Optimize Medication Use Research Articles

Tools for clinical pharmacists to identify medications that can cause drug‐induced cognitive impairment: A systematic review

AbstractCognitive impairment affects around 19% of community‐dwelling older adults in the United States. Pharmacists can play a significant role in identifying and deprescribing cognitive‐impairing medications through cognitive‐focused medication reviews or as part of comprehensive medication management. Multiple tools exist to help pharmacists and other practitioners identify these medications, yet a comprehensive description of these tools has not been undertaken. We searched EBSCO MEDLINE, PubMed, EMBASE, CINAHL, and PsycInfo from inception to August 4, 2023, using search terms relative to medications and cognition. Studies were included if they detailed a tool to assess the cognitive burden of a medication regimen. Abstracts and full texts were screened independently and in duplicate. Any disagreements at the level of full‐text screening were resolved by consensus. Eligible studies underwent data extraction by two authors independently and in duplicate using a data extraction form. Our search identified 13 126 articles of which only four tools were initially included. Additionally, we identified seven articles from the reference lists of excluded review articles for a final inclusion count of 11 tools. Articles were published between 2001 and 2017. Nine of 11 tools (82%) were focused solely on anticholinergic medications, while only one tool indicated a clinically relevant cutoff value and alternative medication recommendations. While there are many tools to assess the cognitive burden from medications, many are limited by the development date, focus on anticholinergic medications, or lack clinically useful information. Further research is needed to develop more comprehensive, up‐to‐date, and readily implementable tools that clinical pharmacists can utilize to assess medication‐induced cognitive risks. Such as tool could be applied by pharmacists in many settings to optimize medication use and improve patient outcomes.

Compounded GLP 1 and Dual GIP/GLP 1 Receptor Agonists: A Statement from the American Diabetes Association

The use of glucagon-like peptide 1 receptor agonist (GLP-1 RA) and dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 RA (GIP/GLP-1 RA) classes has increased substantially over the past several years for treating type 2 diabetes and obesity. Increased demand for these pharmacotherapies has resulted in temporary product shortages for both GLP-1 RA and dual GIP/GLP-1 RA medications. These shortages, in part, have led to entities producing and marketing compounded formulations that bypass regulatory measures, raising safety, quality, and efficacy concerns. Even as shortages resolve, compounded GLP-1 RA and GIP/GLP-1 RA products continue to be heavily marketed to people with diabetes and obesity. The purpose of this statement by the American Diabetes Association is to guide health care professionals and people with diabetes and/or obesity in these circumstances of medication unavailability to promote optimal care and medication use safety.

A Core Outcome Set for studies testing interventions to optimise medication use following hospital discharge - An international Delphi study

A Core Outcome Set for studies testing interventions to optimise medication use following hospital discharge - An international Delphi study

Pharmacogenomic approaches for tailoring medication to genetic profiles in diverse populations

Pharmacogenomics, a branch of precision medicine, focuses on how genetic variations influence individual responses to drugs, allowing for more tailored and effective treatments. This approach has the potential to significantly enhance therapeutic outcomes by improving drug efficacy, minimizing adverse reactions, and optimizing medication use. By considering genetic makeup, pharmacogenomic strategies enable healthcare providers to personalize treatments for patients, particularly in the management of complex conditions like cancer, cardiovascular diseases, and mental health disorders. However, pharmacogenomics must be applied equitably across all populations to reach its full potential. Inclusive research and comprehensive policies are crucial in addressing disparities in access to pharmacogenomic testing and therapies, particularly for underrepresented and marginalized communities. This paper discusses the importance of advancing pharmacogenomic approaches in personalized medicine, emphasizing the need for diverse research and equitable access to ensure that these innovations benefit all patients.

