Appropriate Use Of Medications Research Articles

Fenugreek Seeds as a Therapeutic Supplement for Patients with Noninsulin Dependent Diabetes Mellitus: A Cross-sectional Study

Introduction: Diabetes mellitus is a metabolic disorder, for which there is no known cure except in very specific situations. Management of diabetes is based on keeping blood sugar levels as close to normal as possible, without causing hypoglycaemia. Usually, this can be accomplished with diet, exercise and use of appropriate medications. In India, herbs are used in treatment to maintain normal blood glucose and lipid levels. In any form of management of diabetes with drug or insulin, diet is a common factor. Besides diet, many plants and foods of medicinal value have proved to be very useful in which one of them is fenugreek seed. Aim: The present study was aimed to evaluate the blood glucose modulating effect of Fenugreek Seed Powder (FSP) in patients of Noninsulin Dependent Diabetes Mellitus (NIDDM). Materials and Methods: A cross-sectional study was conducted on 25 patients of NIDDM of age group 40 to 50 years. A 5 gm Fenugreek seed powder was given to the patients on empty stomach early in the morning every day. Before beginning the study and at the end of every month, the blood glucose level (fasting and postprandial) was measured consecutively for three months. Statistics Program for Social Sciences (SPSS, version 17.0) computer software package was used for statistical analysis of the data. Results: Administration of FSP lowered the blood glucose levels in patients of NIDDM and a significant reduction in blood glucose level (fasting and postprandial) was observed in the study. Conclusion: Present study suggested that FSP might have potential to modulate blood glucose level which can serve as an effective supportive therapy in the prevention and management of long-term complications of diabetes.

Optimizing pharmacotherapy on geriatric hospital units in Belgium – a national survey

ABSTRACT Objective Inappropriate prescribing remains highly prevalent on geriatric units. The aim of this investigation, initiated by the Belgian College for Geriatrics, was to evaluate the implementation of strategies to optimize pharmacotherapy on geriatric units in Belgium. Methods A literature search was performed to identify strategies to support the appropriate use of medications in very old inpatients. These strategies were subsequently validated based on Delphi consensus rounds and a national survey was developed. Experts were selected by the research team in collaboration with the Belgian College for Geriatrics. The survey was sent to the heads of the geriatric departments of all Belgian hospitals (n = 100). Results After 3 months a response rate of 55% was achieved. Strategies that were implemented more frequently were the use of electronic prescribing (85%), performing a structured medication review (69%) and providing patient education (76%). In a minority (24%) of hospitals, a clinical pharmacist was directly involved in the multidisciplinary geriatric team. Implementation of clinical decisions support systems (CDSS) was reported by 36% of the hospitals. Educational strategies for healthcare professionals and strategies to optimize transitional care were variable. Conclusion Taking into account the current body of evidence, strategies that include transitional care components, CDSS or ward-based clinical pharmacy services should be further promoted on Belgian geriatric units.

Non-antibiotic medication use in an Indonesian community cohort 0-18 months of age.

Rational medication use for treatment is mandatory, particularly in children as they are vulnerable to possible hazards of drugs. Understanding the medication use pattern is of importance to identify the problems of drug therapy and to improve the appropriate use of medication among this population. A post-hoc study of the RV3-BB Phase IIb trial to children aged 0-18 months which was conducted in Indonesia during January 2013 to July 2016. Any concomitant medication use and health events among 1621 trial participants during the 18 months of follow-up were documented. Information on medication use included the frequency, formulation, indication, duration of usage, number of regimens, medication types, and therapeutic classes. The majority of participants (N = 1333/1621; 82.2%) used at least one non-antibiotic medication for treatment during the 18-month observation period. A total of 7586 medication uses were recorded, mostly in oral formulation (90.5%). Of all illnesses recorded, 24.7% were treated with a single drug regimen of non-antibiotic medication. The most common therapeutic classes used were analgesics/antipyretics (30.1%), antihistamines for systemic use (17.4%), cough and cold preparations (13.5%), vitamins (8.6%), and antidiarrheals (6.6%). The main medication types used were paracetamol (29.9%), chlorpheniramine (16.8%), guaifenesin (8.9%), zinc (4.6%), and ambroxol (4.1%). Respiratory system disorder was the most common reason for medication use (51.9%), followed by gastrointestinal disorders (19.2%), pyrexia (16.9%), and skin disorders (7.0%). A large number of children were exposed to at least one medication during their early life, including those where evidence of efficacy and safety in a pediatric population is lacking. This supports the need for further research on pediatric drug therapy to improve the appropriate use of medication in this population.

