Prevalence and risk factors of drug-related problems identified in pharmacy-based medication reviews

Abstract

Background Medication safety is a major health concern, especially for older patients, in whom drug-related problems occur frequently as a consequence of polypharmacy and frailty, increasing the risk of adverse drug events. Objective To investigate the prevalence and types of drug-related problems in community pharmacies and to identify associated risk factors in order to adjust the focus of care. Setting 300 German community pharmacies in Saxony-Anhalt (Germany). Method In April 2015, community pharmacists conducted brown bag medication reviews for primary care patients, in which they identified and solved drug-related problems with patients or their physicians. Data from these reviews were analyzed, including frequency and nature of problems and their respective resolutions. Potentially inappropriate medications according to the PRISCUS list were identified by post hoc analysis. Risk factors for drug-related problems were determined using bivariate and multivariate logistic regression analysis. Main outcome measure Prevalence and risk factors of drug-related problems. Results 1090 medication reviews were conducted. On average, patients were 72.0 ± 9.1 years old and had 10.6 ± 3.7 medications, 62.0% (n = 676) presented a medication plan. Knowledge gaps about medications were detected in almost a third of patients (n = 345). Drug-related problems were identified in 84.2% (n = 918) of patients (in 3836 medications). Frequent problems concerned drug–drug-interactions (53.7%, n = 585) as well as drug use and adherence (46.7%, n = 509). Most problems (72.2%, n = 2769) were resolved between pharmacist and patient. Knowledge gaps and the number of drugs were independently associated with a higher risk of drug-related problems. For older patients, potentially inappropriate medications were a risk factor in bivariate, but not in multivariate analysis. Conclusion Pharmacists identified and resolved considerable rates of drug-related problems, suggesting that they are capable and well-positioned to conduct medication reviews. Knowledge gaps, the number of drugs, patient age and, in older patients, potentially inappropriate medications may indicate an increased risk for drug-related problems.

Prevalence of adverse drug reactions in the primary care setting: A systematic review and meta-analysis

“…About one-third of the studies were performed in a general practice setting [ 14 , 25 , 42 , 48 , 49 , 52 , 55 , 56 , 59 , 61 ], while seven studies were conducted within primary care internal medicine [ 23 , 27 , 30 , 39 , 41 , 43 , 44 ]. The remaining studies were performed in the community pharmacy (n = 5) [ 53 , 57 , 60 , 62 , 63 ], long-term care facilities (n = 4) [ 40 , 47 , 51 , 54 ], paediatric practice (n = 2) [ 26 , 58 ], and home setting (n = 4) [ 45 , 46 , 50 , 64 ], where healthcare professionals performed domiciliary medication review.…”

Adherence to cardiovascular pharmacotherapy by patients in Iraq: A mixed methods assessment using quantitative dried blood spot analysis and the 8-item Morisky Medication Adherence Scale

“…The mean (±SD) of medications in the nonadherent patients was 5.46 ± 2.15, compared to 2.50 ± 1.40 in the adherent group. Polypharmacy is common practice to control CVD [ 6 , 7 ] and to improve mortality and morbidity, however it can expose patients to increased risk of adverse drug reactions and drug-drug interactions [ 43 ] and is a known contributor to intentional medication nonadherence [ 5 ]. The prevalence of substandard and falsified medications in the markets of developing countries such as Iraq could also account for the unintentional nonadherence to prescribed drug therapy and the differences in levels of nonadherence for the different medications [ 5 , 14 ].…”

“…Patient adherence to the prescribed pharmacotherapy helps ensure that the blood drug concentration is within the therapeutic limits in order to improve clinical outcomes. Nonadherence to medications is documented to be a major issue in situations where self-administration of oral medications is required [ 5 ] and in situations where polypharmacy exists [ 6 , 7 ]. There is evidence that as many as 50% of prescribed CVD medications are not taken by patients as recommended [ 8 – 10 ].…”

Analysis of interaction risks of patients with polypharmacy and the pharmacist interventions performed to solve them—A multicenter descriptive study according to medication reviews in Hungarian community pharmacies

“…Old age and polypharmacy are significant risk factors for the development of drug-related problems (DRPs) [ 7 , 8 ]. According to Pharmaceutical Care Network Europe (PCNE), DRP is defined as “an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes” [ 9 ].…”