Evaluation of drug‐related problems in older polypharmacy primary care patients

Vezmar-Kovačević, Sandra; Miljković, Branislava; Ćulafić, Milica; Kovačević, Milena; Golubović, Bojana; Jovanović, Marija; Vučićević, Katarina; Gier, Johan J. de

doi:10.1111/jep.12737

Cited by 34 publications

(42 citation statements)

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“…Our population had a high number of DRPs. The mean number of DRPs per patient of 7.2 is, on average, twice the mean found in some studies (1.37–2.5 DRPs per patient) conducted in elderly patients in various primary care settings (Serbia, Sweden, Canada) and similar to that in other studies (Netherlands) . The value seems to concur more with that in studies conducted on elderly patients in hospital settings (6.5–9.8 DRPs per patient) .…”

Section: Discussionsupporting

confidence: 84%

“…‘Drug use without indication’ or ‘unnecessary therapy’ is common in studies conducted in hospitals . ‘Non‐adherence’ and ‘adverse drug reaction’ are more common to studies conducted in primary care and are more often detected by patient interviews . ‘Drug indicated but not prescribed’ is also frequent in some studies .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, these patients had to be either 70 years of age or older (≥70) with at least two (≥2) chronic conditions, under the age of 70 (<70) with at least three (≥3) chronic conditions, to have had a recent loss of autonomy or a recent hospitalisation with medication changes initiated in the hospital. This definition of complex needs was based on criteria already used by physicians in practice and on the fact that polypharmacy can increase DRPs and therefore the potential benefits of a consultation with the FMG pharmacist. The pharmacists assessed patient eligibility on their first encounter with the referred patients.…”

Section: Methodsmentioning

confidence: 99%

“…According to Statistics Canada data, 27% of Canadians aged 65 years or older took five different drugs or more in 2008 . Polypharmacy can be at the origin of a decline in the quality of pharmacotherapy by increasing drug‐related problems (DRPs) . A DRP is ‘an event or circumstance involving drug treatment that interferes or potentially interferes with a patient’s experiencing an optimum outcome of medical care’ .…”

Section: Introductionmentioning

confidence: 99%

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Impact of pharmacists' interventions on the pharmacotherapy of patients with complex needs monitored in multidisciplinary primary care teams

Abdin

Grenier-Gosselin

Guénette

2019

International Journal of Pharmacy Practice

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Objectives Recently, pharmacists have joined multidisciplinary healthcare teams within family medicine groups (FMG) in Quebec Province, Canada. This study assessed the impact of their interventions on the pharmacotherapy of patients with complex needs monitored in FMGs. Methods We performed a pre/post real-life intervention study among patients with complex needs referred to the FMG pharmacist in four FMGs in Quebec City. Pharmacists collected data at baseline, during follow-up and up to 6 months after the first encounter. They recorded all drug-related problems (DRPs) identified, interventions made and recommendations that were accepted by physicians. The researchers used the data collected to compare the medication regimen complexity index (MRCI) and medication adherence (using the proportion of days covered (PDC)) before and after the pharmacist's interventions. Descriptive statistics and paired sample t-tests were computed. Key findings Sixty-four patients (median age: 74.5 years) were included; four patients were lost to follow-up. Pharmacists detected 300 DRPs (mean: 7.2 per patient) during the study period for which they made an intervention. The most common DRP was 'drug use without indication' (27%). The physicians accepted 263 (87.7%) of those interventions. The mean number of prescribed drugs per patient decreased from 13.8 (95% confidence interval (CI): 12.24 to 15.29) to 12.4 (95% CI: 10.92 to 13.90). The mean MRCI decreased from 47.18 to 41.74 (À5.44; 95% CI: 1.71 to 9.17), while the mean PDC increased from 84.4% to 90.0% (+5.6%; 95% CI: 2.7% to 8.4%). Conclusion Family medicine groups pharmacists can detect and resolve DRPs and can reduce medication regimen complexity and non-adherence to treatment in patients with complex needs monitored in FMGs.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of pharmacists' interventions on the pharmacotherapy of patients with complex needs monitored in multidisciplinary primary care teams