Patterns and determinants of prescribed drug use among pregnant women in Adigrat general hospital, northern Ethiopia: a cross-sectional study

BackgroundA vigilant prescription of drugs during pregnancy can potentially safeguard the growing fetus from the deleterious effect of the drug while attempting to manage the mother’s health problems. There is a paucity of information about the drug utilization pattern in the area of investigation. Hence, this study was implemented to investigate the pattern of drug utilization and its associated factors among pregnant women in Adigrat general hospital, Northern Ethiopia.MethodsAn institution-based cross-sectional study was conducted among randomly selected 314 pregnant women who attended obstetrics-gynecology and antenatal care units of the hospital. Relevant data were retrieved from the pregnant women’s medical records and registration logbook. The drugs prescribed were categorized based on the United States Food and Drug Administration (US-FDA) fetal harm classification system. Data analysis was done using SPSS version 20 statistical software. Multivariate logistic regression was employed to analyze the association of the explanatory variables with the medication use, and p < 0.05 was declared statistically significant.ResultsThe overall prescribed drug use in this study was found to be 87.7%. A considerable percentage of the study participants (41.4%) were prescribed with supplemental drugs (iron folate being the most prescribed drug) followed by antibiotics (23.4%) and analgesics (9.2%). According to the US-FDA drug’s risk classification, 42.5, 37, 13, and 7% of the drugs prescribed were from categories A, B, C, and D or X respectively. Prescribed drug use was more likely among pregnant women who completed primary [AOR = 5.34, 95% CI (1.53–18.6)] and secondary education [AOR = 4.1, 95% CI (1.16–14)], who had a history of chronic illness [AOR = 7.9, 95% CI (3.14–19.94)] and among multigravida women [AOR = 2.9, 95% CI (1.57 5.45)].ConclusionsThe finding of this study revealed that a substantial proportion of pregnant women received drugs with potential harm to the mother and fetus. Reasonably, notifying health practitioners to rely on up-to-date treatment guidelines strictly is highly demanded. Moreover, counseling and educating pregnant women on the safe and appropriate use of medications during pregnancy are crucial to mitigate the burden that the mother and the growing fetus could face.

Evaluating Practice Readiness of Advanced Pharmacy Practice Experience Students Using the Core Entrustable Professional Activities

Objective. To evaluate levels of entrustability and practice readiness in advanced pharmacy practice experience (APPE) students using a pilot instrument designed to assess their competency in performing the entrustable professional activities (EPAs) expected of new pharmacy graduates. Methods. A pilot instrument was developed directly from EPAs to measure entrustability levels on a scale of one to five. Five APPE preceptors from several different practice areas participated. Fourth-year students used the instrument to self-evaluate their knowledge and skills at the beginning, midpoint, and end of the APPE. The preceptors evaluated students using the same instrument at APPE midpoint and end. The instrument had assigned weights for each EPA and entrustability level for a score of 100 if all items were marked five. If a rating of non-applicable was chosen, score adjustments were made. All students in the graduating class of 2018 were invited to perform a self-evaluation at the end of the fourth (APPE) year using the same instrument that study participants used. Results. Twenty-eight students and five preceptors completed evaluations during the APPE year. Overall scores from both preceptor evaluations of students and student self-evaluations increased significantly from pre-APPE to midpoint to final. Student self-evaluations were only slightly higher than preceptor evaluations. The mean (SD) preceptor scores for students and student self-assessment scores at the end of each APPE were 85.4% (7.1) and 87.2% (10.3), respectfully. One practice manager EPA and three population health EPAs were considered to not be applicable by preceptors on ≥50% of evaluations. Approximately 94% of all graduating students completed the year-end self-evaluations, with a mean (SD) score of 89% (8.6) and no EPAs marked as not applicable. Conclusion. Pharmacy students' proficiency in EPA improved during individual APPEs. According to preceptors, students' greatest improvement in entrustability was in educating patients and colleagues regarding appropriate use of medications and collecting information to identify medication-related problems.

