Drug related problems in admitted geriatric patients: The impact of clinical pharmacist interventions (original) (raw)
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International Journal of Medical Science and Public Health, 2017
Background : Geriatric patients are at high risk of Drug Related Problems (DRPs) due to multi-morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients are often excluded from premarketing trials that can further increase the occurrence of DRPs. This study was aimed to identify DRPs and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimization. Methods : A prospective observational study was conducted among geriatric patients admitted to medical and surgical wards of Jimma University Medical Center from April to July 2017. Clinical pharmacists reviewed patients drug therapy, identi ed drug related problems and provided interventions. Data were analyzed by using SPSS statistical software version 20.0. Descriptive statistics were performed to determine the proportion of drug related problems. Logistic regression analyses were performed to identify the determinants of drug related problems. Results: A total of 200 geriatric patients were included in the study. The mean age of the participants was 67.3 years (SD7.3). About 82% of the patients had at least one drug related problems. A total of 380 drug related problems were identi ed and 670 interventions were provided. For the clinical pharmacist
Pattern of drug prescribed and drug related problems among hospitalized elderly patients
CERN European Organization for Nuclear Research - Zenodo, 2022
Prescribing drugs for elderly patients is not an easy task since elderly patients are frequently with comorbid conditions. In Libya, there are no guidelines for the management of medications used in elderly patients and no specialized geriatric health institutions. The aim of this study is to assess the pattern of medication use among hospitalized elderly patients in Sebha Medical Centre and the drug-related problems associated with these patterns. This report is descriptive and retrospective cross-sectional study that is conducted at Sebha Medical Center during 2021. Potential drug-related problems were assessed based on the classification of Hepler and Strand. In this study, out of 195 participants, most of the patients have been given antibiotics (92%). The majority of patients have been prescribed anti-gastric agents, vitamins and anti-thrombotic agents which accounted for 75%, 62% and 55%, respectively. To less extent, anti-hypertensive agents, analgesics and anti-hyperlipidemics were reported by 45%, 43%, and 38%, correspondently. Almost all the patients have at least one event of drugrelated problem and more than three-quarters of the patients had more than one event of drug-related problems. The highest rate was untreated indications which were reported for 77% then followed by drug use without indication nearly a half of the events 48%. To fewer extent rates were reported: "in improper drug selection", "drug interaction" and "adverse effects" which were reported for 25%, 23% and 18% of the total events, respectively. Almost all elderly patients have been prescribed antibiotics, analgesics and vitamins. Drug-related problems are predominant prevalent in the clinical practice at the center. This study highlights the importance of activation of clinical pharmacist interventions at hospitals which can contribute to reducing the chance of risk of drug-related problems events among hospitalized elderly patients and ensuring rational drug prescribing in the geriatric clinical settings.
Drugs - Real World Outcomes, 2016
Background The role of the clinical pharmacist within the healthcare system remains unclear. Objective Our objective was to describe a pharmacist's comprehensive geriatric assessment (pCGA) at admission of elderly patients and to assess its relevance in terms of medication compliance and pharmacist interventions (PIs). Methods We conducted a prospective interventional study over 29 months in a 34-bed medical/rehabilitation geriatric ward in a French geriatric hospital. At admission, patients received pharmaceutical care through a consistent threestep process: (1) pharmacists met with the patient to undertake cognitive screening and assess their medication adherence (using the Girerd score) and medication history; (2) medication reconciliation was conducted at admission to detect intentional and unintentional discrepancies in treatment; and (3) clinical medication review was carried out throughout the patient's stay. The pharmacist conveyed proposed interventions to optimise treatment to the physician through the electronic health record. The number and type of PIs and their rate of implementation were recorded. Results In total, 539 patients aged [65 years were included; their mean age was 84 years. Cognitive screening showed that 45% of patients were confused at admission. Medication adherence assessment indicated that 50.2% had adherence problems. Medication reconciliation at admission detected discrepancies in 48%, with a mean of 1.09 unintended discrepancies per patient. Patients were taking an average of 7 ± 3 drugs. In total, 828 PIs were reported to physicians; 520 were accepted and implemented (62.8% acceptance rate). Conclusion This approach helps to avoid medication errors and enables the suggestion of relevant PIs, which were implemented by physicians in two-thirds of cases. Key Points Elderly patients are at risk of adverse drug events, and medication errors can often occur during times of transition in care, such as admission to hospital. Involving clinical pharmacists in the patient management process helps to obtain more exhaustive and accurate information regarding the patient's medication history through medication reconciliation. A systematic approach to pharmaceutical care at hospital admission can help identify relevant pharmacist interventions and may reduce unintended medication discrepancies.
