Change In Number Of Medications Research Articles

Medication-Related Hospital Readmissions Within 30 Days of Discharge: Prevalence, Preventability, Type of Medication Errors and Risk Factors.

Background: Hospital readmission rates are increasingly used as a measure of healthcare quality. Medicines are the most common therapeutic intervention but estimating the contribution of adverse drug events as a cause of readmissions is difficult. Objectives: To assess the prevalence and preventability of medication-related readmissions within 30 days after hospital discharge and to describe the risk factors, type of medication errors and types of medication involved in these preventable readmissions. Design: A cross-sectional observational study. Setting: The study took place across the cardiology, gastroenterology, internal medicine, neurology, psychiatry, pulmonology and general surgery departments in the OLVG teaching hospital, Netherlands. Participants: Patients with an unplanned readmission within 30 days after discharge from an earlier hospitalization (index hospitalization: IH) were reviewed. Measurements: The prevalence and preventability of medication-related readmissions were assessed by residents in multidisciplinary meetings. A senior internist and hospital pharmacist reassessed the prevalence and preventability of identified cases. Generalized estimating equation with logistic regression was performed to identify risk factors of potentially preventable medication-related readmissions. Results: Of 1,111 included readmissions, 181 (16%) were medication-related, of which 72 (40%) were potentially preventable. The number of medication changes at IH (Adjusted odds ratio [ORadj]: 1.14; 95% CI: 1.05–1.24) and having ≥3 hospitalizations 6 months before IH (ORadj: 2.11; 95% CI: 1.12–3.98) were risk factors of a preventable medication-related readmission. Of these preventable readmissions, 35% were due to prescribing errors, 35% by non-adherence and 30% by transition errors. Medications most frequently involved were diuretics and antidiabetics. Conclusion: This study shows that 16% of readmissions are medication-related, of which 40% are potentially preventable. If the results are confirmed in larger multicentre studies, this may indicate that more attention should be paid to medication-related harm in order to lower the overall readmission rates.

Phacoemulsification with Goniosynechialysis versus Phacoemulsification Alone in Angle-Closure Glaucoma: A Meta-Analysis of Randomized Controlled Trials.

Purpose This meta-analysis aimed to compare the efficacy and safety of phacoemulsification with goniosynechialysis (Phaco-GSL) with those of phacoemulsification alone (Phaco-alone) in patients with angle-closure glaucoma and cataract. Methods Randomized controlled trials (RCTs) were selected through a search of electronic databases. Trial eligibility and risk of bias were assessed using Cochrane review methods. Primary measures included the intraocular pressure (IOP), number of antiglaucoma medications, peripheral anterior adhesion (PAS) extent, and their pre- and postoperative changes. For continuous parameters, we calculated weighted mean differences and 95% confidence intervals. Statistical analysis was performed using RevMan 5.3 software. Results Eight RCTs were included, where 224 and 236 eyes were in the Phaco-GSL and Phaco-alone groups, respectively. Both postoperative IOP and number of medications were not significantly different between the study groups at the six- and twelve-month follow-up. However, the 12-month postoperative PAS extent was significantly smaller in the Phaco-GSL group than in the Phaco-alone group. Similarly, changes from the preoperative to 12-month postoperative PAS extent were significantly greater in the Phaco-GSL group than in the Phaco-alone group, but IOP and the number of medication changes were not different. Conclusions Our results provide evidence that Phaco-GSL provides advantages over Phaco-alone treatment regarding PAS reduction. In terms of IOP and medication reduction, both groups were comparable. Thus, Phaco-GSL can be considered for the treatment of patients with angle-closure glaucoma and cataract due to its ease, safety, and potential benefit for the anterior chamber angle.