Assessment of the relevance of a prescribing competency framework in Kuwait – An e-Delphi study

Abstract Introduction Prescribing is the most common intervention used to manage patients. Globally, prescribing competency frameworks have been developed to standardize prescribing practice across all healthcare disciplines1. Research on prescribing practice in different chronic diseases in Kuwait has shown some inconsistencies in the quality of care delivered to patients. Aim This study assesses the relevance of the National Pharmaceutical Society (NPS) MedicineWise Prescribing Competency Framework statements amongst physicians, dentists, and pharmacists in Kuwait as a first step in developing a National Prescribing Competency Framework for Kuwait. Methods Ethical approval was granted by Kuwait’s Ministry of Health (MOH) for this project. A 4-phase adopt and adapt approach was planned to develop the Prescribing Competency Framework for Kuwait. This study covers phases 1 and 2 of this approach. Phase one involved translating the Framework into Arabic using parallel translation. Phase two utilised the e-Delphi method to reach consensus on the relevance of 48 statements (divided into 7 Competency Areas) for prescribing in Kuwait. For this phase, a survey, with a 4-point Likert scale, was developed using Google Forms and distributed to experts participating in the e-Delphi process. Purposive and snowballing method was used to recruit the experts, targeting all doctors, dentists, and pharmacists working in MOH. Participants were asked to rate their agreement with the relevance of the statements to Kuwait and allowed to leave comments. Statements achieving a consensus level ≥90%, with no answer as strongly disagree, were deemed relevant. Statements not reaching consensus will be reevaluated in Round 2 of the e-Delphi process (planned for July-September 2024). Results The translation phase yielded a bilingual framework that could be utilised by prescribers in Kuwait. Round 1 of the e-Delphi included 36 experts (22 doctors, 8 dentists, and 6 pharmacists). Out of the seven Competency Areas in the NPS framework, four Competency Areas reached 100% consensus (Areas 1, 4, 5, and 6). 90% of the statements in Competency Area 2 reached consensus, while only 40% of the statements in Competency Area 3, and 85.7% of the statements in Competency Area 7 reached consensus. Competency statements that did not reach consensus will be re-assessed in Round 2 of the e-Delphi process. Conclusion To our knowledge, this is the first study conducted to initiate the process of adopting and adapting a Prescribing Competency Framework in Kuwait. Competency statements involving patient engagement in their management plan seemed to gain the least consensus in Round 1 of our study, which will be explored further in Round 2 of our e-Delphi process. This is consistent with current published literature in the Middle Eastern and North African regions which shows that there is no clear understanding by healthcare professionals of how to apply patient-centred care2,3. Limited comments on disagreed statements in Round 1 require further clarification. There is a need to standardize the prescribing process due to the complexity of choosing the right medication, the imperative to optimize medication use, a change in the patient's care models, and the possibility of other healthcare professionals taking on prescribing roles.

Characteristics of High-Cost Beneficiaries of Prescription Drugs in Kazakhstan: A Cross-Sectional Study of Outpatient Data from 2022.

Limited information is available regarding the distribution of increasing pharmaceutical expenditures within large representative samples of national populations globally. The aim was to investigate the distribution of pharmaceutical costs in outpatient treatment and analyze the primary characteristics of users of expensive drugs within the healthcare system of Kazakhstan. This study utilized data from the Information System for Outpatient Drug Supply, which includes nationally representative data from all regions of Kazakhstan, covering both rural and urban populations. The key explanatory variables in this study included age, gender, number of prescribed medications, disease categories based on ICD-10 codes, and insurance coverage status. These variables were selected to capture demographic, clinical, and healthcare access factors influencing prescription drug costs. In total, 2.2 million people, who were prescribed outpatient medications were included. High-cost users (HCUs) were characterized as individuals whose prescription drug expenses ranked within the highest 5%. The distribution of pharmaceutical costs exhibits significant discrepancy, with 5% of the population receiving prescription drugs covered by the state budget and social medical insurance fund contributing to nearly three-quarters of all costs. Notably, these HCUs tended to be younger than low-cost drug users. HCUs, on average, consumed a greater quantity of medications compared to non-HCUs. Among children, the top diseases contributing to high costs were rare hereditary diseases and malignancies, while in adults, cancer and diabetes were the primary cost drivers. There is a concentration of public drug program spending within a small percentage of beneficiaries with high drug costs in Kazakhstan. This discovery offers valuable insights for shaping policies tailored to this specific population, aiming to mitigate escalating costs and enhance the optimal use of medications.

