Drug Duplication Research Articles

Trends in Drug Duplications in Swedish Older Adults: A Nationwide Register Study from 2006 to 2021.

Drug duplication (DD), the use of two identical drugs simultaneously, is a medication error increasing the risk of adverse drug events. We describe the trends and implicated drugs in potential DD in older adults in Sweden from 2006 to 2021. We conducted a register-based, repeated cross-sectional study of all older adults (aged ≥65years) dispensed drugs at a community pharmacy in 2006-2021. DD was defined as a ≥30-day overlap of two dispensations of drugs with the same 5th level (chemical substance) Anatomical Therapeutic Chemical (ATC) classification, but with different brand names, within a 3-month period each year. Among Swedish older adults with ordinary prescriptions (i.e. multidose excluded; n≈1,200,000-1,600,000 per year), the prevalence of potential DD increased from 5.2% to 10.6% in 65- to 79-year-olds and from 7.0% to 11.7% in those aged ≥80years. The drug groups (ATC level 3; pharmacological subgroup) most frequently implicated in DD in 2006 were β-blocking agents, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers, and in 2021Vitamin B12 and folic acid, β-blocking agents and angiotensin II receptor blockers. DD represents a common but unnecessary and potentially hazardous medication error. Our results indicate that during the last two decades, the prevalence has almost doubled in older adults with ordinary prescriptions, reaching 11% in 2021. More national efforts are needed to revert this trend, including a nationally available complete drug list for all patients, and prescriber support to detect DD.

Polypharmacy and Deprescription: Role of Internists.

Polypharmacy is the concurrent use of five or more drugs per day. It is common in old age because of multimorbidity. The prevalence of polypharmacy is increasing as the number of old people is increasing worldwide. The proliferation of clinical guidelines and wider availability of preventive and curative medicines are important causes of polypharmacy. Appropriate polypharmacy is beneficial to the patients. However, polypharmacy may be inappropriate, causing adverse effects, drug interactions (DI), poor treatment efficacy, hospitalizations, and high healthcare costs. Prescribing cascade and legacy prescribing add to the burden of inappropriate polypharmacy. Inappropriate polypharmacy can be prevented or managed by medication optimization through medication review, deprescription, ensuring adherence, and patient education. Deprescription includes the removal of risky, unnecessary, and duplicate drugs, replacement with efficacious drugs, and relaxation of tight control as per life expectancy. Several deprescription tools (both explicit and implicit) exist for helping physicians to decide when to deprescribe or to add medicines, especially in old age. Care should be taken during deprescription to prevent unjustified omission, reduction to subtherapeutic dose, and onset of withdrawal features. Age and disease-related changes in pharmacokinetics and pharmacodynamics of drugs should be considered during the optimization of pharmacotherapy.

The prevalence of medication-related problems in kidney transplant recipients at a tertiary care hospital in Saudi Arabia

BackgroundLimited data are available regarding the prevalence of medication-related problems (MRPs) in kidney transplant recipients. This study aimed to determine the prevalence and types of medication-related problems.MethodsA cross-sectional study was conducted including kidney transplant recipients aged ≥ 18 years who were receiving immunosuppressive agents for at least 3 months post-transplant. The primary outcome was to determine the prevalence of MRPs. The secondary outcomes were to identify the pharmacological classes, categories of medications contributing to MRPs, and predictors of developing > 3 MRPs.ResultsWe enrolled 107 kidney transplant recipients. The mean ± standard deviation (SD) of age and body mass index (BMI) were 50 ± 15.8 years and 28.9 ± 5.3 (kg/m2), respectively, and 66.3% were male. The prevalence of MRPs was 28.97% [95% confidence intervals (CI) 19.68%, 41.125] in 1393 prescriptions. The frequent types of MRPs were drug‒drug interactions (46.1%), duplication (12%), and medication use without an indication (11.7%). Immunosuppressive agents and cardiac medications were the main classes causing MRPs. The number of medications and the years post-kidney-transplant were significant predictors of developing > 3 MRPs.ConclusionThe results showed that drug‒drug interactions were the most frequent MRPs, with immunosuppressive agents being the most common class causing MRPs.