Colágeno polivinilpirrolidona versus mitomicina C en trabeculectomía en pacientes con glaucoma primario de ángulo abierto. Seguimiento a 36 meses

PurposeDescribe and compare the effects of intraoperative application of Polyvinylpyrrolidone Collagen (PVP) versus Mitomycin C (MMC) on the pattern of change in mean IOP reduction and mean number of medications over 36-months follow-up in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy. MethodsProspective, randomized, comparative study. Twenty-six eyes of 26 patients with POAG and no previous incisional glaucoma surgery underwent trabeculectomy and were randomized to PVP or MMC and completed a 36-month follow-up. Main outcome measures were IOP and number of glaucoma medications. Multivariate longitudinal analysis was performed by fitting a linear trend model adjusting for baseline response for the IOP outcome and a log-linear regression model with within-subject associations for the number of hypotensive medications outcome. Sensitivity analysis was performed to assess lower and higher order polynomial trends over time in IOP. ResultsThe univariate analysis revealed that the mean IOP reduction from baseline to 36 months was 7.62mmHg (3.05; 12.18) in the MMC group and 8.15mmHg (−0.64; 16.95) in the PVP group. Mean percentage IOP reduction from baseline was 37.09% (15.93; 58.17) and 36.08% (5.16; 67.20) in the PVP group. Mean change in number of medications from baseline to 36 months was −0.92 medications (−3.38; +1.54) for the MMC group and −1 medication (−3.12; +1.12) for the PVP group. Both groups had a statistically significant decline in mean IOP over the follow-up period (p<0.001) but there was no discernible difference between the two exposure groups in the rate of change in IOP (p=0.5975). Sensitivity analysis showed that a linear trend model is adequate to describe the IOP reduction over the follow-up period. Both groups had a statistically significant change in the number of hypotensive medications used between baseline and month 36 (p<0.05) but there was no discernible difference between exposure groups (p=0.2917). Both the PVP and MMC groups showed an initial reduction in number of medications until month 12 and a relatively linear increase towards month 36. A longer follow-up may be warranted to reveal differences in the number of medications between the two exposure groups. Postoperative complications were less frequent in the PVP group. ConclusionsThe use of PVP during trabeculectomy achieves and maintains a statistically significant IOP reduction from baseline to 36 months and decreases the number of glaucoma medications. Secondary outcome measures showed a lower incidence of adverse events in the PVP group.

A pharmacist intervention for monitoring and treating hypertension using bidirectional texting: PharmText BP

BackgroundNew approaches are needed to better monitor blood pressure (BP) between physician visits, especially for patients in rural areas or for those who lack transportation. We have developed a custom-built bi-directional texting platform for home BP measurements that can then be managed by clinical pharmacists located remotely. The purpose of this study is to evaluate whether the BP texting approach combined with a pharmacist-based intervention improves BP management and to determine if the approach is cost effective. MethodsThis study is a randomized, prospective trial in four primary care offices that serve patients in rural areas. Subjects will receive standardized research BP measurements at baseline, 6 and 12 months. The primary outcome will be differences between the intervention and control group in mean systolic BP at 12 months. Secondary outcomes will include systolic BP at 6 months; diastolic BP at 6 and 12 months, number of medication changes and costs. ConclusionsThis study plans to enroll subjects through 2022, follow-up will be completed in 2023 and results will be available in 2024. This study will provide information on whether a combined approach using texting of home BP values and a pharmacist-based telehealth services can improve BP control.

Laser Trabeculoplasty for Open-Angle Glaucoma: A Systematic Review and Network Meta-Analysis

We sought to comprehensively evaluate the effectiveness of different types of laser trabeculoplasty (LT) in the treatment of open-angle glaucoma. Systematic review and network meta-analysis. Eligible randomized controlled trials were identified by searching PubMed, EMBASE, Cochrane Library, SCOPUS, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Service System for studies published between January 1, 2000 and April 20, 2020. Eight interventions were evaluated, including argon LT (ALT), medications, 180-degree selective LT (SLT), 270-degree SLT, 360-degree SLT, new LT, transscleral 360-degree SLT with SLT performed without gonioscopy, and low-energy 360-degree SLT. The primary outcome was reduction of medicated and unmedicated intraocular pressure (IOP) at 6months. Secondary outcomes included reduction of IOP at 12months, incidences of complications, and change in number of medications. Head-to-head meta-analysis and network meta-analysis were performed using Stata and R software. In total, 22 studies were included, involving 2859 eyes of 2704 patients. In terms of IOP reduction at 6 and 12months, there were no statistically significant differences in both medicated and unmedicated IOP between any pairs of interventions considered herein, as determined based on both head-to-head and network meta-analyses (all P > .05). In terms of reduction of medications, the individuals treated with 180-degree SLT required fewer medications than those treated with ALT at 12months (0.28 [95% confidence interval, 0.06-0.50]; P= .014). No severe adverse outcomes were reported for any of the interventions. All the available types of LT are equally effective for decreasing IOP compared with medication-based therapy. The 180-degree SLT was slightly more effective than ALT in terms of reducing the number of medications needed. Additional well-performed randomized controlled trials with larger sample sizes are needed.

