Background: Multi-dose dispensing (MDD) of medications is a health technology designed to promote medication adherence and patient safety. MDD has been used as an alternative to ordinary prescription dispensing for patients, mostly elderly with high medication use. Objective: To evaluate the initiation phase of the MDD service to older adults ≥65 years and assess wheter the medication use of the new MDD patients is appropriate in terms of drug related problems. Methods: The European Union EU( 7)-PIM list and the Inxbase databases were used for identifying potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs). The study sample consisted of a total of 208 patients aged 65-108 years who were involved in the MDD service (PharmaService Ltd.) in Finland in 2015-2016. Clinically significant differences of PIM and DDI occurrences were identified using a Pearson's chisquare test throughout the demographic groups under study. Results: Results demonstrate that for 81% of the study participants, at least one medication from the EU (7)-PIM list was prescribed, and up to 64% of PIMs were clinically significant. According to the Inxbase database, five patients (2.4%) were prescribed category D clinically significant DDIs. Additionally, 61% of the patients saw an increase in the number of medications prescribed within six months after the initial MDD order. Conclusions: The results suggest that the MDD service should be accompanied by a regular medication review tailored to specific patient groups (i.e., older patients) to avoid potential DRPs.
Estonia, with a population of 1.3 million, is the smallest country in the three Baltic States. As a post-soviet country, Estonia over the past 30 years has built up a new health care system, including the pharmaceutical sector. The GDP allocated to cover health care costs is significantly lower in Estonia compared to the EU average. Despite this, Estonia has excelled in the development of digital e-services in healthcare at both the domestic and international levels. The development and integration of the Estonian community pharmacy sector into primary health care has been influenced and affected by the liberalization within pharmaceutical policy and the lack of cooperation with the rest of the health care sector. Community pharmacy ownership and location matters have been prevalent. The promotion of the pharmacy services has mostly taken place on the basis of a professional initiative, as cooperation with the state has not been active. Possibly the professional fragmentation of the pharmacy sector may have played a negative role. The community pharmacy network in Estonia, especially in cities, enables fast and convenient access to the pharmacy services. Community Pharmacy Service Quality Guidelines support the harmonization of the provided services and patient-centered concept to enhance the patient role and involvement in their care. In recent years, community pharmacies in Estonia have also offered various extended services that are more or less integrated with the primary health care system. New developments may be affected by frequent changes in legislation and a shortage of professional staff in community pharmacies. The ownership reform of pharmacies in 2020 has so far not had a significant impact on the operation of pharmacies or the quality of services provided.
We aimed to systematically review the prevalence of potentially inappropriate prescribing (PIP) in older adults in Central and Eastern Europe (CEE) in all care settings. We searched Embase and MEDLINE (up to June 2019) and checked the reference lists of the included studies and relevant reviews. Eligible studies used validated explicit or implicit tools to assess the PIP prevalence in older adults in CEE. All study designs were considered, except case‒control studies and case series. We assessed the risk of bias using the Joanna Briggs Institute Prevalence Critical Appraisal Tool and the certainty of evidence using the GRADE approach. Meta-analysis was inappropriate due to heterogeneity in the outcome measurements. Therefore, we used the synthesis without meta-analysis approach—summarizing effect estimates method. This review included twenty-seven studies with 139,693 participants. Most studies were cross-sectional and conducted in high-income countries. The data synthesis across 26 studies revealed the PIP prevalence: the median was 34.6%, the interquartile range was 25.9–63.2%, and the range was 6.5–95.8%. The certainty of this evidence was very low due to the risk of bias, imprecision, and inconsistency. These findings show that PIP is a prevalent issue in the CEE region. Further well-designed studies conducted across countries are needed to strengthen the existing evidence and increase the generalizability of findings.
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