Home medication management problems and associated factors among psychiatric patients under home care pharmacy services at government hospitals in west Malaysia

Background Proper home medication management plays a role in improving medication adherence, preserving drug efficacy and ensuring safe medication practices, which is crucial to establish positive treatment outcomes. However, no published studies are available on home medication management among psychiatric patients. The study aimed to identify home medication management problems among psychiatric patients in Malaysia and to examine the association between inappropriate medication storage and lack of medication administration schedule with socio-demographic factors, disease insight, number of medication and type of Home Care Pharmacy Services (HCPS). Methods This multicentre cross-sectional study was conducted among psychiatric patients under HCPS in six government hospitals in west Malaysia. Data was extracted from the HCPS form used for each visit as per protocol published by the Pharmaceutical Services Division, Ministry of Health Malaysia. A minimum sample size of 169 was needed. Proportional random sampling was applied. Associations between inappropriate medication storage and lack of medication administration schedule with study parameters were analysed using multiple logistic regressions. Results A total of 205 home visits were conducted with 229 home medication management problems identified; inappropriate medication storage and lack of medication administration schedule topped the list. Inappropriate medication storage was significantly associated with low income [AOR=4.34 (95%CI 1.17:15.98), p=0.027], alcohol consumption [AOR=14.26 (95%CI 1.82:111.38), p=0.011], poor insight [AOR=2.34 (95%CI 1.08:5.06), p=0.030] and part-time HCPS [AOR=2.60 (95%CI 1.20:5.67), p=0.016]. Lack of administration schedule was significantly associated with low income [AOR=6.90 (95%CI 1.46:32.48), p=0.014], smoking [AOR=2.43 (95%CI 1.20:4.92), p=0.013], poor insight [AOR=5.32 (95%CI 2.45:11.56), p<0.05] and part-time HCPS [AOR=2.96 (95%CI 1.42:6.15), p=0.004]. Conclusions Inappropriate medication storage and lack of medication administration schedule is common among psychiatric patients. The study also highlighted the potential of HCPS to improve disease insight and home medication management among psychiatric patients, provided if the service is utilised fully.

Healthcare professionals’ perceptions on medication communication challenges and solutions – text mining and manual content analysis - cross-sectional study

Background Communication challenges contribute to medication incidents in hospitals, but it is unclear how communication can be improved. The aims of this study were threefold: firstly, to describe the most common communication challenges related to medication incidents as perceived by healthcare professionals across specialized hospitals for adult patients; secondly, to consider suggestions from healthcare professionals with regard to improving medication communication; and thirdly, to explore how text mining compares to manual analysis when analyzing the free-text content of survey data. Methods This was a cross-sectional, descriptive study. A digital survey was sent to professionals in two university hospital districts in Finland from November 1, 2019, to January 31, 2020. In total, 223 professionals answered the open-ended questions; respondents were primarily registered nurses (77.7 %), physicians (8.6 %), and pharmacists (7.3 %). Text mining and manual inductive content analysis were employed for qualitative data analysis. Results The communication challenges were: (1) inconsistent documentation of prescribed and administered medication; (2) failure to document orally given prescriptions; (3) nurses’ unawareness of prescriptions (given outside of ward rounds) due to a lack of oral communication from the prescribers; (4) breaks in communication during care transitions to non-communicable software; (5) incomplete home medication reconciliation at admission and discharge; (6) medication lists not being updated during the inpatient period due to a lack of clarity regarding the responsible professional; and (7) work/environmental factors during medication dispensation and the receipt of verbal prescriptions. Suggestions for communication enhancements included: (1) structured digital prescriptions; (2) guidelines and training on how to use documentation systems; (3) timely documentation of verbal prescriptions and digital documentation of administered medication; (4) communicable software within and between organizations; (5) standardized responsibilities for updating inpatients’ medication lists; (6) nomination of a responsible person for home medication reconciliation at admission and discharge; and (7) distraction-free work environment for medication communication. Text mining and manual analysis extracted similar primary results. Conclusions Non-communicable software, non-standardized medication communication processes, lack of training on standardized documentation, and unclear responsibilities compromise medication safety in hospitals. Clarification is needed regarding interdisciplinary medication communication processes, techniques, and responsibilities. Text mining shows promise for free-text analysis.

Assessment of Knowledge, Attitude and Practice towards Disposal of in-Home Medication among Community in Eastern Province, Saudi Arabia

Aim: Current study conducted with aims to assess general public knowledge, attitude and practice towards disposal of in-home medication among community in Eastern province, Saudi Arabia. Methods: A cross-sectional survey-based study was conducted from 1st September 2019 to 31st October 2019 among the community in Eastern province, Saudi Arabia. A validated self-administered questionnaire was distributed to easily approachable 1400 participants through social media in which 916 respondents were completely filled the survey form. Chi square test were used for the calculation of variance among the group. P-value less than and equal to 0.05 is considered statistically significant. Results: The response rate of survey was 65.42%.The mean age of the survey respondents was 30.34 ±9.95 years. Among all the respondents 225(24.56%) respondents were male and 691(75.43%) respondents were female from community of Eastern province, Saudi Arabia. The majority of the respondents 709 (77.4%) (p<0.05) purchased the medicines on prescription. The majority of the respondents 763 (84.8%) (p<0.05) answered that improper disposal of unused and expired medicines causes damage of environment and health. The results revealed that the most common Over the counter (OTC) drugs as follows, analgesics with 456 (49.78%)(p<0.05), Vitamins & Minerals 272 (29.69%), Cold and flu Drugs 84 (9.17%), Food Supplements 56 (6.11%) and in the last Digestive drugs with 48 (5.24%). Conclusion: Gaps persist in practices, hence vigorous, safe and cost-effective pharmaceutical waste management program reinforced campaign is required. Healthcare providers (HCPs) and community pharmacists (CPs) should organize training to educate customers on standard medicine disposal practices.