Medication‐related 30‐day rehospitalizations in palliative care patients

AbstractPurposePrior studies suggest that inpatient palliative care services can reduce rehospitalizations. However, medications commonly prescribed by palliative care providers (eg, opioids, benzodiazepines, and antipsychotics) have been independently associated with rehospitalizations. Little is known regarding the role of adverse drug reaction (ADR)‐related rehospitalizations within the palliative care population.ObjectiveTo determine the prevalence and explore predictors of ADR‐related 30‐day rehospitalizations in an inpatient palliative care population.MethodsA retrospective cohort study that included 284 palliative care patients who were readmitted within 30‐days of discharge from two academic hospitals in Western Pennsylvania. All unplanned rehospitalizations were assessed for medication causality via the Naranjo algorithm by at least two independent reviewers.ResultsThe mean (SD) age of the cohort was 61 (16) years and included 45% (n = 127) female and 81% Caucasians (n = 229). Of the 254 unplanned rehospitalizations, 11 (4%) were classified as doubtful ADRs, 224 (88%) were classified as possible ADRs, and 19 (7%) were defined as probable or definite ADR‐related. Tacrolimus was associated with three probable and one definite ADR‐related rehospitalization. Oncologic agents (eg, venetoclax, nivolumab, vincristine, and decitabine, carfilzomib; n = 5), anticoagulants (eg, rivaroxaban, apixaban, and warfarin; n = 4), antimicrobials (eg, cephalexin and vancomycin; n = 2), potassium chloride (n = 2), lorazepam (n = 1), and nicotine replacement (n = 1) were all associated with probable ADRs. Only the number of medication changes during the index admissions was observed as a statistically significant predictor of rehospitalizations in this population (P = .043).ConclusionsPalliative care patients often suffer from potential ADR‐related rehospitalizations and the number of medication changes during the index hospital admissions is associated with future potential ADRs. Clinical pharmacists should consider these findings when developing initiatives to reduce rehospitalizations in the inpatient palliative care patient population.

P582Real-world experience with ehealth telemonitoring in patients with hypertension

Abstract Background Hypertension is the strongest modifiable risk factor for cardiovascular disease worldwide, while incidence and prevalence remain high. Home-monitoring is known to improve blood pressure in patients with hypertension. Despite promising results, few home monitoring programs have successfully been integrated into daily care and little evidence exists on their cost-effectiveness. The Dutch HartWacht eHealth program, initiated in June 2016, is one of the first eHealth programs that is fully reimbursed and integrated into clinical practice. Purpose The purpose of the study is to demonstrate the effect of an integrated and cost-effective telemonitoring program in a real-life setting. Methods In the HartWacht program patients with uncontrolled hypertension (office BP &gt;140/90) receive a blood pressure monitor that is connected to their smartphone and integrated with their personal electronic patient file. Measurements are checked by a dedicated health care team. If values exceed pre-defined thresholds, patients are contacted by the team for swift therapeutic action. In this study, the first results of the program are evaluated. Comparisons were made between last office blood pressure before the program; average blood pressure of first week of home measurement (twice daily, morning and evening); and blood pressure of home measurement at three, six and twelve months after start. Results 122 patients started the HartWacht program for hypertension (female: 57 (46.7%); mean age: 61.2 (±9.5) years; mean follow-up: 13.4 (±7.6) months; mean number of anti-hypertensive drugs at start of HartWacht: 1.8 (±0.9); mean number of medication changes per year during follow-up (including changes in dose): 1.0 (±1.6); mean number of contact moments per year during follow-up (including calls with nurse or cardiologist): 4.9 (±5.0)). At final follow-up, 67 patients participated at least one year. Others started later or stopped the program, mainly because of reaching normotensive values (n=22; home BP &lt;135/85). The mean last office systolic blood pressure (SBP) measurement (n=122) was 157.9 mmHg (±19.2). The mean home SBP in the first week (n=120) was 139.9 mmHg (±13.9). After 3 months the mean home SBP lowered to 133.8 mmHg (±14.9), a significant decrease compared to week 1 (mean: 6.1 (±13.8), p&lt;0.001). After this moment the mean home SBP was stable: 132.5 mmHg (±12.6) at six months (n=99) and 132.2 mmHg (±12.4) at 12 months (n=67). No correlation was found between the number of medication adaptations and/or contact moments with the healthcare team and reaching target values. Conclusion This integrated eHeatlh telemonitoring program demonstrates significant and persistent blood pressure reduction in a real-life setting. As measurements are continuously monitored, swift therapeutic action is guaranteed. The Dutch HartWacht program has proven to be cost-effective, is reimbursed, and has the potential to be scaled up (inter-)nationally.

