Drug-related problems in institutionalized, polymedicated elderly patients: opportunities for pharmacist intervention (original) (raw)
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Medication‐related problems in older people in Catalonia: A real‐world data study
Pharmacoepidemiology and Drug Safety, 2020
The aim of this study was to determine medication-related problems (MRPs) in primary care patients over 65 years of age. Methods: Cross-sectional study based on the electronic health records of patients (65-99 years of age) visited in 284 primary health care centers during 2012 in Catalonia. Variables: age, sex, sociodemographic variables, number of drugs, kidney and liver function and MRPs (duplicate therapy, drug-drug interactions, potentially inappropriate medications [PIMs] and drugs contraindicated in chronic kidney disease and in liver diseases). Unconditional logistic regression models were used to identify the factors associated with MRPs in patients with multimorbidity. Results: 916 619 older people were included and 853 085 of them met the criteria for multimorbidity. Median age was 75 years and 57.7% of them were women. High percentages of MRPs were observed: PIMs (62.8%), contraindicated drugs in chronic kidney disease (12.1%), duplicate therapy (11.1%), contraindicated drugs in liver diseases (4.2%), and drug-drug interactions (1.0%). These numbers were higher in the subgroup of patients with ≥10 diseases. The most common PIMs were connected to drugs that increase the risk of fall (66.8%), antiulcer agents without criteria for gastroprotection (40.6%), and the combination of drugs with anticholinergic effects (39.7%). In the multivariate analysis, the variables associated with all MRPs among the patients with multimorbidity were the number of drugs and the number of visits. Conclusions: The coexistence of multimorbidity and polypharmacy is associated with an elevated risk of MRPs in older people. Medication safety for older patients constitutes a pressing concern for health services.
Medication-related problems in older people: how to optimise medication management
Hong Kong Medical Journal, 2020
Older patients are at risk of medication-related problems because of age-related physiological changes and multiple medications taken for multiple co-morbidities. The resultant polypharmacy is frequently associated with inappropriate medication use, which in turn contributes to a range of adverse consequences, including geriatric syndromes (eg, falls, cognitive decline, urinary incontinence) and hospitalisation. In addition, medication nonadherence or discrepancies between the medications prescribed and those actually taken by patients, either intentional or unintentional, are prevalent and can lead to treatment failure. A large proportion of adverse drug events are preventable, and medication errors occur most commonly at the stages of prescribing and subsequent monitoring. There are a number of strategies to address these issues with the aim of ensuring safe prescribing. Furthermore,
2019
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, identified 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 re...
Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward
Acta medica portuguesa, 2019
INTRODUCTION Polypharmacy is often observed in elderly patients and is associated with an increased risk of adverse drug reactions, side effects and interactions. Clinicians should be alert to inappropriate drug prescribing and reduce polypharmacy. MATERIAL AND METHODS Observational, longitudinal, retrospective and descriptive study in an internal medicine ward in a Portuguese hospital. Polypharmacy was defined as the use of five or more different medicines. The purpose of this study was to describe the prevalence of polypharmacy and inappropriate prescribing at admission and discharge in an internal medicine ward, according to deprescribing.org guidelines/algorithms. A total of 838 consecutive patients were admitted between January and July 2017. All patients were aged under 65 years old, and those who died before discharge were excluded. Patients' medications were reviewed from a medical database at hospital admission and discharge. We examined whether patients were taking ant...
Management of Drug Related Problems in the Elderly -A Review
https://www.ijrrjournal.com/IJRR\_Vol.9\_Issue.11\_Nov2022/IJRR-Abstract50.html, 2022
Drug Related Problems (DRPs) also known as Medication Related Problems (MRPs) are the problems that occur because of the drugs when a person is undergoing a treatment. Older patients are particularly vulnerable to ADRs because of age-related changes in pharmacokinetics and pharmacodynamics, such as reduced hepatic and renal function, prolonged elimination half-life, and increased sensitivity to drugs, which have been shown to be associated with an increased risk of ADRs. This may (in most cases) interfere with the desired outcome of the therapy. This in turn, reduces the quality of life of a person. DRPs may be life-threatening in some and this poses the importance of identification of DRPs. The DRPs can be identified and can be categorized as whether it is preventable or not. It can also be classified into different classes-Adverse Drug Reaction (ADR) and Drug Interaction being the most common causes for the incidence of DRP. The pharmacist can play a key role in identification, categorization and prevention of DRPs. The aim of this review is for the better understanding of DRPs and to shine light on the causes of DRPs that is often left unseen or underestimated. This review also aims to show the big role that can be played by pharmacist in identifying, preventing DRPs and thereby improving the quality of life of patients.
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
Drug-related problems in elderly general practice patients receiving pharmaceutical care
International Journal of Pharmacy Practice, 2005
Objective To describe the types of drug-related problems identified by pharmacists providing pharmaceutical care to elderly patients in the primary care or general medicine setting, and the impact of their recommendations on drug-related outcomes. Methods Searches of the MEDLINE, EMBASE, CINAHL, HealthSTAR, and International Pharmaceutical Abstracts electronic databases from 1990 to 2002 were conducted and a manual search of references from retrieved articles and references on file was performed. Large (n > 100) randomised, controlled studies comparing the provision of pharmaceutical care to usual care in seniors in primary care or general medicine settings were included. Two reviewers evaluated articles based on inclusion criteria and extracted data from the intervention arm of each study, resolving discrepancies by consensus. Nine original articles were included for analysis. Key findings The mean number of drug-related problems (DRPs) identified per patient was 3.2 and the mean number of recommendations made per patient was 3.3. The most common DRP identified was not taking/receiving a prescribed drug appropriately (35.2%, range 4.7-49.3%). The most common recommendations made involved patient education (37.2%, range 4.6-48.2%). Implementation rates were generally high for all types of recommendations, with the highest being for provision of patient education (81.6%). The small number of studies available examining measures of drug utilisation and costs, health services utilisation, and patient outcomes produced inconsistent results, making it difficult to draw conclusions. Conclusions Substantial numbers and a wide range of DRPs were identified by pharmacists who provided pharmaceutical care to seniors in the primary care and general medicine setting. Pharmacists' drug-therapy recommendations were well accepted; however, further study is needed to determine the impact of these recommendations on health-related outcomes.