Embodiment of Pharmacist Intervention in Palliative Care and Augmentation of a Curriculum for its Assessment

Background Palliative care is the care of patients who have progressive, life-threatening illnesses and who are facing death in the foreseeable future. Since there is a growing need for pharmacist’s intervention in palliative care and there is a gap in the education of palliative care for pharmacy students, this study aims to identify roles and services that have to be performed by palliative care pharmacists in medication-related areas and also to formulate an add-on course to train pharmacy graduates. Materials and Methods A prospective interventional study was done in the palliative care centre in Perinthalmanna, Kerala, India. Relevant data were pooled and analysed for drug-related problems. Necessary interventions were made. Results were interpreted and an add-on course for the training of pharmacy graduates was formulated. Results A total of 88 patients were included in the study. The most prevalent conditions in our palliative setting were kidney disease, liver disease, cancer and stroke. Notably, 38 and 10 cases were found to have drug interactions and drug duplications, respectively. Four patients required dosage adjustments. Fifty cases involved pharmacist intervention which improved the outcome by 80%. At the end of the study, a curriculum was formulated to implement a 3-month add-on course entitled ‘PALLIATIVE PHARMACY’ under the guidance of an Expert committee for training pharmacists and pharmacy students. Conclusion The study identified that there are various roles a pharmacist must undertake in a palliative setup. The involvement of pharmacists in patients’ treatment helps to prevent drug-related problems to a greater extent. The addition of an integrated course for the management of palliative care patients will help to improve the learning as well as practical skills of pharmacists. Incorporating basic and clinical sciences in the therapeutic course is an effective learning plan.

Deprescribing in Older Poly-Treated Patients Affected with Dementia.

Polypharmacy is an important issue in older patients affected by dementia because they are very vulnerable to the side effects of drugs'. Between October 2021 and September 2022, we randomly assessed 205 old-aged outpatients. The study was carried out in a Center for Dementia in collaboration with a university center. The primary outcomes were: (1) deprescribing inappropriate drugs through the Beers and STOPP&START criteria; (2) assessing duplicate drugs and the risk of iatrogenic damage due to drug-drug and drug-disease interactions. Overall, 69 men and 136 women (mean age 82.7 ± 7.4 years) were assessed. Of these, 91 patients were home care patients and 114 were outpatient. The average number of the drugs used in the sample was 9.4 drugs per patient; after the first visit and the consequent deprescribing process, the average dropped to 8.7 drugs per patient (p = 0.04). Overall, 74 potentially inappropriate drugs were used (36.1%). Of these, long half-life benzodiazepines (8.8%), non-steroidal anti-inflammatory drugs (3.4%), tricyclic antidepressants (3.4%), first-generation antihistamines (1.4%), anticholinergics (11.7%), antiplatelet drugs (i.e., ticlopidine) (1.4%), prokinetics in chronic use (1.4%), digoxin (>0.125 mg/day) (1.4%), antiarrhythmics (i.e., amiodarone) (0.97%), and α-blockers (1.9%) were included. The so-called "duplicate" drugs were overall 26 (12.7%). In total, ten potentially dangerous prescriptions were found for possible interactions (4.8%). We underline the importance of checking all the drugs taken periodically and discontinuing drugs with the lowest benefit-to-harm ratio and the lowest probability of adverse reactions due to withdrawal. Computer tools and adequately trained teams (doctors, nurses, and pharmacists) could identify, treat, and prevent possible drug interactions.

