Drug-related Problems Research Articles

Analysis of Drug Management Ability on the Elderly in the East Surabaya Using MedMaIDE™

The elderly are at the highest risk for drug-related problems caused by age-related physiological changes, multiple chronic illnesses, polypharmacy, and poor drug management. This study aims to analyze the ability of elderly regarding drug management. This study used an observational research method with an elderly population in the East Surabaya area. The research instrument used was MedMaIDETM (Medication Management Instrument for Deficiencies in the Elderly), which can be used to measure ability in medication management in the elderly community who are undergoing self-medication with at least one medication. Sampling was carried out using a non-random sampling method with a purposive sampling technique. The number of respondents obtained in this study were 100 elderly who live in the East Surabaya area. The inclusion criteria for research respondents were: (1) willing to be a respondent; (2) domiciled in the East Surabaya area; (3) aged ≥ 60 years; (4) able to communicate in Indonesian; and (5) consuming at least one medicine. The variable studied was drug management skills in the elderly which includes knowledge of the medications aspect, knowledge on how to take the medication aspect, and knowledge on how to obtain the medication. The average MedMAIDE scores of respondents in the three domains with a total average value of 1.18 and a standard deviation of 0.10, meanings each elderly at least had one deficiency out of 13 maximun score of deficiencies. There were 70 respondents out of 100 respondents who had limitations in drug management with one deficiency score as the smallest score and the largest total deficiency score being 7. Meanwhile, 30 other respondents had a no deficiency. The most difficult tasks were identified the problems after taking the medication, fill a glass with water, sip enough water to swallow medication and identify if a refill exists on a prescription. The ability of elderly people in the East Surabaya area to manage their medicines was good. The elderly were able to recognize the drugs used, use the drugs correctly, and comply with drug administration.

SYSTEMATIC REVIEW OF PHARMACIST-LED HOME MEDICATION REVIEWS TO IMPROVE ADHERENCE TO ANTIDIABETIC MEDICATIONS AMONG ADULT TYPE 2 DIABETES PATIENTS

Pharmacists can contribute to the improvement in diabetes management and help patients recognise and manage barriers to optimal medication adherence. Home medication review (HMR) services provided by pharmacists could also assist patients in minimising drugrelated problems. This systematic review aimed to evaluate and summarise evidence from recent literature on the effectiveness of pharmacist-led home medication review interventions to improve medication adherence in adult type-2 diabetes mellitus (T2DM) patients. Primary research articles published in English from 1st January 2012 to 31st May 2022, were retrieved from five online electronic databases (MEDLINE, Embase, Scopus, Cochrane Reviews and the Web of Science). The methodological quality of all included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklists. The literature search identified 2,178 publications; only four were included in this review. All four studies found that pharmacist-led HMR was associated with significant positive changes in the patient’s medication adherence. Significant improvements were demonstrated either through self-reported medication adherence assessment questionnaires or the pill counting adherence ratio before and after HMR visits. There was evidence of statistically significant effectiveness of pharmacist-led HMR initiatives to improve patient adherence to medication among adult T2DM patients.

Corrigendum: Drug-related problems among transfusion-dependent thalassemia patients: a real-world evidence study

Corrigendum: Drug-related problems among transfusion-dependent thalassemia patients: a real-world evidence study

Impacto de la Intervención Farmacéutica en el tratamiento del paciente mayor pluripatológico

