Medication management among home-dwelling older patients with chronic diseases: Possible roles for community pharmacists

Abstract

Objective: To describe medication management among home-dwelling older adults. These data should allow us to identify potential problems and to indicate target areas for community pharmacist intervention.Design: Cross-sectional observational study Setting: Community pharmacies (n=86) in Belgium.Participants: Home-dwelling older adults using at least one chronic medicine (n=338).Measurements: Data on drug use were taken from the electronic pharmacy databases, while drug adherence was measured by pill count, self-report and estimation by GP and pharmacist. Drug knowledge and practical drug management capacity were assessed by patient interview and questionnaire, respectively. Results:The study population (n=338) used a median of 5 chronic drugs per patient. Half of our sample (n=169) used psychotropic medication chronically, mainly benzodiazepines. In 100 patients (29.6%) at least one drug-drug interaction of potential clinical significance was observed. The overall mean adherence per patient was very high (98.1%), but 39.6% of individuals was underadherent with at least one medication. Seventy-six % of patients had an acceptable knowledge of the indication for at least 75% of their medication. In nearly 15 % of the study population cognitive impairment was suspected by the Mini-Cog Test. The participants reported several practical problems with drug taking: difficulties with vision (32.0%), blister opening (12.1%), tablet swallowing (14.8%), tablet splitting (29.7% [represents % of patients who have to split tablets]) and distinction between different drug packages (23.4%). Conclusion:This study identified the following aspects of medication management by home-dwelling older adults that could be improved by pharmaceutical care services: (i) assistance of cognitively impaired patients, (ii) management of practical drug taking problems, (iii) DDI screening, (iv) drug adherence, and (v) chronic benzodiazepine use.3

Accuracy of tablet splitting and liquid measurements: an examination of who, what and how

“…The lower probability of participants above 60 years of age being able to split a tablet warrants further investigation, given the small proportion (4%) of participants aged above 60 years in the study. There is growing importance of tablet splitting as a cost‐cutting measure in the treatment of elderly patients, and the expectations that the motor and cognitive capabilities of geriatric patients may determine their ability to accurately split a tablet . Friends and relatives of the pharmacy students made up 35% of the participants in the general population group.…”

Missed Drug Therapy Alerts as a Consequence of Incomplete Electronic Patient Records in Dutch Community Pharmacies

“…These problems could have been overcome by switching to an alternative medication, dosage form, or package or by additional counselling by the pharmacist. 21 It is becoming more apparent that medication taking is prone to high error rates, which can decrease the effectiveness of drug therapy. 22 Therefore, pharmacists should be aware of the practical drug use problems that patients encounter and of the ability of the patient to administer the medication.…”

Medication Incidents Related to Automated Dose Dispensing in Community Pharmacies and Hospitals - A Reporting System Study

“…[2], [3] Home-dwelling elderly patients can have several problems when managing medicines, such as vision or cognitive impairments, which make it difficult to differentiate between medicine packages. [4] Patients need support tools to use their medicines appropriately. Automated dose dispensing (ADD), also known as multi dose dispensing, is an example of such a tool.…”