Optimize Medication Use Research Articles

Potentially inappropriate medications in older individuals with diabetes: A population-based study in Quebec, Canada

AimTo study the population-based prevalence of potentially inappropriate medication (PIM) among older individuals with diabetes, and to identify factors associated with their use. MethodsWe used the Quebec Integrated Chronic Disease Surveillance System (QICDSS) database to conduct a population-based cohort study of individuals with diabetes ≥66 years between April 1st, 2014 and March 31st, 2015. PIMs were defined according to the 2015 Beers Criteria. Factors associated with PIM use were identified using robust Poisson regression models. Risk ratios (RR) and 99% confidence intervals (99%CI) were calculated. ResultsMore than half (56%) of the 286,962 older individuals with diabetes used at least one PIM over a year. Benzodiazepines (41%), proton pump inhibitors (27%) and endocrine medication (mainly glibenclamide) (25%) were the most common PIMs used. Factors associated with PIM use included female sex (RR: 1.17; 99%CI: 1.16–1.18), and comorbidities such as schizophrenia (1.48; 1.45–1.51), anxiety disorders (1.34; 1.33–1.35) and Alzheimer's disease (1.14; 1.13–1.25). Risks of using PIMs increased both with increasing comorbidities and number of medications. ConclusionPIM use is highly prevalent among older individuals with diabetes. Interventions to promote optimal medication use should particularly target individuals with comorbidities and polypharmacy who are most vulnerable to adverse drug events.

NSAIDs for COVID-19

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

From uncertainty to empowerment: Pharmacists respond to COVID-19

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Self-care and COVID-19

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

COVID-19 Pandemic

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Experiencing COVID-19 in the health-system pharmacy

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes: Findings From the ARTEMIS Trial.

Cost is frequently cited as a barrier to optimal medication use, but the extent to which copayment assistance interventions are used when available, and their impact on evidence-based medication persistence and major adverse cardiovascular events is unknown. The ARTEMIS trial (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) randomized 301 hospitals to usual care versus the ability to provide patients with vouchers that offset copayment costs when filling P2Y12 inhibitors in the 1 year post-myocardial infarction. In the intervention group, we used multivariable logistic regression to identify patient and medication cost characteristics associated with voucher use. We then used this model to stratify both intervention and usual care patients by likelihood of voucher use, and examined the impact of the voucher intervention on 1-year P2Y12 inhibitor persistence (no gap in pharmacy supply >30 days) and major adverse cardiovascular events (all-cause death, myocardial infarction, or stroke). Among 10 102 enrolled patients, 6135 patients were treated at hospitals randomized to the copayment intervention. Of these, 1742 (28.4%) never used the voucher, although 1729 (99.2%) voucher never-users filled at least one P2Y12 inhibitor prescription in the 1 year post-myocardial infarction. Characteristics most associated with voucher use included: discharge on ticagrelor, planned 1-year course of P2Y12 inhibitor treatment, white race, commercial insurance, and higher out-of-pocket medication costs (c-statistic 0.74). Applying this propensity model to stratify all enrolled patients by likelihood of voucher use, the intervention improved medication persistence the most in patients with high likelihood of voucher use (adjusted interaction P=0.03, odds ratio, 1.86 [95% CI, 1.48-2.33]). The intervention did not significantly reduce major adverse cardiovascular events in any voucher use likelihood group, although the odds ratio was lowest (0.86 [95% CI, 0.56-1.16]) among patients with high likelihood of voucher use (adjusted interaction P=0.04). Among patients discharged after myocardial infarction, those with higher copayments and greater out-of-pocket medication costs were more likely to use a copayment assistance voucher, but some classes of patients were less likely to use a copayment assistance voucher. Patients at low likelihood of voucher use benefitted least from copayment assistance, and other interventions may be needed to improve medication-taking behaviors and clinical outcomes in these patients. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02406677.

ACIP meeting focuses on influenza, coronavirus, Ebola, rabies, and more

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Significance of a clinical pharmacist-led comprehensive medication management program for hospitalized oncology patients.