Implementation of an outpatient clinical pharmacy service at an adult cystic fibrosis center

BackgroundHigh treatment burden can adversely impact health outcomes in people with cystic fibrosis (PwCF). There is a continued need for medication adherence education and further research to evaluate impact of cystic fibrosis (CF) pharmacist interventions in an ambulatory care setting. ObjectivesTo evaluate whether pharmacist integration into an outpatient adult CF clinic can positively impact patient satisfaction and medication adherence through various pharmacist-based interventions. MethodsAt a single urban medical center, a clinical pharmacist on an adult CF care team conducted comprehensive counseling sessions with PwCF. During these visits, types of pharmacist interventions were documented. Patients were provided a baseline and postcounseling survey to assess satisfaction with the pharmacist visit. Adherence to cystic fibrosis transmembrane regulator (CFTR) modulator and mucolytics were tracked 12 months before and 12 months after the counseling session. ResultsA total of 723 pharmacist interventions were performed throughout 100 pharmacist visits in 100 PwCF. Most common interventions were inhaler technique education (17%), drug interaction identification (12%), provision of drug education material (12%), and medication refills (12%). Prior to any intervention, 97% of patients felt they could benefit from a pharmacist visit. Postcounseling survey results demonstrated that 98% of patients found pharmacist counseling to be beneficial. Medication adherence rate prior to pharmacy intervention was 81.9% for CFTR modulators and 62.5% for mucolytics, and 86.9% (P = 0.143) and 63.6% (P = 0.773), respectively, after pharmacist intervention. ConclusionIntegration of a clinical pharmacist within the CF clinic can help improve satisfaction and understanding of medication use among PwCF. Nearly all PwCF favorably perceived pharmacist counseling. We report that various pharmacist interventions including optimizing medication use knowledge, reinforcing adherence strategies, and streamlining timely access to treatment can contribute to enhanced care of PwCF.

Development and validation of the Behavioral Determinants of Deprescribing Questionnaire (BDDQ)

Abstract Background Deprescribing is a strategy to optimize medication use. While health behaviour can successfully be predicted by health behavior theories, the literature on deprescribing relies almost exclusively on questionnaires that measure attitudes only, such as the Beliefs about Medicines Questionnaire and the Patients Attitudes Towards Deprescribing, resulting in poor predictive validity. The aim of this study was to develop a new tool to measure the psychological determinants of deprescribing among people aged over 60, based on concepts derived from health behaviour theories. Methods A draft self-report questionnaire was developed consisting of 64 questions measuring 11 dimensions representing determinants of deprescribing. As well as previous deprescribing experience, current deprescribing behaviour and willingness to deprescribe. Face validity was assessed by asking 10 health professionals and 13 of older people to complete the questionnaire and comment in a small group discussion, resulting in the removal of 18 items. Construct validity was assessed on a sample of 103 participants aged over 60, using exploratory factor analysis (EFA). Internal consistency was assessed via Cronbach’s alpha. Results The EFA could confirm 11 dimensions explaining 70,5% of the total variance, but revealed poor loadings for several items and inadequate alphas (<.50) for two factors. Removal of items and these two dimensions resulted in 26 items measuring 9 dimensions, all showing acceptable internal consistencies (between .52 and .77): perceived risk; relatives’ involvement; deprescribing concerns; attitudes; medication beliefs; healthcare support; perceived difficulties; motivation to comply; communication accessibility. Conclusions This study produced a conceptually based and psychometrically validated questionnaire to assess behavioural determinants of deprescribing. It provides for a more comprehensive investigation of deprescribing intentions and behaviour of older adults. Key messages • A conceptually sound, psychometrically validated questionnaire (BDDQ) was developed. • BDDQ can be used for a more comprehensive study of de-prescribing in older people.

Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis.

Medication reconciliation is essential for optimizing medication use. In part to promote effective medication reconciliation, the Department of Veterans Affairs (VA) invested substantial resources in health information exchange (HIE) technologies. The objectives of this qualitative study were to characterize VA clinicians' use of HIE tools for medication reconciliation in their clinical practice and to identify facilitators and barriers. We recruited inpatient and outpatient prescribers (physicians, nurse practitioners, physician assistants) and pharmacists at four geographically distinct VA medical centers for observations and interviews. Participants were observed as they interacted with HIE or medication reconciliation tools during routine work. Participants were interviewed about clinical decision-making pertaining to medication reconciliation and use of HIE tools, and about barriers and facilitators to use of the tools. Qualitative data were analyzed via inductive and deductive approaches using a priori codes. A total of 63 clinicians participated. Over half (58%) were female, and the mean duration of VA clinical experience was 7 (range 0-32) years. Underlying motivators for clinicians seeking data external to their VA medical center were having new patients, current patients receiving care from an external institution, and clinicians' concerns about possible medication discrepancies among institutions. Facilitators for using HIE software were clinicians' familiarity with the HIE software, clinicians' belief that medication information would be available within HIE, and their confidence in the ability to find HIE medication-related data of interest quickly. Six overarching barriers to HIE software use for medication coordination included visual clutter and information overload within the HIE display; challenges with HIE interface navigation; lack of integration between HIE and other electronic health record interfaces, necessitating multiple logins and application switching; concerns with the dependability of HIE medication information; unfamiliarity with HIE tools; and a lack of HIE data from non-VA facilities. This study is believed to be the first to qualitatively characterize clinicians' HIE use with respect to medication reconciliation. Results inform recommendations to optimize HIE use for medication management activities. We expect that healthcare organizations and software vendors will be able to apply the findings to develop more effective and usable HIE information displays.

Exploring GP and patient attitudes towards the use and deprescribing of dietary supplements: a survey study in Switzerland

BackgroundDietary supplements are commonly used by older adults, but their inappropriate use may lead to adverse events. To optimise medication use, general practitioners (GPs) ideally are aware of all substances that patients use, including supplements. This cross-sectional study explored the use of dietary supplements by older patients with polypharmacy, the rate at which they disclosed this use to their GPs, and compared patients’ and GPs’ attitudes towards discontinuing dietary supplements.MethodsTen GPs in Swiss primary care recruited five to ten of their older patients taking ≥ 5 regular medications. Both GPs and their patients completed a survey on patients’ use of dietary supplements and attitudes towards deprescribing those. We described and compared their responses. We assessed the association of supplement disclosure with patient characteristics using multilevel logistic regression analysis.ResultsThree out of ten GPs (30%) were female, and GPs’ average age was 52 years (SD = 8). 45% of patients were female (29/65). Most patients (n = 45, 70%) were taking ≥ 1 supplement. On average, patients reported to be using three supplements (SD = 2). In 60% (n = 39) of patients, GPs were unaware of ≥ 1 supplement used. We did not find evidence for an association between supplement disclosure to GPs and patient characteristics. Only 8% (n = 5) of patients and 60% (n = 6) of GPs reported ≥ 1 supplement they would be willing to deprescribe and none of the supplements reported by GPs and patients to deprescribe matched.ConclusionSwiss GPs were unaware of many dietary supplements used by their older patients, which may affect medication optimisation efforts.

Effect of polypharmacy and potentially inappropriate medications on physical functional decline among older adults with advanced cancer receiving systemic treatment.

