Drug-related problems in institutionalized elderly in Brasilia, Brazil

Oliveira, Mirna Poliana Furtado de; Novaes, María Rita Carvalho Garbi

doi:10.1016/j.biomag.2011.09.007

Cited by 9 publications

(19 citation statements)

References 37 publications

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“…This is not surprising because, as more health conditions arise, the higher the need for additional therapy. However, no relation was found between the number of medicines and age, contradicting previous findings [18]. …”

Section: Discussioncontrasting

confidence: 95%

“…However, it should be stressed that this study is innovative by using a simple classification, with vast use in primary care worldwide, particularly in Portuguese- and Spanish-speaking countries, but with so far little research published applying it in nursing homes residents. To our knowledge, there was only one publication describing the use of the Dader method in a similar sample, but which did not fully characterise the prevalence or type of DRP found [18]. …”

Section: Discussionmentioning

confidence: 99%

“…However, few reports of pharmacist-led medication reviews focus on the identification of DRPs, and these have either used the Pharmaceutical Care Network Europe classification [15, 16] or the DOCUMENT classification [17]. The Dader method has been used in nursing homes [18] but, to our knowledge, no paper has yet described the nature of DRP detected using the Granada classification to guide pharmacist-led medication reviews [19, 20]. Therefore, this study aimed at determining the prevalence of manifest and potential DRPs in polypharmacy elderly patients residing in nursing homes and to describe the nature of DRPs using the Granada classification.…”

Section: Introductionmentioning

confidence: 99%

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Drug-Related Problems Identified in a Sample of Portuguese Institutionalised Elderly Patients and Pharmacists’ Interventions to Improve Safety and Effectiveness of Medicines

Costa

Silvestre

Periquito

et al. 2016

Drugs - Real World Outcomes

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BackgroundCurrently, people live longer but often with poor quality of life. The decrease in healthy life-years is partly attributable to the institution of polypharmacy to treat various comorbidities.ObjectivesThe objectives of the study were to determine the prevalence and nature of drug-related problems (DRPs) in polypharmacy elderly patients residing in nursing homes and to test the acceptability of a pharmacist’s intervention.MethodsAn exposure cohort was constituted in three Portuguese nursing homes, where all polypharmacy (five or more medicines) elderly patients (≥65 years of age) were analysed and then a random stratified sample was extracted to be subject to an intervention. Clinical and therapeutic data were collected and analysed for DRPs and classified according to the II Granada Consensus, by a pharmacist-led team. The intervention was the formulation of a pharmacist’s recommendations to prescribers addressing clinically relevant DRPs, along with suggestions for therapy changes.ResultsThe initial sample included 126 elderly patients taking 1332 medicines, where 2109 DRPs were identified. The exposure cohort included 63 patients, with comparable baseline data (p > 0.005). Manifest DRPs occurred in 31.7 % of the intervention group (mainly quantitative ineffectiveness–DRP 4), whereas potential DRPs were identified in 100 % of patients (mainly non-quantitative unsafe–DRP 5). Amongst the DRPs identified, 584 (56.7 %) were reported to prescribers (all types of DRPs) and 113 (11 %) to nurses (only non-quantitative ineffectiveness–DRP 3). A total of 539 pharmacist recommendations were presented to physicians, corresponding to 62 letters sent by mail, each including an average of 8.7 recommendations to solve DRPs present in intervention group (IG) patients. There was a high non-response rate (n = 34 letters; 54.8 %; containing 367 pharmacist recommendations; 68.1 %) and amongst recommendations receiving feedback, only 8.7 % of pharmacist recommendations made were accepted (n = 15). Positive responses were significantly associated with a lower number of recommendations made, whereas a higher number of recommendations increased the odds of no response (p < 0.001).ConclusionA pharmacist-led medication review proved useful in identifying DRPs in elderly polypharmacy nursing home residents. Stronger bonds must be developed between healthcare professionals to increase patient safety in the vulnerable institutionalised elderly population.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drug-Related Problems Identified in a Sample of Portuguese Institutionalised Elderly Patients and Pharmacists’ Interventions to Improve Safety and Effectiveness of Medicines

Costa

Silvestre

Periquito

et al. 2016

Drugs - Real World Outcomes

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“…We suggest requiring the monitoring of the outcomes of treatments prescribed to analyze whether the pharmaceutical interventions prescribed by the physician were of positive clinical significance. The literature confirms a positive association between the number of medicines and the presence of drug interactions pointing to polypharmacy as a precipitating factor of interactions and high mortality rates [32, 33]. …”

Section: Discussionmentioning

confidence: 90%

Evaluation of pharmacotherapy complexity in residents of long-term care facilities: a cross-sectional descriptive study

Alves-Conceição

Silva

Santana

et al. 2017

BMC Pharmacol Toxicol

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BackgroundPolypharmacy is a reality in long-term care facilities. However, number of medications used by the patient should not be the only predictor of a complex pharmacotherapy. Although the level of complexity of pharmacotherapy is considered an important factor that may lead to side effects, there are few studies in this field. The aim of this study was to evaluate the complexity of pharmacotherapy in residents of three long-term care facilities.MethodsA cross-sectional study was performed to evaluate the complexity of pharmacotherapy using the protocols laid out in the Medication Regimen Complexity Index instrument in three long-term care facilities in northeastern Brazil. As a secondary result, potential drug interactions, potentially inappropriate medications, medication duplication, and polypharmacy were evaluated. After the assessment, the association among these variables and the Medication Regimen Complexity Index was performed.ResultsIn this study, there was a higher prevalence of women (64.4%) with a high mean age among the study population of 81.8 (±9.7) years. The complexity of pharmacotherapy obtained a mean of 15.1 points (±9.8), with a minimum of 2 and a maximum of 59. The highest levels of complexity were associated with dose frequency, with a mean of 5.5 (±3.6), followed by additional instructions of use averaging 4.9 (±3.7) and by the dosage forms averaging 4.6 (±3.0).ConclusionsThe present study evaluated some factors that complicate the pharmacotherapy of geriatric patients. Although polypharmacy was implicated as a factor directly related to complexity, other indicators such as drug interactions, potentially inappropriate medications, and therapeutic duplication can also make the use of pharmacotherapy in such patients more difficult.

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“…Pharmacovigilance systems constitute a permanent drug monitoring tool which can reduce the morbidity, mortality and cost for health systems (23). The number of ADR reports for a drug can increase if there are specific warnings about it, which allows health institutions to focus pharmacovigilance on certain drugs.…”

Section: Discussionmentioning

confidence: 99%