Background The use of highly toxic drugs in cancer treatment and supportive care medications exposes patients to an increased number of drug-related problems (DRPs). Clinical pharmacists contribute to the optimal use of medications by intervening in identified drug-related problems. Objective To evaluate the relevance of a comprehensive medication management service in oncology patients. Setting Marmara University Teaching and Research Hospital Medical Oncology Ward, Istanbul, Turkey. Methods This prospective study was carried out between December 2015 and April 2016 with adult patients with confirmed malignancy. Comprehensive medication management was performed by the clinical pharmacist throughout the patient's hospital stay. The medication-related data as well as data regarding demographic and general health status of the patients were reviewed for the presence of drug-related problems. The identified problems, interventions and acceptance rate by physicians were recorded with the help of the Pharmaceutical Care Network Europe V6.0 (PCNE) classification. Main outcome measures Number and causes of drug-related problems, nature and acceptance rate of clinical pharmacist interventions and rate of problems solved. Results The study included 137 patients. The mean (SD) age of the patients was 58 (14.6) years. A total of 481 drug-related problems were recorded. The most frequent drug-related problems were 'adverse drug events [including drug interactions]' (n = 376), 'untreated indications' (n = 59) and 'unnecessary drug treatment' (n = 25). Inappropriate combination of drugs was the cause of 73.2% of the total problems. Interventions were made to stop administration of a suitable drug if the combination with another drug was contraindicated while prescribers were mostly informed about major drug interactions. The prescribers approved 93% of the total intervention proposals. The majority (90.9%) of the identified problems were totally solved. Conclusion Integration of clinical pharmacy services through a comprehensive medication management program in oncology will help to reduce the number of drug-related problems.

What Can Your Pharmacist Do for You? Role of Collaborative Drug Therapy Management in Hospice (QI641)

•Describe and explain the role of collaborative drug therapy management (CDTM) in community and inpatient hospice as it applies to physicians, pharmacists, and nurses.•Illustrate an innovative care model that emphasizes patient-centered, team-based care linking system and patient-level outcomes to manage individualized drug therapy in hospice.•Evaluate reduced pharmacoeconomic expenditures through optimal use of medications in CDTM. American healthcare systems, including community-based organizations, are grappling with rising healthcare costs and medication-related expenditures. Annually, more than 1.5 million preventable adverse events are caused by inappropriate use of medications. This costs our healthcare system $290 billion annually. Rising drug costs and medication safety concerns provide a rationale for increased clinical pharmacist collaborative medication management, especially in the hospice setting. In this poster presentation, we describe our innovative approach of CDTM. The process and requirements for this approach will be presented using a Massachusetts-based hospice as an example. CDTM allows a clinical pharmacist to therapeutically assess and identify patients' medication related needs and act as an extension of the physician. The goal is to optimize medication-related outcomes and includes selection, initiation, monitoring, and adjusting medications as defined in the CDTM agreement. Additionally, this quality improvement project evaluates the benefit of a pharmacist as a member of the interdisciplinary team and thus manage the overall pharmaceutical budget. Telephonic and/or virtual visit medication therapy management will be provided by clinical pharmacist(s) to hospice patients within two teams (n=160). Each patient's medical record will be reviewed and concurrently monitored on admission and subsequent IDT sessions with the entire team. Validity to be measured as a prospective cohort study. The teams that utilize a hospice pharmacist will see an increase in their Consumer Assessment of Heathcare Providers and Systems (CAHPS) scores and overall decrease in medication costs by 25% versus those teams that did not. Additionally, it is anticipated that over 500 drug therapy related matters will be resolved. This tailored care aims to improve quality of patient outcomes by symptom improvement, increase patient satisfaction and quality of life, and manage costs. This study highlighted the role of pharmacists in managing medications for hospice patients and described a clear path for a CDTM.

Deprescribing potentially inappropriate medications in memory clinic patients (DePIMM): A feasibility study.

