Colin Curtain - Academia.edu (original) (raw)

Papers by Colin Curtain

Aim The purpose of this investigation was to evaluate the clinical decision support capacity of c... more Aim The purpose of this investigation was to evaluate the clinical decision support capacity of commercial computer software designed to assist pharmacists performing medication reviews. The primary hypothesis was: If medication review software is related to pharmacist knowledge, then the detection of therapeutic problems will result in a similar frequency and scope of identified problems as those identified by pharmacists. Method Home medication review data collected during 2008 for a previous study were used for this investigation. The data contained original pharmacist findings of drug-related problems (DRPs), patient demographics, medications, laboratory results and diagnoses. Two commercial software applications advertising decision support were assessed, Monitor-Rx (MRX) utilising simple rules triggered by the presence of medication and Medication™ Review Mentor (MRM) utilising an advanced artificial intelligence rules-based approach. The previously collected data were entered...

The International journal of pharmacy practice, Jan 29, 2016

To evaluate the quality of pharmaceutical advertisement claims and supporting references in Austr... more To evaluate the quality of pharmaceutical advertisement claims and supporting references in Australian pharmacy journals that target community pharmacists. All full-page advertisements for a medicinal product, found in two Australian pharmacy journals from the year 2012 to 2015 were included. Advertisement claims and references were evaluated by claim type (unambiguous to immeasurable) and level of evidence (strong to irrelevant) in supporting references. Two hundred and ninety distinct advertisements and 598 claims were identified, with a median of 2 claims per advertisement. Twenty-seven percent of claims were unambiguous, 40% were vague, 16% were emotive/immeasurable and 17% were non-clinical or other marketing claims. Half of all claims were referenced. Although 68% of unambiguous claims were referenced, 63% of those were supported by studies that were funded directly or indirectly by pharmaceutical companies. Only 13% of claims were supported with strong or moderate independent...

Drug safety, Jan 6, 2017

Adverse drug reactions (ADRs) have been commonly cited as a major cause of hospital admissions in... more Adverse drug reactions (ADRs) have been commonly cited as a major cause of hospital admissions in older individuals. However, despite the apparent magnitude of this problem, there are limited prospective data on ADRs as a cause of hospitalization in elderly medical patients. The objective of this study was to evaluate the proportion, clinical characteristics, causality, severity, preventability, and outcome of ADR-related admissions in older patients admitted to two Tasmanian hospitals. We conducted a prospective cross-sectional study at the Royal Hobart and Launceston General Hospitals in Tasmania, Australia. A convenience sample of patients, aged 65 years and older, undergoing unplanned overnight medical admissions was screened. ADR-related admissions were determined through expert consensus from detailed review of medical records and patient interviews. The causality, preventability and severity of each ADR-related admission were assessed. Of 1008 admissions, the proportion of po...

PLOS ONE, 2016

Adverse drug reactions (ADRs) are the major cause of medication-related hospital admissions in ol... more Adverse drug reactions (ADRs) are the major cause of medication-related hospital admissions in older patients living in the community. This study aimed to develop and validate a score to predict ADR-related hospitalization in people aged ≥65 years. ADR-related hospitalization and its risk factors were determined using a prospective, cross-sectional study in patients aged ≥65 years admitted to two hospitals. A predictive model was developed in the derivation cohort (n = 768) and the model was applied in the validation cohort (n = 240). ADR-related hospital admission was determined through expert consensus from comprehensive reviews of medical records and patient interviews. The causality and preventability of the ADR were assessed based on the Naranjo algorithm and modified Schumock and Thornton criteria, respectively. In the derivation sample (mean [±SD] age, 80.1±7.7 years), 115 (15%) patients were admitted due to a definite or probable ADR; 92.2% of these admissions were deemed preventable. The number of antihypertensives was the strongest predictor of an ADR followed by presence of dementia, renal failure, drug changes in the preceding 3 months and use of anticholinergic medications; these variables were used to derive the ADR prediction score. The predictive ability of the score, assessed from calculation of the area under the receiver operator characteristic (ROC) curve, was 0.70 (95% confidence interval (CI) 0.65-0.75). In the validation sample (mean [±SD] age, 79.6±7.6 years), 30 (12.5%) patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; admissions were related to definite or probable ADRs; 80% of these admissions were deemed preventable. The area under the ROC curve in this sample was 0.67 (95% CI 0.56-0.78). This study proposes a practical and simple tool to identify elderly patients who are at an increased risk of preventable ADR-related hospital admission. Further refinement and testing of this tool is necessary to implement the score in clinical practice.

