Drug Therapy Problem Severity Following Hospitalization and Association With 30-Day Clinical Outcomes

2018 ◽  
Vol 52 (12) ◽  
pp. 1195-1203 ◽  
Author(s):  
Sarah M. Westberg ◽  
Angela Yarbrough ◽  
Eric D. Weinhandl ◽  
Terrence J. Adam ◽  
Amanda R. Brummel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drug Therapy ◽  
Hospital Discharge ◽  
Severity Score ◽  
Hospital Readmission ◽  
Medication Management ◽  
Statistical Uncertainty ◽  
Problem Severity ◽  
Strength Of Association ◽  
Drug Therapy Problems

Background: Improved understanding of how drug therapy problems (DTPs) contribute to rehospitalization is needed. Objective: The primary objectives were to assess the association of DTP likelihood of harm (LoH) severity score, as measured by comprehensive medication management (CMM) pharmacist after hospital discharge, with 30-day risk of hospital readmission, observation visit, or emergency department visit, and to determine whether resolution of DTPs reduces 30-day risk. Secondary objectives were to determine if any eventswere associated with DTPs and preventability of events. Methods: Data were collected for 365 patients who received CMM following hospitalization and had at least 1 DTP identified. Retrospective chart reviews were completed for 80 patients with subsequent events to assess associationg with a DTP and its preventability. Results: For each 1-point increment in maximum LoH score, there was 10% higher risk of the composite end point (hazard ratio [HR]=1.10; 95% CI:0.97-1.26; P=0.13). When DTPs were resolved by the CMM pharmacist, the association was attenuated, with a HR of 1.15 (95% CI:0.96-1.38; P=0.12) when the DTP was unresolved and HR of 1.09 (95% CI:0.96-1.25; P=0.52) when resolved; for hospital readmission alone, the corresponding HRs were 1.23 (95% CI:1.00-1.53; P=0.05) and 1.05 (95% CI:0.87-1.27; P=0.60). Of 80 subsequent events, 44 were associated with a medication; 22 were considered preventable. Conclusion and Relevance: The LoH severity score was associated with risk of 30-day events. The strength of association was attenuated when DTPs were resolved by the CMM pharmacist. However, because of statistical uncertainty, larger studies are needed to confirm these patterns.

scholarly journals Drug Therapy Problems Identified by Pharmacists Through Comprehensive Medication Management Following Hospital Discharge

2017 ◽  
Vol 33 (3) ◽  
pp. 96-107 ◽  
Author(s):  
Sarah M. Westberg ◽  
Sarah K. Derr ◽  
Eric D. Weinhandl ◽  
Terrence J. Adam ◽  
Amanda R. Brummel ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Hospital Discharge ◽  
Clinical Significance ◽  
Medication Management ◽  
Antiplatelet Agents ◽  
Health Care Outcomes ◽  
Drug Classes ◽  
Care Outcomes ◽  
Hospital To Home ◽  
Drug Therapy Problems

Background: Pharmacists influence health care outcomes through the identification and resolution of drug therapy problems (DTPs). Objective: The objectives of this study were to describe number, type, and severity of DTPs based on clinical significance and likelihood of harm in patients transitioning from hospital to home as assessed during a comprehensive medication management (CMM) visit with a pharmacist. Secondary objectives were to assess intrarater reliability in severity ratings and assess likelihood of harm for adverse drug reactions (ADR) by drug classes. Methods: Retrospective review of 408 patients having a face-to-face, telephonic, or virtual CMM visit within the Fairview Health System. Teams of 3 investigators reviewed each DTP from the electronic medical record for each of the 408 patients and assigned a severity score (0-10) for clinical significance and likelihood of harm. Main Results: The highest severity DTP classes were adherence and ADR. The lowest severity DTP class was unnecessary drug therapy. An average of 2.5 DTPs was found per patient at the index CMM visit following hospital discharge. The most common DTP classes were needs additional therapy and dose too low. There were statistically significant differences in DTP severity scoring between reviewer types, though differences were <5%. Drug classes with the highest severity ADR included diabetes, cardiovascular, and anticoagulant/antiplatelet agents. Conclusions: The DTP severity ratings indicated that reviewers found ADR and adherence DTPs were potentially the most severe. There were differences in DTP ratings between reviewer types, though clinical significance of these differences is unclear.

