist. Clinical Pharmacy, Cantonal Hospital of Baden. Baden (Switzerland).
| | - Kurt E Hersberger
- Professor. Head of Pharmaceutical Care Research Group, University of Basel. Basel (Switzerland).
| | - Monika Lutters
- Chief of Clinical pharmacy, Cantonal Hospital of Baden. Baden (Switzerland).
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Neeman M, Dobrinas M, Maurer S, Tagan D, Sautebin A, Blanc AL, Widmer N. Transition of care: A set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward. Eur J Intern Med 2017; 38:30-37. [PMID: 27890453 DOI: 10.1016/j.ejim.2016.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/24/2016] [Accepted: 11/04/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the transition of care. METHODS This study took place in the internal medicine ward and in surrounding community pharmacies. The intervention group's patients underwent a set of pharmaceutical interventions during their hospital stay: medication reconciliation at admission, medication review, and discharge planning. The two groups were compared with regards to: number of community pharmacist interventions, time spent on discharge prescriptions, and number of treatment changes. RESULTS Comparison between the groups showed a much lower (77% lower) number of community pharmacist interventions per discharge prescription in the intervention (n=54 patients) compared to the control group (n=64 patients): 6.9 versus 1.6 interventions, respectively (p<0.0001); less time working on discharge prescriptions; less interventions requiring a telephone call to a hospital physician. The number of medication changes at different steps was also significantly lower in the intervention group: 40% fewer (p<0.0001) changes between hospital admission and discharge, 66% fewer (p<0.0001) between hospital discharge and community pharmacy care, and 25% fewer (p=0.002) between community pharmacy care and care by a general practitioner. CONCLUSION An intervention group underwent significantly fewer medication changes in subsequent steps in the transition of care after a set of interventions performed during their hospital stay. Community pharmacists had to perform fewer interventions on discharge prescriptions. Altogether, this improves continuity of care.
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Affiliation(s)
- Marine Neeman
- Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland
| | - Maria Dobrinas
- Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland
| | - Sophie Maurer
- Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland; Pharmacie du Marché, Vevey, Switzerland
| | - Damien Tagan
- Hôpital Riviera-Chablais, Vaud-Valais (HRC), Vevey, Switzerland
| | | | - Anne-Laure Blanc
- Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland.
| | - Nicolas Widmer
- Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland; Division of Clinical Pharmacology, Lausanne University Hospital, Lausanne, Switzerland
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Investigating the prevalence, predictors, and prognosis of suboptimal statin use early after a non-ST elevation acute coronary syndrome. J Clin Lipidol 2016; 11:204-214. [PMID: 28391887 PMCID: PMC5399750 DOI: 10.1016/j.jacl.2016.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 12/06/2016] [Accepted: 12/16/2016] [Indexed: 11/24/2022]
Abstract
Background High-potency statin therapy is recommended in the secondary prevention of cardiovascular disease but discontinuation, dose reduction, statin switching, and/or nonadherence occur in practice. Objectives To determine the prevalence and predictors of deviation from high-potency statin use early after a non-ST elevation acute coronary syndrome (NSTE-ACS) and its association with subsequent major adverse cardiovascular events (MACE) and all-cause mortality (ACM). Methods A total of 1005 patients from a UK-based prospective NSTE-ACS cohort study discharged on high-potency statin therapy (atorvastatin 80 mg, rosuvastatin 20 mg, or 40 mg daily) were included. At 1 month, patients were divided into constant high-potency statin users, and suboptimal users incorporating statin discontinuation, dose reduction, switching statin to a lower equivalent potency, and/or statin nonadherence. Follow-up was a median of 16 months. Results There were 156 suboptimal (∼15.5%) and 849 constant statin users. Factors associated in multivariable analysis with suboptimal statin occurrence included female sex (odds ratio 1.75, 95% confidence interval [CI] 1.14–2.68) and muscular symptoms (odds ratio 4.28, 95% CI 1.30–14.08). Suboptimal statin use was associated with increased adjusted risks of time to MACE (hazard ratio 2.10, 95% CI 1.25–3.53, P = .005) and ACM (hazard ratio 2.46, 95% CI 1.38–4.39, P = .003). Subgroup analysis confirmed that the increased MACE/ACM risks were principally attributable to statin discontinuation or nonadherence. Conclusions Conversion to suboptimal statin use is common early after NSTE-ACS and is partly related to muscular symptoms. Statin discontinuation or non-adherence carries an adverse prognosis. Interventions that preserve and enhance statin utilization could improve post NSTE-ACS outcomes. Deviation from high-potency statin therapy is common early in secondary prevention. Deviation can be by discontinuation, dose reduction, switching, or nonadherence. Muscular symptoms are associated with suboptimal statin use. Statin discontinuation/nonadherence is associated with increased adverse outcomes. Interventions to enhance statin use could improve secondary prevention outcomes.