Objectiveto analyze the impact of Pharmacy Intervention (PI), within the healthcare team who manages elderly multi-pathological patients, regarding the evolution of Drug Related Problems (DRPs) and Negative Outcomes Associated with Medication (NOMs). To estimate the prevalence of DRPs, NOMs, and Potentially Inappropriate Prescriptions (PIPs), and the drugs involved, considering the characteristics of their healthcare location. Methodmulticenter, prospective study, on > 65-year-old patients with multiple pathologies, either institutionalized or hospitalized. The Pharmacist reviewed the chronic medication of the patient in order to detect DRPs and NOMs, and issued recommendations to the physician responsible for the patient, and this intervention was subsequently evaluated. DRPs and NOMs were classified according to the Third Consensus of Granada. The STOPP/START Criteria were used for PIP detection. The primary variables were: number of PIs conducted and accepted by the physician. Outcomes338 patients were included, and 326 (96.4%) presented some DRP. 1089 DRPs were detected, with 983 PIs suggested for their solution, and 651 (69.9%) of these were accepted. PIs solved 58.9% of DRPs, and an association was found between PI and the solution for the DRP (p < 0.001). PIs were more accepted in institutionalized than in hospitalized patients (p = 0.002), by physicians with a higher specialization (p < 0.001) and when they involved quantitative safety NOMs (p = 0.042). The STOPP/START Criteria detected 65% of PIPs, and more PIPs not associated with these criteria were found in institutionalized than in hospitalized patients (p < 0.001). Conclusionspharmacy Intervention within the multidisciplinary team can solve in a significant way both DRPs and NOMs in elderly multi-pathological patients, and thus help to improve the quality of their pharmacological therapy. This is the first multicenter clinical trial with these characteristics that has been conducted in Spain.

Drug related problems in Liver Transplant Clinic at Maharaj Nakorn Chiang Mai Hospital

Drug related problems in Liver Transplant Clinic at Maharaj Nakorn Chiang Mai Hospital

Analisis Drug Related Problems dan Pengaruhnya terhadap Pengendalian Glukosa Darah pada Pasien Covid-19 dengan Komorbiditas Diabetes Melitus Tipe 2

This study aims to anayze the effect of drug related problems (DRPs) on glycemic control in COVID-19 patients with comorbid diabetes mellitus type 2. This research is a cross-sectiona study using retrospective data obtained from secondary data from the medica records of Covid-19 patients. with type 2 diabetes mellitus. The research location was at Jati Padang Hospita. The sample consisted of 76 medica records with total sampling method. Data collected using PCNE V9.00 were then tested using the Wilcoxon test comparing initia GDS in hospita with GDS at the end of patient discharge, the Chisquare test which correlated changes in GDS with patient clinica outcomes and the Spearman test which linked changes in GDS with DRPs, characteristics of Covid-19 patients with diabetes mellitus predominant age 46-55 years (30.3%), predominant sex mae (51.3%), length of stay 6-10 days (64.5%), profile of drug use that is often used antivira, antibiotics, vitamins and supplements, symptomatic and antidiabetic (100%). The most common comorbidities were hypertension (60.4%), the incidence of DRPs (92.1%), the most common fina GDS was hyperglycemia (≥ 200 mg/dL) (65.8%). 58 patients were discharged with a negative sample (76.3%). The results of the Wilcoxon test on blood glucose showed differences in blood glucose at the beginning and at the end. The results of the Chi-square test between changes in blood glucose and the patient's clinica outcome (p&gt;0.05) showed that there was no significant relationship between changes in blood glucose levels and the patient's clinica outcome. Spearmen's correlation test results (p&gt;0.05) showed a significant relationship between DRPs and changes in patient's blood glucose. The correlation between the incidence of DRPS and blood glucose (0.169) shows a weak relationship. It can be interpreted that DRPs do not realy affect changes in blood glucose in patients at Jati Padang Hospital.&#x0D; &#x0D;

Comparison of Blood Pressure in Hypertensive Patients with Monotherapy and Combination Antihypertensive Therapy