scholarly journals Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092879
Author(s):  
Katarina Fehir Šola ◽  
Iva Mucalo ◽  
Andrea Brajković ◽  
Ivona Jukić ◽  
Donatella Verbanac ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Therapy ◽  
Medication Management ◽  
Institutional Care ◽  
Nursing Home Residents ◽  
Median Number ◽  
Cross Sectional ◽  
High Prevalence ◽  
Care Facilities ◽  
Drug Therapy Problems

Objective The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. Method We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. Results Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. Conclusion The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.

Clinical pharmaceutical screening in critical situations in a radioiodine therapy management service

2021 ◽  
pp. 107815522110453
Author(s):  
Lídia Freitas Fontes ◽  
Mariana Martins Gonzaga do Nascimento ◽  
Djenane Ramalho-de-Oliveira ◽  
Cristiane de Paula Rezende ◽  
Célia Helena Fernandes da Costa ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Thyroid Carcinoma ◽  
Radioiodine Therapy ◽  
Descriptive Analysis ◽  
Medication Management ◽  
Differentiated Thyroid Carcinoma ◽  
Management Service ◽  
Extensive Evaluation ◽  
Drug Therapy Problems ◽  
Pharmaceutical Interventions

Radioiodine therapy can be used in differentiated thyroid carcinoma and requires extensive evaluation to ensure effectiveness and safety. Therefore, it is necessary to evaluate all health problems and medications used in the pre-radioiodine therapy period and comprehensive medication managementservices can serve as a screening tool in this context. The present study aims to describe critical clinical situations identified during the initial assessments of a comprehensive medication management service offered to differentiated thyroid carcinoma patients pre-radioiodine therapy, and the pharmaceutical interventions performed to solve them. A descriptive study with regard to the initial ten months of a comprehensive medication management service was carried out in a large oncology hospital (Rio de Janeiro, Brazil). Descriptive analysis was used to describe the critical clinical situations identified, as well as the correspondent drug therapy problems and the type, acceptability, and outcomes of the pharmaceutical interventions performed to solve them. Thirty patients with an average of 45.8 years and 5.1 medications were evaluated. Five critical clinical situations were identified; corresponding to drug therapy problems two(needs additional drug therapy – n = 4) and drug therapy problems four (dosage too low – n = 1). All pharmaceutical interventions were accepted. The comprehensive medication management service provision pre-radioiodine therapy is feasible and represents an important screening strategy.

scholarly journals Medication management issues identified during home medication reviews for ambulatory community pharmacy patients

2019 ◽  
Vol 152 (5) ◽  
pp. 334-342
Author(s):  
John Papastergiou ◽  
Mathew Luen ◽  
Simona Tencaliuc ◽  
Wilson Li ◽  
Bart van den Bemt ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Medication Review ◽  
Health Care Cost ◽  
Medication Management ◽  
Cost Savings ◽  
Home Medication ◽  
Chronic Medications ◽  
Medication Reviews ◽  
Drug Therapy Problems ◽  
Management Issues