Medication-related problems and inappropriate medication use are prevalent among people attending memory clinics. There have been no deprescribing intervention studies in this setting. To evaluate the feasibility of a pharmacist-led interdisciplinary deprescribing intervention study in a memory clinic. A pre-post-intervention study conducted at an outpatient memory clinic of an Australian tertiary care public hospital. Participants were English-speaking, community-dwelling patients identified as being at risk of a medication-related problem, or their carers. Participants received a medication review in their home from a consultant pharmacist who collaborated with the patient/carer, memory clinic, general practitioner and community pharmacist to develop a plan for optimising medication use. The primary outcome was feasibility, based on i) proportion of memory clinic patients eligible for the study, ii) proportion of eligible patients who consented, and iii) proportion of pharmacist-identified inappropriate/unnecessary medications that were deprescribed (reduced or ceased) at six months. One-third of memory clinic patient/carers were eligible (n=82/238), 61% (n=50/82) consented to participate. The median (IQR) age of participants who received the intervention (n=46) was 80.5 (71.5-85.0) years and median (IQR) number of medications was 11 (8.0-13.3). Pharmacists recommended deprescribing 124 medications, and 53 (42.7%) had been ceased or dose-reduced at six months. It was feasible to recruit study participants and deliver a pharmacist-led interdisciplinary deprescribing intervention in this memory clinic setting. A larger, multi-centre study with longer follow-up is needed to confirm effectiveness and clinical outcomes.

The Journey to Use Medication Optimally to Support Recovery

The Journey to Use Medication Optimally to Support Recovery

Making the economic value proposition for pharmacist comprehensive medication management (CMM) in primary care: A conceptual framework.

Comprehensive medication management (CMM) is a patient care process provided by clinical pharmacists in primary care settings that ensures optimal use of medications with timely follow-up. Despite widespread evidence that shows CMM improves clinical and medication-related outcomes, pharmacist-delivered CMM services often fail to be adopted into U.S. primary care settings. This study presents a conceptual framework linking outcomes of pharmacist-delivered CMM services in primary care settings to financial benefits for health plans providing coverage of CMM services and primary care practices investing and implementing CMM. A critical review of the literature was performed in PubMed and the gray literature to identify financing opportunities that justify the coverage of CMM by third-party health plan administrators or the implementation of CMM by primary care practices. Financing elements that could be impacted by pharmacist-led CMM outcomes, namely higher achievement of medication-related quality measures and reduction of total costs of care, were recorded and utilized to develop the conceptual framework. The framework suggests that CMM provides economic benefits to both health plans and primary care practices by increasing market competitiveness, direct revenue, and quality bonuses. Health plans may benefit from higher plan quality ratings, lower premiums and plan bids, increased shared savings, and quality bonus payments. Primary care practices may achieve increased negotiating power through accreditation recognition and patient satisfaction, increased revenue through shared savings and fee-for-service reimbursement, and achievement of quality bonus payments. The alignment of economic benefits from CMM advances a strong value proposition for greater adoption of CMM coverage by health plans and implementation in the U.S. primary care system. Through broader CMM implementation, pharmacists can work alongside physicians in advanced care models and play a vital role in shaping the primary care practice transition to value-based care.

Utilization evaluation of anti-cancer agents in patients with head and neck cancer in a South Indian specialty cancer hospital

BACKGROUND: This study was aimed to understand prescribing patterns of anti-cancer agents in patients with head and neck cancer, and to provide practice recommendations/educational interventions to optimize medication use in patients with head and neck cancer. MATERIALS AND METHODS: This study was carried out in an oncology specialty hospital for 3 years. The retrospective data were collected for 6 months for head and neck cancer patients treated in a last one year, and the prescribing pattern was studied. The selection of anticancer drug(s), dosage of the anticancer drugs, and emesis management were reviewed with respect to the National Cancer Comprehensive Network guidelines, whereas the administration was reviewed with respect to the hospital policies. The deviations were observed, and practice recommendations were developed. Health care professionals (oncology treatment team) were updated/educated on these recommendations. This was followed by a prospective phase for 18 months wherein the prescribing pattern was reviewed in a similar manner as retrospective phase. Compliance to treatment standards was assessed in both phases and reviewed to study an impact of educational interventions provided. RESULTS: One hundred and four retrospective prescriptions were reviewed and showed a compliance of 88% in selection of anticancer drug, 71% in its dosing, and 75% in its administration whereas antiemetics prescription showed 55% compliance in selection, 53% in dosing, and 88% in administration. Two hundred and eighty-eight prescriptions were reviewed prospectively and showed 92% compliance in selection of anticancer drug, 80% in its dosing, and 85% in its administration, whereas antiemetics prescription showed 87% compliance in selection, 75% in dosing, and 92% in administration. CONCLUSION: This study demonstrated that practice recommendations provided by research panel, in form of educational interventions were useful in improving use of medications in study population. It was evident from relatively higher compliance rate to treatment standards after interventions.