A texting-based blood pressure surveillance intervention.

The authors examined whether using home BP measurements collected via a custom-built bi-directional-texting platform incorporated into patients' electronic medical records would lead to treatment calibration and improved BP management. Patients were randomized to either the intervention group and collected home measurements based on reminders and reported via bi-directional texting, or to the control group, with home BP measurement reporting via standard practice (eg, phone, electronic medical record portal) and instructed to return 7 morning and 7 evening BP measurements. Outcomes included number of BP measurements submitted, the number of medication changes, reduction in BP, and BP control. 72% of the intervention group submitted at least 14 readings, compared with 45% of the control group. BP control improved in both groups. However, the authors found no statistically significant difference in BP or the number of BP-medication changes at 1, 3, or 6months compared with the control group.

Investigation of medication adherence and reasons for poor adherence in patients on long-term glaucoma treatment regimes.

ABSTRACTPurposeLong-term treatment adherence for a chronic asymptomatic condition is a demanding task for many patients. Treating progressive glaucoma can also be confounding for physicians, particularly when management relies on assumption of adherence. This study investigated associations between self-reported adherence and frequency of medication changes due to glaucoma progression.MethodsA total of 128 participants with primary open angle glaucoma were recruited from glaucoma clinics in Flinders Eye Center, South Australia, and completed confidential questionnaires. Information was obtained regarding beliefs about glaucoma and their treatment. Adherence was assessed using the four-item Morisky, Green and Levine Medication Adherence Questionnaire (MGL). Medical records were analyzed for the number of medication changes, due to glaucoma progression.Results Adherence to topical glaucoma medication was categorized as ‘high’ in 41.4% (Morisky, Green and Levine (MGL). Data were analyzed for behaviors affecting adherence, history of adherence, and reasons for changed adherence. Chi-squared test demonstrated that there was no significant association noted between adherence and changes in medication regime (χ2 (2,128)=0.968, P=0.915); however, a significantly lower adherence was detected if participants had difficulties with their drop regime (χ2 (2,128)=7.24, P=0.027) or had help with drop insertion (χ2 (1,128)=9.77, P=0.008).ConclusionThis study revealed a higher rate of non-adherence than has previously been demonstrated in other studies. This may be attributed to the unique design of the confidential questionnaire and the independent and sympathetic questioning techniques used. Further work to develop a specific glaucoma medication adherence questionnaire would be valuable to enhance glaucoma management.

Impact of a coordination of care program in an independent community pharmacy

ObjectiveThe first objective was to determine the impact on hospital readmissions at 30- and 90-days after discharge. The second objective was to examine the change in number of medications a patient was taking before enrollment versus after enrollment and potential health care savings. SettingIndependent community pharmacy in the southeastern United States. Practice descriptionBlue Ridge Pharmacy, Inc. is composed of 2 long-term care pharmacies, 2 community pharmacies, a compounding pharmacy, and a specialty pharmacy. Practice innovationThe Access Program is a transitions of care and coordination of care program. Sona Access helps patients who have undergone a transition of care from a skilled nursing facility, health system, physician office, or community partner. Access incorporates social care services and medication services such as free home delivery, home visit, monthly care calls, and adherence packaging. EvaluationThis retrospective study included participants age 18 years and older who enrolled in the program between March 2015 and March 2016 and had at least 3 months of data. Data collected included patient demographics, reason for referral, admissions to hospitals or skilled nursing facilities, number of medications before enrollment, and number of medications three months after enrollment. ResultsThe mean age (±SD) was 70 ± 13.8 years, and 65% of patients were female. The 123 patient enrollments yielded 113 total hospitalizations, resulting in a mean of 0.92 hospitalizations per patient. Pharmacist consultation and reconciliation decreased the average number of medications from 12 to 10 medications per patient. Within the 113 hospitalizations that occurred after enrollment, 5 occurred within 30 days, 13 occurred within 90 days, and 95 occurred at 91 days or greater. ConclusionThis study suggests that the delivery of coordination of care services through medication reconciliation, medication synchronization, and home visits has a positive effect on health outcomes for patients who have undergone a recent transition of care.