Background: The health risks associated with poor medication practices in the home suggest that patients would benefit from home-based medication reviews that could detect and resolve these issues. However, remuneration for home visits often excludes ambulatory, nonhomebound patients. A subset of these patients have issues that cannot be adequately identified and resolved during the course of a typical pharmacy-based medication review. Purpose: This study aims to characterize the prevalence and nature of “hidden in the home” medication management issues in nonhomebound patients. Methods: Pharmacists facilitated subject enrollment among patients at 6 community pharmacies in Toronto over a 15-month period, from January 2016 to March 2017. Patients taking 5 or more chronic medications who were ambulatory (able to visit the pharmacy) and scored 3 points or higher on a prescreening questionnaire were invited to participate. Visits included a standard medication review, the identification of drug therapy problems and an assessment of the patient’s medication and organization/storage practices, followed by a medication cabinet cleanup. Results: One hundred patients were recruited, with a mean age of 76.9 years and taking on average 10 chronic medications. Pharmacists identified a total of 275 drug therapy problems (2.75 per patient). The most common issues reported additional therapy required (23.6%), nonadherence (23.3%) and adverse drug reactions (17.8%). For those patients 65 years or older (87%), 32% were found to be using at least 1 medication on the Beers Criteria list, while 6% were using 3 or more. Sulfonylureas, non-steroidal anti-inflammatory drugs and short-acting benzodiazepines were the most commonly implicated drugs. Medications were removed from the homes of 67% of the patients, with expiry of medication being the most common reason for removal (54.2%). The mean duration of a home visit was 49.5 minutes. Conclusion: Pharmacist-directed home medication reviews offer an effective mechanism to address the pharmacotherapy issues of patients taking multiple medications. These findings highlight the frequency of medication management issues in this group and suggest that home medication reviews could serve to minimize inappropriate use of medication and maximize health care cost savings in this unique patient population. Can Pharm J (Ott) 2019;152:xx-xx.

scholarly journals Clinical Results of Comprehensive Medication Management Services in Primary Care in Belo Horizonte

Pharmacy ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 58 ◽  
Author(s):  
Carina de Morais Neves ◽  
Mariana Martins Gonzaga do Nascimento ◽  
Daniela Álvares Machado Silva ◽  
Djenane Ramalho-de-Oliveira
Keyword(s):  
Drug Therapy ◽  
Medication Management ◽  
Clinical Results ◽  
Initial Assessment ◽  
Laboratory Parameters ◽  
Primary Health ◽  
High Prevalence ◽  
Quasi Experimental ◽  
Belo Horizonte ◽  
Drug Therapy Problems

The high prevalence of chronic diseases and use of multiple medications identified in Primary Health Care (PHC) suggest the need for the implementation of Comprehensive Medication Management (CMM) services. This study aimed to evaluate the clinical results of CMM services in a Brazilian PHC setting. A quasi-experimental study was performed with patients followed-up for two years (n = 90). Factors associated with the detection of four drug therapy problems (DTP) or more in the initial assessment were evaluated (univariate and multivariate analyses), as well as the clinical impact observed in laboratory parameters (HbA1c, Blood Pressure, LDL- and HDL-covariance analysis). A predominance of women (61.1%), a mean age of 65.5 years, and a prevalence of polypharmacy (87.8%)—use of five or more drugs—were observed. A total of 441 DTP was identified, 252 required interventions with the prescriber, 67.9% of which were accepted and 59.6% were solved. The main DTP were ‘non-adherence’ (28.1%), ‘need for additional drug therapy’ (21.8%), and ‘low dose’ (19.5%). Hypertension was positively associated with the identification of four DTP or more. A statistically significant reduction was detected in all assessed laboratory parameters (p < 0.05). CMM services contributed to the resolution of DTP and improved clinical outcomes.

Relationship between Asthma Drug Therapy Patterns and Healthcare Utilization

2002 ◽  
Vol 36 (4) ◽  
pp. 557-564 ◽  
Author(s):  
Theresa I Shireman ◽  
Pamela C Heaton ◽  
Wendy E Gay ◽  
Robert J Cluxton ◽  
Charles J Moomaw
Keyword(s):  
Emergency Department ◽  
Drug Therapy ◽  
Healthcare Utilization ◽  
Emergency Department Visits ◽  
Oral Steroid ◽  
Short Acting ◽  
Asthma Patients ◽  
Asthma Drug ◽  
Leukotriene Receptor ◽  
Drug Therapy Problems

