Group-Based Trajectory Models: Assessing Adherence to Antihypertensive Medication in Older Adults in a Community Pharmacy Setting

ObjectivePrevious prevalence estimates of POtentially Serious Alcohol–Medication INteractions in Older adults (POSAMINO) are based on in-home inventories of medications; however, this method is associated with under-reporting of medications when compared with dispensing records. This study aims to estimate the prevalence of POSAMINO among community-dwelling older adults using drug dispensing data from the community pharmacy setting.DesignCross-sectional study.SettingIrish Community Pharmacy.Participants1599 consecutive older adults presenting with a prescription to 1 of 120 community pharmacies nationwide; community-dwelling, aged ≥65 years, able to speak and understand English, with no evidence of cognitive impairment. The mean age of sample was 75.5 years (SD 6.5); 55% (n=884) female.Measures38 POSAMINO criteria were identified using participants’ pharmacy dispensing records linked to self-reported alcohol consumption (beverage-specific quantity and frequency measures) over the last 12 months.ResultsThe overall prevalence of POSAMINO in the study population was 28%, with 10% at risk of at least one POSAMINO criteria and 18% at risk of two or more. Exposure to POSAMINO most commonly involved cardiovascular agents (19%) and central nervous system agents (15%). Exposure to a higher number of POSAMINO criteria was associated with younger age (adjusted incident rate ratio (AIRR): 0.97; 95% CI: 0.95 to 0.98), male sex (AIRR: 0.55; 95% CI: 0.45 to 0.67) and a higher number of comorbidities (AIRR: 1.05; 95% CI: 1.01 to 1.13).ConclusionThis study adds to the growing body of evidence, which suggests that older adults are vulnerable to potentially serious alcohol–medication interactions, particularly those involving cardiovascular and central nervous system agents, increasing their risk of orthostatic hypotension, gastrointestinal bleeds and increased sedation. Application of the POSAMINO criteria at the point of prescribing may facilitate the risk stratification of older adults and prioritise alcohol screening and brief alcohol interventions in those at greatest risk of harm.

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Reliability of a Modified Medication Appropriateness Index in Community Pharmacies

Annals of Pharmacotherapy ◽

10.1177/106002800303700101 ◽

2003 ◽

Vol 37 (1) ◽

pp. 40-46

Author(s):

Rosemin Kassam ◽

Linda G Martin ◽

Karen B Farris ◽

Homero A Monsanto ◽

Jean-Marie Kaiser

Keyword(s):

Community Pharmacy ◽

Interrater Reliability ◽

Intraclass Correlation ◽

Community Setting ◽

Medication Appropriateness Index ◽

Paired Samples ◽

Psychometric Data ◽

Ambulatory Patients ◽

Pharmacy Setting ◽

Medication Appropriateness

Background The medication appropriateness index (MAI) has demonstrated reliability in selected outpatient clinics where medical data were easily accessible from medical charts. However, its use in the community setting where patient data may be limited has not been examined. Objective To evaluate the usefulness of a modified MAI for use in the community pharmacy setting by testing interrater reliability using 3 different rating schemes. Methods Two raters evaluated 160 medications for 32 elderly ambulatory patients. Patient information was acquired using community pharmacist-collected medication histories. A summated MAI score, percent agreement, κ, positive agreement, negative agreement, and intraclass correlation coefficient were calculated for each criterion using 3 scoring schemes. A paired samples t-test (95% CI) was used to test interrater reliability. Results The κ statistics were >0.75 for indication and effectiveness, but good (0.41–0.66) for the remaining criteria using the Hanlon scoring scheme. The intraclass coefficients (0.82, 0.86, 0.87) and overall κ (0.65, 0.66, 0.61) were similar for the 3 schemes. Conclusions This study suggests that the modified MAI has the potential to detect medication appropriateness and inappropriateness in the community pharmacy setting; however, it is not without limitations. Because the MAI has the most clinimetric and psychometric data available, the instrument should be studied further to increase its reliability and generalizability.

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A Pharmacist-Led Medication Coaching Program Serving Senior Residents of Low-Income Housing

Innovation in Aging ◽

10.1093/geroni/igaa057.2748 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 761-762

Author(s):

Jennifer Bacci ◽

Joshua Akers ◽

Katie Mahan ◽

Geoffrey Meer ◽

Jeffrey Kinter ◽

...

Keyword(s):

Older Adults ◽

Community Pharmacy ◽

Affordable Housing ◽

Low Income ◽

Culturally Diverse ◽

Organization Structure ◽

Local Area ◽

Fiscal Year ◽

Service Process ◽

Process Outcomes

Abstract In 2015, one independent community pharmacy partnered with the local Area Agency on Aging to provide medication coaching to low-income, culturally diverse, older adults living in 6 affordable housing buildings in the Seattle area. A pilot was conducted during the 2015-2016 fiscal year to determine the need for and feasibility of the service. Process outcomes, including patient and service demographics, medication-related problems, and pharmacist interventions, were captured via the pharmacists’ patient care documentation. Pharmacists had 34 total visits with 17 unique residents who were taking an average of 8.1 medications. Pharmacists identified 97 medication-related problems, averaging 5.7 problems per resident, and performed 88 interventions, averaging 5.2 interventions per resident. The findings of this pilot demonstrated the needs and feasibility of implementing pharmacists’ services within a housing organization structure and has resulted in the continuation and growth of the program.

