Medicines Related Problems (MRPs) Originating in Primary Care Settings in Older Adults - A Systematic Review

Abstract

Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.

Global Mapping of Potentially Inappropriate Prescribing for Older Adults in Community Settings: An Umbrella Review

“…The results of the methodological quality assessment of the SRs are provided in Supplement 4. Among the 19 SRs, seven SRs were classified as high quality, 11,[26][27][28]32,34,35) 10 as moderate, 5,12,13,[22][23][24][29][30][31]33) and two as low quality. 14,25) The median AMSTAR score was 5 (range, [3][4][5][6][7][8][9][10][11].…”

“…26,30) In two SRs, the quality assessment was not well documented. 5,31) In one SR, the risk of bias was not assessed for the cross-sectional studies that described the prevalence of PIP. interest.…”

“…Despite the lack of well-documented critical appraisal of the two SRs, the quality of their included studies was reported to be moderate and high. 5,31) In terms of overlap assessment, 413 out of the 548 included studies in the SRs were indexed publications (r=413), which resulted in a slight overlap, as estimated by a CCA of approximately 2%. A cross-table can be found in Supplement 5.…”

“…5,[11][12][13][14][22][23][24][25][26][27][28][29][30] In the remaining five SRs, the prevalence was reported in addition to the main outcomes. [31][32][33][34][35] https://doi.org/10.4082/kjfm. 23…”

WHO Five Moments for Medication Safety: A time to organize?

“…Older adults are especially vulnerable. 6 Drug name confusion commonly leads to medication errors. 7 Reports from the US Agency for Healthcare Research and Quality, and the UK National Reporting and Learning System singled out transitions in care as a key hazard point in medication use.…”