BACKGROUND AND OBJECTIVE: Asthma drug therapy problems contribute significantly to preventable hospitalizations and increased healthcare use in asthmatics. Since asthma patients often require >1 medication for control of symptoms, concurrent asthma drug therapies may be important in predicting excessive healthcare utilization. The purpose of this study was to link inappropriate asthma drug therapy patterns and selected patient demographics to healthcare utilization. METHODS: This study was a retrospective, cross-sectional analysis of Ohio Medicaid medical, institutional, and prescription claims. We included ambulatory patients aged 15–65 years who had ≥2 claims for asthma (493.x) and who were continuously enrolled in the Medicaid fee-for-service program for the 12-month period from April 1998 through March 1999. We examined age, race, gender, metropolitan residence, presence of gastroesophageal reflux disease, and the usage patterns of inhaled corticosteroids, short-acting β2-agonists, long-acting β2-agonists, theophylline, and leukotriene receptor modifiers to identify asthma drug therapy problems based on national guidelines. The primary outcomes included the number of asthma-related hospitalizations, asthma-related emergency department visits, and oral steroid bursts. RESULTS: Among 10 959 asthma patients, only 46.8% of the study patients received >1 puff of inhaled corticosteroid per day. Forty-four percent of the patients received >3 puffs of short-acting β2-agonists per day. The most common outcome was an oral steroid burst (46.5%). Patients on high doses of short-acting β2-agonists had the greatest odds of receiving an oral steroid burst and were most likely to be hospitalized. African Americans were more likely to incur a hospitalization or emergency department visit. Women had greater odds of any undesirable asthma outcome. Higher use of short-acting β2-agonists led to higher odds of receiving a steroid burst or being hospitalized. Leukotriene receptor modifier use was related to higher levels of all outcomes. CONCLUSIONS: A large percentage of Ohio Medicaid patients were not receiving asthma medications in compliance with the National Heart, Lung, and Blood Institute guidelines. Despite nearly a decade of national efforts, asthma drug therapy patterns still have substantial room for improvement and continue to be associated with excess healthcare utilization.

scholarly journals Implementing a Pharmacist-Led Medication Management Pilot to Improve Care Transitions

2012 ◽  
Vol 3 (2) ◽  
Author(s):  
Rachel Root ◽  
Pamela Phelps ◽  
Amanda Brummel ◽  
Craig Else
Keyword(s):  
Primary Care ◽  
Drug Therapy ◽  
Health System ◽  
Medication Management ◽  
Care Transitions ◽  
Care Visit ◽  
Discharge Medication ◽  
Drug Therapy Problems ◽  
The Continuum

Purpose: The purpose of this project was to design and pilot a pharmacist-led process to address medication management across the continuum of care within a large integrated health-system. Summary: A care transitions pilot took place within a health-system which included a 150-bed community hospital. The pilot process expanded the pharmacist's medication management responsibilities to include providing discharge medication reconciliation, a patient-friendly discharge medication list, discharge medication education, and medication therapy management (MTM) follow-up. Adult patients with a predicted diagnosis-related group (DRG) of congestive heart failure or chronic obstructive pulmonary disease admitted to the medical-surgical and intensive care units who utilized a primary care provider within the health-system were included in the pilot. Forty patients met the inclusion criteria and thirty-four (85%) received an intervention from an inpatient or MTM pharmacist. Within this group of patients, 88 drug therapy problems (2.6 per patient) were identified and 75% of the drug therapy recommendations made by the pharmacist were accepted by the care provider. The 30-day all-cause readmission rates for the intervention and comparison groups were 30.5% and 35.9%, respectively. The number of patients receiving follow-up care varied with 10 (25%) receiving MTM follow-up, 26 (65%) completing a primary care visit after their first hospital discharge, and 23 (58%) receiving a home care visit. Conclusion: Implementation of a pharmacist-led medication management pilot across the continuum of care resulted in an improvement in the quality of care transitions within the health-system through increased identification and resolution of drug therapy problems and MTM follow-up. The lessons learned from the implementation of this pilot will be used to further refine pharmacy care transitions programs across the health-system.   Type: Original Research

scholarly journals Effect of Therapeutic Interchange on Medication Changes Between Admission and Discharge

