Medicine-related Problems Research Articles

CP-084 Pharmacist identification of potential side effects in patients with multimorbidity and polypharmacy

BackgroundDenmark’s first outpatient clinic for multimorbidity and polypharmacy opened at Silkeborg Regional Hospital in 2012. The clinic treats patients with at least 2 chronic illnesses, who present with a variety...

DI-049 Pharmacist’s interventions to improve drug supply and parentsí knowledge at paediatric hospital discharge

BackgroundDischarging paediatric patients from hospital is a complex process that can lead to non-compliance and medicines-related problems. Crucial issues are drug supply in community pharmacies and patients’ knowledge of treatments....

OHP-029 Parents of paediatric liver transplant patients – Opinions and experiences of medicines issues

BackgroundImmunosuppressant treatment is a critically important aspect of post-transplant patients’ care. In our English paediatric hospital, a multidisciplinary team including doctors, specialist nurses and pharmacy staff is involved in family-centred...

CP-137 Ensuring safe medical treatment during planned hospital admission by clinical pharmacist telephone contact

BackgroundMedicines lists are often incomplete, with a lot of discrepancies, which may lead to adverse drug events during hospitalisation and after discharge. In Denmark no single electronic system contains all...

PS-018 Adverse drug events (ADEs) in Spanish hospitals

BackgroundSpecific studies focusing exclusively on ADEs show different values in incidence and nature of the reported events. Evidence from general adverse events studies has never been analysed in Spain.PurposeTo evaluate...

CP-013 Prevalence of potentially inappropriate use of medicines in older adults

BackgroundPotentially inappropriate medicines (PIM) use in older adults has been associated with increased medicines-related problems and morbidity. Investigating the prevalence of this problem is important for the initiation of intervention...

A Framework for Assessing the Economic Value of Pharmacovigilance in Low- and Middle-Income Countries

Pharmacovigilance (PV) programs are an essential component of national healthcare systems. Well-functioning PV programs can improve population health by identifying and reducing medicines-related problems (MRPs). Many low- and middle-income countries lack functional PV systems, but this deficiency has not been described in terms of the potential economic value of strengthening PV systems. The assessment of economic value for PV can support rational decision making at the country level. We propose a framework for assessing the economic value of PV. We divide national PV systems into four levels: (1) no PV, (2) basic PV, (3) semi-functional PV, and (4) functional PV. These categories represent increasing levels of investment in PV capacity at the national or health facility level for all available medicines, including vaccines. The proposed framework can be used to estimate the costs of PV (including the value of investments to increase PV capacity and the costs of managing MRPs) and outcomes associated with PV (including improvements in morbidity, mortality, and quality of life as a result of the reduction in MRPs). The quantitative approach proposed for assessing costs and benefits uses a decision-analytic modeling framework that would estimate the value of the consequences of MRPs adjusted for their probability of occurrence. This allows the quantification of value using monetary outcomes (cost-benefit analysis), natural units (cost-effectiveness analysis), or mortality adjusted for quality of life or disability (cost-utility analysis). Evidence generated using this framework could assist policy makers, program managers, and donors in evaluating investments that aim to increase the capacity and efficiency of national and facility-level PV programs in low- and middle-income countries.

Australian community pharmacists’ awareness and practice in supporting secondary prevention of cardiovascular disease

Pharmacists are well placed to identify, prevent and resolve medicine related problems as well as monitor the effectiveness of treatments in cardiovascular disease (CVD). Pharmacists' interventions in CVD secondary prevention have been shown to improve outcomes for clients with established CVD. To explore the scope of pharmacists' activities in supporting CVD secondary prevention. Community pharmacies in New South Wales, Australia. Twenty-one in-depth, semi-structured interviews with a range of community pharmacists were conducted. All interviews were audio-recorded and transcribed ad verbatim. Data were analyzed using a 'grounded-theory' approach by applying methods of constant comparison. Community pharmacists' awareness and current practice in supporting secondary prevention of CVD. Four key themes identified included 'awareness', 'patient counselling', 'patient monitoring', and 'perceptions of the role of pharmacists in CVD secondary prevention'. The pharmacists demonstrated a moderate understanding of CVD secondary prevention. There was considerable variability in the scope of practice among the participants, ranging from counselling only about medicines to providing continuity of care. A minority of pharmacists who had negative beliefs about their roles in CVD secondary prevention offered limited support to their clients. The majority of pharmacists, however, believed that they have an important role to play in supporting clients with established CVD. Community pharmacists in Australia make a contribution to the care of clients with established CVD despite the gap in their knowledge and understanding of CVD secondary prevention. The scope of practice in CVD secondary prevention ranged from only counselling about medicines to offering continuity of care. The extent of pharmacists' involvement in offering disease management appears to be influenced by their beliefs regarding what is required within their scope of practice.

