Drug‐Related‐Problem Outcomes and Program Satisfaction from a Comprehensive Brown Bag Medication Review

O’Connell, Mary Beth; Chang, Feng Yee; Tocco, Ashley; Mills, Megan E.; Hwang, Jamie M.; Garwood, Candice L.; Khreizat, Hanan S.; Gupta, Nidhi

doi:10.1111/jgs.13597

Cited by 22 publications

(22 citation statements)

References 17 publications

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“…They reported the same DRP prevalence of 93% for 182 patients (a mean of 2.5 DRPs per patient, SD 1.5) as in our study (Milos et al , 2013 ). Our results for the polypharmacy subgroup (67% of the DelpHi-MV study participants with five or more prescription medications) are comparable to the 95% prevalence of at least one DRP observed in a recent analysis of participants from senior centers and residential facilities in the USA aged 60 years and older (mean age 75.9 ± 8.5) taking five or more medications (O'Connell et al , 2015 ). A high number of drugs taken increase the number of DRPs in persons both with dementia and without dementia, as has been shown in previous studies (Lau et al , 2010 ; Kaufmann et al , 2015 ; Lavan and Gallagher, 2016 ).…”

Section: Discussionsupporting

confidence: 83%

Drug-related problems in community-dwelling primary care patients screened positive for dementia

Wucherer

Thyrian

Eichler

et al. 2017

Int. Psychogeriatr.

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Background:Older people have a higher risk of drug-related problems (DRPs). However, little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care.Methods:The Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi-MV) study is a general practitioner (GP)-based cluster-randomized controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in the primary care setting in Germany. Medication reviews of 446 study participants were conducted by pharmacists based on a comprehensive baseline assessment that included a computer-based home medication assessment. ClinicalTrials.gov Identifier: NCT01401582.Results:A total of 1,077 DRPs were documented. In 414 study participants (93%), at least one DRP was detected by a pharmacist. The most frequent DRPs were administration and compliance problems (60%), drug interactions (17%), and problems with inappropriate drug choice (15%). The number of DRPs was significantly associated with the total number of drugs taken and with a formal diagnosis of a mental or behavioral disorder.Conclusions:Degree of cognitive impairment (MMSE defined) and formal diagnosis of dementia were not risk factors for an increased number of DRPs. However, the total number of drug taken and the presence of a diagnosis of mental and behavioral disorders were associated with an increased total number of DRPs.

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Section: Discussionsupporting

confidence: 83%

Drug-related problems in community-dwelling primary care patients screened positive for dementia

Wucherer

Thyrian

Eichler

et al. 2017

Int. Psychogeriatr.

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“…Due to the use of different MRP classification systems, it is challenging to make sound comparisons with other studies. However, in relation to type, i.e., unnecessary use of medication (and number of MRPs), our findings from this rural area are consistent with former studies from Norway, Sweden, Switzerland, and the USA [10,[29][30][31][32]. In a recent study using the same classification tool as we did, Devik et al found a mean of 3.7 MRPs per nursing home resident.…”

Section: Medication Use and Medication Related Problemssupporting

confidence: 92%

A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes

2019

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Background: The provision of responsible medication therapy to old nursing home residents with comorbidities is a difficult task and requires extensive knowledge about optimal pharmacotherapy for different conditions. We describe a stepwise pharmacist-led medication review service in combination with an interdisciplinary team collaboration in order to identify, resolve, and prevent medication related problems (MRPs). Methods: The service included residents from four rural Norwegian nursing homes during August 2016–January 2017. All residents were eligible if they (or next of kin) supplied oral consent. The interdisciplinary medication review service comprised four steps: (1) patient and medication history taking; (2) systematic medication review; (3) interdisciplinary case conference; and (4) follow-up of pharmaceutical care plan. The pharmacist collected information about previous and present medication use, and clinical and laboratory values necessary for the medication review. The nurses collected information about possible symptoms related to adverse drug reactions. The pharmacist conducted the medication reviews, identified medication-related problems (MRPs) which were discussed at case conferences with the responsible physician and the responsible nurses. The main outcome measures were number and types of MRPs, percentage agreement between pharmacists and physicians and factors associated with MRPs. Results: The service was delivered for 151 (94%) nursing home residents. The pharmacist identified 675 MRPs in 146 (97%) medication lists (mean 4.0, SD 2.6, range 0–13). The MRPs most frequently identified concerned ‘unnecessary drug’ (22%), ‘too high dosage’ (17%) and ‘drug interactions’ (16%). The physicians agreed upon 64% of the pharmacist recommendations, and action was taken immediately for 32% of these. We identified no association between the number of MRPs and sex (p = 0.485), but between the number of MRPs, and the number of medications and the individual nursing homes. Conclusion: The pharmacist-led medication review service in the nursing homes was highly successfully piloted with many solved and prevented MRPs in interdisciplinary collaboration between the pharmacist, physicians, and nurses. Implementation of this service as a standard in all four nursing homes seems necessary and feasible. If such a service is implemented, effects related to patient outcomes, interdisciplinary collaboration, and health economy should be studied.

