Clinical pharmacist interventions in elderly patients with mental disorders in primary care focused on psychotropics: a retrospective pre–post observational study

Background: Mental disorders pose a significant clinical burden and affect approximately one-third of older adults. Although studies have shown positive impacts of clinical pharmacist (CP) interventions within the general population, the long-term effects of such cooperation on geropsychiatric patients in primary care settings are not yet known. This study evaluated whether CP interventions have a long-term impact on the quality of medication prescribing in geropsychiatric patients. Methods: We conducted a retrospective non-interventional observational pre–post study for the 2015–2017 period, involving patients aged 65 or above for whom a medication review was provided by a CP. The study included participants with mental disorders treated with polypharmacy, including at least one psychotropic. Potentially inappropriate medications (PIMs) in elderly patients were determined with the Priscus list, and potential type X drug–drug interactions (pXDDIs) with Lexicomp®. Up-to-date treatment guidelines were used to evaluate patient pharmacotherapy, and patient medication was evaluated before the initial medication review and again 6 months later. Results: The study included 48 patients (79.4 years, SD = 8.13) receiving a total of 558 medications (155 for the treatment of mental disorders). The number of medications decreased by 9.5% after the medication review. The CP proposed 198 interventions related to psychotropics, of which 108 (55%) were accepted by the general practitioners. All accepted (99.1%) interventions except one were still maintained 6 months after the interventions had been proposed. They led to a significant decrease in the total number of medications, PIMs, and pXDDIs ( p < 0.05), and improved treatment guidelines adherence. Conclusions: CP interventions decreased the number of medications, PIMs, and pXDDIs, and almost all interventions were maintained 6 months later. These results provide evidence for the positive effects of CP interventions in a primary care setting. Additional research with a larger sample size and a randomized study design is needed.

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Impact of Clinical Pharmacist Interventions on Potentially Inappropriate Medications in Elderly Primary Care Patients With Mental Disorders Using Polypharmacy: A Cohort Retrospective Study

10.21203/rs.3.rs-131367/v1 ◽

2021 ◽

Author(s):

Matej Štuhec ◽

Alja Nemec

Keyword(s):

Primary Care ◽

Mental Disorders ◽

Clinical Pharmacist ◽

Potentially Inappropriate Medications ◽

Primary Care Patients ◽

Observational Cohort ◽

The Impact ◽

Patient Subgroups ◽

Inappropriate Medications ◽

Retrospective Observational Cohort Study

Abstract Potentially inappropriate medications (PIMs) are highly prevalent in elderly patients with mental disorders (MPHs) treated with polypharmacy. This study's main aim was to determine the impact of a clinical pharmacist (CP)’s recommendations on the total number of PIMs and to evaluate the differences in PIMs between two patient subgroups with mental disorders with either fully or partially accepted recommendations that have not been studied until now.A retrospective observational cohort study involving primary care patients aged 65 or above in 2015–2017 was conducted. To evaluate the impact of the interventions on the number of PIMs, odds ratios (ORs) were used. Ninety-nine patients were included (79.4 y, SD=7.92). At least one PIM was present in 69.7% or 92.9% of the patients (PRISCUS and Beers list). The interventions led to a 21.2% decrease (n=23; PRISCUS) and a 17.3% decrease (n=38; Beers) (p<0.05). The ORs for PIMs were significantly smaller in the full-acceptance subgroup (OR=3.8, CI 1.4-10.1; Beers) and insignificantly smaller for another group (OR=2.8, CI 1.0-8.2; PRISCUS). The CP's interventions decreased the number of PIMs according to the PRISCUS and the Beers list, and ORs for PIMs decreased if all proposed interventions were accepted.

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Clinical pharmacist interventions in elderly patients in primary care treated with polypharmacy and psychotropics : observational retrospective study

10.26226/morressier.5b681765b56e9b005965c5d9 ◽

2018 ◽

Author(s):

Matej Stuhec

Keyword(s):

Primary Care ◽

Retrospective Study ◽

Elderly Patients ◽

Clinical Pharmacist ◽

Pharmacist Interventions

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Impact of clinical pharmacist’s interventions on pharmacotherapy management in elderly patients on polypharmacy with mental health problems including quality of life: A prospective non-randomized study

Scientific Reports ◽

10.1038/s41598-019-53057-w ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Matej Stuhec ◽

Nika Bratović ◽

Aleš Mrhar

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Elderly Patients ◽

Mental Health Problems ◽

Randomized Study ◽

The Elderly ◽

Health Problems ◽

Potentially Inappropriate Medications ◽

The Impact

AbstractMental health problems (MHPs) are very common in the elderly and can have an important influence on their quality of life (QoL). There is almost no data on the impact of clinical pharmacists’ (CPs) interventions on the QoL including elderly patients and MHPs. The main aim of this study was to determinate the impact of (CP’s) interventions on the QoL and quality of pharmacotherapy. A prospective non-randomized pre-post study was designed which included residents of a nursing home aged 65 age or more with at least one MHP. Each patient also filled out the EQ-5D questionnaire. The medical review MR included drug-related problems (DRPs) and potentially drug-drug interactions (pDDIs), as well as potentially inappropriate medications (PIMs). After 2 months, the participants were interviewed again. The mean number of medications before the intervention was 12,2 ± 3,1 per patient and decreased to 10,3 ± 3,0 medications per patient (p < 0,05) (n = 24). The total number of PIMs and pDDIs was also reduced and QoL was also significantly higher (p < 0,05). A collaborative care approach with a CP led to a decrease of DRPs, pDDIs, PIMs, the total number of medications and to an improvement in the patients’ QoL.

