Effects Of Medication Use Research Articles

Short-Term Medication Effect on Fall Risk in Multimorbid Inpatients with Dementia

Introduction: Dementia increases the risk of falls and fall-related injuries, which may be caused by inappropriate medication use. To date, there is little evidence on which medications are more likely to cause falls. We therefore investigated the effects of medication use and medication changes 48 h before falls in hospitalised patients with dementia. Methods: This matched case-control study included 74 patients with a mean age of 83 years (38% women) who had been hospitalised for at least 7 days. Information on medications, diagnoses, disease severity, use of walking aids, falls, and demographics was collected from electronic medical records. The effects of the number of medications and psychotropics, equivalent daily doses of antidepressants, antipsychotics and benzodiazepines, anticholinergic burden, medication initiation, dose change, medication discontinuation, as-needed medications, opioid use and the presence of fall-increasing diseases were examined separately for the periods 0 h–24 h and 24 h–48 h before the falls using binomial logistic regression analyses. Results: Falls increased significantly with higher daily antipsychotic doses 24 h before the fall. In addition, the rate of falls increased with higher anticholinergic burden and prevalence of medication discontinuation 24–48 h before the fall. Notably, the total number of medications and psychotropic medications had no effect on the incidence of falls. Conclusion: With regard to the short-term effects of medication on fall risk, particular attention should be paid to the daily dose of antipsychotics, anticholinergic burden and medication discontinuation. Further studies with larger samples are needed to confirm the results of this study.

Assessing cumulative effects of medication use: New insights and new challenges.

Assessing cumulative effects of medication use: New insights and new challenges.

Association of medication use with increased fall risk in inpatients: a single-center matched study

Background: Evaluation of drug-induced fall risk is often neglected in clinical practice. The purpose of this study was to analyze the effects of medication use on falls in hospitalized elderly patients. Methods: This was a retrospective case-control study. A total of 1,020 patients were evaluated who were 60 years and over and admitted between January 1st and December 31, 2021. Patients aged 60 years and over with reports of fall accidents in 2021 were included in the fall group. Cases were matched 1:4 on sex, age, medical department, and Morse Fall Scale (MFS) score to randomly selected control from patients with no falls. Demographics, MFS score, physical examination, and medication profile were collected from electronic medical records. Data were analyzed by chi-square test and multiple logistic regression analysis.Results: After adjustment for age, sex, medical department, MFS score and Charlson comorbidity index, hemoglobin level, sodium level, ambulatory aid, gait/transferring (impaired), mental status, polypharmacy (10 and more), use of anxiolytics, antipsychotics, opioids, and anticholinergics were significantly associated with falls. On multiple regression analysis, hemoglobin level, ambulatory aid (furniture), use of anxiolytics, and opioids were significantly associated with falls in every model. Conclusions: The type of medication, especially anxiolytics and opioids, was more significantly associated with increased risk of falls than polypharmacy. It is suggested to be aware of the effects of medication on falls and evaluate medication use on a regular basis.

Understanding medication-related burden from patient perspectives: a qualitative study testing the applicability of the conceptual model among chronically ill outpatients in Finland

ObjectivesDisease self-management and medication therapy can cause burden to patients that can influence adherence. The conceptual model ‘patients’ lived experience with medicine’ (PLEM) brings new insights into medication-related burden (MRB)...

Levothyroxine initiation and the risk of pregnancy loss among pregnant women with subclinical hypothyroidism: An observational study emulating a target trial.