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“…Previous studies have assessed patient satisfaction after providing pharmacy services delivered by pharmacists in the community . Assessment of services has been published from many countries including England, Michigan (United States), Spain and Australia …”

Section: Introductionmentioning

confidence: 99%

“…[13,14] Previous studies have assessed patient satisfaction after providing pharmacy services delivered by pharmacists in the community. [7,15] Assessment of services has been published from many countries including England, [1,16] Michigan (United States), [17] Spain [18] and Australia. [19] We have previously reported the results of a study aimed at assessing the impact of an MMR service on the type and frequency of TRPs, and certain clinical outcomes in outpatients with chronic conditions who visited community pharmacies.…”

Section: Introductionmentioning

confidence: 99%

Assessing patient satisfaction with the Medication Management Review service delivered in Jordan

Basheti

Tadros

Alnajjar³

et al. 2018

Journal of Pharmaceutical Health Services Research

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Objective To investigate the effect of the Medication Management Review (MMR) service on the number of treatment‐related problems (TRPs), patient satisfaction and factors affecting patient satisfaction. Methods This prospective, randomized controlled trial was conducted at community pharmacies in Amman, Jordan. Eligible patients were randomized into active and control groups. A validated Pharmaceutical Care Manual was used for data collection and to identify TRPs for both groups. Identified TRPs for patients in the active group were resolved at the pharmacist level or sent to the patients’ physicians for approval and implementation. Patients in both groups were followed up at 3 months to determine the number of TRPs end of the study. Patients in the active group completed a validated, Likert scale MMR‐satisfaction questionnaire. Factors affecting satisfaction were assessed through multiple regression analysis. Key findings Outpatients with chronic conditions (n = 160) were recruited into the study, with mean age 53.01 ± 15.39; mean number of medical conditions of 3.56 ± 1.15 and 4.73 ± 1.79 mean number of medications. A mean number of 5.37 ± 3.01 TRPs per patient was identified, with no significant difference between both groups (active group n = 82, 5.57 ± 2.68; control n = 78, 5.18 ± 3.36, P = 0.412). At follow‐up, significantly lower number of TRPs were identified for patients in the active group compared to patients in the control group (1.06 ± 1.30 versus 4.53 ± 3.43, P < 0.001). Majority of patients were satisfied/very satisfied with the service (n = 77, 94.5%). A lower number of TRPs at follow‐up (B = −0.438; t = −4.477, P < 0.001) and higher number of TRPs agreed upon and implemented (B = 0.553; t = 6.949, P < 0.001) were significantly associated with higher level of patient satisfaction. Conclusion The MMR has proven to be an effective pharmaceutical care service when delivered in a developing country, such as Jordan. It led to high patient satisfaction, which was significantly associated with lower number of TRPs at follow‐up.

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Drug‐Related‐Problem Outcomes and Program Satisfaction from a Comprehensive Brown Bag Medication Review

Abstract: Older adults found the medication review helpful and implemented 63% of the DRP recommendations.

Cited by 22 publications

References 17 publications

Drug-related problems in community-dwelling primary care patients screened positive for dementia

Drug-related problems in community-dwelling primary care patients screened positive for dementia

A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes

Assessing patient satisfaction with the Medication Management Review service delivered in Jordan

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