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O16. Can Long-Term Bisphosphonate and Drug Holiday Review in Primary Care be Performed by a Clinical Pharmacist?

Rheumatology ◽

10.1093/rheumatology/keu087.004 ◽

2014 ◽

Vol 53 (suppl_1) ◽

pp. i32-i32

Author(s):

Louise Maguire ◽

Chris Ollershaw ◽

Sharon Abdy ◽

Mike Scott ◽

Steve Turley ◽

...

Keyword(s):

Primary Care ◽

Clinical Pharmacist ◽

Drug Holiday

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Polypharmacy and use of potentially inappropriate medications in long-term care facilities: does coordinated primary care make a difference?

International Journal of Pharmacy Practice ◽

10.1111/ijpp.12397 ◽

2017 ◽

Vol 26 (4) ◽

pp. 318-324 ◽

Cited By ~ 8

Author(s):

Melissa K. Andrew ◽

Chad A. Purcell ◽

Emily G. Marshall ◽

Nirupa Varatharasan ◽

Barry Clarke ◽

...

Keyword(s):

Primary Care ◽

Long Term Care ◽

Potentially Inappropriate Medications ◽

Term Care ◽

Care Facilities ◽

Inappropriate Medications

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Frequent short sickness absence, occupational health service utilisation and long-term sickness absence due to mental disorders among young employees

International Archives of Occupational and Environmental Health ◽

10.1007/s00420-021-01728-5 ◽

2021 ◽

Author(s):

Jaakko Harkko ◽

Hilla Nordquist ◽

Olli Pietiläinen ◽

Kustaa Piha ◽

Minna Mänty ◽

...

Keyword(s):

Primary Care ◽

Mental Disorders ◽

Health Service ◽

Occupational Health ◽

Sickness Absence ◽

Cox Regression ◽

Occupational Health Service ◽

Linkage Data ◽

Service Utilisation

Abstract Objectives We examined whether frequent short-term sickness absence (FSTSA) and primary care use in occupational health service (OHS) were associated with medically-certified long-term sickness absence (LTSA) due to mental disorders among young employees. Methods We used record-linkage data covering the young employees (< 35 years) of the City of Helsinki, Finland (n = 8,282) from 2010 to 2014. The outcome was LTSA due to mental disorders. Cox regression models were fitted. Results FSTSAs were associated with subsequent LTSA. Also OHS use predicted LTSA due to mental disorders; however, this association was not found for those with prior FSTSA. Conclusions Both FSTSA and primary care use indicate subsequent LTSA independently, and together these indicators identify a larger proportion of individuals at risk of LTSA due to mental disorders.

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A comparison of the Beers and STOPP criteria for identifying the use of potentially inappropriate medications among elderly patients in primary care

Journal of Evaluation in Clinical Practice ◽

10.1111/jep.12319 ◽

2015 ◽

Vol 21 (2) ◽

pp. 320-325 ◽

Cited By ~ 23

Author(s):

Márcio Galvão Oliveira ◽

Welma Wildes Amorim ◽

Sandra Rêgo de Jesus ◽

Jacqueline Miranda Heine ◽

Hérica Lima Coqueiro ◽

...

Keyword(s):

Primary Care ◽

Elderly Patients ◽

Potentially Inappropriate Medications ◽

Stopp Criteria ◽

Inappropriate Medications

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Impact of Automated Targeted Medication Review Electronic Alerts to Reduce Potentially Inappropriate Medication Prescribing Among Medicare Enrolled Patients With Dementia

Annals of Pharmacotherapy ◽

10.1177/1060028020915790 ◽

2020 ◽

Vol 54 (10) ◽

pp. 967-974

Author(s):

Armando Silva-Almodóvar ◽

Andrea Malfara ◽

Milap C. Nahata

Keyword(s):

Primary Care ◽

Medication Review ◽

Inappropriate Medication ◽

Female Gender ◽

Primary Care Providers ◽

Potentially Inappropriate Medications ◽

Care Providers ◽

Poverty Level ◽

Medication Therapy ◽

Electronic Alerts

Background: Background:Finding ways to reduce prescribing of potentially inappropriate medications (PIMs) among patients with dementia is necessary. Objectives: To evaluate an automated targeted medication review (TMR) service to reduce PIM prescribing among patients with dementia. Methods: This was a retrospective observational analysis of patients in a Medication Therapy Management (MTM) program for year 2017. Patients included if Medicare enrolled, MTM eligible, had dementia, and with PIM prescribing. Descriptive statistics described reduced PIM prescribing. Odds ratios (ORs) assessed prescriber relationship with PIM prescribing. Regression evaluated relationship between patient characteristics and discontinued PIMs. Results: A total of 33 696 TMRs were triggered for 17 933 patients. Four months later, 11 608 TMRs led to a discontinued PIM among 8002 patients. Medications with the largest discontinuations were antihistamines (56%), muscle relaxants (53%), antiemetics (53%), and typical antipsychotics (40%). Physician primary care providers (PCPs) were more likely than nonphysician PCPs (OR = 4.54; 95% CI = 4.15-4.97; P < 0.001), psychiatrists (OR = 1.64; 95%CI = 1.44-1.86; P < 0.001), and neurologists (OR = 4.48; 95% CI = 4.07-4.93; P < 0.001) to prescribe medications to treat dementia and PIMs. Regression showed that younger age, female gender, higher poverty level, and a greater number of pharmacies, medications, and prescribers were associated with discontinued PIMs. Conclusions and Relevance: TMRs were effective in reducing PIM prescribing. Younger patients, individuals living in higher poverty levels, and patients with multiple prescribers or pharmacies may benefit most from this service. TMRs in primary care offices may reduce PIM prescribing.

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