Drug Related Problems in Geriatric Patients with Inappropriate Medication Use
https://www.ijrrjournal.com/IJRR\_Vol.8\_Issue.5\_May2021/IJRR-Abstract059.html, 2021
Drug related problem (DRP) is an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. Nowadays geriatric patients are at high risk of DRPs due to polypharmacy and altered physiology or due to older patients cannot manage their medication. DRPs also could arise from age related chronic diseases. The DRPs following hospital discharged cases also increased in elder people with chronic disease. Geriatric patients faces DRPs include inappropriate use of medication, polypharmacy, noncompliance, ADRs, drug-drug interaction, etc. Geriatric patients require more care because DRPs sometimes leads to hospital admission days, cost of the medication, increased morbidity rate and reduce the quality of life etc. So these category people need special consideration while selecting the drug therapy and its pattern. Like other health care services this special category of patients' needs good care or services from a team of health care professionals including clinical pharmacists. This review article aims to understand the risk factors and different types of DRPs that are facing by the elderly people due to inappropriate medication use and pharmaceutical care by clinical pharmacists.
International journal of clinical pharmacy, 2015
Background An aging population and the increasing prevalence of chronic diseases have led to the increased use of medicines. Portugal is one of the European countries where more medicines are consumed and the associated expense is higher. Medicines are associated with enormous health benefits but also with the potential to cause illness and death. A drug related problem (DRP) is an "an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes". In the U.S., they represent the 4th-6th leading cause of death and have an estimated cost of 130 billion dollars. Moreover, many of these DRP can be avoided. Elderly are at increased risk of DRP due to multiple factors: pluripathology and consequent polypharmacy, complex dosing regimens, pharmacokinetic/pharmacodynamic and functional/cognitive changes. Therefore, this population would be the one who would benefit most from the prevention, detection and control of DRP. The role ...
Drug utilization studies on geriatric population are an area of research where the data available is very limited and this population is generally neglected. This study was done to assess the usage of essential medicines and to identify the diseases common among this population. It was a cross sectional, unicentric observational drug utilization study with admitted patients in medicine ward as study population. The sample size was 111 patients. The case sheets of the patients were verified after obtaining written informed consent and the drugs prescribed were analyzed. The majority of patients were found to be in the age group of 60 to 70 years (76%).It was noticed that males were more (63%) compared to females. The drugs prescribed were categorized and drugs used for respiratory disorders were used more commonly of which Deriphylline was prescribed for almost half of the patients in this study group. The Average number of drugs per prescription was 9.4±0.31 (SEM). Average drug cost per admission was Rs.981.93±87.49 (SEM). Brand names were used (74%) in preference to generic names. Among the drugs prescribed 78% were from the national list of essential medicines (NLEM) and only 58% were from the WHO Essential Medicines List. This study revealed the chronic nature of diseases affecting the geriatric population with an increased incidence of respiratory diseases and rightly the drug deriphyllin was the most common drug utilized. The pattern of drug prescription also shows a trend towards polypharmacy (> 5 drugs) which has to be viewed with caution given the pharmacokinetic changes in the elderly. These studies can help to promote rational use of drugs.
