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 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.

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.

scholarly journals Non-dispensing pharmacists’ actions and solutions of drug therapy problems among elderly polypharmacy patients in primary care

2019 ◽  
Vol 36 (5) ◽  
pp. 544-551 ◽  
Author(s):  
Ankie C M Hazen ◽  
Dorien L M Zwart ◽  
Judith M Poldervaart ◽  
Johan J de Gier ◽  
Niek J de Wit ◽  
...  
Keyword(s):  
General Practice ◽  
Drug Therapy ◽  
Medication Review ◽  
Cross Sectional Study ◽  
Online Data ◽  
Cross Sectional ◽  
Clinical Medication Review ◽  
Active Patient ◽  
General Practices ◽  
Drug Therapy Problems

Abstract Objective To evaluate the process of clinical medication review for elderly patients with polypharmacy performed by non-dispensing pharmacists embedded in general practice. The aim was to identify the number and type of drug therapy problems and to assess how and to what extent drug therapy problems were actually solved. Method An observational cross-sectional study, conducted in nine general practices in the Netherlands between June 2014 and June 2015. On three pre-set dates, the non-dispensing pharmacists completed an online data form about the last 10 patients who completed all stages of clinical medication review. Outcomes were the type and number of drug therapy problems, the extent to which recommendations were implemented and the percentage of drug therapy problems that were eventually solved. Interventions were divided as either preventive (aimed at following prophylactic guidelines) or corrective (aimed at active patient problems). Results In total, 1292 drug therapy problems were identified among 270 patients, with a median of 5 (interquartile range 3) drug therapy problems per patient, mainly related to overtreatment (24%) and undertreatment (21%). The non-dispensing pharmacists most frequently recommended to stop medication (32%). Overall, 83% of the proposed recommendations were implemented; 57% were preventive, and 35% were corrective interventions (8% could not be assessed). Almost two-third (64%) of the corrective interventions actually solved the drug therapy problem. Conclusion Non-dispensing pharmacists integrated in general practice identified a large number of drug therapy problems and successfully implemented a proportionally high number of recommendations that solved the majority of drug therapy problems.

scholarly journals Innovative Collaboration between a Medical Clinic and a Community Pharmacy: A Case Report

Pharmacy ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 62
Author(s):  
William R. Doucette
Keyword(s):  
Community Pharmacy ◽  
Medication Management ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Care Organization ◽  
Medical Clinic ◽  
Collaborative Relationships ◽  
Payer Perspective ◽  
Medication Reviews ◽  
Out Of Pocket Expenses

As value-based payments become more common in healthcare, providers can develop collaborative relationships to support performance. A medical clinic and community pharmacy worked together to deliver collaborative medication management services to targeted patients in an accountable care organization. The community pharmacy was paid by the clinic to conduct comprehensive medication reviews (CMRs) for 116 patients. The CMRs initially were delivered to patients taking at least 10 medications and to patients rated as high cost/risk by the clinic. The most common medication-related problem types were Needs additional therapy (38.8%) and Suboptimal therapy (19.0%). The most common pharmacist actions were to Change medication (18.1%) and Initiate new therapy (13.8%). Financial analyses showed net savings in annual patient out-of-pocket expenses just over $15,000 for the cohort of patients, and net annual direct cost savings from a payer perspective of about $70,000. This innovative partnership between a medical clinic system and a regional pharmacy chain built upon initial discussions and planning. The partners were able to address problems that arose with their collaboration, changing their approach as needed. The outcomes were positive for the clinic and pharmacy, their patients and the payer(s). Interested providers are encouraged to pursue similar collaborations, which could be key to success in today’s healthcare environment.

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 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.

Home-Based Comprehensive Medication Reviews: Pharmacist's Impact on Drug Therapy Problems in Geriatric Patients

2016 ◽  
Vol 31 (10) ◽  
pp. 598-605 ◽  
Author(s):  
Katelyn M. Steele ◽  
Janelle F. Ruisinger ◽  
Jessica Bates ◽  
Emily S. Prohaska ◽  
Brittany L. Melton ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Geriatric Patients ◽  
Home Based ◽  
Medication Reviews ◽  
Drug Therapy Problems

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.

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