2019 ◽  
Vol 55 (6) ◽  
pp. 382-390
Author(s):  
Ryan A. Popp ◽  
Kathleen A. Lusk ◽  
Shelley S. Glaess ◽  
Donna Burkett ◽  
Rebecca L. Attridge
Keyword(s):  
Emergency Department ◽  
Hospital Discharge ◽  
Emergency Department Visit ◽  
Hospital Readmission ◽  
Emergency Department Visits ◽  
Care Hospital ◽  
Discharge Medication ◽  
Therapeutic Interchange ◽  
The Relationship ◽  
Medication Changes

Background: Therapeutic interchange (TI) is the dispensing of an alternative medication within the same class as the original medication. TI often occurs in hospitals; however, failure to return patients to their original medications may increase the risk of adverse effects following hospital discharge. Objective: The purpose of this study was to evaluate the relationship between TI and discharge medication changes, hospital readmission rates, and emergency department visit rates following hospital discharge. Methods: Patient demographic and medication data were collected retrospectively for patients admitted to a nonprofit, acute care hospital. The primary outcome was the relationship between TI and the rate of discharge medication changes. Secondary outcomes included types of discharge medication changes and the relationship between TI and both hospital readmissions and emergency department visits following hospital discharge. Results: A total of 497 patients accounting for 1072 medications were included; 21.2% of home medications were interchanged following admission, and 21.8% of home medications were changed at discharge. TI increased the incidence of discharge medication changes by 70% (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.22-2.37, P = .0021). Cardiovascular agents were most likely to be changed at discharge (26%), and gastrointestinal agents were most likely to be interchanged (65%). Psychotropic agents were least likely to be changed at discharge (12%) or interchanged (7%). Neither TI nor discharge medication changes were predictive of 30-, 60-, or 90-day hospital readmission or emergency department visits following discharge. Conclusion and Relevance: This study was the first to examine the effects of TI on post-discharge outcomes. Despite being associated with an increased rate of discharge medication changes, the presence of TI did not correlate with hospital readmission or emergency department visit rates. This study supports the safety of TI.

scholarly journals A Descriptive Quantitative Analysis on the Extent of Polypharmacy in Recipients of Ontario Primary Care Team Pharmacist-Led Medication Reviews

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 110 ◽  
Author(s):  
Nichelle Benny Gerard ◽  
Annalise Mathers ◽  
Christoph Laeer ◽  
Eric Lui ◽  
Tom Kontio ◽  
...  
Keyword(s):  
Primary Care ◽  
Drug Therapy ◽  
Medication Management ◽  
Care Team ◽  
Primary Care Team ◽  
Convenience Sample ◽  
Medication Discrepancies ◽  
Medication Reviews ◽  
Medication Complexity ◽  
Drug Therapy Problems

Pharmacist-led medication reviews have been shown to improve medication management, reducing the adverse effects of polypharmacy among older adults. This paper quantitatively examines the medications, medication discrepancies and drug therapy problems of recipients in primary care. A convenience sample of 16 primary care team pharmacists in Ontario, Canada contributed data for patients with whom they conducted a medication review over a prior four-week period. Data were uploaded using electronic data capture forms and descriptive analyses were completed. Two hundred and thirty-seven patients (on average, 67.9 years old) were included in the study, taking an average of 9.2 prescription medications (±4.7). Majority of these patients (83.5%) were categorized as polypharmacy patients taking at least five or more prescribed drugs per day. Just over half of the patients were classified as having a low level of medication complexity (52.3%). Pharmacists identified 2.1 medication discrepancies (±3.9) and 3.6 drug therapy problems per patient (±2.8). Half these patients had more than one medication discrepancy and almost every patient had a drug therapy problem identified. Medication reviews conducted by pharmacists in primary care teams minimized medication discrepancies and addressed drug therapy problems to improve medication management and reduce adverse events that may result from polypharmacy.

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