Polypharmacy and potentially inappropriate medications (PIM) are common among older adults with advanced cancer, but their association with physical functional outcomes is understudied. This study aimed to estimate the risk of physical functional decline associated with medication measures in older adults with advanced cancer starting a new line of systemic treatment. This secondary analysis of GAP 70+ Trial (PI: Mohile) enrolled patients aged 70+ with advanced cancer, had ≥ 1 geriatric assessment domain impairment and planned to start a new antineoplastic regimen with a high risk of toxicity. Polypharmacy (concurrent use of ≥ 8 medications (meds)) was assessed before initiation of treatment. PIM were categorized using Screening Tool of Older Person's Prescriptions (STOPP) criteria and 2019 Beers criteria. Physical functional outcomes were assessed within 3months of treatment initiation: (1) Activity of Daily Living (ADL) decline: 1-point decrease in ADL score between baseline and 3months; (2) Instrumental ADL (IADL) decline: 1-point decrease in IADL score between baseline and 3months; (3) Short physical performance battery (SPPB) decline, defined as 1-point decrease on SPPB; (4) ≥ 1 falls within 3months of treatment. Separate multivariable, cluster-weighted Generalized Estimating Equations models adjusted for relevant covariates (e.g., age, baseline function/comorbidities). Among 616 participants, mean number of meds was 6 (range 0-24); 28% received ≥ 8 meds. Polypharmacy was associated with increased risk of ADL decline (adjusted risk ratio [aRR], 1.31; 95% CI, 1.00-1.71). Taking ≥ 1 PIM per STOPP was associated with increased risk of IADL decline (aRR, 1.21; 95% CI, 1.04-1.40) and falls (aRR, 1.93; 95% CI, 1.49-2.51). In a large cohort of vulnerable older adults with advanced cancer receiving systemic treatment, polypharmacy and PIM were independently associated with an increased risk of physical functional decline. This emphasizes the need to develop interventions to optimize medication use, intending to improve outcomes in these patients. ClinicalTrials.gov Identifier: NCT02054741. Registered 01-31-2014.

Emergency Department Use of Heart Failure-Exacerbating Medications in Patients with Chronic Heart Failure.

Use of heart failure-exacerbating medications (HFEMs) may lead to preventable episodes of acute decompensated heart failure (HF). HFEMs use is common in patients with HF, and there may be opportunities to reduce their use from the emergency department (ED). We performed an observational study on patients with HF presenting to EDs within a healthcare system between 1 January 2016 and 31 December 2020. Patients with chronic HF were identified using diagnostic codes within the electronic health record. The cohort was restricted to ambulatory (i.e., discharged to home) ED encounters. Medications, either ordered in the ED or prescribed at ED discharge, were extracted from the medication administration record and identified as potential HFEMs based on the 2016 American Heart Association Scientific Statement. Descriptive statistics were used to summarize the prevalence of HFEM use during ambulatory ED encounters. Exploratory analyses to identify correlates of HFEM use were performed. The study cohort included 23,907 ED encounters. ED administration or prescription of HFEMs occurred during 20% of ambulatory ED encounters. HFEM administration in the ED (17%) was more common than HFEM prescription at ED discharge (6%). The most common HFEMs administered in the ED included nonsteroidal anti-inflammatory drugs (11%) and albuterol (7%). HFEM use is common in patients with HF seeking ED care, occurring in roughly one-fifth of ambulatory ED encounters. There may be opportunities to optimize medication use among patients with HF in the ED.

Association between polypharmacy and 2-year outcomes among Chinese older inpatients: a multi-center cohort study