While the benefits of levothyroxine are well-established for overt hypothyroidism, they are unclear for subclinical hypothyroidism (SCH) among pregnant women. To estimate the effect of initiation of levothyroxine on pregnancy loss among women with SCH with an emulated target trial using observational data. We emulated a target trial using the United Kingdom's Clinical Practice Research Datalink to account for the staggered timing of diagnosis and treatment of SCH and the time of entry of women into prenatal care. We emulated multiple nested trials (at each gestational week) and used an intention-to-treat approach to define levothyroxine use (≥1 prescription in the 7 days prior to trial entry), with eligible users matched to non-users (1:4) on time of diagnosis, gestational week of the first eligible trial and high-dimensional propensity score. Pregnancy losses included spontaneous abortion and stillbirth. A pooled logistic regression model with bootstrap resampling was used to estimate the hazard ratios (HR) and 95% confidence intervals (CI). Based on 159,177 eligible person-trials (5781 women), the matched cohort included 181 initiators and 640 non-initiators of levothyroxine, with 57 pregnancy losses occurring during follow-up. Overall, the mean age of women was 32.2 years (SD 5.4), 25% were obese, 8% had type 2 diabetes and about 50% were nulliparous. After matching, women who initiated levothyroxine versus not had higher thyroid-stimulating levels during pregnancy and were more likely to have a history of hypothyroidism. The cumulative incidence of pregnancy loss was lower in initiators versus non-initiators of levothyroxine. The adjusted HR for pregnancy loss was 0.87 (95% CI 0.22, 1.56). Although our assessment of the effect of initiation of levothyroxine for SCH in pregnancy precludes any definitive conclusions due to wide confidence intervals, this study illustrates the feasibility of using the target trial emulation framework to examine the effectiveness of medication use in pregnancy.

Gynecomastia - a literature review of management, diagnosis and treatment

Introduction and Purpose: Gynecomastia is a common clinical problem that can also be a symptom of many serious disorders. The aim of this study is to analyze the etiology, pathogenesis, diagnostics, as well as pharmacological and surgical treatment, while also addressing the psychological aspect of the condition. State of Knowledge: Gynecomastia is the development of noncancerous breast tissue in males. It can occur unilaterally or bilaterally and may cause pain. It can be a natural occurrence during infancy, adolescence, and and in older age. It is usually accompanied by an imbalance between estrogens and androgens. Hormonal disorders lead to the growth of stromal and ductal proliferation. In the diagnostic process, the most important aspect is establishing the cause of the condition, allowing for the implementation of appropriate treatment. Gynecomastia can cause a decrease in quality of life, depression, anxiety, and reduced self-esteem. Conclusions: Gynecomastia is a complex condition that requires an individualized approach to the patient. It can be a side effect of medication use, result from an underlying disease, or occur idiopathically. Surgical treatment forms the basis of the therapeutic process. Currently, combined surgical techniques are most commonly used to achieve the best cosmetic effect.

Effects of Medications on Heat Loss Capacity in Chronic Disease Patients: Health Implications Amidst Global Warming.

Pharmacological agents used to treat or manage diseases can modify the level of heat strain experienced by chronically ill and elderly patients via different mechanistic pathways. Human thermoregulation is a crucial homeostatic process that maintains body temperature within a narrow range during heat stress through dry (i.e., increasing skin blood flow) and evaporative (i.e., sweating) heat loss, as well as active inhibition of thermogenesis, which is crucial to avoid overheating. Medications can independently and synergistically interact with aging and chronic disease to alter homeostatic responses to rising body temperature during heat stress. This review focuses on the physiologic changes, with specific emphasis on thermolytic processes, associated with medication use during heat stress. The review begins by providing readers with a background of the global chronic disease burden. Human thermoregulation and aging effects are then summarized to give an understanding of the unique physiologic changes faced by older adults. The effects of common chronic diseases on temperature regulation are outlined in the main sections. Physiologic impacts of common medications used to treat these diseases are reviewed in detail, with emphasis on the mechanisms by which these medications alter thermolysis during heat stress. The review concludes by providing perspectives on the need to understand the effects of medication use in hot environments, as well as a summary table of all clinical considerations and research needs of the medications included in this review. SIGNIFICANCE STATEMENT: Long-term medications modulate thermoregulatory function, resulting in excess physiological strain and predisposing patients to adverse health outcomes during prolonged exposures to extreme heat during rest and physical work (e.g., exercise). Understanding the medication-specific mechanisms of altered thermoregulation has importance in both clinical and research settings, paving the way for work toward refining current medication prescription recommendations and formulating mitigation strategies for adverse drug effects in the heat in chronically ill patients.

Effects of Motherwort Injection Versus Intramuscular Oxytocin for Preventing Postpartum Hemorrhage Among Women Who Underwent Cesarean Section.