Phacotrabeculectomy using collagen matrix implant (Ologen® ) versus mitomycin C: a prospective randomized controlled trial.

To compare the efficacy and safety of collagen matrix implant (Ologen® ; OLO) with mitomycin C (MMC) in phacotrabeculectomy. Prospective, single-centre, nonblinded, randomized controlled trial. A total of 53 eyes of 45 patients were enrolled in the study protocol with 27 eyes randomly assigned to OLO and 26 to MMC. The follow-up was 12months. The primary outcome measure was mean change from baseline intraocular pressure (IOP) in both groups after 12months. The secondary outcome measures were cumulative success rates at 12months with Kaplan-Meier analysis, change in number of medications, change in best corrected visual acuity (BCVA), and bleb morphology assessed using Moorfields Bleb Grading System and anterior segment swept-source optical coherence tomography. The mean IOP decreased from 26.4±6.1mmHg to 13.7±3.8 in the OLO group and from 23.4±3.6mmHg to 13.3±2.8 in the MMC group at 1year without significant intergroup differences. At 1year, the overall success rates were 92.6% and 92.3% in the OLO and MMC groups, respectively. There were no significant differences in the overall success rates, BCVA, number of medications, morphology of the filtering blebs and rate of complications at the end of the follow-up. Ologen (OLO) provides similar surgical outcomes in phacotrabeculectomy compared with adjunctive MMC. It may be a new, safe and effective alternative to MMC for combined phacoemulsification and trabeculectomy surgery.

Appropriateness of Medications in Older Adults Living With Frailty: Impact of a Pharmacist-Led Structured Medication Review Process in Primary Care.

Background: Older persons with frailty take multiple medications and are vulnerable to inappropriate prescribing. Objective: This study assesses the impact of a team-based, pharmacist-led structured medication review process in primary care on the appropriateness of medications taken by older adults living with frailty. Methods: This was a quasi-experimental pretest-posttest design in 6 primary care practices within an academic clinic in Edmonton, Alberta, Canada. We enrolled community dwelling older adults 65 years and older with frailty who have polypharmacy and/or 2 or more chronic conditions (ie, high-risk group for drug-related issues). The intervention was a structured pharmacist-led medication review using evidence-based explicit criteria (ie, Beers and STOPP/START criteria) and implicit criteria (ie, pharmacist expertise) for potentially inappropriate prescribing, done in the context of a primary care team-based seniors’ program. We measured the changes in the number of medications pre- and postmedication review, number of medications satisfying explicit criteria of START and STOPP/Beers and determined the association with frailty level. Data were analyzed using descriptive and inferential statistics (a priori significance level of P < .05). Results: A total of 54 participants (61.1% females, mean age 81.7 years [SD = 6.74]) enrolled April 2017 to May 2018 and 52 participants completed the medication review process (2 lost to hospitalization). Drug-related problems noted on medication review were untreated conditions (61.1%), inappropriate medications (57.4%), and unnecessary therapy (40.7%). No significant changes in total number of medications taken by patients before and after, but the intervention significantly decreased number of inappropriate medications (1.15 meds pre to 0.9 meds post; P = .006). Conclusion: A pharmacist-led medication review is a strategy that can be implemented in primary care to address inappropriate medications.