ANALISIS KELENGKAPAN ADMINISTRASI, FARMASETIK DAN KLINIS PADA RESEP DI PUSKESMAS X KOTA SUNGAI PENUH, JAMBI

A good prescription should have enough information to allow the pharmacist concerned to know what drug to give the patient. But there are still errors found. This can be detrimental to the patient due to possible errors in prescribing or medication (medication error). Completeness of prescription includes Administration, Pharmaceutical, and Clinical. The purpose of this study is to find out the completeness of Administration, Pharmaceuticals and Clinical Prescriptions at Puskesmas X City of SungaiFull in 2022 in accordance with Permenkes No.74 of 2016 concerning Pharmaceutical Service Standards at Puskesmas and technical instructions for pharmaceutical service standards at Puskesmas of the Ministry of Health of the Republic of Indonesia in 2019 This type of research is a retrospective descriptive design. The results showed that the complete administration category included aspects of patient name (96%), age aspects (44%), gender aspects (0%), weight aspects (21.79%), height aspects (0.5%) doctor's name (44.87%), doctor's initials (1.02%), date of prescription (98.7%), unit of prescription (4.87%). The Pharmaceutical category includes aspects of dosage form and strength (23.84%), aspects of dosage and amount of drug (83.07%), aspects of directions for use (96.41%), aspects of stability and availability (0.25%), aspects of non-mixture medicine (100%). The clinical category includes aspects of proper dosage (96.41%), aspects of drug duplication (100%), aspects of side effects and drug interactions (100%), aspects of contraindications and addictive effects 0. Conclusion: Based on the research that has been done it can be concluded that there are still incomplete Pharmaceutical and clinical administration in the 2022 Prescription in accordance with Minister of Health Regulation No. 74 of 2016 concerning Pharmaceutical Service standards at Community Health Centers and technical guidelines for pharmaceutical service standards at Health Ministry Health Centers of the Republic of Indonesia in 2019.
 Keywords: Completion of Prescription, Medication Error, Community Health Center.

A Clinical Pharmacist-led Approach on Reducing Drug Related Problems Among Patients with Neurological Disorders: An Interventional Study

BackgroundNeurological disorders are common in the general population and the majority of patients have other chronic diseases, necessitating the use of multiple medications, which increases the incidence of drug-related problems (DRPs). Studies from different countries discovered an average of 0.29–1.45 DRPs per patient admitted into the neurology unit. ObjectivesTo identify common DRPs and to evaluate the impact of clinical pharmacist's interventions in resolving the identified DRPs in patients with neurological disorders. MethodsA prospective interventional study was conducted in the Department of Neurology in a tertiary care teaching hospital in Southern India, for a period of six months. Patients aged ≥18 years and had been hospitalized for >24 h, were intensively monitored until discharge for the occurrence of any DRPs and pharmacist interventions were provided. The identified DRPs were classified according to Hepler and Strand's Classification. ResultsA total of 310 prescriptions were reviewed, of which 174 patients (mean age 45.93 ± 2.49 years) experienced at least one DRP during their hospital stay. The average DRP per patient was found to be 1.75, with drug-drug interactions [254 (83%)] being the predominant DRPs, followed by adverse drug reactions [13 (4%)], and drug duplications [9 (3%)]. Most of the drug-drug interactions were pharmacokinetic [144 (56.69%)]. Hyponatremia [2 (15%)]; and nausea and vomiting [2 (15%)] were most commonly reported ADRs. All 306 DRPs involved active clinical pharmacist intervention, of which [275 (89.87%)] of pharmacists' interventions were accepted, which led to modification of the therapy. ConclusionMonitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational drug prescribing, therapy optimization and enhanced patient safety.

The Effect of Electronic Medical Records on Service Quality and Patient Satisfaction: A Literature Review

Background: Electronic medical records (EMR) are important to implement because they reduce doctors' workload, costs and errors. With Electronic Medical Records, Doctors and health workers also benefit from easy access to patient information which ultimately helps improve patient safety and clinical decision-making such as diagnoses, allergic reactions, and drug duplication. Electronic Medical Record (EMR) benefits patients because of efficiency in the health care process. Therefore, the purpose of this study was to review the literature on the implementation of EMR on service quality and patient satisfaction. Methods: A systematic review with Prisma on literature published between 2020 – 2023 with the inclusion criteria of national and international research articles in English and published in 2020-2023 relating to the title of the effect of Electronic Medical Records on Service Quality and patient satisfaction and the database source used, namely Scopus, Science Direct and PubMed. Results: Based on a comparison of hospitals that have implemented EMR vs. Paper Medical Records (PMR), it was found that implementing EMR would improve service quality more optimally than PMR. EMR enables healthcare providers to access and update patient information in real-time, quickly and accurately, increasing patient comfort and helping reduce waiting times by increasing healthcare efficiency.