Assessment of Antibiotic Utilization Pattern In Hospital Settings

Drug utilization evaluation is an effective tool for detecting the possible drug related problems and in enhance the clinical use of drugs in public and its impact on the health care system. This tool is adapted by pharmacists to assess appropriate use of medication. DUE usually focus on drugs with more side-effects, high cost or complex dosing regimens. It is important for almost all drugs especially for antibiotics because of its increased utilizationin hospitals and community settings. In prior to starting antimicrobial therapy, the prescriber should consider the type of infection, characteristics of the antibiotic, its category of use, spectrum of activity, cost- effectiveness and duration of therapy. The evolution of multidrug resistance and the emergence of multidrug- resistant microbes are on the rise which can be reduced by increasing the habits of appropriate antibiotic prescribing for the successful outcome of the therapy. Prescribing an antibiotic by understanding the significance of antimicrobial stewardship and following an appropriate guideline may lead to appropriate selection of an antibiotic. Hence, antibiotic utilization studies can help in improving the practice of rational use of antibiotics thereby improving patient safety, which in turn helps in reducing antimicrobial resistance, drug related problems and risk of mortality and morbidity.

Barriers and Facilitators to Implementation of Medication Decision Support Systems in Electronic Medical Records: Mixed Methods Approach Based on Structural Equation Modeling and Qualitative Analysis

BackgroundAdverse drug events (ADEs) resulting from medication error are some of the most common causes of iatrogenic injuries in hospitals. With the appropriate use of medication, ADEs can be prevented and ameliorated. Efforts to reduce medication errors and prevent ADEs have been made by implementing a medication decision support system (MDSS) in electronic health records (EHRs). However, physicians tend to override most MDSS alerts.ObjectiveIn order to improve MDSS functionality, we must understand what factors users consider essential for the successful implementation of an MDSS into their clinical setting. This study followed the implementation process for an MDSS within a comprehensive EHR system and analyzed the relevant barriers and facilitators.MethodsA mixed research methodology was adopted. Data from a structured survey and 15 in-depth interviews were integrated. Structural equation modeling was conducted for quantitative analysis of factors related to user adoption of MDSS. Qualitative analysis based on semistructured interviews with physicians was conducted to collect various opinions on MDSS implementation.ResultsQuantitative analysis revealed that physicians’ expectations regarding ease of use and performance improvement are crucial. Qualitative analysis identified four significant barriers to MDSS implementation: alert fatigue, lack of accuracy, poor user interface design, and lack of customizability.ConclusionsThis study revealed barriers and facilitators to the implementation of MDSS. The findings can be applied to upgrade MDSS in the future.

Patient Care Management (Handbook for Hospital and Community Pharmacists)

Most people on the outside of the health care profession are not familiar with this new role of the pharmacist. The general public has created a stereotypical pharmacist's picture as being a person who stands behind a counter, dispenses medicine with some instructions to the respective consumer. Pharmacy practice has changed substantially in recent years. Today’s pharmacists have unique training and expertise in the appropriate use of medications and provide a wide array of patient care services in many different practice settings. As doctors are busy with the diagnosis and treatment of patients, the pharmacist can assist them by selecting the most appropriate drug for a patient. Interventions by the pharmacists have always been considered as a valuable input by the health care community in the patient care process by reducing the medication errors, rationalizing the therapy and reducing the cost of therapy. The development and approval of the Pharmacists’ Patient Care Process by the Joint Commission of Pharmacy Practitioners and incorporation of the Process into the 2016 Accreditation Council for Pharmacy Education Standards has the potential to lead to important changes in the practice of pharmacy, and to the enhanced acknowledgment, acceptance, and reimbursement for pharmacy and pharmacist services. As an author, it is my heartiest believe that the book will adjoin significant apprehension to future pharmacists in patient care as most of the portion created from recently published articles focusing pharmacists in patient care settings.