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Ehnbom EC, Raban MZ, Walter SR, Richardson K, Westbrook JI. Do electronic discharge summaries contain more complete medication information? A retrospective analysis of paper versus electronic discharge summaries. Health Inf Manag 2016; 43:4-12. [PMID: 27009792 DOI: 10.1177/183335831404300301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complete, accurate and timely hospital discharge summaries are important for continuity of care. The aim of this study was to evaluate the effectiveness of an electronic discharge summary system in improving the medication information provided compared to the information in paper discharge summaries. We conducted a retrospective audit of 199 paper and 200 electronic discharge summaries from a 350-bed teaching hospital in Sydney, Australia. The completeness of medication information, and whether medication changes during the admission were explained, were assessed. Further, the likelihood of any incomplete information having an impact on continuity of care was assessed. There were 1352 and 1771 medication orders assessed in paper and electronic discharge summaries, respectively. Of these, 90.9% and 93.4% were complete in paper and electronic discharge summaries, respectively. The dose (OR 25.24, 95%CI: 3.41-186.9) and route (OR 8.65, 95%CI: 3.46-21.59) fields of medication orders, were more likely to be complete in electronic as compared with paper discharge summaries. There was no difference for drug frequency (OR 1.09, 95%CI: 0.77-1.55). There was no significant improvement in the proportion of incomplete medication orders rated as unclear and likely to impede continuity of care in paper compared with electronic discharge summaries (7.3% vs. 6.5%). Of changes to medication regimen, only medication additions were more likely to be explained in the electronic (n=253, 37.2%) compared to paper (n=104, 14.3%) discharge summaries (OR 3.14; 95%CI: 2.20-4.18). In summary, electronic discharge summaries offer some improvements over paper discharge summaries in terms of the quality of medication information documented. However, explanations of changes to medication regimens remained low, despite this being crucial information. Future efforts should focus on including the rationale for changes to medication regimens in discharge summaries.
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Affiliation(s)
- Elin C Ehnbom
- The University of New South Wales UNSW Sydney NSW 2052 Australia
| | - Magdalena Z Raban
- Australian Institute of Health Innovation The University of New South Wales, Sydney NSW
| | - Scott R Walter
- Australian Institute of Health Innovation The University of New South Wales, Sydney NSW 2052
| | | | - Johanna I Westbrook
- Centre for Health Systems and Safety Research Australian Institute of Health Innovation The University of New South Wales, Sydney NSW 2052
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Impact of Hospitalization on Antihypertensive Pharmacotherapy among Older Persons. Drugs Real World Outcomes 2016; 2:239-247. [PMID: 27747570 PMCID: PMC4883215 DOI: 10.1007/s40801-015-0033-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Little is known about the impact of hospitalization on antihypertensive pharmacotherapy and blood pressure control in older persons. Objectives The aim of this study was to explore the impact of hospitalization on the management of hypertension and antihypertensive pharmacotherapy in a cohort of older patients with a documented diagnosis of hypertension. Methods A retrospective, cross-sectional medical record audit was conducted in a large Australian metropolitan teaching hospital. Patients aged 65 years or older, admitted between January 1st 2010 and December 31st 2010, and with a documented diagnosis of hypertension in their medical record were included in the study. Antihypertensive pharmacotherapy and blood pressure control was compared between admission and discharge. Factors associated with changes to antihypertensive pharmacotherapy were identified. Results Changes to antihypertensive pharmacotherapy occurred in 39.5 % (n = 135) of patients (n = 342). On discharge, the proportion of patients receiving antihypertensive pharmacotherapy (89.0 vs 85.3 %, p < 0.0001) and the mean number of antihypertensive agents per patient (1.7 ± 1.1 vs 1.5 ± 1.1, p < 0.0001) declined compared with admission. Adverse drug reactions [odds ratio (OR) = 5, 95 % confidence interval (CI): 2.80–9.34] were the main reason documented for antihypertensive pharmacotherapy changes. Patients admitted under the care of medical (OR = 0.3, 95 % CI: 0.17–0.70) or surgical (OR = 0.3, 95 % CI: 0.12–0.53) specialties were less likely to experience changes to their antihypertensive pharmacotherapy than those treated by gerontology or cardiology teams. Conclusions Hospitalization has a significant impact on antihypertensive pharmacotherapy. Two out of every five older persons on antihypertensive medications will experience changes to their regimens during admission to hospital with most changes in antihypertensive pharmacotherapy due to adverse drug reactions.
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