Rational Therapeutic Approaches for the Management of Congestive Cardiac Failure

Background: Heart failure is a serious and progressive condition where the heart's ventricle fails to pump sufficient blood to the body's tissues. Flaws in the rationality of medication use, particularly with narrow therapeutic index drugs like digoxin, have been observed. These include multiple drug-drug interactions, polypharmacy, and therapeutic duplication. Pharmacists play a crucial role in minimizing medication errors through dose adjustments, patient counseling, and ensuring proper administration. Aims and Objectives: The objective of this project was to assess the appropriateness of recommended pharmacotherapies and their implementation in a clinical setting, focusing on drug-drug interactions, polypharmacy, contraindications, and untreated conditions. Study Design: For this study, a specialized questionnaire-based approach was used to gather data on congestive heart failure (CHF) patients. The collected information included patient demographics (name, gender, and age), chief complaints, co-morbidities, past medical and medication history, biochemical tests, diagnosis, social history, allergies, family history, and past surgeries. Materials and Methods: From a collection of 20 patient histories, it was observed that the majority of cases involved congestive heart failure (43.57%), followed by left ventricular dysfunction (30.35%), myocardial infarction (17.23%), and atrial fibrillation (8.71%) as the primary causes of hospitalization. Among the patients, co-morbidities such as diabetes mellitus (31.71%) and hypertension (25.23%) were prevalent. The collected data was regularly examined and analyzed. Results were evaluated based on ±SD (Standard). Results and Conclusion: In this study, 60 drugs were identified as contraindicated for patients, and some drugs required monitoring due to their profiles. Among the identified drug-related errors, 56.66% were attributed to drug interactions, often resulting from the simultaneous prescription of two interacting drugs. The incidence of polypharmacy was found to be 8.88%. Narrow therapeutic index drugs accounted for 5.55% of the medications, which were not adequately monitored. The analysis revealed that 33.35% and 25.80% of patients had diabetes and hypertension, respectively, in addition to heart failure. Heart failure was most commonly observed in individuals aged 51-60 years. The study highlighted several irrationalities in prescription practices, including inadequate dose adjustment for patients with chronic renal failure, polypharmacy, drug duplication, adverse drug reactions, cost-related issues, unavailability of therapeutic alternatives, and lack of monitoring for narrow therapeutic index medications.

Results of the clinical and economic analysis of the state of pharmaceutical provision of patients with dementia in Alzheimer’s disease in Ukraine

Aim. To conduct the clinical and economic analysis of the state of pharmaceutical provision of patients with dementia in Alzheimer’s disease in Ukraine.
 Materials and methods. Both general theoretical (historical, analytical-comparative, systemic, graphical, logical, hypothetical-deductive) and applied (clinical-economic, mathematical-statistical) research methods were used.
 Results. It was found that the vast majority of patients belonged to socially unprotected segments of the population. Thus, the proportion of pensioners was 71.0 %, and 40 patients (20.0 %) had disability groups. All patients, without exception, had a burdened anamnesis. On average, patients were treated in specialized medical institutions for 43.8 bed-days. The sum of 548,714.5 UAH (19,072.45 USD) was spent on drug provision for these patients, which amounted to 2,743.57 UAH (95.36 USD) per one patient. For one bed-day, patients used drugs for only 62.64 UAH (2.18 USD). Physicians wrote 2,487 prescriptions (12.4 per a patient) and used 128 drugs under international non-proprietary names or 218 drugs taking into account all their trade names. In the structure of medical prescriptions, there was a significant duplication of drugs represented by international non-proprietary names. According to the first level of the ATC classification system, the highest rates of prescription frequency were for group N – Drugs affecting the nervous system (861 prescriptions or 34.62 %), and according to the second level, there were drugs from group C01 – Cardiac therapy group (375 prescriptions or 15 .08 %). At the same time, the second and third positions by the number of prescriptions were occupied by drugs from groups N05 – Psycholeptics (363 prescriptions or 14.60 %) and N06 – Psychoanaleptics (309 prescriptions or 12.42 %). It was found that physicians prescribed 617 (24.81 %) drugs recommended by the Clinical Protocol for the treatment of cognitive and non-cognitive behavioral disorders in patients with dementia due to Alzheimer’s disease. Of the drugs in group N06D – Anti-dementia drugs, the drugs in group N06DX – Other drugs for the treatment of dementia had the highest prescribing rates (191 physicians), while drugs of group N06DA – Cholinesterase inhibitors were prescribed by physicians only 43 times. The highest prescription rates in the structure of pathogenetic therapy were drugs of group N06DX01 – Memantine (188 prescriptions or 30.47 %). Then, drugs of group N06DA03 – Rivastigmine (34 prescriptions or 5.51 %) and N06DA02 – Donepezil (6 prescriptions or 0.97 %) followed by a significant margin. The drugs of group N06DX01 – Memantine also occupied leading positions in the structure of drug consumption. Thus, the volume of their consumption was equal to 84,420.2 UAH (2,934,314 USD), which accounted for 15.39 % of the total cost of drug provision for patients and 91.76 % of drug consumption in group N06D – Medicines for use in dementia.
 Conclusions. A significant financial burden associated with the need to use pathogenetic therapy drugs in patients with dementia in Alzheimer’s disease requires the development and implementation of effective models of resource provision for pharmacotherapy and social support of neuropsychiatric patients in Ukraine.