Background: Hypertension is a cardiovascular risk factor that is closely related to the patient's systolic and diastolic blood pressure profile. Objective: This study aims to determine the comparison of systolic and diastolic blood pressure profiles using antihypertensives in patients with cardiovascular risk factors. Method: Conducted in the period August-December 2021 on 83 patients who met the inclusion criteria, namely outpatients diagnosed with hypertension with cardiovascular risk factors, adult patients over 18 years of age, a medical record sheet, and a written prescription in full. Data analysis used the Kruskal Wallis test. Results: Shows a p value of 0.02 &lt; 0.05 that there is a difference in systolic and diastolic blood pressure when using antihypertensive monotherapy or combination. The use of antihypertensive monotherapy is able to achieve the target of reducing systolic and diastolic blood pressure, namely amlodipine by -42.4mmHg/-11.7mmHg. Meanwhile, the combination antihypertensive that provides maximum results is a combination of 2 drugs, namely Candesartan + Hydrochlorthiazide which produces a reduction of -42.64 mmHg/-16.09 mmHg; a combination of 3 drugs: Amlodipine + Candesartan + Hydrochlorthiazide resulted in a reduction of -49 mmHg/-19.1 mmHg. Conclusion: There are differences in the profile of reducing systolic and diastolic blood pressure when using monotherapy and combination antihypertensives. The choice of monotherapy and combination can provide benefits in reducing blood pressure, tolerability and the level of compliance with the drugs consumed. Rational dose selection and drug selection in hypertensive patients is an important part in achieving successful therapy and preventing drug related problems, so pharmacists need to always monitoring blood pressure profiles as a form of monitoring the effectiveness of existing antihypertensive drugs consumed by patients.

Pharmaceutical Interventions for Inpatients with Liver Cirrhosis and Liver Transplantation: A Systematic Review of Experimental Studies.

Liver cirrhosis, which is considered one of the leading causes of death in the world, can lead to severe complications, and is often followed by a liver transplantation. These patients take an average of nine medications daily. If not managed adequately, it can be accompanied by serious drug-related problems. To reduce this risk, a clinical pharmacist may be included as part of the healthcare team to optimize medication therapy in this population. This study aimed to systematically identify the pharmaceutical interventions which reduced drug-related problems and improved medication therapy for adult hospitalized liver cirrhotic and liver transplant patients when compared to standard care. Three databases (PubMed, Embase, and CENTRAL) were systematically searched from the inception of each database to 25 October 2023, and interventional studies in the English language were included. The risk of bias was assessed according to RoB-I for the UBA study and RoB2 for the identified RCT. The detected interventions to reduce drug-related problems in liver cirrhotic and liver transplant patients were extracted and classified according to a "Hierarchy of Controls" model. Two studies from Germany and the USA met our inclusion criteria, respectively. In these studies, we identified two interventions that included education, expert consultation, and the monitoring of the immunosuppressive medications serum level. The main objective of the two included studies was improving patients' compliance through adherence. These pharmaceutical interventions identified were classified as administrative controls, which is one of the lowest levels in the "Hierarchy of Controls" with which to address a potential risk. Pharmaceutical interventions to optimize medication therapy were found to be rare in the examined population, and were limited to "administrative controls". These interventions were limited to transplant patients' education and the monitoring of the immunosuppressive medication serum levels. No interventional studies were found to have investigated pharmaceutical interventions in patients with liver cirrhosis. Especially regarding this patient group, future studies to reduce DRPs using pharmaceutical interventions are needed. This study received no external funding and its PROSPERO registration number is CRD42022309122.

Quality of the record of drug-related problems in a database for voluntary adverse event reporting

ObjectiveTo determine the number and type of errors found in the record of drug-related problems in the SINEA database, an electronic system for voluntary reporting of adverse events in healthcare, in order to quantify the differences between the raw and refined databases, suggest improvements, and determine the need for refining said databases. Methods: A Pharmacist reviewed the database and refined the adverse events reported from January to August, 2014, considering the “descri-be_what_happened“ field as the gold standard. There was a comparison of the rates of medication errors, both potential and real, adverse reactions, impact on the patient, impact on healthcare, and medications more frequently involved in the raw and refined databases. Agreement was calculated through Cohen’s Kappa Coefficient. Results364 adverse events were reported: 66.7% were medication errors, 2.7% adverse reactions to the medication (2 were wrongly classified as both, showing a total percentage >100%) and 31% were other events. After refinement, the percentages were 69.5%, 5.8% and 24.7%, respectively (κ=0.85; CI95% [0.80-0.90]). Before refinement, 73.6°% of medication errors were considered potential vs. 82.3% after refinement (κ =0.65; CI95% [0.54-0.76]). The medication most frequently involved was trastuzumab (20.9%). The “molecule” field was blank in 133 entries. A mean of 1.8±1.9 errors per entry were detected. ConclusionsAlthough agreement is good, the refinement process cannot be avoided, as it provides valuable information to improve pharmacotherapy. Data quality could be improved by reducing the number of type-in text fields, using drop-down lists, and by increasing the training of the reporters.