Adverse drug reactions in the elderly

Medications probably are the single most important health care technology in preventing illness, disability, and death in the geriatric population. Age-related changes in drug disposition and pharmacodynamic responses have significant clinical implications; increased use of a number of medications raises the risk that medicine-related problems may occur. The relationship between increased use of drugs including the prescription medication and elderly is well established. Majority of ADRs (80%) causing admission or occurring in hospital are type A reactions. Although less common occurring in elderly, type B ADRs may sometimes cause serious toxicity. Studies have correlated the integral association between old age and increased rate of adverse drug reactions arising out of confounding association between age and polypharmacy contributed by age-related changes in pharmacodynamics and pharmacokinetics at least for some medical conditions. A drug combination may sometimes cause synergistic toxicity which is greater than the sum of the risks of toxicity of either agent used alone. But, strategies to increase opportunities for identifying ADRs and related problems have not been emphasised in current international policy responses especially in India to the increase in elderly population and chronic conditions. Careful epidemiological studies that encompass large numbers of elderly drug users are required to obtain this information as increased knowledge of the frequency and cost of adverse drug reactions is important in enabling both more rational therapeutic decisions by individual clinicians and more optimal social policy.

GRP-039 Classification of the Pharmaceutical Interventions Made Using the ISOFAR Programme

BackgroundA variety of errors in the medication process means reduced safety for the patient and less effective treatment.PurposeTo analyse from the Unidosis area the types of intervention, medicines-related problems (MRPs),...

GRP-137 Pharmaceutical Interventions at Beatriz Angelo Hospital

BackgroundBeatriz Ângelo Hospital (HBA) is 424-bed district hospital (210-bed Medical Specialties, 90-bed Surgical Specialties, and 22-bed Intensive/Intermediate care unit, among others).All prescriptions are validated by a pharmacist at the Department...

Medicine use and medicine-related problems experienced by ethnic minority patients in the United Kingdom: a review

The aim of this review was to establish type(s) and possible cause(s) of medicine-related problems (MRPs) experienced by ethnic minorities in the UK and to identify recommendations to support these patients in the effective use of medicines. A systematic search of studies related to problems with medicine use experienced by ethnic minorities in the UK was performed using the following databases: PubMed, Embase, International Pharmaceutical Abstract and Scopus from 1990 to 2011. A hand search for relevant citations and key journals was also performed. Fifteen studies were found. The MRPs identified across studies included lack of information, problems with not taking medicines as advised, concern of dependency or side effects, lack of regular monitoring and review, risk of adverse drug reactions, adverse events and problems in accessing healthcare services. Many problems are common in other groups, however, studies examining possible explanatory factors discussed how the cultural and religious beliefs, previous experiences, different expectations, language and communication barriers, lack of knowledge of the healthcare services and underestimating patients' desire for information may contribute to the problems. Some of the recommendations were made based on the problems that were found, but these have not been evaluated. Little evidence is known of what influences MRPs among ethnic minorities, despite the increased diversification of populations in countries throughout the world. To support their entire populations in the use of medicines, we have to ensure that we understand their different perspectives and needs regarding the effective use of medicines.

Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

BackgroundChronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda.MethodsA cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data.ResultsOverall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37).ConclusionsPatients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

Exploring patients’ motivation to participate in Australia’s Home Medicines Review program

Patients at risk of experiencing medicine-related problems do not always appear willing to participate in collaborative medication management services. Little is known about the psycho-social factors which motivate patients to participate in these services. The theory of motivated information management (TMIM) suggests that patients' willingness to participate may be motivated by their uncertainty and worry about their medicines. The objective of this study was to investigate factors which may motivate patients to participate in a collaborative medication management program. Fourteen semi-structured focus group interviews held throughout Australia provided the data for the study. Eighty participants were recruited by community pharmacists. Participants were recruited into the study if they had experienced Australia's Home Medicines Review (HMR) program or would be eligible to participate in the program because they were at risk of experiencing medicine-related problems. Methods An interview guide was developed which was informed by TMIM. Focus group data were audio-recorded, transcribed and where necessary, translated into English. Qualitative data were thematically analysed to identify participants' expectations about the outcomes of HMR and the factors which may influence these expectations. Participants' most salient outcome expectancies of HMR were that it was a medication-information source which would assist them to manage their medicines. Recipients of the program held overall positive outcome expectancies, whereas nonrecipients' expectancies varied widely. Consistent with theory, participants who expressed some worry about their medicines, generally held positive outcome expectancies and were willing to participate in HMR. Compared with younger participants, older participants (those aged >74 years) tended to engage less in their thoughts about being at risk, and consequently did not experience worry. Worry about medicines is a key factor in motivating participants to engage in medicines information-seeking. Older persons who rely heavily on heuristics appeared less likely to worry about their medicines and willing to participate in medication management services. Age-related reduction in the motivation to participate may have important implications for medication safety. Further examination of this effect is warranted because older persons are at greatest risk of medicine related problems.