Medication Appropriateness in Elderly Patients Diagnosed with Pneumonia

Ageing is a natural process accompanied with compromised good health. Pneumonia is associated with several independent risk factors, including the severity of clinical presentation, age, comorbidities, and specific pathogens which increase the burden of morbidity, mortality in aged patients. This study was carried out to assess the appropriateness of therapy for pneumonia in elderly patients. A prospective, observational study was conducted from July 2018 to June 2021 in the department of pulmonary medicine of a tertiary care teaching hospital in Bangalore, India. A total of 90 elderly patients aged >65 years, diagnosed with pneumonia who fulfilled study criteria and consented to take part in the study were enrolled. A well designed and internally validated case report form was used to document the findings after a due approval from the Institutional Ethics Committee. Socio-demographic characteristics, prescribed medications and clinical characteristics were documented and analyzed. Out of the 90 elderly patients, 25.6% were male while 75.4% were female. The mean age of the participants was 70.03±5.26 (SD) years. Applying tools like START/STOPP criteria, Beers criteria and MAI index, it was found that, 16.7% were received incorrect dose, 12.22% received drug duplication, 3.3% received drug which was not indicated, 2.2% received drug which was not effective for that condition and in 1.1% patients did not receive drugs for required duration. The findings from this study provide the feedback to the healthcare team to ensure rational management of pneumonia in elderly patients and enable this vulnerable population with improved health related quality of life.

Efficacy of a Pharmacist Team Clinical Medication Review in Older Adults: A Prospective and Retrospective Observational Study.

Polypharmacy in older adults causes problems such as increased adverse drug reactions, overdose or duplication, and poor medication adherence. We have established a "medication review team" organized by pharmacists. This prospective and retrospective observational study evaluated the effectiveness of the pharmacist-led team-based approach for reducing polypharmacy as compared to the individual pharmacist approach. Data on the individual pharmacist approach were collected retrospectively, but prospectively for the pharmacist-led team approach. The study included patients who were admitted to the nephrology, orthopedic surgery, and psychiatry wards. Characteristics for patient included in each study group were adjusted using the propensity score method. The pharmacist-led team approach had a significantly higher medication change rate compared to that of the individual pharmacist approach (odds ratio (OR), 2.28; 95% confidence interval (CI), 1.21 to 4.46; p = 0.009). The rate of patients with two or more medication discontinuations and the rate of patients with intervention by young clinical pharmacist were also significantly higher in the pharmacist-led team approach (OR, 2.19; 95% CI, 1.06 to 4.74; p = 0.03 and OR, 5.67; 95% CI, 1.22 to 53.15; p = 0.02, respectively). The rate of patients with discontinuation of potentially inappropriate medications was not significantly different between the two groups (OR, 2.07; 95% CI, 0.86 to 5.33; p = 0.11). Our results suggest that it is possible to improve the quality of medication review by conducting team conferences even with only pharmacists.

Effectiveness Of Medication Reviews In Identification And Management Of Medication Related Problems By Clinical Pharmacist