Assessment of Drug-Related Problems and Health-Related Quality of Life Domains in Elderly Patients with Type 2 Diabetes Mellitus.

This study aimed to investigate the prevalence and predictors of Drug-related problems (DRPs), as well as to evaluate the impact of DRPs on the health-related quality of life in geriatric patients with type 2 diabetes mellitus. A cross-sectional study was conducted over a three-month period. Patients aged 60 years and older visited diabetes clinics from October 1, 2022, to December 31, 2022, were included in the study. Data were collected through structured questionnaires, whereas lab results, medication records, comorbidities, and the consequences of DRPs were collected from electronic medical records. DRPs were identified and classified using the PCNE V501 classification system. Health-related quality of life (HRQoL) was evaluated using the validated EuroQol criteria. A total of 491 patients participated in the study, and the mean age of the patients was 67.51 years (SD = 5.84 years). Female patients represented 52.34% of total subjects. A total of 461 (around 94%) experienced at least one drug-related problem (DRP), ranging from one to nine DRPs per patient, with a total number of DRPs equal to 1625 identified. The most common DRP was the drug choice problem, affecting 52.98% of patients. Factors such as high drug frequency, living conditions, the number of diabetes medications, comorbidities, and smoking were significantly associated with higher numbers of DRPs. Higher numbers of DRPs were found to significantly worsen health-related quality of life (HRQoL) among patients. Geriatric individuals with type 2 diabetes mellitus encounter a significant prevalence of DRPs, with drug choice problems being the most common followed by dosing problems. Risk factors contributing to these DRPs include high drug frequency, living conditions, high number of diabetes medications, multimorbidity, and smoking. Also, the study concluded that the increased number of DRPs was associated with negative impact on HRQoL domains in geriatric patients with type 2 diabetes.

Improving the impact of pharmacy interventions in hospitals

The clinical and pharmaceutical interventions of pharmacy professionals are considered impactful inputs towards optimised patient care and safety, by rationalising prescriptions, enhancing therapeutic choices and reducing and preventing medication errors...

HUBUNGAN DRUG RELATED PROBLEMS (DRPs) KATEGORI DOSIS OBAT AMLODIPIN DAN KAPTOPRIL TERHADAP KONDISI TEKANAN DARAH PADA PASIEN HIPERTENSI

The incidence of drug-related problems (DRPs) in the dose category on the use of antihypertensive drugs has been associated with the failure of the patient's optimal blood pressure target. The study aims to analyze the relationship between drug-related problems (DRPs) on administering amlodipine and captopril drugs to the blood pressure conditions of elderly hypertensive patients in Puskesmas. This research is observational research with a cross-sectional design of analytical nature—purposive sampling techniques. The total number of samples meeting the inclusion and exclusion criteria was 435 patients. Analysis of DRPs dose category relationship data on administration of amlodipine and captopril against blood pressure conditions using a chi-square test. The results of the study showed that the characteristics of patients visited tended to be aged 65-69 years (53.33%), female (68,51%), stage II hypertensive (62.1%), amlodipine (80.92%). The incidence of the DRP dose category in stage II hypertensive (7.6%). Statistically known DRPs of amlodipine and captopril dosing categories showed different significance in each patient's condition of prehypertension (p=0.260), hypertension stage I (p = &lt;0,001), hypertensive stage II (p&lt;0,001). This study concludes, there is a relationship between the incidence of DRPs in the dose category in patients with stage I and stage II hypertension.