Chronic pain, cardiovascular health and related medication use in ageing African Americans with osteoarthritis.

To describe the (a) prevalence and perceptions of cardiovascular disease and related health conditions in African Americans with osteoarthritis pain, (b) their knowledge of cardiovascular safety of commonly prescribed analgesics for osteoarthritis and (c) frequency of high-risk analgesic use. African Americans have more disabling osteoarthritis pain and an excessive burden of cardiovascular disease than any other US racial group. However, minimal research has investigated the relationship between chronic pain and cardiovascular disease and subsequent medication knowledge and use in African Americans. Consolidated Criteria for Reporting Qualitative and Srengthening the Reporting of Observational studies in Epidemiology checklists were followed. A descriptive, secondary mixed-methods analysis. A convenience sample of 110 African American adults (50-94years and older) completed surveys and individual qualitative interviews. Data were analysed using descriptive statistics, chi-square or Fisher's exact test, t test, Mann-Whitney U and a qualitative content analysis. Hypertension was the most common cardiovascular condition reported, and African Americans with hypertension reported greater pain than those without. The survey questions revealed that most participants did not possess accurate knowledge about the appropriateness of analgesics in heart failure and other cardiovascular-related diseases; however, during the interviews, some did acknowledge a general understanding of the negative effects of some medications. Still, many older adults were taking nonsteroidal anti-inflammatory drugs despite having hypertension. There was evidence of multimorbidity in our sample; based on our data, chronic osteoarthritis pain and hypertension are two highly comorbid conditions, suggesting a possible syndemic. More disparate is the lack of knowledge that African Americans possess as it relates to safe use of analgesic medications when cardiovascular disease is present. Chronic pain and cardiovascular-related diseases are common and often co-occur and should be evaluated in all older adults, particularly African Americans. Both issues are important to manage, including the safe and appropriate use of medications, to prevent adverse effects.

Assessment of antibiotics use for children upper respiratory tract infections: a retrospective, cross-sectional study from Pakistan

Background: Since drug utilization evaluation is essential to assess the appropriate use of medications, the present study was carried out to evaluate antibiotics use for children upper respiratory tract infections (URTIs).Methods: A retrospective, cross-sectional study was conducted in the six health care settings of central Punjab, Pakistan. Medical records of children ≤ 12 years who were admitted in the study settings from 1st Jan-28th Feb 2019 were reviewed. Patterns of antibiotic use were assessed in the light of the WHO prescribing indicators and appropriateness of antibiotics treatment was assessed from British National Formulary for children.Results: A total of 1843 cases of URTI were analyzed, containing 6635 total medications. All of the patients were given antibiotics (mean 1.94 ± 0.63 antibiotics). Cephalosporin was the most commonly used antibiotics class (37.8%) followed by penicillins. Injections were given to all the patients. Only 11% of the cases received appropriate therapy according to the indication. Of these (n = 204), around 93% received right dose whereas right frequency and duration were found in 96.5% and 95.5% of the cases, respectively.Conclusion: Our study revealed alarmingly high utilization of antibiotics among Pakistani children with URTIs. A great emphasis should be placed on implementing antimicrobial stewardship strategies for the rational use of antimicrobials in Pakistan and pharmacists should be in the front and centre to lead antimicrobial stewardship.