Medication related problems (MRPs) are any preventable events that lead to inappropriate medication use or patient harm. Clinical pharmacist plays a key role in various clinical activities of hospital and contributes to improve the quality of medication use and patient safety with an aim to provide better patient outcome. Hence our aim in this study is to identify, classify and develop management strategy of various MRPs in a tertiary care teaching hospital and report them to concerned doctors to modify the drug therapy accordingly. Out of total collected cases; prescribing errors (21%) and adverse drug reaction (ADR) (35%) were most common, followed by drug duplication (11%), improper drug selection (8%), untreated indication (7%), double dosing (6%), wrong dose (5%) were frequently repeated drug related issues. Other MRPs were inappropriate dose, omission error, drug without indication and drug insufficiency with very minimal appearance which also satisfy the PCNE categorization of drug related problems. We found that Anticonvulsants and Antibiotics were frequently identified prescription medicine to develop MRPs.. Cerebrovascular accidents and Epilepsy were mostly involved in disease where MRPs were seen frequently. Standard management guidelines were also described to the doctors for individual MRP cases. Certain MRPs were frequently appearing and clinical pharmacists should be alert enough to address them with proper management strategy. Our study highlights the significant role of clinical pharmacist’s intervention in identification of MRPs, which generally remain unidentified unless harm occurs. This study also shows a new avenue of drug therapy optimization by providing proper medication information to overcome identified MRP issues to enhance patient safety and care. Our role was highly accepted and appreciated by various doctors.

A Survey of Prescription Errors in Paediatric Outpatients in Multi-Primary Care Settings: The Implementation of an Electronic Pre-Prescription System.

BackgroundPrescription errors impact the safety and efficacy of therapy and are considered to have a higher impact on paediatric populations. Nevertheless, information in paediatrics is still lacking, particularly in primary care settings. There exists a need to investigate the prevalence and characteristics of prescription errors in paediatric outpatients to prevent such errors during the prescription stage.MethodsA cross-sectional study to evaluate paediatric prescription errors in multi-primary care settings was conducted between August 2019 and July 2021. Prescriptions documented within the electronic pre-prescription system were automatically reviewed by the system and then, potentially inappropriate prescriptions would be reconciled by remote pharmacists via a regional pharmacy information exchange network. The demographics of paediatric patients, prescription details, and types/rates of errors were assessed and used to identify associated factors for prescription using logistic regression.ResultsA total of 39,754 outpatient paediatric prescriptions in 13 community health care centres were reviewed, among which 1,724 prescriptions (4.3%) were enrolled in the study as they met the inclusion criteria. Dose errors were the most prevalent (27%), with the predominance of underdosing (69%). They were followed by errors in selection without specified indications (24.5%), incompatibility (12.4%), and frequency errors (9.9%). Among critical errors were drug duplication (8.7%), contraindication (.9%), and drug interaction (.8%) that directly affect the drug's safety and efficacy. Notably, error rates were highest in medications for respiratory system drugs (50.5%), antibiotics (27.3%), and Chinese traditional medicine (12.3%). Results of logistic regression revealed that specific drug classification (antitussives, expectorants and mucolytic agents, anti-infective agents), patient age (<6 years), and prescriber specialty (paediatrics) related positively to errors.ConclusionOur study provides the prevalence and characteristics of prescription errors of paediatric outpatients in community settings based on an electronic pre-prescription system. Errors in dose calculations and medications commonly prescribed in primary care settings, such as respiratory system drugs, antibiotics, and Chinese traditional medicine, are certainly to be aware of. These results highlight an essential requirement to update the rules of prescriptions in the pre-prescription system to facilitate the delivery of excellent therapeutic outcomes.

Characteristics of Drug-related Problems in Outpatients Based on Analyses of PreAVOID Reports by Community Pharmacists

PreAVOID, which refers to cases in which pharmacists avoid or reduce undesirable drug-related issues (eg, adverse drug reactions [ADRs], drug-drug interactions, and insufficient therapeutic effects) by pharmaceutical interventions, have been used as one of the indicators of pharmacists’ professional performance. In recent years, despite the efforts undertaken by community pharmacists to promote PreAVOID, PreAVOID reports by community pharmacists have not been adequately examined. In this study, we analyzed PreAVOID reports by community pharmacists to understand the characteristics of drug-related problems (DRPs) that required pharmaceutical interventions in outpatients and the profession of community pharmacists. We classified DRPs into eight categories and 33 subcategories and analyzed community pharmacists’ pharmaceutical interventions for various DRPs (eg, overdosage, duplication of drugs with similar effects, and history of ADRs). Of note, 70.9％ of the PreAVOID by community pharmacists led to the avoidance of ADRs, and it was estimated that interventions for the avoidance of ADRs in the reported cases alone potentially reduced medical costs by approximately JPY 83 million. These results indicate that community pharmacists contribute to the avoidance of undesirable pharmaceutical issues in patients, mainly by performing interventions that help prevent ADRs. The classification used for DRPs in daily medical practice in this study could help identify DRPs that could be resolved by community pharmacists.