Drug-related problems causing hospital admissions in the emergency rooms at of high complexity hospital

ObjectiveDetermining hospital admissions prevalence associated with problems related to medicines in the emergency services of high complexity hospital; performing the pertinent pharmaceutical interventions. MethodDescriptive observational cross-sectional study. The medical records of the patients admitted to the emergency services were reviewed. Those that reported hospitalization due to problems related to medication were selected. These were classified according to the Third Consensus of Granada adaptation. A pharma-therapeutic profile was made to hospitalized patients; performing the necessary pharmaceutical interventions to avoid future medication related problems. Results3.8% of patients were included in the study. The problems related to medications had a preventability of 87.7% and the most frequent were those of need with 42.2%. A pharma-therapeutic profile was done to hospitalized patients (137). 150 pharmaceutical interventions were done, which had an acceptance of 95.3%. The most intervened risk was administering an unnecessary medication 62.7%. ConclusionsLack of supervision and analysis of problems related to medication could cause therapeutic approach failure, therefore, health and life quality improvement of the patients is not achieve. The pharmaceutical chemist plays a fundamental role in the health care of patients, helping to the prevention and proper use of medicines. The Pharmaceutical Care program proves that it provides an invaluable contribution to public health service by improving the pharmacological safety of treatments, reducing costs and public health problems.

Evaluating potentially inappropriate medications in elderly patients in a pharmacy setting in Bulgaria: A pilot study utilizing the EU (7)-PIM List

Objective: The primary aim of this study was to evaluate, for the first time, the use of the EU-7 PIM List in identifying potentially inappropriate medications among older patients. Researchers have firmly established the connection between drug-related problems, which include increased morbidity and mortality rates and the heightened utilization of healthcare services. While previous studies have focused on methodologies for identifying potentially inappropriate medications in Bulgaria, further research is warranted to explore the applicability of the widely recognized EU(7)- PIM List. Materials and methods: A prospective review was conducted on patient prescriptions aligned with the National Health and Insurance Fund, explicitly focusing on patients aged over 65 years from a single pharmacy in Veliko Turnovo City, Bulgaria. The review spanned from November 2022 to April 2023. The prescriptions analyzed in this study exclusively comprised medications covered by the insurance fund. The pharmacy manager provided patient prescription data in a coded form, which included information on the patients’ age, corresponding medications, and accompanying ICD codes. Results: The study analyzed a sample of 255 patients. Healthcare providers prescribed 2,623 medications, and 61.96% of the patients had polypharmacy, taking more than five medications daily. Among the study population, 67% with polypharmacy had at least one PIM based on the EU (7)-PIM List criteria. In total, 173 potentially inappropriate medications (PIMs) were identified. The main PIMs were categorized into four groups: alimentary tract and metabolism, blood and blood-forming organs, cardiovascular system (CVS), and nervous system. Most PIMs (75.72%) were in the ATC cardiovascular system. Within the CVS category, 11 PIMs were associated with digoxin intake and 11 with antiarrhythmics such as propafenone, flecainide, and amiodarone. In addition, trimetazidine was linked to 9 PIMs, and centrally acting antiadrenergic agents had 22 PIMs, with moxonidine being the most prevalent (n=16). Peripherally acting agents were linked to 22 PIMs, primarily doxazosin. The study identified 24 PIMs related to diuretics, specifically spironolactone, and 18 PIMs related to selective calcium channel blockers such as verapamil. The antithrombotic agent category had the highest share, with 30 identified PIMs, including acenocoumarol, dabigatran, rivaroxaban, and apixaban. Furthermore, the examination of ICD codes confirmed that most PIMs occurred within CVS, with patients having ICD I11.0 and ICD I11.9 being associated with 40 and 47 PIMs, respectively. Conclusion: This study highlights many PIMs among patients with cardiovascular diseases. Using the EU (7)-PIM List as a pilot study demonstrates its effectiveness in managing adult patients’ conditions. Given the significant role of PIMs in deprescribing strategies for older patients with polypharmacy, there is a need for prescribers, educators, and drug regulatory institutions to show increased interest in regulatory measures and specific aspects related to PIM use. This is important because the demographic trend of population ageing continues, and organizations increasingly focus on the elderly population.