Medication discrepancy rates among Medicaid recipients at hospital discharge

ObjectivesTo compare the rate of discrepancies per patient for medications changed during hospitalization in patients with and without prescription provider comments at hospital discharge. Secondary objectives included comparing 35-day readmission rates, describing the overall medication discrepancy rate stratified by age group and type of discrepancy, collecting average number of medication changes, and reporting percentage change in admission medications at discharge. MethodsThis single-center prospective cohort included NC Medicaid recipients discharged from East Carolina University Family Medicine service from November 1, 2015, to January 31, 2016. Patients were assigned to a group based on presence or absence of provider comments on discharge prescriptions. Outpatient pharmacy claims were compared with the discharge summary to identify medication discrepancies. Medication discrepancy rates between groups were to be compared by means of independent-samples t test. Medication discrepancy rates were compared according to 35-day readmission status, age group, and type of discrepancy by means of independent-samples t tests and analysis of variance. Descriptive statistics were used for other secondary outcomes. ResultsOf 118 patients included, only 1 had provider comments. Therefore, a medication discrepancy rate comparison was not performed. Patients had a mean of 4 medication changes made to their regimen and 21.3% change in admission medications. Sixty-one percent of patients had at least 1 medication discrepancy, with an overall rate of 1.19. Patients readmitted within 35 days had a significantly greater medication discrepancy rate than those not readmitted (1.63 vs. 1.05, respectively; P = 0.044). Patients 18-49 years of age had the highest discrepancy rate and those older than 80 years of age the lowest (1.58 and 0.50, respectively). New or changed discharge medication not filled accounted for 69% of discrepancies. ConclusionAlthough medication discrepancies were common, use of provider comments was rare. Future studies should address more effective ways to communicate pertinent information to community pharmacists and methods to improve adherence in obtaining new medications.

Pharmaceutical interventions on hospital discharge prescriptions: Challenges for community pharmacists

Background and objectives Transition between hospital and ambulatory care is a delicate step, which involves several healthcare professionals and presents a considerable risk of drug related problems. The community pharmacist plays an active role in preventing and solving medication errors and can increase patient safety. Methods A study was conducted in 14 community pharmacies surrounding a Swiss hospital. Patients discharged from the internal medicine ward of the hospital, taking more than four drugs chronically and capable of discernment were included in the study upon their approval. For each hospital discharge prescription, community pharmacists collected data about all the interventions performed and time needed for prescription validation. Analyses of the number and type of pharmaceutical interventions and propositions, time spent on discharge prescriptions and number of medication changes during transition of care were performed. Results Sixty-four patients were included in the study. The total number of interventions done by community pharmacists on the 64 discharge prescriptions was 439, representing a mean of 6.9 ± 3.5 (range: 1–16) interventions per patient. No hospital discharge prescription required zero interventions and 61 prescriptions (95%) needed a phone call to the patients’ hospital physician. Most frequent pharmaceutical interventions were: confirming voluntary omission of a drug taken before hospitalisation (31.7%), treatment substitution (20.5%), different dosage compared to history (16.9%), reimbursement issues (8.8%), optimization of galenic formulation (6.6%) and confirming drug omission (6.3%). Roughly half (52%) of hospital discharge prescriptions required between 10 and 20 minutes for pharmaceutical validation, whereas 14% required less than 10 minutes and 6% more than 40 minutes. The most frequent pharmaceutical proposition was the use of a pillbox. In average, there were 17 medication changes per patient at different steps of the transition of care: 10 changes between hospital admission and discharge, 3 changes between hospital discharge and community pharmacy, and 4 changes between community pharmacy and general practitioner appointment. Discussion and conclusions Hospital discharge prescriptions are often complex and present a risk of medication errors. The community pharmacist plays a key role in preventing and identifying drug related problems, but time required for pharmaceutical validation might be a constraint. Medication reconciliation at hospital admission and a better communication of medication changes at discharge may facilitate community pharmacists’ work, ensure continuity of care and thus increase patient safety.

Selective laser trabeculoplasty in patients with pseudoexfoliative glaucoma vs primary open angle glaucoma: a one-year comparative study.