Cost outcomes of potentially inappropriate prescribing in middle‐aged adults: A Delphi consensus and cross‐sectional study

Potentially inappropriate prescribing (PIP) is common in older adults and is associated with increased medication costs and costs of associated adverse drug events. PIP also affects almost 1/5 of middle-aged adults (45-64 y), as defined by the PRescribing Optimally in Middle-aged People's Treatments (PROMPT) criteria. However, there has been little research on PIP medication costs within this age group. Calculate the medication costs of PIP for middle-aged adults according to the 22 PROMPT criteria and compare with the cost of consensus-validated, evidence-based (adequate) alternative prescribing scenarios. Adequate alternatives to the 22 PROMPT criteria were created via literature review. A Delphi consensus panel of experts was recruited (n =16), supported by a patient and public involvement group, to achieve consensus on the alternatives. A retrospective repeated cross-sectional study from 2014 to 2019 was then conducted utilising pseudonymised primary care data from Lambeth DataNet in South London (41 general practices, n =1 185 335, using Lambeth DataNet May 2020 extract) to calculate the cost of PIP. The cross-sectional study included 55 880 patients. The total PIP cost was £2.79 million, with adequate alternative prescribing costing £2.74 million (cost savings of £51 278). Duplicate drug classes was the most costly criterion for both PIP and alternative prescribing. This study calculated the medication costs of PIP and created alternative prescribing scenarios for the 22 PROMPT criteria. There is no substantial cost difference between adequate prescribing vs. PIP. Future studies should investigate the wider health economic costs of alternative prescribing, such as reducing hospital admissions.

Direct Intercession Approach by Clinical Pharmacist to Manage Medication Related Problems for Enhanced Patient Care

<p style="text-align: justify;"><strong>Background:</strong> Medication related problems (MRPs) leads to patient harm and healthcare burden as develops frequently in general practice and hospital setup. To enhance therapeutic outcome; active intercessions by clinical pharmacist through meticulous prescription review to reduce prescription errors are strongly recommended. Studies in abroad shown that clinical pharmacist led medication review enhances therapeutic outcome through suitable therapeutic elucidation. In India, this practice restricted merely reporting but direct intercessions to modify the therapy rarely reported. Hence the present study is planned to provide appropriate and referred modification for identified MRPs as a direct patient care process with main axiom &lsquo;better patient care&rsquo;. <strong>Methods: </strong>This &lsquo;prospective open-label observational clinical cohort&rsquo; study conducted between August&rsquo;19 and January&rsquo;20 at Gandhi Hospital, Secunderabad, India. Collected cases simultaneously reviewed to identify MRP, thoroughly crossed matched with standard reference, justified and reported to doctor with suitable modification suggestions. <strong>Results: </strong>Result highlights; equal distribution of patient sex and vast distribution of age from neonates to elderly. Diagnosis has no co-relation on MRP development. Antibiotics, gastro-protective and anticoagulants are with maximum frequency to develop MRPs and entail strong vigilance. Furthermore drug toxicity, drug duplication, wrong dose and prescribing errors are most recurrent appeared problems. Subsequently appropriate modifications were suggested for every identified MRP and were closely observed till discharge for final outcome. <strong>Conclusion:</strong> Certain MRPs are frequently emerging and needs tackling with proper management strategy. Our study further highlights about necessitate of clinical pharmacist intercession in optimizing drug therapy by providing proper medication information and same has been accepted and appreciated by various doctors. <p style="text-align: justify;"><strong>Key words: </strong>Clinical pharmacist intercession, Enhanced patient care, Medication related problems.

Application of Novel Pharmacists' Risk in Pharmacotherapy (PHARIPH) Scale for Identification of Factors Affecting the Safety of Hospital Pharmacotherapy-An Observational Pilot Study.

