Medication-related problems in individuals with spinal cord injury in a primary care-based clinic

Abstract

Objective: To determine the frequency of medical problems, reason for referral/primary complaint, products used, medication-related problems, and polypharmacy in patients with spinal cord injury (SCI) seen at an interprofessional primary care mobility clinic. Design: Retrospective review of medical records of patients with SCI for patient visits between August 2012 and March 2013. Methods: Data were abstracted from medical records of patients with SCI. Results: Of 74 patients who presented to the clinic, 19 had an SCI. Mean age was 46.7 years and 74% were male. Most frequent medical problems were depression/anxiety (37%), osteoporosis/osteopenia (26%), hypertension (21%), dyslipidemia (21%), and osteoarthritis (21%). Most common presenting complaints were pain (23%) and bowel/bladder issues (13%). Most common medication-related problems were untreated conditions (41%), ineffective medications (21%), adverse drug reactions (18%), and under-and over-dosage (each 9%). Patients with SCI most frequently used products to treat pain (68%), constipation (42%), muscle spasm (42%), hypertension (42%), and depression (37%). When including natural health products, vitamins and minerals, polypharmacy was seen in 74% of patients with SCI (63% when limited to prescription and over-the-counter medications). For patients with SCI in whose care a pharmacist collaborated, a mean of 3.2 medication-related problems per patient were identified compared with 1 per patient when the pharmacist was not involved. Conclusion: This study is the first to describe medication use, polypharmacy and medication-related problems in patients with SCI seen at an interprofessional primary care clinic. Use of high-risk medications, polypharmacy, and medication-related problems in patients with SCI suggest the need for collaborative interprofessional care that includes a pharmacist.

Medication adherence for persons with spinal cord injury and dysfunction from the perspectives of healthcare providers: A qualitative study

“…[6][7][8] As a result, treatment plans are often complex, 9,10 involving the concomitant use of multiple medications (i.e. polypharmacy), [11][12][13][14] which often include high-risk prescription drugs (e.g. opioids, benzodiazepines).…”

“…14,15 While research is limited, 16 rates of polypharmacy range from 31% to 87%. [12][13][14] Polypharmacy is commonly associated with adverse drug events, 13 reduced medication adherence, 17 increased healthcare costs, 18 and lower quality of life. 19 A recent retrospective study found that individuals with SCI/D and polypharmacy were at a greater risk of experiencing an adverse drug event compared to a non-SCI/D control population.…”

“The strategies are the same, the problems may be different”: a qualitative study exploring the experiences of healthcare and service providers with medication therapy management for individuals with spinal cord injury/dysfunction

“…People with spinal cord injury or dysfunction (SCI/D) typically take multiple medications (also known as polypharmacy) to manage secondary health complications (e.g., spasticity, urinary tract infections, pressure sores, respiratory infections) and multimorbidity (e.g., heart disease and diabetes) [1][2][3][4][5][6]. The reported polypharmacy rates among persons with SCI/D vary between 31 to 87% [6][7][8][9]. Pharmacotherapeutic treatment plans for persons with SCI/D often include a combination of prescription and over-the-counter medications and natural health products.…”

“…While a small body of research identifies a high prevalence of polypharmacy among persons with SCI/D [6][7][8][9], there remains a lack of critical research to help understand the experiences of different healthcare and service providers with MTM for this population. Therefore, the main purpose of this study is to understand the experiences of healthcare and service providers with MTM for persons with SCI/D, as well as the barriers and enablers of optimal MTM.…”

Changes in psychotropic prescription medication use and their relationship with mortality among people with traumatic spinal cord injury

“…These conditions are often managed pharmacologically, and individuals with SCI are frequently prescribed multiple medications. Recent research suggests individuals with SCI who use multiple prescribed medications are at higher risk for adverse drug events and medication errors [5,6]. It is important to understand how prescription medication use impacts health and longevity in this population.…”