Physician agreement with pharmacist-suggested drug therapy changes for elderly outpatients

Hanlon, Joseph T.; Landsman, Pamela B.; Cowan, Katie; Schmader, Kenneth E.; Weinberger, Morris; Uttech, Kay M.; Samsa, Gregory P.; Cohen, Harvey Jay

doi:10.1093/ajhp/53.22.2735

Cited by 12 publications

(5 citation statements)

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“…There are many ways to define medication-related prob-CME course available at www.archinternmed.com lems in elderly patients, including the use of lists containing specific drugs to avoid in the elderly and appropriateness indexes applied by pharmacists or clinicians. 1,10,11 Systematic review of the evidence-based literature on medication use in elderly patients is another approach to defining the problem, but the number of controlled studies on medication use in elderly patients is limited.…”

mentioning

confidence: 99%

Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Fick

Cooper²,

Wade³

et al. 2003

Arch Intern Med

2,158

1,622

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mentioning

confidence: 99%

Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Fick

Cooper²,

Wade³

et al. 2003

Arch Intern Med

2,158

1,622

View full text Add to dashboard Cite

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“…When doctors consider a medication-related problem to be of low risk they may reasonably decide to leave things unchanged, only acting on what they consider to be the high-risk problems. 17 Several studies have reported that a substantial number of pharmacist-identified medicationrelated problems or medication review recommendations are of low or minor clinical significance. 6,16,18,19 In our study, where the medication reviews were undertaken by a pharmacist with postgraduate clinical pharmacy qualifications and over 10 years of clinical experience, around 20% of pharmacist-identified medication-related problems were rated by the geriatricians as low risk or no risk.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Risk Associated with Medication‐Related Problems in Elderly Outpatients

Elliott

Woodward

2009

Pharmacy Practice and Res

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Background:The Society of Hospital Pharmacists of Australia's (SHPA) Standards of Practice for Clinical Pharmacy provide a risk-classification system for interventions made by pharmacists in hospital inpatients. These standards are based on Australian standards for risk management, where risk is based on an estimate of the likelihood and consequences of an adverse outcome from a medication-related problem, if no intervention was made. Aim: To adapt and validate the SHPA risk-classification system for use in geriatric ambulatory care and to explore differences in classifications of risk made by pharmacists and geriatricians. Method: The SHPA risk-classification system was modified, piloted and reviewed by experts to assess face validity. 113 medication-related problems identified by an outpatient clinical pharmacist in aged care were independently classified by a senior clinical pharmacist, a geriatrician and the outpatient clinical pharmacist. When there was disagreement, the case was discussed and consensus reached. A random sample of 30 medication-related problems, stratified by consensus risk classification was classified by a second geriatrician. Results: Face validity of the adapted risk-classification system was established. Agreement between pharmacists on medication-related problem risk was moderate and agreement between pharmacists and geriatricians was fair. Risk of adverse outcomes was rated lower by geriatricians than pharmacists. Consensus was easily reached through case discussion. Conclusion: A system for classifying risk associated with pharmacist-identified medication-related problems in geriatric ambulatory care was developed. Differences were identified between pharmacists and geriatricians in the way medicationrelated risks are perceived. Classification of pharmacist-identified medication-related problems/interventions may need to be based on consensus between at least one doctor and pharmacist. J Pharm Pract Res 2009; 39: 109-13. 21. Jackson S, Tenni P, Naunton M. Collaborative RMMRs in aged care facilities. Aust Pharm 2006; 25: 758. 22. Volume CI, Burback LM, Farris KB. Reassessing the MAI: elderly people's opinions about medication appropriateness. Int J Pharm Pract 1999; 7: 129-37.

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“…In all of the included studies, a pharmacist medication review to identify drug related problems was the cornerstone of the pharmacotherapy consult or intervention. 1,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The medication reviews included factors such as patient interviews by a pharmacist to evaluate medication use and adherence, [5][6][7][8][9]11,12,14,16,18 patient use of health and human services, 5 a quality of life survey, 5,8,9 or other physical and mental assessments, 6,8,14 the cost of the patients' medications, 5,7,8,12 and any patient reported problems with medications. 7,9,11,12,14 In addition to medication reviews, the pharmacist interventions in four of the studies were more extensive.…”

Section: 19mentioning

confidence: 99%

“…6,10,16,17 From the information obtained through the medication reviews and patient interviews, pharmacists developed pharmaceutical care plans and medication recommendations that were submitted to the patient's physician. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In some interventions pharmacists counselled patients on any accepted changes [5][6][7][8][9][11][12][13]16 in addition to other important issues such as adherence and medication safety.…”

Section: 19mentioning

confidence: 99%

“…It is important to consider the prescribing practices of physicians and the instances of inappropriate prescribing or pharmaceutical care issues, as these can potentially lead to serious ADRS. 13 The authors of one study concluded that pharmacist intervention increased the number of documented medication issues resolved, especially those related to patients' information needs, dosage, prescription problems, and monitoring to prevent ADRs. 5 This study showed that 70% of all pharmaceutical care issues were resolved in the intervention group compared to only 14% of issues resolved in the control group.…”

Section: Clinical Outcomes: Decreased Adverse Drug Reactionsmentioning

confidence: 99%

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Efectos de las intervenciones del farmacéutico en pacientes polimedicados

Chumney

Robinson

2006

Pharmacy pract. (Granada Ed. impr.)

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Polypharmacy, the state of being prescribed or taking more medications than clinically appropriate, can result in a variety of negative outcomes for both patients and healthcare facilities. These include negative outcomes such as adverse drug effects, hospitalizations, and poor patient health, as well as economic outcomes such as increased drug cost and costs associated with increased utilization of health services. Available data suggests pharmacists have the potential to have a large effect in combating this problem through a variety of interventions such as reducing the number of medications taken, reducing the number of doses taken, increasing patient adherence, preventing adverse drug reactions (ADRs), improving patient quality of life and decreasing facility and drug costs. A small number of studies have been performed on the pharmacists' role in addressing the problem of polypharmacy; however, they include various populations, settings, and measured outcomes. Furthermore, some of the results are conflicting. Nonetheless, this review of the available literature concludes that pharmacist interventions can improve patient outcomes. With the ever-increasing costs of healthcare, the substantial cost savings for patients as well as institutions provided by these interventions are further justification for widespread implementation of pharmacist interventions at healthcare institutions.

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Physician agreement with pharmacist-suggested drug therapy changes for elderly outpatients

Cited by 12 publications

References 0 publications

Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Assessment of Risk Associated with Medication‐Related Problems in Elderly Outpatients

Efectos de las intervenciones del farmacéutico en pacientes polimedicados

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