Background: The widespread occurrence of medication errors (MEs) has become a global problem because it poses a serious threat to the health and lives of patients, can prevent the achievement of treatment goals, undermines patient trust in the health care system, and increases treatment costs. The purpose of this study was to develop an appropriate tool to identify key risk factors that hospital pharmacists believe threaten pharmacotherapy safety in the hospital. Methods: A diagnostic survey method using the authors’ PHARIPH (Pharmacists’ Risk in Pharmacotherapy) scale and authorial questions was used to identify risks that may result in patient pharmacotherapy errors at the hospital pharmacist level. A total of 125 Polish hospital pharmacists participated in the study. Results: The original authors’ created PHARIPH scale was characterized by a Cronbach’s alpha coefficient of 0.958. According to the surveyed pharmacists, the greatest threat to pharmacotherapy safety was misreading of a doctor’s order (similar drug nomenclature) and preparing a wrong drug (similar drug packaging, similar drug nomenclature). Female pharmacists compared to male pharmacists attributed significantly higher importance to such risk factors such as pharmacist’s ignorance of a list of drug substitutes (p = 0.047, risk 8), preparation from an expired/withdrawn drug (p = 0.002, risk 14), preparation from a drug stored in inappropriate conditions (p = 0.05, risk 15), preparation of drugs ordered in hospital and PODs (patients’ own drugs) without checking for possible drug duplication (p = 0.011, risk 17) and their potential effect on patient safety. Conclusions: The PHARIPH scale could be applied as a novel tool for identification of pharmacotherapy risks.

Antibiotic prescribing errors generated by the use of an electronic prescribing system in the emergency department: A mixed-method study

Context: Inappropriate prescribing of antibiotics can result in serious patient harm. Aims: To investigate the incidence, nature, clinical severity, and causes of antibiotic prescribing errors (APEs) in the emergency department (ED) of a large hospital in Jordan. Methods: A mixed-method approach was used to explore the incidence and types of APEs by direct observation of electronic prescriptions (EPS) of antibiotics over four weeks, and to identify causes of errors by semi-structured interviews with ED physicians. The clinical severity of APEs was rated by a committee of experts. SPSS V26 and NVivo 10 were used for the analysis of quantitative and qualitative data, respectively. Results: The incidence of APEs caused by the use of EPS was 4.3%. Wrong quantity (32.62%), wrong dose (15.25%), and duplicate drugs (13.55%) were identified as the most common types of APEs. More than one-third of APEs identified were deemed clinically significant, seven were serious, and one was lethal. Minor and significant antibiotic APEs across physicians who attended workshops on EPS and those who did not were 75.00% versus 46.77% (p = 0.001) and 18.75% versus 52.41% (p = 0.013), respectively. Three major causes of errors were identified: 1) System-related (system crash, drop-down menu), 2) user-related (lack of computer skills), and 3) workplace-related (overcrowding, inadequate staffing). Conclusions: APEs generated by the use of EPS were common in EDs in Jordan, clinically significant, and multifactorial. Further research is required to cover pharmacists’ perspectives of this kind of errors.

The impact of treatment choices on potential drug-drug interactions in hypertensive patients.

The aim of this study was to analyse potential drug-drug interactions (pDDIs) and their potential adverse drug reactions (ADRs) among hypertensive patients. Moreover, we investigated the possibility of reducing pDDIs with different treatment choices. This was a cross-sectional study including all outpatients with hypertension and two or more medications, treated in a university hospital in Serbia. Lexicomp Interact (Lexi-Comp, Inc., Hudson, OH) was used for identification of pDDIs and potential ADRs. Treatment choices were explored according to patient characteristics, treatment guidelines and the interacting potential of drugs. Data were analysed using descriptive analysis and multiple logistic regression. A total of 350 patients were included in this study, with average age (77 [36-98] years and 6.1 [2.5]) medications. The majority of patients (86.0%) had at least one clinically significant pDDI, and the average was 3.78 (3.90) (range 1-25). Suggestions for treatment change aimed mainly at eliminating drug duplications, reducing the use of thiazide diuretics, sulfonylureas, alpha-lipoic acid and pentoxifylline and increasing the use of calcium-channel blockers, when appropriate. pDDIs would have decreased to 2.10 (2.52), P <.001, yet male gender, ≥6 medications, cardiovascular diseases, diabetes, benign prostatic hyperplasia, would be predictive of two or more pDDIs. The main potential adverse outcomes of pDDIs were hypotension, renal failure, hypoglycaemia, bradycardia and lactic acidosis. Careful choice of drugs can reduce but not eliminate pDDIs and their potential ADRs in hypertensive patients. Close monitoring for hypotension, renal failure, hypoglycaemia, bradycardia and lactic acidosis is necessary.