The Evaluation of home medication review for patients with type 2 diabetes mellitus by community pharmacists: a randomised controlled trial

Background: Successful diabetes treatment requires commitment and understanding of disease management by the patients. Objective: This trial aimed to evaluate the programme effectiveness of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and reducing medication wastage. Methods: A randomised controlled trial was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The cost of medication wastage was calculated based on the total missed dose by the T2DM patients multiplied by the cost of medication. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively. Results: No significant difference was observed in the demographic and anthropometric data at baseline between the two groups except for fasting blood glucose (FBG). There was a significant reduction in the HbA1c (-0.91%) and FBG (-1.62mmol/L) over the study period (p<0.05). A similar observation was noted in diastolic blood pressure (DBP) and total cholesterol (TC) but not in high-density lipoprotein (HDL), and anthropometric parameters. Both utility value and Michigan Diabetes Knowledge Test (MDKT) scores increased significantly over time. As for the intervention group, significant changes in PCAR (p<0.001) and the number of DRP (p<0.001) were noted. Conclusions: HMR-CP significantly improved the glycaemic control, QoL, medication adherence, and knowledge of T2DM patients as well as reduced the number of DRP and cost of medication wastage. However, the impact of HMR-CP on certain clinical and anthropometric parameters remains inconclusive and further investigation is warranted.

Home Medication Review to Identify the Medication Errors in the Paediatric Population

Medication errors are therapeutic obstacles that have the potential to threaten the patient outcomes and result in unexpected events. Home medication review (HMR) is a patient-focused process which advocates the optimal and quality use of medication at the patient’s home. It involves a systematic and detailed assessment of the patient’s medication in order to identify and meet the medication-related needs as well as to identify and prevent medication errors. The aim of this study is to identify the medication errors in paediatric population. The paediatric population is a vulnerable part of the community as they should be treated with utmost care due to their differing pharmacokinetic properties. This study is a community based prospective observational study including 150 paediatric participants. A specially designed data collection form will be used to collect the data from the patients who are eligible for the study. Several dosing and administration errors were also found in the study. Several studies have been done under home medication review but only a few with paediatric population is seen. Home medication review can be very useful for the society if it is implemented. It will be helpful to the community in clarifying any misunderstandings regarding the treatment and can lead to better outcomes. Keywords: Home medication review, paediatric population, adherence.

Assessment of Storage of Medicines at Home using Home Medication Review in Pediatric Population - A Community Based Study

People take medicines and vitamins to feel well and to stay well. However, any medicine, including those we buy without a prescription, can cause harm if taken in the wrong way or by the wrong person. That too in case of pediatric population it has to be considered very much.Medicines stored incorrectly at home can pose a health risk. Adult cold medications and antibiotics were the most commonly stored drugs at home, followed by analgesics. The most popular location for storing drugs was the refrigerator (50.6 percent). The majority of people did not read the packaging inserts. Self-medication was reported by a large percentage of homeowners (53.6%), and antibiotics recommended by doctors were frequently reused. There was a link between self-medication and educational attainment, but not with age, sex, marital status, occupation, or insurance type. There is a need for more public awareness and information about the storage and risks of reusing prescription drugs. The study conducted here is a community based prospective study where the paediatric storage of medicines was obtained through home medication review. Out of 150 pediatric participants, it was found that 20.66% of them stored in box or drawer or bag with lock and 79.33% without lock. The checking of expiry date was also enquired and in that those who checked expiry date never was 28%, timely 25% and before administration 47%.Therefore awareness of storage of medicines and looking into the expiry date of medicines is a less focused area among people.Consumers who use medications in the community should be urged to keep them in a way that preserves the medicine's quality while also protecting the consumer, their family, and visitors to their house. Keywords: Pediatric storage of medicines, Home medication review, Expiry date of medicines.

Efficacy of Home Anticonvulsant Administration for Second-Line Status Epilepticus Treatment

Objective:To investigate whether receiving a second-line anticonvulsant medication that is part of a patient’s home regimen influences outcomes in benzodiazepine-refractory convulsive status epilepticus.Methods:Using the Established Status Epilepticus Treatment Trial (ESETT) data, allocation to a study drug included in the patient’s home anticonvulsant medication regimen was compared to receipt of an alternative second-line study medication. The primary outcome was cessation of clinical seizures with improved consciousness by 60 minutes after study drug initiation. Secondary outcomes were seizure cessation adjudicated from medical records and adverse events. We performed inverse probability of treatment-weighted [IPTW] logistic regressions.Results:Of 462 patients, 232 (50%) were taking 1-2 of the 3 study medications at home. The primary outcome was observed in 39/89 (44%) patients allocated to their home medication versus 76/143 (53%) allocated to a non-home medication (IPTW odds ratio [OR] 0.66, 95% confidence interval [CI] 0.39-1.14). The adjudicated outcome occurred in 37/89 (42%) patients versus 82/143 (57%) respectively (IPTW OR 0.52, 95% CI 0.30-0.89). There was no interaction between study levetiracetam and home levetiracetam and there were no differences in adverse events.Conclusion:There was no difference in the primary outcome for patients who received a home medication versus non-home medication. However, the retrospective evaluation suggested an association between receiving a non-home medication and seizure cessation.Classification of Evidence:This study provides Class II evidence that for patients with refractory convulsive status epilepticus, use of a home second-line anticonvulsant compared to a non-home anticonvulsant did not significantly affect the probability of stopping seizures.