To compare the efficacy of single-session 360-degree selective laser trabeculoplasty (SLT) for reduction of intraocular pressure (IOP) in patients with pseudoexfoliative glaucoma (PXFG) and primary open angle glaucoma (POAG). This is a single-center, prospective, nonrandomized comparative study. Patients older than 18 years of age with uncontrolled PXFG or POAG eyes requiring additional therapy while on maximally tolerated IOP-lowering medications were included. The primary outcome measure changed in IOP from baseline. Success was defined as IOP reduction ≥20% from baseline without any additional IOP-lowering medication. All patients were examined at 1d, 1wk, 1, 3, 6, 9, 12mo after SLT. Nineteen patients (20 eyes) with PXFG and 27 patients (28 eyes) with POAG were included in the study. In the visual fields mean deviation was -2.88 (±1.67) in the POAG and -3.1 (±1.69) in the PXFG groups (P=0.3). The mean (±SD) IOP was 22.9 (±3.7) mm Hg in the POAG group and 25.7 (±4.4) mm Hg in the PXFG group at baseline and decreased to 18.4 (±3.2) and 18.0 (±3.9) mm Hg in the POAG group (P<0.001 and P=0.02), and to 17.9 (±4.0) and 21.0 (±6.6) mm Hg in the PXFG group (P<0.001 and P=0.47) at 6 and 12mo, respectively. The number of medications was 2.6 (±0.8) in the POAG group and 2.5 (±0.8) in the PXFG group at baseline, and did not change at all follow-up visits in both groups (P=0.16 in POAG and 0.57 in PXFG). Based on Kaplan-Meier survival analysis, the success rate was 75% in the POAG group compared to 94.1% in the PXFG group (P=0.08; log rank test) at 6mo, and 29.1% and 25.0% at 12mo, respectively (P=0.9; log rank). The 360-degree SLT is an effective and well-tolerated therapeutic modality in patients with POAG and PXFG by reducing IOP without any change in number of medications. The response was more pronounced early in the postoperative period in patients with PXFG whereas there was no statistically significant difference at 12-month follow-up.

Effects of Changes in Number of Medications and Drug Burden Index Exposure on Transitions Between Frailty States and Death: The Concord Health and Ageing in Men Project Cohort Study.

To investigate the effects of number of medications and Drug Burden Index (DBI) on transitions between frailty stages and death in community-dwelling older men. Cohort study. Sydney, Australia. Community-dwelling men aged 70 and older (N=1,705). Self-reported questionnaires and clinic visits were conducted at baseline and 2 and 5 years. Frailty was assessed at all three waves according to the modified Fried frailty phenotype. The total number of regular prescription medications and DBI (a measure of exposure to sedative and anticholinergic medications) were calculated over the three waves. Data on mortality over 9 years were obtained. Multistate modeling was used to characterize the transitions across three frailty states (robust, prefrail, frail) and death. Each additional medication was associated with a 22% greater risk of transitioning from the robust state to death (adjusted 95% confidence interval (CI)=1.06-1.41). Every unit increase in DBI was associated with a 73% greater risk of transitioning from the robust state to the prefrail state (adjusted 95% CI=1.30-2.31) and a 2.75 times greater risk of transitioning from the robust state to death (adjusted 95% CI=1.60-4.75). There was no evidence of an adjusted association between total number of medications or DBI and the other transitions. Although the possibility of confounding by indication cannot be excluded, additional medications were associated with greater risk of mortality in robust community-dwelling older men. Greater DBI was also associated with greater risk of death and transitioning from the robust state to the prefrail state.

The effects of pharmacist prescribing on patient outcomes in the hospital setting: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this review is to determine the effects of pharmacist prescribing in the hospital setting. More specifically, the objectives are to quantitatively analyze the effectiveness of pharmacist prescribing on patient outcomes, including, but not limited to, the reduction of error rates and adverse events related to medication prescription in patients who present to hospital, either in the inpatient or outpatient setting. INCLUSION CRITERIA Types of participants This review will consider studies that include patients in a hospital setting, including those admitted to hospital, those being assessed prior to elective admission, and those being assessed in outpatient clinics. Children and adults of all ages (i.e. from neonates to geriatrics), not limited to any specific medical condition or admission reason, who are prescribed medication(s) by a pharmacist, will be included in this review. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate all forms of pharmacist prescribing in the hospital setting. The comparator will be usual care, i.e. prescriptions by hospital medical staff. Types of outcomes This review will consider any study that reported the effects of pharmacist prescribing on patient outcomes. A strict definition of outcome measures is not defined, but may include: • Primary: error rates in prescriptions, including, but not limited to, medication administration errors of omission due to omission of the medicine from the medication chart; any measurable clinical outcomes such as adverse events, morbidity or mortality including therapeutic failure or therapeutic benefit. • Secondary: change in number of medications on discharge TRUNCATED AT 250 WORDS

The Effect of Teaching Clinics on Prescribing Practices.