BackgroundThe escalating global prevalence of polypharmacy presents a growing challenge to public health. In light of this issue, the primary objective of our study was to investigate the status of polypharmacy and its association with clinical outcomes in a large sample of hospitalized older patients aged 65 years and over.MethodsA two-year prospective cohort study was carried out at six tertiary-level hospitals in China. Polypharmacy was defined as the prescription of 5 or more different medications daily, including over-the-counter and non-prescription medications. Baseline polypharmacy, multimorbidity, and other variables were collected when at admission, and 2-year outcomes were recorded by telephone follow-up. We used multivariate logistic regression analysis to examine the associations between polypharmacy and 2-year outcomes.ResultsThe overall response rate was 87.2% and 8713 participants were included in the final analysis. The mean age was 72.40 years (SD = 5.72), and women accounted for 42.2%. The prevalence of polypharmacy among older Chinese inpatients is 23.6%. After adjusting for age, sex, education, marriage status, body mass index, baseline frailty, handgrip strength, cognitive impairment, and the Charlson comorbidity index, polypharmacy is significantly associated with frailty aggravation (OR 1.432, 95% CI 1.258–1.631) and mortality (OR 1.365, 95% CI 1.174–1.592), while inversely associated with readmission (OR 0.870, 95% CI 0.764–0.989). Polypharmacy was associated with a 35.6% increase in the risk of falls (1.356, 95%CI 1.064–1.716). This association weakened after adjustment for multimorbidity to 27.3% (OR 1.273, 95%CI 0.992–1.622).ConclusionsPolypharmacy was prevalent among older inpatients and was a risk factor for 2-year frailty aggravation and mortality. These results highlight the importance of optimizing medication use in older adults to minimize the risks associated with polypharmacy. Further research and implementing strategies are warranted to enhance the quality of care and safety for older individuals exposed to polypharmacy.Trial registrationChinese Clinical Trial Registry, ChiCTR1800017682, registered 09/08/2018.

A retrospective analysis of e-prescriptions for non-communicable diseases on a telehealth platform in Malaysia

BackgroundThe management of non-communicable diseases (NCDs) has benefited from telehealth services. As these services which include teleconsultation services and e-prescriptions are relatively new in Malaysia, the data generated provide an unprecedented opportunity to study medication use patterns for the management of NCDs in the country. We analyze e-prescriptions from a local telehealth service to identify medication use patterns and potential areas to optimize medication use in relation to clinical practice guidelines.MethodsA cross sectional observational study was conducted by retrieving e-prescription records retrospectively from a telehealth service. 739,482 records from January 2019 to December 2021 were extracted using a designated data collection form. Data cleaning, standardization and data analysis were performed using Python version 3.11. The diagnoses were classified according to the International Classification of Disease 10 (ICD-10), while medications were classified using the Anatomical Therapeutic Chemical (ATC) system. Diagnoses, frequency of use for medication classes and individual medications were analyzed and compared to clinical practice guidelines.ResultsThe top five NCD diagnoses utilized by the service were hypertension (37.7%), diabetes mellitus (25.1%), ischemic heart disease (24.3%), asthma (14.4%), and dyslipidemia (11.7%). Medications were prescribed mostly in accordance with guideline recommendations. However, angiotensin receptor blockers (ARBs) were significantly more frequently prescribed compared to angiotensin converting enzyme inhibitors (ACEIs). Several medication classes appeared underutilized, including ACEIs in hypertensive patients with diabetes or ischemic heart disease, sodium glucose cotransporter 2 inhibitors in diabetic patients with ischemic heart disease, and metformin in patients with diabetes.ConclusionsTelehealth services are currently being utilized for the management of NCDs. Medication use for the management of NCDs through these services are mostly in accordance with guideline recommendations, but there exist areas that would warrant further investigation to ensure optimal clinical and economic outcomes are achieved.

The 2023 American Geriatrics Society Updated Beers Criteria® Application in Low- and Middle-Income Countries: A Walk-through.

The 2023 update of the American Geriatrics Society Beers Criteria® provides a comprehensive set of guidelines for optimizing medication use in older people. While this update is based on a rigorous review of evidence from clinical trials and research studies published between 2017 and 2022, its application in low- and middle-income countries (LMICs) may present unique challenges and considerations. LMICs often face different health care realities compared with high-income countries, such as limited access to medications, varying prescribing practices, and resource constraints. As a result, the Beers Criteria® 2023 update, which includes the addition, deletion, and revision of medicines based on new evidence, may not be entirely applicable or feasible in these settings. This commentary aims to explore the implications of the 2023 Beers Criteria® update for LMICs, highlighting the need for context-specific adaptations and strategies to optimize medication use and improve health outcomes for older people in resource-limited settings.

