Abstract
BackgroundThere is no nationwide data on polypharmacy in palliative care in Japan. In this study, the research committee of the Japanese Society for Pharmaceutical Palliative Care and Sciences conducted an online survey on polypharmacy and inappropriate prescriptions involving its members who worked as hospital pharmacists.MethodsThe online questionnaire included questions about hospital pharmacist interventions for cancer patients who regularly used six or more drugs during a two-month period from October to November 2017.ResultsOf 2618 hospital pharmacists, 359 responded (13.7%). With regard to cancer patients receiving opioids, 40.9 and 22.3% of the respondents replied that percentages of patients prescribed six or more regular medications were “40–69%” and “70–99%,” respectively. Regarding patients on polypharmacy, 73.0% of the respondents reported a low or moderate rate of inappropriate prescriptions, with responses such as “long-term administration of irresponsible or aimless medications”, “adverse drug reactions,” and “duplication of the pharmacological effect”. Furthermore, 24.2, 46.8, and 23.4% of respondents replied that the rates of drug reduction due to pharmacist recommendations were “0”, “1–39%”, and “more than 40%,” respectively. Pharmacist interventions decreased the use of inappropriate medications, including antiemetics, gastrointestinal medications, and hypnotic sedatives, and reduced or prevented adverse drug reactions such as extrapyramidal symptoms, delirium, and sleepiness. Similar results were obtained for cancer patients who did not use opioids. However, the rates of cancer patients on polypharmacy and with reduction of inappropriate medications by pharmacist interventions were significantly higher in cancer patients receiving opioids. Finally, recommendations of board-certified pharmacists in palliative pharmacy contributed to a decrease in the use of inappropriate medications in cancer patients on polypharmacy (p = 0.06).ConclusionThis nationwide survey clarified pharmacist interventions for polypharmacy in palliative care in Japan. Our data showed frequent polypharmacy in cancer patients receiving opioids, and benefits of pharmacist interventions, especially by board-certified pharmacists in palliative pharmacy, for reducing inappropriate medications and improving adverse drug reactions.Trial registrationThe study approval numbers in the institution; 0046. Registered November 6, 2017.
Highlights
Polypharmacy was defined 150 years ago, and it has been cited and addressed as an important issue since the 1960s [1]
The top four board certifications were as follows: Board-Certified Pharmacist in Palliative Pharmacy (BCPPP) offered by the JSPPCS (n = 123, 34.3%), Board Certified Pharmacist in Oncology Pharmacy (BCPOP) (n = 82, 22.8%), the JSPHCS certification of Oncology Pharmacist (n = 52, 14.5%), and Accredited Pharmacist of Ambulatory Cancer Chemotherapy (APACC) (n = 32, 8.9%)
We showed that the rate of cancer patients on polypharmacy was higher in opioid-using patients
Summary
Polypharmacy was defined 150 years ago, and it has been cited and addressed as an important issue since the 1960s [1]. There is no clear consensus on the number of medications [4], many reports define five or more, or six or more regular use medications as polypharmacy [5,6,7,8]. Polypharmacy potentially associated with inappropriate prescriptions, and causes various problems such as drug interactions, adverse events, increased medical expenses, and decreased medication adherence [12] and has been considered a problem in Japan in recent years. An observational survey conducted by a visiting pharmacist revealed the rate of inappropriate prescription was 48% in older patients in Japan [13]. The research committee of the Japanese Society for Pharmaceutical Palliative Care and Sciences conducted an online survey on polypharmacy and inappropriate prescriptions involving its members who worked as hospital pharmacists
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