Research in Social and Administrative Pharmacy, 2016

Current medical research and opinion, Jan 10, 2015

The primary objective of this study was to investigate the impact of Residential Medication Manag... more The primary objective of this study was to investigate the impact of Residential Medication Management Reviews (RMMRs) on anticholinergic burden quantified by seven anticholinergic risk scales. Retrospective analysis. Accredited pharmacists conducted RMMRs in aged-care facilities (ACF) in Sydney, Australia. RMMRs pertaining to 814 residents aged 65 years or older. Anticholinergic burden was quantified using seven scales at baseline, after pharmacists' recommendations and after the actual GP uptake of pharmacists' recommendations. Change in the anticholinergic burden was measured using the Wilcoxon sign rank test. At baseline, depending on the scale used to estimate the anticholinergic burden, between 36 and 67% of patients were prescribed at least one regular anticholinergic medication (ACM). Anticholinergic burden scores were significantly (p<0.001) lower after pharmacists' recommendations as determined by each of the seven scales. The reduction in anticholinergic bu...

Lecture Notes in Computer Science, 2014

A commercially used expert system using multiple-classification ripple-down rules applied to the ... more A commercially used expert system using multiple-classification ripple-down rules applied to the domain of pharmacist-conducted home medicines re-view was examined. The system was capable of detecting a wide range of po-tential drug-related problems. The system identified the same problems as pharmacists in many of the cases. Problems identified by pharmacists but not by the system may be related to missing information or information outside the domain model. Problems identified by the system but not by pharmacists may be associated with system consistency and perhaps human oversight or human selective prioritization. Problems identified by the system were considered rele-vant even though the system identified a larger number of problems than human counterparts.

Drugs & Aging, 2014

Drug-related problems (DRPs) are common in aged care facilities and few studies have been conduct... more Drug-related problems (DRPs) are common in aged care facilities and few studies have been conducted to determine the impact of the pharmacist-conducted medication review services. Studies determining the prevalence of chronic kidney disease (CKD) and data regarding inappropriate prescribing of renally cleared medications in aged care facilities in Australia are also lacking. To investigate the number and nature of DRPs identified and recommendations made by pharmacists in residents of aged care facilities. To determine the prevalence of CKD and estimate the magnitude of inappropriate prescribing of renally cleared medications in residents of aged care facilities. DRPs identified and recommendations made by pharmacists were classified using the adapted version of the DOCUMENT classification system. The modification of diet in renal disease formula was used to estimate the prevalence of CKD, and the Cockcroft-Gault formula was used to estimate the magnitude of inappropriate prescribing of renally cleared medications. Over 98 % of residents of aged care facilities had at least one DRP. Most (83.8 %) recommendations made by accredited pharmacists to resolve DRPs were accepted by general practitioners. CKD was prevalent in 48 % of residents, and inappropriate prescribing of renally cleared medications was identified in 28 (16 %) residents with CKD. DRPs are common in aged care facilities and the impact of medication review services appears to be high. CKD is also common among residents of aged care facilities, and inappropriate prescribing of renally cleared medications was also prevalent, warranting attention to regular renal function monitoring and appropriate drug and dose selection in residents of aged care facilities.

Journal of Clinical Pharmacy and Therapeutics, 2014

Drugs & Aging, 2013

Studies have compared prescribing criteria for older people in general terms, reporting the findi... more Studies have compared prescribing criteria for older people in general terms, reporting the findings without true side-by-side comparisons of the frequency and type of potential drug-related problems (DRPs). The aim of this study was to compare the frequency and type of DRPs identified by several prescribing criteria. Additionally, original pharmacist DRP findings were compared with DRPs identified using the prescribing criteria. Three prescribing criteria were automated: Beers 2012 (Beers), Screening Tool of Older Person&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START), and Prescribing Indicators in Elderly Australians (PIEA). The criteria were applied to medication reviews of 570 ambulatory older Australian patients. DRPs identified by each set of criteria were recorded. Each DRP was assigned a descriptive term which highlighted mainly drug classes and/or diagnoses to provide a meaningful common language for comparison between recorded DRPs. Descriptive terms were used to compare the frequency and type of DRP identified by each set of criteria, as well as against original pharmacists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; findings. Beers identified 399 DRPs via 21 different descriptive terms, STOPP/START identified 1,032 DRPs via 42 terms, and PIEA identified 1,492 DRPs via 33 terms. The various types of DRPs identified by all of the three prescribing criteria were represented by 53 different terms. When constrained to the same 53 different terms, pharmacists identified 862 DRPs. Each set of criteria displayed relevance through mutual agreement of known high-risk medication classes in older people. The number and scope of DRPs identified by pharmacists was best represented by STOPP/START. The application of STOPP/START may be further augmented with relevant criteria from PIEA and Beers.