Pharmacists’ attitudes towards interprofessional collaboration to optimise medication use in older patients in Switzerland: a survey study

BackgroundCollaboration between physicians and pharmacists facilitates the conduct of medication optimisation efforts. In the context of deprescribing, pharmacists’ roles are often described as making deprescribing recommendations to physicians. Little is known about factors associated with pharmacists’ willingness to make deprescribing recommendations and their interprofessional collaboration with physicians in Swiss primary care settings.ObjectiveTo explore pharmacists' perspectives on medication optimisation and deprescribing in older adults, and their preferences for interprofessional collaboration in Swiss primary care settings.MethodsIn this cross-sectional study, a random sample of 1000 pharmacist members of the Swiss Pharmacists Association pharmaSuisse was invited to participate in a survey on medication optimisation, deprescribing, and interprofessional collaboration. The survey contained three case vignettes of multimorbid patients with polypharmacy aged ≥ 80 years old, with different levels of dependency in activities in daily living (ADL) and cardiovascular disease (CVD). For each case vignette, pharmacists were asked if and which medications they would deprescribe. We calculated proportions of pharmacists’ willingness to deprescribe by case vignette and performed a multilevel logistic regression to assess associations between CVD, ADL, and willingness to deprescribe.ResultsOne hundred thirty-eight (14%) pharmacists responded to the survey: 113 (82%) were female, their mean age was 44 years (SD = 11), and 66% (n = 77) reported having never received any specific training on how to conduct structured medication reviews. Eighty-three (72%) pharmacists reported to be confident in identifying deprescribing opportunities. All pharmacists were willing to deprescribe ≥ 1 medication in all vignettes. Patients with CVD were at lower odds of having medications deprescribed (OR = 0.27, 95%CI 0.21 to 0.36). Willingness to deprescribe was lower with higher dependency in ADL (medium versus low dependency: OR = 0.68, 95%CI 0.54 to 0.87, high versus low dependency: OR = 0.72, 95%CI 0.56 to 0.91). However, the effect of dependency in ADL on willingness to deprescribe was significantly modified by the history of CVD. One hundred five pharmacists (97%) reported to interact with physicians to clarify questions regarding prescriptions at least once a week and 88 (81%) wished to be more involved in deprescribing and medication review.ConclusionPharmacists were willing to make deprescribing suggestions for older patients with polypharmacy, but two-thirds reported having received no formal training on how to perform structured medication reviews. Pharmacists would like to be more involved in the process of medication review and deprescribing, which should be leveraged in the context of Swiss primary care settings.

Collaborative discussions between GPs and pharmacists to optimise patient medication: a qualitative study within a UK primary care clinical trial.

There has been significant investment in pharmacists working in UK general practice to improve the effective and safe use of medicines. However, evidence of how to optimise collaboration between GPs and pharmacists in the context of polypharmacy (multiple medication) is lacking. To explore GP and pharmacist views and experiences of in-person, interprofessional collaborative discussions (IPCDs) as part of a complex intervention to optimise medication use for patients with polypharmacy in general practice. A mixed-method process evaluation embedded within the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial conducted in Bristol and the West Midlands, between February 2021 and September 2023. Audio-recordings of IPCDs between GPs and pharmacists, along with individual semi-structured interviews to explore their reflections on these discussions, were used. All recordings were transcribed verbatim and analysed thematically. A total of 14 practices took part in the process evaluation from February 2022 to September 2023; 17 IPCD meetings were audio-recorded, discussing 30 patients (range 1-6 patients per meeting). In all, six GPs and 13 pharmacists were interviewed. The IPCD was highly valued by GPs and pharmacists who described benefits, including: strengthening their working relationship; gaining in confidence to manage more complex patients; and learning from each other. It was often challenging, however, to find time for the IPCDs. The model of IPCD used in this study provided protected time for GPs and pharmacists to work together to deliver whole-patient care, with both professions finding this beneficial. Protected time for interprofessional liaison and collaboration, and structured interventions may facilitate improved patient care.