The objective of this study was to investigate the effect of lack of continuity in a teaching clinic and to ascertain the role of supervisory attending in treatment decisions in a teaching psychiatric clinic. A retrospective evaluation of paired consecutive visits of patients attending an education clinic was performed. Medication changes occurred in 56.3% of all visit pairs. Visit pairs in which the resident was unchanged had significantly more medication changes than visit pairs in which the attending was unchanged. When the resident stays the same, the number of medication changes is high and does not change significantly even if the attending is the same or different. Similarly, when the resident is different, the number of medication changes is low and does not change significantly if the attending is the same or different. Residents, not the attending physicians, are more instrumental in medication changes in patients attending an education clinic.

Appropriate Prescribing for Older People: A New Tool for the General Practitioner.

Appropriate prescribing for older people is a challenge. General practitioners (GPs) are aware of their key position in relation to prescribing practice in the elderly. However, they often feel powerless and report a need for simple GP friendly tools to assess and support their prescribing practice. In this study such a tool is developed: the Appropriate Medication for Older people-tool (AMO-tool). The purpose of the study is to investigate whether GPs consider the use of the AMO-tool to be practically feasible and resulting in more appropriate prescribing. This pilot study with an interventional design was conducted over a period of six months. The study was conducted in nursing homes visited by GPs. The studied population consisted of nine GPs and 67 nursing home residents. The intervention consisted of the use of the AMO-tool. The Short Form (SF)-12 questionnaire was administered to the patients. Patients' medication lists were recorded. The GPs completed a semi-quantitative questionnaire on their experiences with the AMO-tool. A descriptive qualitative and semi-quantitative analysis was carried out on the GP questionnaire. The results of the SF-12 questionnaires and medication lists were analysed quantitatively. A multivariate analysis was carried out. In the perception of GPs, applying the AMO-tool to medication lists of nursing home residents was feasible and resulted in more appropriate prescribing. A slight reduction was recorded in the number of medications prescribed. Self-reported well-being improved and rose in parallel with the number of medication changes. According to GPs, the AMO-tool offers GPs the support in their prescribing practice. Changes are made to medication lists and improvements occur in patients' self-reported well-being. Future research should objectify the appropriateness of prescriptions before and after using the tool. Furthermore, it should investigate the possible causal relationship between the use of the AMO-tool, an increase in appropriateness of medication lists and an improvement of general well-being.

Abstract 404: The Use of Renin and Aldosterone Profiling in the Treatment of Complex Hypertension

Uncontrolled hypertension (HTN) remains highly prevalent and contributes to the risk for increased CVD and stroke. The purpose of this study is to determine if renin/aldosterone profiling in patients new to the complex HTN clinic would aid in identification of certain subsets of HTN and lead to improved BP control. Methods: We conducted a retrospective study of all new patients seen at the Penn HTN clinic by a single HTN specialist between 2005-2010. We examined all adult patients that were screened with plasma renin (ng/ml) and serum aldosterone (ng/dl) levels. Patients with known causes of secondary HTN such as pheochromocytoma were excluded. All data was reviewed from the first visit and for all subsequent visits for the first year. The patients were classified as follows: normal, salt sensitive (renin &lt; 1, aldo &lt;15), hyperaldosteronism (renin &lt; 1, aldo ≥ 15) and high renin (renin ≥ 10). Medications were then tailored to the individual profile. Results: We identified 158 patients with a mean age of 52.9 ± 1.25 years, 47% (74 of 158) males; 53% (84 of 158) females; 75% (117 of 158) were white; 21% (33 of 158) black and 4 % (6 of 158) other. The mean SBP/DBP at baseline for the entire cohort was 149/87 ± 1.85/1.17 mmHg and was decreased by a mean of 20.3/8.6 ± 1.88/1.2 at 1 year (p=0.000). There was no change in the overall number of medications at baseline and at one year despite improved BP control ( p = 0.770). Conclusion: Renin/aldosterone profiling in subjects with severe HTN helps the physician tailor therapy resulting in improved BP control without an overall increase in the number of medications needed. Most patients did require at least 3 meds to achieve good BP control.