Objectives: Subject to ethical constraints, real-world data are an important resource for evaluating treatment effects of medication use during pregnancy and the postpartum period. This study investigated whether motherwort injection, a traditional Chinese medicine preparation, was more effective than intramuscular (IM) oxytocin for preventing postpartum hemorrhage (PPH) in a real-world setting when intravenous (IV) oxytocin is administered. Methods: We conducted an active-controlled, propensity-score matched cohort study using an established pregnancy registry database. Women who underwent cesarean section and received IV oxytocin at the third stage of labor were included. We used an active-comparator design to minimize indication bias, in which we compared IM motherwort injection in the uterus versus IM oxytocin, both on top of IV oxytocin use. We applied 1:1 propensity-score matching (PSM) to balance patient baseline characteristics and used a logistic regression model to estimate treatment effect (i.e., risk difference (RD) and odds ratio (OR)) by using the counterfactual framework. The outcomes of interest were blood loss over 500 ml within 2 h after delivery (PPH, primary) and blood loss over 1,000 ml (severe PPH, secondary). We conducted four sensitivity analyses to examine the robustness of the results. Results: A total of 22,519 pregnant women underwent cesarean sections, among which 4,081 (18.12%) PPH and 480 (2.13%) severe PPH occurred. Among included women, 586 (2.60%) were administrated with IM motherwort injection, and 21,933 (97.40%) used IM oxytocin. After PSM, patient baseline characteristics were well balanced. Compared with IM oxytocin, the use of IM motherwort injection was associated with significantly lower risk of PPH (RD −25.26%, 95% CI −30.04% to −20.47%, p < 0.001; OR 0.25, 95% CI 0.18 to 0.32, p < 0.001) and severe PPH (RD −3.58%, 95% CI −5.87% to −1.30%, p < 0.001; OR 0.39, 95% CI 0.20 to 0.71, p < 0.002). Sensitivity analyses showed that the results were similar. Conclusion: With the use of data from a real-world setting, the findings consistently showed that among women undergoing cesarean section who had received IV oxytocin, the additional use of IM motherwort injection could achieve a lower risk of PPH as compared to the additional use of IM oxytocin. Our study suggested a paradigm for investigating the treatment effect of Chinese herbal medicine in the real-world practice setting.

Impacts and effects of the use of medications by crew and passengers during air transport

During a flight, changes occur in the human body, whose possible reactions can influence the well-being and quality of health of medicine users, subject of scarce studies. The aim of this paper is to analyze the impacts and effects of medication use during air transport. Through a literature review and documentary research methodology, relevant facts about the precautions that should be taken regarding the use of medication in flights were considered. As a practical contribution, some important medications and their possible effects during flights are presented, as well as some warnings about medication interactions, and some advice for better quality air travel for the health of passengers and crew are given. As a theoretical contribution, this study gathers the scattered information presented in the literature about the problems that the use of medications during a flight can cause to the human body and possible recommendations. As social contribution, this study warns about the risks of self-medication, and establishes a basis for future discussions with society about the use of medication in flights.

Methods for controlling time-varying confounding in pharmaco-epidemiological studies: a systematic reveiw

Objective: To systematically review the application of methods for controlling time-varying confounding in pharmaco-epidemiological studies. Methods: PubMed, Embase, CNKI, and Wanfang were searched for pharmaco-epidemiological studies involving time-varying confounding on June 15th, 2020. The basic characteristics, drug exposure and outcome, time-varying confounders and the application of methods to control these confounders were analyzed. Results: A total of 298 articles were included. An increasing trend was observed in numbers of studies dealing with time-varying confounding in pharmaco-epidemiological studies in recent years. A total of 106 (35.6%) studies involved the safety or effectiveness of medication use in HIV/AIDS patients and 92 of them involved antiretroviral drugs. The most common outcome was mortality, while the most commonly concerned time-dependent confounders were laboratory examination results (179, 60.1%), comorbidities (136, 45.6%), and co-used medications (108, 36.2%). Marginal structure model (MSM) and inverse probability of treatment weighting (IPTW) were the most commonly used methods to control time-varying confounding factors (244, 81.9%). Compared with the results after properly controlling time-varying confounding, traditional methods adjusting only baseline confounders resulted in substantial bias (median 18.2%, interquartile range, 7.4%-40.8%). As for basic assumptions needed for causal methods controlling time-varying confounding, 28.9% and 64.8% of the included studies examined or discussed the assumptions of positivity and no unmeasured confounders, respectively. Conclusions: At present, most of the fields of drug therapy for chronic diseases still pay insufficient attention to time-varying confoundings. Information collected in routine medical practice, such as laboratory tests, comorbidities, and co-used drugs, was the most commonly concerned time-varying confounder. MSM and IPTW were the most commonly applied methods for dealing with time-varying confounding.