Perceptions Among General Medical Practitioners Toward Implementation of Medication Reconciliation Program for Patients Discharged From Hospitals in Penang, Malaysia

This study aims to explore the perceptions of general practitioners (GPs) from the state of Penang toward the feasibility of implementing the medication reconciliation program in Malaysia. A cross-sectional descriptive study using a validated, self-completed anonymous 18-item questionnaire was undertaken over a period of 2 months in 2010. The study was conducted in the state of Penang, Malaysia. A letter consisting of survey questionnaires and prepaid return envelope were mailed to 429 GPs identified from the Private Medical Practice Control Department Registry. A total of 86 responses were received with response rate of 20.1%. Majority (90.1%) of the respondents agreed that medication reconciliation can be a feasible strategy to improve medication safety, and 97.7% confirmed that having an accurate up-to-date list of the patient's previous medication will be useful in the rational prescribing process. However, about half (56.9%) of them felt that standardization of the medication reconciliation process in all clinics will be difficult to achieve. Three quarters (73.2%) of the respondents believed that the involvement of GPs alone is insufficient, and 74.5% agreed that this program should be expanded to community pharmacy setting. More than 90% of the respondents agreed upon the medication reconciliation card proposed by the researchers. General practitioners in Penang are generally in favor of the implementation of medication reconciliation program in their practice. Because medication reconciliation has been shown to reduce many medicine-related problems, it is thus worth considering the feasibility of nationwide implementation of such program.

A clinical pharmacist-based home medication review of geriatric patients

BackgroundThe world's population is rapidly ageing and the older are projected to increase from 600 million in 2000 to 1.2 billion in 2025.1 Medicines-related problems (MRP) are more common in...

Re-engineering processes in an outpatients pharmacy area

BackgroundThe Outpatient Pharmacy Area (OPA) has experienced an increase in patients and in the number and variety of medicines in recent years. Consequently new strategies are needed to ensure efficient...

The development and evaluation of an extended adherence support programme by community pharmacists for elderly patients at home

Abstract Objective To devise, implement and evaluate a medication adherence support service by community pharmacists for elderly patients living at home and at risk of non-adherence. Method Six community pharmacists identified patients who were 65 years of age and older, prescribed four or more regular medicines and living alone. A random sample of patients was visited at home and assessed for adherence-related problems using a structured interview. The pharmacist then drew up an action plan in conjunction with the patient and general practitioner (GP), and returned for a second home visit, where the revised regime was delivered and explained. A self-reported adherence questionnaire was also administered. After two months an independent researcher visited the patients at home to assess progress. Setting Six community pharmacies in the city of Leeds, UK, and patients' homes. Key findings A total of 143 patients were recruited and 441 medicine-related problems were identified. Of these, 241 (55 per cent) required the provision of information and advice, 106 (24 per cent) required consultation with the GP and 86 (20 per cent) required changes in the presentation of the medicines. The median number of regular prescribed medicines fell from six to five (P<0.001). Overall, there was a reduction in the number of patients with one or more problems from 94 per cent to 58 per cent (P<0.001). The proportion of patients who reported non-adherence fell from 38 per cent to 14 per cent (P<0.001). Conclusion This study shows that community pharmacists can target patients at risk of medication non-adherence and, using a structured approach, identify problems and implement solutions. The pharmacy patient medication record is an underutilised tool for identifying patients with adherence problems. The software needs enhancing to enable pharmacists to maximise their use of these records in adherence support. An adherence support programme needs to take more account of intentional non-adherence and should be closely linked with the rest of the primary health care team.

Improving use of medicines with clinician‐led use of validated clinical indicators

se of clinical indicators with collection and monitoring of meaningful data has been recognised as important for driving improvements in the safety and quality of health care. 1 Quality Use of Medicines (QUM) is one aspect of health care in which continual improvement is vitally important. QUM forms part of Australia’s National Medicines Policy and involves judicious selection of treatment options (including choice between drug or non-drug treatment and no treatment), appropriate choice of medicines when they are required, and safe and efficacious use of medicines. 2 Problems with medicines use are costly and occur commonly at all stages of the medicines management pathway 3 and in all health care settings. Elderly, paediatric and chronically ill patients are at particular risk of experiencing adverse drug events. In Australia, some 190 000 admissions per year are associated with medicinerelated problems, costing the health care system about $660 million, and adverse events involving medicines are consistently among the most frequently reported incidents in voluntary incident-reporting systems. 4 Thus, to stimulate quality improvement in this area of health care, it is critical to systematically collect meaningful data about medicines use. Organisations such as the Australian Commission on Safety and Quality in Health Care, the Australian Council on Healthcare Standards (ACHS), the Australian Institute of Health and Welfare, the Council of Australian Governments and the National Prescribing Service are developing clinical indicators for measuring and improving the safety and quality of health care. However, QUM issues are addressed inconsistently in indicators relating to hospitalised patients — probably because medicines management is complex and multidisciplinary 3 and not wholly “owned” by any one profession, specialty or discipline.

PharmD or Needs Based Education: Which Comes First?

PharmD or Needs Based Education: Which Comes First?