Knowledge and attitude towards pharmacovigilance among healthcare students at a medical college in Nepal

Background: Pharmacovigilance is the science and activities relating to the detection, assessment, understanding, and prevention of adverse drug reactions (ADRs) and any other possible drug-related problems. Under reporting of adverse drugs reactions are the global health problem. The adequate knowledge and skills towards pharmacovigilance and adverse drugs reactions reporting are crucial for the health care students to ensure patients’ medication safety. This study aims to assess the knowledge and attitude of the health care students towards pharmacovigilance and ADRs. Methods: A closed ended, structured, self-administered questionnaire was administered to 204 undergraduate health care students to collect the data. Data were analyzed using SPSS version 21. Non-parametric tests (Mann Whitney U test and Kruskal Wallis test) were used for analysis. Results: Among 204 respondents, the majority of them had a poor knowledge (91.18%) and positive attitude (87.25%) towards Pharmacovigilance. The inter quartile range (median) score of the respondents’ knowledge was 5.0±2.211 and attitude was 27.0±2.88 towards Pharmacovigilance and ADRs reporting. The main reason for under reporting of ADRs was difficulty to decide whether ADR has occurred or not (32.4%) due to the lack of appropriate knowledge and training. There is a poor knowledge and positive attitude towards Pharmacovigilance. Conclusions: Adequate coverage of Pharmacovigilance and ADRs reporting issues should be covered in the curriculum as well as hand on training and workshop should be conducted to increase the knowledge and confidence in detecting, monitoring and reporting ADR in their clinical posting.

Scoring tool to identify patients at increased risk for drug-related problems: results of a point prevalence study at hospital admission

Drug therapy is a high-risk process and requires special attention, especially at sectoral borders. Pharmaceutical services such as medication review are appropriate measures to identify drug-related problems and thus improve the safety of drug therapy. Risk-scoring tools have been described in the literature as helpful for prioritizing medication reviews for patients at high risk for drug-related problems. In a multi-centre point prevalence study, we identified patients at increased risk for medication-related problems at hospital admission using the medication risk tool. In addition, the current level of implementation of pharmacy services was surveyed. A total of 11 (58%; 11/19) hospital pharmacies in Saxony participated in the point prevalence survey. The scoring tool identified 32% (279/875) of patients at increased risk for medication-related problems (Meris score >12 group) at admission. Thereby, the number of drugs in the Meris score >12 group was 10.6 (average; standard deviation 3.5; n=279), while in the Meris score ≤12 group it was only five drugs per patient (average 4.6; standard deviation 2.8; n=596). The age of patients in the Meris score >12 group averaged 75.9 ± 11 years, while the age of patients in the Meris score ≤12 group averaged 60.6 ± 17.9 years. Prioritization with the help of a risk-scoring tool is essential as pharmacy services in Saxon hospitals still need to be regularly established and in order to identify patients with an increased risk for drug-related problems at an early stage.

Medication conciliation to prevent epilepsy crisis and adverse drug reactions during pregnancy: An emergency case report

Background: Medication reconciliation is a pharmaceutical care practice to prevent drug-related problems during pharmacotherapy. Case: A 16-year-old woman with a 4-year history of epilepsy was admitted to the emergency care unit following two recent seizures episodes with acute headache. The patient was treated with lamotrigine 25 mg plus carbamazepine 200 mg twice daily but is now breastfeeding at 22 days postpartum. A single dose of diazepam 10 mg plus phenobarbital 100 mg once daily were added in order to control seizures. The changes in the response to treatment may reflect changes in pharmacokinetics or presence of drug interaction during pregnancy. It is also well known that phenobarbital can induce drug metabolism and accelerate drug elimination. Conclusion: In such cases, medication reconciliation is essential in order to optimise response to medication and to prevent drug-related problems.

Monitoring drugs and prison in Europe: key issues and challenges in collecting information and evidence on drug related problems and interventions in prison