The pharmacist’s role in advocating for the health care of immigrants in detention centers

ObjectivesThe primary objectives of this commentary are to (1) summarize the role of pharmacists as an advocate for the health care and appropriate use of medications of migrants in immigration detention centers and (2) describe methods to advocate for this vulnerable population. SummaryThere is a current humanitarian crisis occurring within the United States that violates the responsibilities and values held by members of the profession of pharmacy. Reports by reputable news organizations and members of U.S. Congress have shared that there have been inappropriate distribution and use of medications in migrant detention centers along the southern border. Specific instances have been described, including lack of access to vaccinations and vital medications to control chronic conditions and treat acute conditions. The role of the pharmacist is to ensure safe and effective use of medications. This role is not being fulfilled at migrant detention centers in the United States. By advocating to elected leaders, the Department of Homeland Security, and Customs Border and Protection for legislation that ensures the appropriate use and access of medications for migrants in immigration detention centers, pharmacists can push for the appropriate care for this vulnerable patient population. ConclusionThe professional values of a pharmacist should not be hindered by a border or the citizenship of a patient. As is stated in the Oath of a Pharmacist, pharmacists must “consider the welfare of humanity and relief of suffering [their] primary concern.” Through advocacy, pharmacists and student pharmacists can uphold their professional ethics and roles on the health care team by advocating for the care of a patient population that needs the profession’s help.

Comparing a multivariate response Bayesian random effects logistic regression model with a latent variable item response theory model for provider profiling on multiple binary indicators simultaneously

Provider profiling entails comparing the performance of hospitals on indicators of quality of care. Many common indicators of healthcare quality are binary (eg, short‐term mortality, use of appropriate medications). Typically, provider profiling examines the variation in each indicator in isolation across hospitals. We developed Bayesian multivariate response random effects logistic regression models that allow one to simultaneously examine variation and covariation in multiple binary indicators across hospitals. Use of this model allows for (i) determining the probability that a hospital has poor performance on a single indicator; (ii) determining the probability that a hospital has poor performance on multiple indicators simultaneously; (iii) determining, by using the Mahalanobis distance, how far the performance of a given hospital is from that of an average hospital. We illustrate the utility of the method by applying it to 10 881 patients hospitalized with acute myocardial infarction at 102 hospitals. We considered six binary patient‐level indicators of quality of care: use of reperfusion, assessment of left ventricular ejection fraction, measurement of cardiac troponins, use of acetylsalicylic acid within 6 hours of hospital arrival, use of beta‐blockers within 12 hours of hospital arrival, and survival to 30 days after hospital admission. When considering the five measures evaluating processes of care, we found that there was a strong correlation between a hospital's performance on one indicator and its performance on a second indicator for five of the 10 possible comparisons. We compared inferences made using this approach with those obtained using a latent variable item response theory model.

Evaluation of the entrustable professional activities (EPAs) of the population health promoter domain by North Dakota pharmacists.

Background:Entrustable Professional Activities (EPAs) are a list of professional tasks that pharmacy educational organizations support, and accreditation organizations encourage, for assessment by colleges and schools of pharmacy.Objective:This manuscript evaluates the perceived frequency of performing EPAs in the population health promoter (PHP) domain among pharmacists practicing in North Dakota.Methods:This survey evaluated the self-reported EPA activities of registered pharmacists living and practicing in North Dakota. For EPAs and supporting tasks in the 6 domains (including the PHP domain), respondents were asked to self-report the number of times during the last 30 days that they perform the task, using a 6 point response scale (0, 1, 2, 3, 4, 5 or more times). There were 990 pharmacists surveyed, and 457 (46.1%) of pharmacists responded.Results:Within the PHP domain, pharmacists reported performing “Minimize adverse drug events and medication errors” most frequently (mean=3.4, SD=2.0), followed by “Ensure that patients have been immunized against vaccine-preventable diseases” (mean=2.3, SD 2.3), “Maximize the appropriate use of medications in a population” (mean=2.2, SD 2.3), and “Identify patients at risk for prevalent diseases in a population” (mean=1.3, SD=1.9). In these Core EPAs PHP domains, the clinical pharmacists reported the highest level, followed by pharmacy managers and staff pharmacists.Conclusions:Pharmacists in North Dakota currently perform some population health promoter activities, but not at a consistent and high level. Most of the health prevention activities were medication-related and oriented towards individual patients (micro-level), rather than at a community (population-based) macro-level.