Analysis of the impact of antidepressants and other medications on COVID-19 infection risk in a chronic psychiatric in-patient cohort.

During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, patients with confirmed cases in New York State accounted for roughly 25% of total US cases, with psychiatric hospital in-patients at particularly high risk for COVID-19 infection. The beneficial effects of mental health medications, such as selective serotonin reuptake inhibitors (SSRIs), on the severity of COVID-19 disease outcomes have been documented. Protective effects against infection have also been suggested for these medications. We therefore tested the hypothesis that medication use modifies the risk of COVID-19 infection in a long-stay, chronic in-patient psychiatry setting, where the potential for exposure was likely uniform across the facility, and where these medications were routinely prescribed. This was a retrospective cohort study of an adult psychiatric facility operated by the New York State Office of Mental Health. Current medication information and COVID-19 status was collected from electronic medical records for 165 people who were in-patients during the period January to July 2020, and logistic regression was employed to model the main effects of medication use on COVID-19 infection. A significant protective association was observed between antidepressant use and COVID-19 infection (odds ratio (OR) = 0.33, 95% CI 0.15-0.70, adjusted P < 0.05). Analysis of individual antidepressant classes showed that SSRI, serotonin-norepinephrine reuptake inhibitor and the serotonin-2 antagonist reuptake inhibitor classes of antidepressants, drove this protective effect. Exploratory analyses of individual antidepressants demonstrated an association between lower risk of infection and fluoxetine use (P = 0.023), as well as trazodone use (P = 0.001). The novel finding of reduced COVID-19 infection risk for psychiatric in-patients taking antidepressants, suggests that antidepressants may be an important weapon in the continued fight against COVID-19 disease. This finding may become particularly salient for in-patient settings if vaccine-resistant strains of the virus appear.

The Peripheral Blood Inflammatory Patterns in the Control Levels of Asthma in Children

To evaluate the role of white blood cell count, platelet count (PLT), mean platelet volume (MPV), and eosinophil percentage as objective markers of asthma control in pediatric patients.The study included 348 patients between the ages of 4 and 18 years diagnosed with asthma from January 2011 through September 2015 at the University of Health Sciences in Ankara, Turkey. Within the cohort, 63.2% were male, and 43.1% had controlled asthma.This was a retrospective and cross-sectional study in which subjects with asthma were separated into 2 groups: controlled and uncontrolled asthma (by using the Asthma Control Test). Subjects were further subdivided into groups on the basis of medication use (regular versus irregular) and atopic status (atopic versus nonatopic). The white blood cell count, PLT, MPV, eosinophil percentage, forced expiratory volume in 1 second (%), FVC (%), and forced expiratory volume in 1 second to FVC (%) were extracted from each subject’s medical record. Laboratory data were compared between patients in the controlled and uncontrolled asthma groups. The effect of medication use and atopic status on laboratory data were further analyzed.The eosinophil percentage was significantly higher in the uncontrolled asthma group (4.992 ± 3.43), compared with that of the controlled asthma group (3.493 ± 2.24) independent of atopic status. There were no significant differences in the PLT, MPV, or eosinophil percentages between asthmatics with and without atopy. The eosinophil percentage was significantly higher among asthmatics with regular medication use (4.788 ± 3.007) versus that of those with irregular medication use (3.986 ± 3.077).Eosinophil percentage may be an effective marker to monitor asthma control in the pediatric population.Monitoring asthma control can be difficult in pediatric patients who are too young or unable to perform pulmonary function tests. With this study, the authors suggest a role for biomarkers, such as eosinophil percentage, in the monitoring of pediatric asthma. Eosinophil percentage could be used in the follow-up and treatment of asthma in pediatric patients who are unable to perform other objective tests. Randomized controlled trials are needed to confirm that eosinophil percentage is a reliable parameter.