A Systematic Review of Healthcare Providers Awareness of Medication Switching for Polypharmacy Patients in Saudi Arabia

Background: Polypharmacy, the concurrent use of multiple medications by an individual, presents challenges in medication management, patient safety, and healthcare outcomes, particularly among older adults. In Saudi Arabia, the prevalence of polypharmacy is increasing due to the aging population and the burden of chronic diseases. Understanding healthcare providers' awareness and practices regarding medication switching is crucial for optimizing medication use and improving patient outcomes. Study Aim: This systematic review aims to synthesize and analyze existing literature on healthcare providers' awareness of medication switching for polypharmacy patients in Saudi Arabia. The study focuses on pharmacists and physicians, exploring their knowledge, attitudes, and practices related to medication management, deprescribing, pharmacovigilance, and Medication Therapy Management (MTM) services. Methodology: A systematic search was conducted across major databases, including PubMed, Scopus, and Google Scholar, using predefined search terms related to polypharmacy, medication switching, healthcare providers' awareness, and Saudi Arabia. Eligible studies were selected based on inclusion criteria, including study design, setting, participants, and relevance to the study aim. Data extraction and synthesis were performed to analyze key findings and themes related to healthcare providers' awareness of medication switching. Results: Six eligible studies were included in the systematic review, encompassing survey-based investigations, cross-sectional studies, and qualitative studies conducted in various healthcare settings across Saudi Arabia. The findings revealed gaps in pharmacists' and physicians' knowledge regarding Potentially Inappropriate Medications (PIMs), Drug-Drug Interactions (DDIs), pharmacovigilance practices, and deprescribing strategies. Recommendations for improving pharmacists' education, enhancing pharmacovigilance practices, and promoting collaborative care models were highlighted. Conclusion: Healthcare providers in Saudi Arabia demonstrate varying levels of awareness and practices regarding medication switching for polypharmacy patients. There is a need for targeted educational interventions, standardized pharmacovigilance practices, and collaborative efforts among healthcare providers to optimize medication use, reduce polypharmacy-related risks, and improve patient outcomes.

Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults.

Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population.

Pharmacist-community-based organization collaboration to address health-related social needs

BackgroundCommunity-based organizations (CBOs) help address community issues, including health-related social needs (HRSNs). Community pharmacies are positioned to collaborate with CBOs to help their patients identify and address HRSNs to optimize medication use. ObjectivesTo develop and evaluate 2 models of community pharmacy-CBO collaboration to address HRSNs facing patients taking medications. MethodsTwo different pharmacy-CBO models were studied. The CBO-initiated model had 2 CBOs assess and refer clients to a community pharmacy to address HRSN-related medication concerns. In the pharmacy-initiated model, pharmacists screened patients for HRSNs, addressed those related to medication costs and referred patients to a CBO for other HRSNs. Documented HRSNs were extracted and analyzed. Participating pharmacy and CBO staff were interviewed. The interview recordings were transcribed and coded, using rapid qualitative analyses. ResultsThe CBO-initiated model screened 23 clients with 17 receiving a comprehensive medication review. In the pharmacy-initiated model, 39 patients were screened for HRSNs with 6 patients having medication costs issues addressed at the pharmacy and 23 patients being referred to the CBO. The most common HRSNs were high stress levels (43%), lack of confidence filling out forms (36%), feeling overwhelmed (34%), and inability to get food (27%). Patient-related themes from interviews were patient willingness to participate in the service, obstacles patients faced in obtaining medication therapy, and establishing patient trust. Pharmacy-related and CBO-related themes included fitting new activities into workflow, importance of time management and good communication, and establishing relationships between pharmacy and CBO personnel. ConclusionBoth pharmacy-CBO models effectively identified clients in need of medication management services or patients with HRSNs affecting medication optimization. Limited trust between the patient and the party to which they were referred was an obstacle to successful referral. Developing pharmacy and CBO personal relationships is a vital key in planning and coordinating these pharmacy-CBO collaboration models.