Standard Pharmacist Intervention Checklist to Improve the Appropriate Use of Medications for Inpatients with Polypharmacy

Standard Pharmacist Intervention Checklist to Improve the Appropriate Use of Medications for Inpatients with Polypharmacy

Comprehensive Drug-Class Review Framework for improved evidence-based drug policy and formulary modernization.

Formularies are used by payers to optimize access and ensure the appropriate use of medications. Lack of follow-up and re-evaluation can lead to outdated formularies that are not reflective of current evidence. Formulary modernization, an approach to re-align formularies with current evidence has proven successful. The Ontario Drug Policy Research Network (ODPRN) launched a framework for conducting comprehensive drug-class reviews. This commentary describes the individual components of this framework and lessons learned through completion of 12 reviews between 2013 and 2016. We present the ODPRN drug-class review of treatments for chronic hepatitis B as a case example to illustrate the components and impact. The incorporation of foundational health technology assessment components such as economic evaluations and knowledge synthesis with contextualizing evidence such as patient and clinician perspectives (through qualitative studies), real-world evidence (through data analytics), and cross-jurisdictional comparisons (through environmental scans and data analytics), successfully developed jurisdictionally specific policy recommendations grounded in up-to-date evidence. The ODPRN framework for conducting comprehensive drug-class reviews is a robust and feasible approach to conduct formulary modernization. This framework allows for actionable and specific policies which are likely to be considered by decision makers. Adoption of similar frameworks in other jurisdictions may improve uptake of evidence-informed policy recommendations.

Preventing and treating migraines in children and adolescents

The American Academy of Neurology (AAN) and American Headache Society (AHS) released updated guidelines in the September 10, 2019, issue of Neurology on acute management and prevention of headache in children and adolescents. The guidelines cover appropriate OTC and prescription medications, migraine-healthy habits, and patient counseling points. The acute treatment guideline focuses on diagnosis, treatments, management of associated symptoms, and counseling pearls. The prevention guideline focuses on lifestyle and behavioral factors to minimize headaches, medications used to prevent headaches, and counseling recommendations for patients of childbearing age who may be using these medications. Pediatric migraine is diagnosed in those having at least five headaches over the last year that last 2 to 72 hours with accompanying symptoms if left untreated. At least two of four additional features should be present (pulsatile quality, unilateral, worsening with activity or limiting activity, moderate to severe in intensity), along with nausea, vomiting, photophobia, or phonophobia. The treatment goal is to alleviate the pain and address the accompanying symptoms. Treatment should be given early in the migraine attack when the pain is still mild. Acetaminophen oral solution (15 mg/kg) and ibuprofen oral solution (10 mg/kg) are recommended as initial treatment for pain in children and adolescents, and triptans are listed as an option primarily for adolescents. An alternative triptan can be tried if the first one fails, and combination treatment with a triptan and ibuprofen or naproxen can be offered to those who have an incomplete response to triptan therapy. Recommendations for maximum monthly use are also included to ensure patients and caregivers understand that no more than 14 days of ibuprofen or acetaminophen should be used and no more than 9 days of triptans. No more than 3 straight months of combination therapy should be used to avoid overuse headache. Antiemetics should also be offered to help with migraine-associated nausea, and nonoral formulations of triptans may be preferable in these patients. For prevention, the guideline notes that many monotherapy treatments (e.g., amitriptyline, valproate) tested for pediatric migraine have failed to demonstrate superiority over placebo, except amitriptyline with cognitive behavioral therapy, propranolol, and topiramate. The teratogenic effects of topiramate or valproate must be considered, and patients of childbearing age must be educated on these risks. Education on lifestyle and behavioral factors also is important. Factors that may contribute to headaches include being overweight, caffeine and alcohol use, lack of physical activity, poor sleep habits, and tobacco use. Pharmacists are well positioned to address appropriate use of OTC and prescription medications to manage headaches in children, including proper dosing, maximum use criteria, and limitations of preventive therapies. Inform patients and caregivers that updated guidelines have been released on managing headaches in children and adolescents. Educate them about appropriate use of medications and healthy lifestyle practices that can help to prevent headache, such as eating well-balanced meals, establishing a sleep schedule, not smoking, minimizing stress, and exercising.

