Analysis of interaction risks of patients with polypharmacy and the pharmacist interventions performed to solve them-A multicenter descriptive study according to medication reviews in Hungarian community pharmacies.

András Szilvay,Romána Zelkó,Balázs Hankó,Annamária Dobszay,Orsolya Somogyi,Attiláné Meskó,Vijayaprakash Suppiah

doi:10.1371/journal.pone.0253645

András Szilvay, Romána Zelkó + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0253645

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Journal: PloS one	Publication Date: Jun 22, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: Semmelweis University

Abstract

The study examined the Drug-Related Problems (DRPs) of patients with polypharmacy in 78 Hungarian community pharmacies, especially the interaction risks in terms of their clinical severity. Also, the objective was to analyze pharmacists' interventions to solve the identified interaction risks. The research was carried out in the framework of the training of specialist pharmacists at Semmelweis University, with the participation of 78 graduated pharmacists with the collaboration of 98 GPs. A total of 755 patients participated in pharmaceutical counseling which meant a medication review process. DRPs were uniformly categorized and the interventions were recorded by pharmacists, while a detailed analysis of interaction risks was performed by authors. A total of 984 DRPs were registered. The most common category of DRPs was the "non-quantitative safety problems" (62.6%). Interaction risk was the most common cause of DRPs (54.0%). The highest proportion of interaction risks were between two prescription drugs (66.7%). In 30.7% of interaction risks' cases, there was not known negative outcome. In contrast, it was recommended to modify the therapy in 14.9% of interaction risks. Acetylsalicylic acid (22.8%), acenocoumarol (17.7%), and diclofenac (13.9%) were the most common active substances which caused serious interaction risks. A total of 599 pharmacist interventions were used to solve the 531 interaction risks. Pharmacists notified the GPs about the problem in 28.4% of cases and they intervened without the GP in 63.1% of cases, most often with patient education (27.4%). Medication review by community pharmacists is required for the safe medicine using of patients with polypharmacy, as a significant number of DRPs have been recorded. The incidence of interaction risks stood out. It is essential to develop a pharmaceutical guideline to properly classify the clinical relevance of interaction risks (e.g. according to high-risk active substances) and to increase the collaboration with GPs.

Highlights

In developed countries, the number of medicines used per person is rising as the population ages and the rate of chronic diseases increases [1]
Looking at the underlying causes of Drug-Related Problems (DRPs), we found that interaction was by far the most common cause (54.0%), with a total of 531 interaction risks (0.7 per patient) were found by participating pharmacists
In our previous pilot research on another patient population, we found that the interaction risk was the most common cause of DRPs [38]

Summary

Introduction

The number of medicines used per person is rising as the population ages and the rate of chronic diseases increases [1]. Between 1995 and 2010, the proportion of people taking more than 5 medicines doubled, while the proportion of people taking more than 10 medicines tripled, affecting 20.8% and 5.8% of the adult population respectively [2]. It can be stated that polypharmacy has become a common phenomenon affecting the elderly [3]. The concept of polypharmacy is defined in many ways in the literature. According to the most widely used definition (as in this manuscript): polypharmacy means the continuous concomitant use of 5 or more drugs [4,5]. A few factors may play a role in the development of polypharmacy, such as poor medical record-keeping, poor transitions of care, use of automated refill systems [6]

Results

Discussion

Conclusion