The effect of preventative cardiovascular therapies on coronary artery disease in people with and without type 2 diabetes: a propensity-matched score study

BackgroundAlthough it is known that patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of coronary artery disease (CAD), the actual coronary artery burden of atherosclerotic disease in patients with and without T2DM in a real-world setting and its possible modification by preventative therapies has not been extensively documented.MethodsMerged coronary angiography and hospital discharge data between 2013 and 2019 were obtained for analysis and a random sub-sample of patient charts were reviewed for medication use. Propensity scores were estimated using logistic regression models and used to match patients, looking at the effect of severity of CAD over time in years in an ordinal logistic regression model. A separate propensity score was estimated and used to inverse probability weight the ordinal logistic regression looking at the effect of medication use on CAD severity in patients with and without T2DM.ResultsFrom 3,016 patients in the coronary angiography database, 1421 with T2DM and 1421 without T2DM were matched on propensity score. T2DM patients had more extensive CAD in 2018 compared to 2013 ((adjusted odds ratio) adjOR: 2.06 95% C.I. 1.38, 2.07), but this risk appeared to be attenuated in 2019. In contrast, there was no effect of time on CAD burden in patients without diabetes. In the sub-sample of 760 patients who underwent a chart review of their medication use, there were 367 (48%) with T2DM. For patients with T2DM 69.8% reported taking statins, 64.0% RAS inhibitors and 64.0% anti-platelet drugs. This was significantly higher than patients without diabetes of whom 46.6% reported taking statins, 49.0% RAS inhibitors and 49.9% anti-platelet drugs. As in the full matched sample, patients with diabetes had more extensive CAD (adjOR: 1.32 95% CI: 1.01, 1.74). However, after adjustment for the use of RAS inhibitors, statins and anticoagulants there was no difference in extent of CAD between patients with and without diabetes (adjOR: 1.14 95% CI: 0.85, 1.53).ConclusionsAlthough patients with diabetes have a greater extent of CAD in comparison to those without T2DM, preventative medication use decreases this CAD burden significantly.

Effects of Medication Use on Small Airway Function and Airway Inflammation in Patients with Clinically Controlled Asthma

To observe effects of medication use on small airway function, airway inflammation and acute exacerbations in patients with clinically controlled asthma. Forced expiratory flow over the middle half of the forced expiratory curve (FEF25%-75%), percentage of eosinophil, concentrations of eosinophil cationic protein (ECP) and interleukin (IL)-5 in induced sputum were assessed in patients with clinically controlled asthma who were given oral anti-inflammatory agents alone or in combination with inhaled therapy and inhaled therapy alone. Subsequently, acute exacerbations were compared between two groups during the 24-week follow-up period. FEF25%-75% in 43 patients with clinically controlled asthma given oral anti-inflammatory agents alone or in combination with inhaled therapy was significantly higher than that in 49 patients given inhaled therapy alone. Meanwhile, the percentage of eosinophils and levels of IL-5 and ECP in patients with clinically controlled asthma given oral anti-inflammatory agents alone or in combination with inhaled therapy were significantly lower than those in patients given inhaled therapy alone. Additionally, the patients with clinically controlled asthma given inhaled therapy were likely to have more acute exacerbation than the patients given oral anti-inflammatory agents alone or in combination with inhaled therapy during the 24-week follow-up period. Systemic anti-inflammatory agents may have a greater effect on parameters reflecting small airway patency and reducing acute exacerbations, presumably secondary to reduction in airway inflammation.

Association between current medication use and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative.