Abstract The EMCDDA published a methodological framework to monitor drugs and prison in Europe, with the objective to set up methods and tools for collecting and analysing harmonised data across Europe on the issue of drugs and prison. Two data collection tools are available: a “European Questionnaire on Drug use among people in Prison (EQDP)” aimed at collecting epidemiological data on drug use and drug related problems on people incarcerated during a given time period and; a “European Facility Survey Questionnaire in Prison (EFSQ-P)” aimed at collecting data on availability, coverage and provision of drug related interventions inside prison. The two monitoring tools include a short and long version and are accompanied by methodological guidelines. The toolkit should be used across countries to improve international comparisons and European harmonisation as well as to provide data to national governments or international organisations (e.g. EMCDDA, WHO, UN and others). Based on challenges identified among responding countries a check list of key issues in collecting data on drugs and health information in prison settings was drafted. This check list aims to provide a practical guide for those who want to start gathering data on drugs and health in prison; it has been drafted and agreed by a group of European experts who have implemented drugs monitoring in prison using the EMCDDA tools. The check list aims to discuss possible options and present best practices in drugs monitoring in prison in the different phases of research/data collection. The check list includes examples and recommendation on how to address the following issues: accessing prison, planning data collection, sampling procedures according to type of data to be collected, mode of administration/data gathering, data analysis and dissemination; ethical issues, involvement of people living in prison and staff in all phases of data gathering.

Prevalence of and Risk Factors for Drug-Related Readmissions in Older Adults: A Systematic Review and Meta-Analysis.

Older adults are at an increased risk of drug-related problems, especially following discharge from hospital. Drug-related readmissions place a large burden on the patient and the healthcare system. However, previous studies report inconsistent results on the prevalence and associated risk factors for drug-related hospital readmissions in older adults. We aimed to assess the prevalence of drug-related readmissions in older adults aged 65 years and older and investigate the drug classes, preventability and risk factors most associated with these readmissions. A systematic review and meta-analysis were undertaken to answer our objectives. A search of four databases (MEDLINE, Embase, CINAHL and Scopus) was conducted. Three authors independently performed title and abstract screening, full-text screening and data extraction of all included studies. A meta-analysis was conducted to calculate the pooled prevalence of drug-related readmissions across all studies, and a subgroup analysis was performed to explore heterogeneity among studies reporting on adverse drug reaction-related readmissions. A total of 1978 studies were identified in the initial search, of which four studies were included in the final synthesis. Three studies focused on readmissions due to adverse drug reactions and one study focused on readmissions due to drug-related problems. A pooled prevalence of 9% (95% confidence interval 2-18) was found for drug-related readmissions across all studies, and a pooled prevalence of 6% (95% confidence interval 4-10) was found for adverse drug reaction-related readmissions. Three studies explored the preventability of readmissions and 15.4-22.2% of cases were deemed preventable. The drug classes most associated with adverse drug reaction readmissions included anticoagulants, antibiotics, psychotropics and chemotherapy agents. Polypharmacy (the use of five or more medications) and several comorbidities such as cancer, liver disease, ischaemic heart disease and peptic ulcer disease were identified as risk factors for drug-related readmissions. Almost one in ten older adults discharged from hospital experienced a drug-related hospital readmission, with one fifth of these deemed preventable. Several comorbidities and the use of polypharmacy and high-risk drugs were identified as prominent risk factors for readmission. Further research is needed to explore possible causes of drug-related readmissions in older adults for a more guided approach to the development of effective medication management interventions.

Medication Reviews and Clinical Outcomes in Persons with Dementia: A Scoping Review.

Persons diagnosed with dementia are often faced with challenges related to polypharmacy and inappropriate medication use and could benefit from regular medication reviews. However, the benefit of such reviews has not been examined in this population. Therefore, the current scoping review was designed to identify the gaps in the current knowledge regarding the impact of medication reviews on the clinical outcomes in older adults with dementia. Relevant studies were identified by searching three databases (Ovid MEDLINE, Ovid EMBASE, and Scopus) from inception to January 2022 with a combination of keywords and medical subject headings. After the removal of duplicates and ineligible articles, 22 publications of the initial 8346 were included in this review. A total of 57 outcomes were identified, including those pertaining to the evaluation of medication use (n = 17), drug-related interventions (n = 11), drug-related problems (n = 10), dementia-related behavioral symptoms (n = 8), cost-effectiveness (n = 2), drug-related hospital admissions (n = 1), as well as outcomes classified as other (n = 7). Gaps identified through this scoping review included the paucity of studies measuring the impact of medication reviews on the medication management capacity and medication adherence, quality of life, and mortality.