Pharmacist-Patient Relationship: Commitment to Care

Pharmacist-Patient Relationship: Commitment to Care

2015 Beers Criteria and STOPP v2 for detecting potentially inappropriate medication in community-dwelling older people: prevalence, profile, and risk factors

To comparatively assess the prevalence rates of potentially inappropriate medications (PIMs) obtained by the former and latest versions of American Geriatrics Society Beers Criteria (AGS BC) and screening tool of older person's potentially inappropriate prescriptions (STOPP), and analyze the factors of influence on PIM. Cross-sectional study including 582 community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. A total of 3626 prescriptions were analyzed. PIMs were detected in 35.4% and 47.9% of patients according to the STOPP v1 and the 2012 AGS BC, respectively. This percentage rose to 54% when 2015 AGS BC were used and reached 66.8% with STOPP v2. The kappa coefficient between STOPP v2 and its former version was lower than the one between the updated Beers Criteria and their former version (0.41 vs 0.85). The agreement was good (0.65) between both latest criteria. The number of medications, psychological disorders, and insomnia were predictors of PIM. A novel finding was that bone and joint disorders increased the odds for PIM by 78%. The 2015 AGS BC showed high sensitivity and good applicability to the European older patients. Both updated tools identified some pharmacological groups (benzodiazepines, PPIs, and opioids, among others) and certain health problems (insomnia, psychological disorders, and osteoarticular diseases) as factors of influence on PIM. Based on these findings, interventions aimed at promoting appropriate use of medications should be developed.

Medication-related quality of care in residential aged care: an Australian experience.

To describe medication-related quality of care (MRQOC) for Australian aged care residents. Retrospective cohort using an administrative healthcare claims database. Australian residential aged care. A total of 17 672 aged care residents who were alive at 1 January 2013 and had been a permanent resident for at least 3 months. Overall, 23 evidence-based MRQOC indicators which assessed the use of appropriate medications in chronic disease, exposure to high-risk medications and access to collaborative health services. Key findings included underuse of recommended cardiovascular medications, such as the use of statins in cardiovascular disease (56.1%). Overuse of high-risk medications was detected for medications associated with falls (73.5%), medications with moderate to strong anticholinergic properties (46.1%), benzodiazepines (41.4%) and antipsychotics (33.2%). Collaborative health services such as medication reviews were underutilised (42.6%). MRQOC activities in this population should be targeted at monitoring and reducing exposure to antipsychotics and benzodiazepines, improving the use of preventative medications for cardiovascular disease and improving access to collaborative health services. Similarity of suboptimal MRQOC between Australia and other countries (UK, USA, Canada and Belgium) presents an opportunity for an internationally collaborative approach to improving care for aged care residents.

Youth Experience With Community Pharmacy Services and Their Perceptions Toward Implementation of Medication Therapy Management Services by Community Pharmacists in the Western Region of Saudi Arabia.

Pharmacists are the part of the health care team who can counsel patients on the most appropriate use of medications. This study aims to measure patients' experience with services provided by community pharmacists and their perceptions toward providing medication therapy management (MTM) services by community pharmacists in the Western Region of Saudi Arabia. In addition, this study aims to measure patients' willingness to pay (WTP) for participating in the MTM program led by community pharmacists. Using a cross-sectional research design, a prevalidated questionnaire was developed and posted to respondents through either face-to-face interviews or online social media. All data were analyzed using SPSS, version 22.0, and all alpha values less than 0.05 were considered significant. A total of 953 responses were obtained in this study. Overall, 47.6% of the respondents always buy their medications from different community pharmacies, and 46.1% of respondents said that community pharmacists always respond to all of their questions. In addition, 96% of respondents perceived the MTM program to be beneficial for patient care. Moreover, 70.3% of respondents were willing to register in the MTM program if implemented at community pharmacies. Residents in the Western Region of Saudi Arabia highly appreciate the additional values of the MTM program if implemented by community pharmacists. Decisions makers should encourage community pharmacists to plan for MTM services.