ObjectiveUse of specific medications may accelerate the progression of radiographic knee OA (RKOA). Our aim was to examine the effect of medication use on the progression of RKOA.MethodsWe used longitudinal data from the Osteoarthritis Initiative (OAI), an observational study of risk factors for knee OA. At baseline, we selected participants with RKOA (Kellgren–Lawrence grade ≥2) and excluded those with a history of knee-related injury/surgery and other musculoskeletal disorders. Current medication use (use/non-use in the previous 30 days) and radiographic medial minimum joint space width (mJSW) data were available at baseline and annually up to 96 months follow-up. We used random effects, panel regression to assess the association between current medication use (non-users as reference group) and change in mJSW.ResultsOf 2054 eligible participants, 2003 participants with baseline mJSW data were included [55.7% female, mean age 63.3 (s.d. 8.98) years]. Of seven medication classes, at baseline NSAIDs were the most frequently used analgesia (14.7%), anti-histamine (10.4%) use was frequent and the following comorbidity medications were used most frequently: statins (27.4%), anti-hypertensives (up to 15.0%), anti-depressant/anxiolytics/psychotropics (14.0%), osteoporosis-related medication (10.9%) and diabetes-related medication (6.9%). Compared with current non-users, current use of NSAIDs was associated with a loss of mJSW (b = −0.042, 95% CI −0.08, −0.0004). No other associations were observed.ConclusionsIn current users of NSAIDs, mJSW loss was increased compared with current non-users in participants with RKOA. Clinical trials are required to assess the potential disease-modifying effects of these medications.

The dental management of the asthmatic patients.

Asthma is the most common chronic respiratory condition characterized by airway inflammation and obstruction. Our increased knowledge and understanding of the etiology and pathogenesis of this condition has widely assisted us in delivering effective therapies. Physicians strive to provide the best treatment modality to achieve symptom-control and minimize the adverse effects of medication use. Nonetheless, patients continue to endure oral complications from the use of asthma medications. As dentists, it is prudent to address these oral complications and promote the oral health of these patients by way of early preventive and therapeutic dental intervention. This must be accomplished by adhering to certain precautionary measures for the sake of avoiding intraoperative problems while optimizing oral care. In this article, we discuss the diagnosis, oral findings, dental care, and emergency management of the asthmatic patients.

Patient Perspectives on Health Data Privacy and Implications for Adverse Drug Event Documentation and Communication: Qualitative Study.

BackgroundAdverse drug events are unintended and harmful effects of medication use. Using existing information and communication technologies (ICTs) to increase information sharing about adverse drug events may improve patient care but can introduce concerns about data privacy.ObjectiveThis study aims to examine the views of patients and their caregivers about data protection when using ICTs to communicate adverse drug event information to improve patient safety.MethodsWe conducted an exploratory qualitative study. A total of 4 focus groups were held among patients who had experienced or were at risk of experiencing an adverse drug event, their family members, and their caregivers. We recruited participants through multiple avenues and iteratively analyzed the data using situational analysis.ResultsOf the 47 participants recruited, 28 attended our focus groups. We identified 3 primary themes. First, participants felt that improved information sharing about adverse drug events within their circle of care would likely improve care. Second, participants were concerned about data handling and inappropriate access but believed that the benefits of information sharing outweighed the risks of privacy breaches. Finally, participants were more concerned about data privacy in the context of stigmatized health conditions.ConclusionsCurrent conditions for maintaining health data privacy are consistent with participants’ preferences, despite the fact that health data are susceptible to breaches and mismanagement. Information sharing that increases patient safety may justify potential privacy risks. Greater attention to patient concerns and the effect of social and contextual concerns in the design and implementation of health information technologies may increase patient confidence in the privacy of their information.

PIH13 Medications Risk and Pregnancy: Knowledge, Attitude, and Practice of Pharmacists in Gondar TOWN, North WEST Ethiopia. a CROSS-Sectional Study