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Exploring Older Adults’ Internalizations And Misconceptions Regarding Antihypertensive Medication Management

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101221 ◽

2021 ◽

Vol 10 (1) ◽

pp. 304-308

Author(s):

Kenneth A. Blocker ◽

Wendy A. Rogers

Keyword(s):

Older Adults ◽

Medication Adherence ◽

Antihypertensive Medication ◽

Medication Management ◽

Illness Representation ◽

Effective Management ◽

Structured Interviews ◽

Antihypertensive Medications ◽

Hypertension Knowledge ◽

Management Behaviors

Hypertension, or high blood pressure, is an asymptomatic cardiovascular condition common with increasing age that must be controlled with proper management behaviors, such as adherence to prescribed antihypertensive medications. Unfortunately, older adults may struggle with consistent and effective management of this medication specifically and the disease generally, which can lead to poorer health outcomes. The goal of the study was to investigate older adults’ antihypertensive medication management using the Illness Representation Model as a lens to identify potential misconceptions that may contribute to medication management. We conducted semi-structured interviews with 40 older adults regarding management routines, hypertension knowledge, perceived nonadherence contributors, and perspectives related to their illness. We identified numerous misconceptions regarding hypertension knowledge, disease severity, as well as perceived adherence performance that may contribute to challenges older adults face with maintaining antihypertensive medication adherence. Moreover, these findings inform the need for and design of effective educational tools for improving antihypertensive medication adherence.

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Community pharmacists’ attitudes toward dispensing errors at community pharmacy setting in Central Saudi Arabia

Saudi Pharmaceutical Journal ◽

10.1016/j.jsps.2013.05.002 ◽

2014 ◽

Vol 22 (3) ◽

pp. 195-202 ◽

Cited By ~ 6

Author(s):

Mohamed N. Al-Arifi

Keyword(s):

Saudi Arabia ◽

Community Pharmacy ◽

Community Pharmacists ◽

Pharmacy Setting ◽

Dispensing Errors

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Pharmacy student driven detection of adverse drug reactions in the community pharmacy setting

Pharmacoepidemiology and Drug Safety ◽

10.1002/pds.2069 ◽

2010 ◽

Vol 20 (4) ◽

pp. 399-404 ◽

Cited By ~ 15

Author(s):

Søren Troels Christensen ◽

Birthe Søndergaard ◽

Per Hartvig Honoré ◽

Ole Jannik Bjerrum

Keyword(s):

Community Pharmacy ◽

Adverse Drug Reactions ◽

Pharmacy Student ◽

Drug Reactions ◽

Pharmacy Setting

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The Effectiveness of Screening for Diabetes and Cardiovascular Disease Risk Factors in a Community Pharmacy Setting

PLoS ONE ◽

10.1371/journal.pone.0091157 ◽

2014 ◽

Vol 9 (4) ◽

pp. e91157 ◽

Cited By ~ 45

Author(s):

Andrew Willis ◽

Peter Rivers ◽

Laura J. Gray ◽

Melanie Davies ◽

Kamlesh Khunti

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Community Pharmacy ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Cardiovascular Disease Risk Factors ◽

Pharmacy Setting

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Abstract P347: Sex Differences in Barriers to Antihypertensive Medication Adherence: Findings from the Cohort Study of Medication Adherence among Older Adults (CoSMO)

Circulation ◽

10.1161/circ.127.suppl_12.ap347 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Elizabeth W Holt ◽

Cara Joyce ◽

Adriana Dornelles ◽

Donald E Morisky ◽

Larry S Webber ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Medication Adherence ◽

Antihypertensive Medication ◽

Administrative Databases ◽

Medication Cost ◽

Lifestyle Modifications ◽

Cross Sectional ◽

Men And Women ◽

Factors Associated

Objectives: We assessed whether socio-demographic, clinical, health care system, psychosocial, and behavioral factors are differentially associated with low antihypertensive medication adherence scores among older men and women. Methods: We conducted a cross-sectional analysis using baseline data from the Cohort Study of Medication Adherence in Older Adults (CoSMO, n=2,194). Low antihypertensive medication adherence was defined as a score <6 on the 8-item Morisky Medication Adherence Scale. Risk factors for low adherence were collected using telephone surveys and administrative databases. Results: The prevalence of low medication adherence scores did not differ by sex [15.0% (193 of 1,283) in women and 13.1% (119 of 911) in men p=0.208]. In sex-specific multivariable models, having issues with medication cost and practicing fewer lifestyle modifications for blood pressure control were associated with low adherence scores among both men and women. Factors associated with low adherence scores in men but not women included reduced sexual functioning (OR = 2.03; 95% CI: 1.31, 3.16 for men and OR = 1.28; 95% CI: 0.90, 1.82 for women), and BMI ≥25 (OR = 3.23; 95% CI: 1.59, 6.59 for men and 1.23; 95% CI: 0.82, 1.85 for women). Factors associated with low adherence scores in women but not men included dissatisfaction with communication with their healthcare provider (OR = 1.75; 95% CI: 1.16, 2.65 for women and OR =1.16 95% CI: 0.57, 2.34 for men) and depressive symptoms (OR = 2.29; 95% CI: 1.55, 3.38 for women and OR = 0.93; 95% CI: 0.48, 1.80 for men). Conclusion: Factors associated with low antihypertensive medication adherence scores differed by sex. Interventions designed to improve adherence in older adults should be tailored to account for the sex of the target population.

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