Geriatric Conditions and Adverse Drug Reactions in Elderly Hospitalized Patients
Journal of the American Medical Directors Association, 2012
Adverse drug reactions falls activities of daily living elderly a b s t r a c t Objectives: To investigate the relationship between clinical conditions typically observed in the geriatric patients (geriatric conditions) and adverse drug reactions in older patients admitted to acute care hospitals. Design and Setting: Prospective observational study conducted in 11 acute care medical wards throughout Italy. Participants: Five hundred six patients aged 65 years or older consecutively admitted to participating wards. Measurements: The outcome of the study was the occurrence of any adverse drug reactions during the hospital stay. Geriatric conditions considered in the analysis were basic activities of daily living, history of falls, slow walking speed, malnutrition, dementia, depression, 1 or more unplanned admissions in the previous 3 months, history of stroke, unintentional weight loss, and exhaustion. The relationship between risk factors and outcomes was assessed using logistic regression. Results: Female gender (odds ratio [OR] 2.29; 95% confidence interval [CI] 1.18e4.45) and number of medications taken during hospitalization (OR 1.12; 95% CI 1.06e1.18), but not individual Geriatric conditions, were associated with the outcome after correction for potential confounders. However, the simultaneous presence of history of falls and dependency in at least 1 activities of daily living (OR 2.18; 95% CI 1.13e4.19) was associated with adverse drug reactions during stay. Conclusion: The simultaneous presence of history of falls and dependency in at least one activity of daily living defines a condition of particular vulnerability of elderly hospitalized patients to adverse drug reactions. Physicians should be aware of this high-risk condition when prescribing new drugs to disabled older people.
Drug-related problems identified during geriatric medication review in the community pharmacy
International Journal of Clinical Pharmacy, 2017
Background In line with the changing role of community pharmacists, we describe here a standardised procedure for detecting DRPs in elderly patients for use in community pharmacies. Objectives The primary aim was to describe the number and type of DRPs identified by community pharmacists in elderly patients. Secondary aims were to determine the number and type of associated pharmacist interventions (PIs) that were transmitted to the prescribers, and to identify risk factors associated with the occurrence of a PI. Setting Community pharmacies. Methods In this prospective, multicentre study, pharmacists received patients aged 65 and over. During a 30-min interview with patients who agreed to participate, patient characteristics were recorded such as age, weight, height, frailty (using the Short Emergency Geriatric Assessment grid), estimated renal function and compliance with treatment assessed by the Girerd scale. Main outcome measure DRPs characteristics. Results A total of 892 patients agreed to participate in 55 pharmacies. Among them 334 DRPs were identified and were associated with 259 PIs. Eighty-nine PIs of 259 were sent to the prescribing physicians; 70 (78%) were implemented by the general practitioner. Factors associated with the occurrence of a DRP are compliance problems [odds ratio (OR) = 1.8, 95% confidence interval (CI) (1.26-2.58)], frailty [OR = 1.3, 95% CI (1.01-1.66)], number of prescribed drugs per day [OR = 1.46, 95% CI (1.02-2.07)] and GFR < 60 mL/min [OR = 1.49, 95% CI (1.01-2.2)]. Conclusion This is the first standardised pharmaceutical assessment dedicated to the elderly carried out by community pharmacists in France. If implemented, it could help to find drug-related problems, identify frail elderly patients and ultimately decrease their exposure to iatrogenic medication errors.
2016
Background: Prescribing to the older people is challenging. Pharmacokinetics and pharmacodynamic changes, chronic diseases, polypharmacy prescribing, potentially inappropriate medication (PIMs) prescribing, medication errors, adverse drug reactions, drug interactions, inappropriate prescribing or suboptimal prescribing are causes for challenge. It may lead to non-adherence, increase morbidity, length of hospitalization, poor quality of life, and finally death may occur. Method: A Prospective observational study was conducted in General Medicine department, for a period of 6 months. Patients of either gender who are above 65 years of age in general medicine in-patient ward with or without co-morbidities were included in the study; we excluded seriously ill and patients unable to communicate and Patients unwilling to participate in the study. Results: Total 140 geriatrics patients were admitted. In this study we observed that almost all prescriptions were with polypharmacy. PIMs obser...