:The aim of this study was to assess the knowledge, attitude, and practice of pharmacy professionals toward the risk of medication use during pregnancy in Gondar town. A questionnaire-based cross-sectional survey was carried out over practicing community and hospital pharmacists in Gondar town. Both descriptive and analytic statistics was utilized. For descriptive analysis, results were expressed as numbers, percentages and mean (± SD and 95% CI). Out of 152 pharmacists invited to participate, 135 of them completed the survey giving a response rate of 88.8%.The mean age of respondents was 28.64 years with a standard deviation of ± 5.0. Moreover, the majority of pharmacists 78 (57.8%) had >5years and 57 (42.2%) had <5years of work experience. About 74 (54.8%) of the respondent knew the harmful effect of medication use during pregnancy and two-third of the participants (60%) knew the cause of NSAIDs when it used in the third trimester. More than half of the participants 75 (55.6%) agreed that most of the presently available drugs are unsafe during pregnancy and among the respondent, about 65(48%) of the respondent was believed that drugs increase the risk of birth defects to a very large extent. The majority of the respondent (72%) also reported they tell a common side effect to pregnant women. Most respondents exhibited a healthy attitude and practice but very low knowledge about drug safety during pregnancy. Even if the pharmacists exhibit a healthy attitude towards medication use during pregnancy, there are still gaps in knowledge where educational interventions are needed.

PIH60 MEDICATIONS RISK AND PREGNANCY: KNOWLEDGE, ATTITUDE, AND PRACTICE OF PHARMACISTS IN GONDAR TOWN, NORTH WEST ETHIOPIA. A CROSS-SECTIONAL STUDY

The aim of this study was to assess the knowledge, attitude, and practice of pharmacy professionals toward the risk of medication use during pregnancy in Gondar town. A questionnaire-based cross-sectional survey was carried out over practicing community and hospital pharmacists in Gondar town. Both descriptive and analytic statistics was utilized. For descriptive analysis, results were expressed as numbers, percentages and mean (± SD and 95% CI). Out of 152 pharmacists invited to participate, 135 of them completed the survey giving a response rate of 88.8%.The mean age of respondents was 28.64 years with a standard deviation of ± 5.0. Moreover, the majority of pharmacists 78 (57.8%) had >5years and 57 (42.2%) had <5years of work experience. About 74 (54.8%) of the respondent knew the harmful effect of medication use during pregnancy and two-third of the participants (60%) knew the cause of NSAIDs when it used in the third trimester. More than half of the participants 75 (55.6%) agreed that most of the presently available drugs are unsafe during pregnancy and among the respondent, about 65(48%) of the respondent was believed that drugs increase the risk of birth defects to a very large extent. The majority of the respondent (72%) also reported they tell a common side effect to pregnant women. Most respondents exhibited a healthy attitude and practice but very low knowledge about drug safety during pregnancy. Even if the pharmacists exhibit a healthy attitude towards medication use during pregnancy, there are still gaps in knowledge where educational interventions are needed.

Emergency department-based medication review on outpatient health services utilization: interrupted time series

BackgroundOne in nine emergency department (ED) visits in Canada are caused by adverse drug events, the unintended and harmful effects of medication use. Medication reviews by clinical pharmacists are interventions designed to optimize medications and address adverse drug events to impact patient outcomes. However, the effect of medication reviews on long-term outpatient health services utilization is not well understood. This research studied the effect of medication review performed by clinical pharmacists on long-term outpatient health services utilization.MethodsData included information from 10,783 patients who were part of a prospective, multi-centre quality improvement evaluation from 2011 to 2013. Outpatient health services utilization was defined as total ED visits and physician contacts, aggregated to four physician specialty groups: general and family practitioners (GP); medical specialists; surgical specialists; and imaging and laboratory specialists. During triage, patients deemed high-risk based on their medical history, were systematically allocated to receive either a medication review (n = 6403) or the standard of care (n = 4380). Medication review involved a critical examination of a patient’s medications to identify and resolve medication-related problems and communicate these results to community care providers. Interrupted time series analysis compared the effect of the intervention on health services utilization relative to the standard of care controlling for pre-intervention differences in utilization.ResultsED-based pharmacist-led medication review did not result in a significant level or trend change in the primary outcome of total outpatient health services utilization. There were also no differences in the secondary outcomes of primary care physician visits or ED visits relative to the standard of care in the 12 months following the intervention. Our findings were consistent when stratified by age, hospital site, and whether patients were discharged on their index visit.ConclusionThis was the first study to measure long-term trends of physician visits following an ED-based medication review. The lack of differences in level and trend of GP and ED visits suggest that pharmacist recommendations may not have been adequately communicated to community-based providers, and/or recommendations may not have affected health care delivery. Future studies should evaluate physician acceptance of pharmacist recommendations and should encourage patient follow-up to community providers.