Medication-related problems encountered in the Program of All-Inclusive Care for the Elderly: An observational study

Bankes, David; Amin, Nishita Shah; Bardolia, Chandni; Awadalla, Michael S.; Knowlton, Calvin H.; Bain, K.T.

doi:10.1016/j.japh.2019.10.012

Cited by 12 publications

(26 citation statements)

References 50 publications

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“…No matter the care setting, pharmacists must be prepared for new collaborative endeavors in geriatric care. In the practice setting of this study, 100% of pharmacists are required to be board certified in geriatrics and, furthermore, are supported by a state-of-the-art clinical decision support system [22,24,37,38]. Such extensive training in geriatric pharmacotherapy, coupled with technology support, likely helped these pharmacists respond to DIIs from prescribers.…”

Section: Discussionmentioning

confidence: 99%

“…At a minimum, the pharmacy must dispense both prescription and over-the-counter medications for PACE participants [19]. Currently, regulations do not require pharmacists to be part of the IDT [19], but many PACE organizations contractually collaborate with one or more pharmacists as part of their care model [21][22][23].…”

Section: Setting and Contextmentioning

confidence: 99%

“…It provides comprehensive medication services for more than 35 PACE organizations, including about 75 individual PACE centers, representing a net census exceeding 10,000 PACE participants. In addition to dispensing medications, the pharmacy provides clinical consulting services to help prescribers optimize medication regimens and reduce medication-related risks for PACE participants [22,24]. The pharmacy employs board-certified geriatric pharmacists (i.e., BCGP) who use a clinical decision support system to identify and mitigate medication-related problems, including simultaneous multi-drug interactions [22].…”

Section: Setting and Contextmentioning

confidence: 99%

“…In addition to dispensing medications, the pharmacy provides clinical consulting services to help prescribers optimize medication regimens and reduce medication-related risks for PACE participants [22,24]. The pharmacy employs board-certified geriatric pharmacists (i.e., BCGP) who use a clinical decision support system to identify and mitigate medication-related problems, including simultaneous multi-drug interactions [22]. The clinical pharmacists collaborate with PACE organizations, namely prescribers, to manage the day-to-day medication needs for their participants.…”

Section: Setting and Contextmentioning

confidence: 99%

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Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

Bankes¹,

Schamp²,

Knowlton³

et al. 2020

Pharmacy

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Little is known about the types of drug information inquiries (DIIs) prescribers caring for older adults ask pharmacists during routine practice. The objective of this research was to analyze the types of DIIs prescribing clinicians of Programs of All-Inclusive Care for the Elderly (PACE) made to clinical pharmacists during routine patient care. This was a retrospective analysis of documented pharmacists’ encounters with PACE prescribers between March through December, 2018. DIIs were classified using a developed taxonomy that describes prescribers’ motivations for consulting with pharmacists and their drug information needs. Prescribers made 414 DIIs during the study period. Medication safety concerns motivated the majority of prescribers’ inquiries (223, 53.9%). Inquiries received frequently involved modifying drug therapy (94, 22.7%), identifying or resolving adverse drug events (75, 18.1%), selecting or adjusting doses (61, 14.7%), selecting new drug therapies (57, 13.8%), and identifying or resolving drug interactions (52, 12.6%). Central nervous system medications (e.g., antidepressants and opioids), were involved in 38.6% (n = 160) of all DIIs. When answering DIIs, pharmacists made 389 recommendations. Start alternative medications (18.0%), start new medications (16.7%), and change doses (12.1%) were the most frequent recommendations rendered. Prescribers implemented at least 79.3% (n = 268) of recommendations based on pharmacy records (n = 338 verifiable recommendations). During clinical practice, PACE prescribers commonly ask pharmacists a variety of DIIs, largely related to medication safety concerns. In response to these DIIs, pharmacists provide medication management recommendations, which are largely implemented by prescribers.

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Section: Discussionmentioning

confidence: 99%

Section: Setting and Contextmentioning

confidence: 99%

Section: Setting and Contextmentioning

confidence: 99%

Section: Setting and Contextmentioning

confidence: 99%

See 2 more Smart Citations

Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

Bankes¹,

Schamp²,

Knowlton³

et al. 2020

Pharmacy

Self Cite

View full text Add to dashboard Cite

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“…The dispensing of all medications for PACE participants, including over-the-counter products and medications obtained by on-site fulfillment (e.g., automated dispensing machines) and by local procurement (i.e., community pharmacy networks), is managed by this centralized pharmacy and documented in its electronic record. Additionally, this pharmacy provides medication therapy management services, including comprehensive and targeted medication safety reviews, which consider simultaneous multidrug interactions and time-of-day administrations to optimize drug regimens for PACE participants [9]. The pharmacy is also a training site for pharmacy students and postgraduate pharmacy residents.…”

Section: Study Protocol and Practice Descriptionmentioning

confidence: 99%

Cytochrome P450 (CYP450) Interactions Involving Atypical Antipsychotics Are Common in Community-Dwelling Older Adults Treated for Behavioral and Psychological Symptoms of Dementia

Matos¹,

Bain²,

Bankes³

et al. 2020

Pharmacy

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Treatment of behavioral and psychological symptoms of dementia (BPSD) and comorbidities often necessitates the concomitant use of antipsychotics and non-antipsychotic drugs, thereby potentiating the risk for drug–drug interactions (DDIs). The primary objective of our study was to identify potentially clinically relevant cytochrome P450 (CYP)-mediated DDIs involving antipsychotics among participants enrolled in the Program of All-Inclusive Care for the Elderly (PACE) with BPSD. Additionally, we wanted to determine the prevalence of antipsychotic use in this population. The study included 10,001 PACE participants. The practice setting used a proprietary clinical decision support system (CDSS) to analyze simultaneous multidrug interactions. A retrospective analysis of pharmacy claims data was conducted to identify DDIs involving antipsychotics prescribed for BPSD, using snapshots of medication profiles paired with the CDSS. Of the participants who met inclusion criteria, 1190 (11.9%) were prescribed an antipsychotic; of those, 1071 (90.0%) were prescribed an atypical antipsychotic. Aripiprazole commonly caused (being a perpetrator drug 94.6% of the time) potential DDIs with antidepressants (e.g., duloxetine, venlafaxine, mirtazapine), opioids (e.g., hydrocodone, oxycodone, tramadol) and metoprolol via the CYP2D6 isoform. Risperidone commonly caused (85.7%) potential DDIs with donepezil, lamotrigine and trazodone via the CYP3A4 isoform. Quetiapine exclusively suffered (100%) from potential DDIs with amlodipine, buspirone, omeprazole or topiramate via the CYP3A4 isoform. Antipsychotics are commonly prescribed to PACE participants for BPSD treatment and they may interact with other drugs used to treat comorbidities. A thorough review of concomitant medications will help mitigate the likelihood of potentially dangerous CYP-mediated DDIs involving antipsychotics.

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Implementing pharmacists' medication safety recommendations is associated with reduced health care resource utilization and mortality in high-risk older Americans

Bankes¹,

Jin²,

Williams³

et al. 2023

Journal of the American Pharmacists Association

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Medication-related problems encountered in the Program of All-Inclusive Care for the Elderly: An observational study

Cited by 12 publications

References 50 publications

Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

Cytochrome P450 (CYP450) Interactions Involving Atypical Antipsychotics Are Common in Community-Dwelling Older Adults Treated for Behavioral and Psychological Symptoms of Dementia

Implementing pharmacists' medication safety recommendations is associated with reduced health care resource utilization and mortality in high-risk older Americans

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