Drugs & Aging, 2009

The Drug Burden Index (DBI) is an evidence-based tool that associates medication exposure with fu... more The Drug Burden Index (DBI) is an evidence-based tool that associates medication exposure with functional outcomes in older people. Accredited clinical pharmacists performing medication reviews could consider including the DBI in their medication reviews to optimize prescribing in older people. To examine the impact of residential medication management reviews (RMMRs) performed by accredited clinical pharmacists on DBI in older people living in aged-care homes. A retrospective analysis was performed of a random sample of 500 de-identified RMMR reports from residents aged (mean +/- SD) 84 +/- 9.0 years who had medication reviews conducted by ten accredited clinical pharmacists from 1 January 2008 through 30 June 2008. The data on medication use were collected over 8 months across 62 aged-care homes. DBI scores were calculated at baseline, after the recommendations had been made by the pharmacist and after uptake of pharmacist recommendations by the general practitioner (GP). A statistically significant decrease (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) in median DBI score was observed as a result of uptake of pharmacist recommendations by the GP. GPs were more likely to take up recommendations made by pharmacists that resulted in a decrease in DBI score than recommendations that resulted in an increase in DBI score (60.7% vs 34.6%, respectively). The mean decrease in DBI as a result of pharmacist recommendations was 0.12 (95% CI 0.09, 0.14) representing a 20% decrease in mean baseline DBI for residents. When GPs implemented pharmacists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; recommendations, DBI decreased by a mean of 12% from baseline (mean decrease 0.07; 95% CI 0.05, 0.08). Most of the recommendations proposed by the pharmacists involved withdrawing benzodiazepines or reducing antipsychotic drug dosage. This is the first study in which DBI has been used as a tool to evaluate the impact of RMMRs conducted by accredited clinical pharmacists. The study demonstrates that pharmacist-conducted medication reviews can reduce prescribing of sedative and anticholinergic drugs in older people, resulting in a significant decrease in the DBI score.

Drugs & Aging, 2016

It is currently recommended in Australia that nursing home residents are supplemented daily with ... more It is currently recommended in Australia that nursing home residents are supplemented daily with 1000 IU vitamin D as they are at an increased risk of fractures. Historically, supplementation has been low, and current supplementation prevalence is not known. The aim of this study was to determine the prevalence of vitamin D supplementation amongst nursing home residents in Tasmania, Australia. Resident data, including demographics, medical conditions and medications (including vitamin D and calcium supplement use), exercise and sun exposure, were obtained from residents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; files and staff in consenting nursing homes. Dietary calcium intake was estimated from the weekly menu of one nursing home and total calcium intake estimated from this and calcium supplement use. The prevalence of vitamin D supplementation was compared by resident characteristics and fracture risk factors. Of 811 residents, 409 (50 %) received daily vitamin D supplementation of at least 1000 IU. Residents receiving vitamin D supplementation were slightly younger (mean 83 vs. 85 years for supplemented and unsupplemented groups, respectively, p = 0.003) and more likely to have osteoporosis (29 vs. 22 % for supplemented and unsupplemented groups, respectively, p = 0.019). Only 43 % of residents with osteoporosis received vitamin D supplements. Most residents (86 %) did not have regular sunlight exposure. The median estimated total calcium intake of 800 ± 275 mg daily was below guideline recommendations of 1000-1300 mg daily. The prevalence of vitamin D supplementation in nursing home residents was relatively low, suggesting poor adherence to the relevant clinical guidelines. Additionally, most residents do not access sunlight. Interventions addressing this evidence-practice gap are needed.

Annals of Pharmacotherapy, 2011

International Journal of Clinical Pharmacy, 2014

British Journal of Clinical Pharmacology, 2011

Australasian Medical Journal, 2013

Accredited pharmacists conduct home medicines reviews (HMRs) to detect and resolve potential drug... more Accredited pharmacists conduct home medicines reviews (HMRs) to detect and resolve potential drug-related problems (DRPs). A commercial expert system, Medscope Review Mentor (MRM), has been developed to assist pharmacists in the detection and resolution of potential DRPs.