Abdin

Grenier-Gosselin

Guénette

2019

International Journal of Pharmacy Practice

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“…No mundo, vários pesquisadores (120)(121)(122)(123)(124)(125)(126)(127)(128) (125,(129)(130)(131)(132)(133)(134) . Uma revisão sistemática recente demonstrou que as intervenções realizadas por farmacêuticos para a melhora da adesão ao tratamento foram, estatisticamente, mais efetivas do que as realizadas por médicos e enfermeiros (125) .…”

Section: Discussionunclassified

Avaliação dos desfechos virológicos e de adesão ao tratamento antiviral em pacientes portadores de hepatite B crônica

Abreu¹

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Ao Prof. Dr. Raymond Schinazi, que aceitou coorientar essa pesquisa e recebeu-me em seu laboratório na Emory University por seis meses, em Atlanta -EUA. Foi uma honra trabalhar com ele durante esse período e fazer parte do seu grupo. Em especial, gostaria de agradecer à Profa. Dra. Leda Bassit, por seus ensinamentos e orientações, imprescindíveis para a realização desse trabalho. À Dra. Lilia Ganova-Raeva e ao Dr. Yury Khudyakov (Centers for Disease Control and Prevention -EUA), agradeço pela valiosa ajuda em biologia molecular e apoio ao projeto. Aos pacientes, principal motivação desta pesquisa."A doença é o lado escuro da vida, uma cidadania mais onerosa. Todos que nascemos temos essa dupla cidadania, no reino da saúde e no reino da doença. Embora todos gostaríamos de usar só o bom passaporte, mais cedo ou mais tarde, cada um de nós é obrigado, pelo menos por um tempo, a se identificar como cidadãos daquele outro lugar." Susan Sontag, .

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Healthcare professionals’ agreement on clinical relevance of drug-related problems among elderly patients

et al. 2017

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Background Disagreement among healthcare professionals on the clinical relevance of drug-related problems can lead to suboptimal treatment and increased healthcare costs. Elderly patients with chronic non-cancer pain and comorbidity are at increased risk of drug related problems compared to other patient groups due to complex medication regimes and transition of care. Objective To investigate the agreement among healthcare professionals on their classification of clinical relevance of drug-related problems in elderly patients with chronic non-cancer pain and comorbidity. Setting Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen, Denmark. Method A pharmacist performed medication review on elderly patients with chronic non-cancer pain and comorbidity, identified their drug-related problems and classified these problems in accordance with an existing categorization system. A five-member clinical panel rated the drug-related problems' clinical relevance in accordance with a five-level rating scale, and their agreement was compared using Fleiss' κ. Main outcome measure Healthcare professionals' agreement on clinical relevance of drug related problems, using Fleiss' κ. Results Thirty patients were included in the study. A total of 162 drug related problems were identified, out of which 54% were of lower clinical relevance (level 0-2) and 46% of higher clinical relevance (level 3-4). Only slight agreement (κ = 0.12) was found between the panellists' classifications of clinical relevance using a five-level rating scale. Conclusion The clinical pharmacist identified drug related problems of lower and higher clinical relevance. Poor overall agreement on the severity of the drug related problems was found among the panelists.

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Evaluation of drug‐related problems in older polypharmacy primary care patients

Abstract: Patients with asthma, hypertension, and diabetes and lack of statin, antithrombotic agent, and/or proton pump inhibitor use were associated with higher risks for DRPs.

Cited by 34 publications

References 38 publications

Impact of pharmacists' interventions on the pharmacotherapy of patients with complex needs monitored in multidisciplinary primary care teams

Impact of pharmacists' interventions on the pharmacotherapy of patients with complex needs monitored in multidisciplinary primary care teams

Avaliação dos desfechos virológicos e de adesão ao tratamento antiviral em pacientes portadores de hepatite B crônica

Healthcare professionals’ agreement on clinical relevance of drug-related problems among elderly patients

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