Developing Future Clinical Pharmacy Leaders in the Interprofessional Care of Children with Special Health Care Needs and Medical Complexity (CSHCN-CMC) in a Pediatric Pulmonary Center.

The health care needs of children with special health care needs and medical complexity (CSHCN-CMC) are multifaceted and often require the expertise of various disciplines. The medication-related needs of this population can be further complicated with off-label medication use, polypharmacy, and vulnerability to medication errors. Although clinical pharmacists are increasingly becoming a common part of inpatient, pediatric interprofessional patient care teams, their presence remains lacking in the outpatient or ambulatory care realm. Pediatric clinical pharmacists in the ambulatory care setting have the potential to help optimize medication use and safety through collaborative efforts as part of the interprofessional team. Since the late 1960s, Pediatric Pulmonary Centers (PPCs) provide training programs designed to develop interprofessional leaders who will improve the health status of CSHCN-CMC, specifically those with chronic respiratory and sleep-related conditions. The addition of pharmacists not only provides a more comprehensive care model for CSHCN-CMC, it creates an avenue to encourage the career paths of pediatric pharmacists in the ambulatory care setting. Here, we describe the addition of clinical pharmacy as part of an interprofessional patient care team and the development and implementation of a maternal child health (MCH) pharmacy discipline training model designed to mentor future pharmacist leaders in the care of CSHCN-CMC.

Opportunities for pharmacists to integrate pharmacogenomics into clinical practice.

Many medical centers in the United States have implemented pharmacogenomics (PGx) programs to integrate PGx into clinical practice. The roles of pharmacists in optimizing medication use based on genetic testing results are emergently evolving. A literature search was conducted to assess pharmacists' roles in pharmacogenetics/pharmacogenomics or precision/personalized medicine programs. Fifteen PGx pharmacy practice models implemented in eleven hospitals and one community pharmacy in the U.S. were selected for evaluation. Pharmacists perform results interpretation, genotype-guided medication selection and adjustment, medication acquisition, adverse reactions monitoring, and patient education. Institutions that are interested in implementing a PGx program should plan the strategies to overcome the challenges, such as educational knowledge gaps, informatics, and reimbursement issues. Strong institutional support, well-defined goals, standardized procedures, and strategies to educate clinicians and patients are the prerequisites to comprehensively deliver genomic data for individualized drug therapy.

Assessing the Level of Awareness for the Optimal Use of Medication Among Saudi Community

Introduction: Self-medication can lead to several unwanted consequences. Therefore, it is important to ensure that the selected medication is safe and effective in order to meet the required health needs. The aim of this study is to assess the patients’ attitude, knowledge and practice towards the use of safe medication and to evaluate the awareness level for optimal medication use among the Saudi community. Materials & Methods: We conducted a cross-sectional study using a validated questionnaire from “Survey of Medication Knowledge and Behaviors Among College Students in Taiwan” that was translated into Arabic language and validated for use in our study. Results: A total number of 1,576 participants were included. Questions evaluating knowledge about drug-food interactions and the appropriate use of antacids had the lowest number of correct responses, with a response rate of 44.73% and 38.32% respectively. Among these, 952 participants (60.41%) mentioned their effective awareness level regarding pharmacist consultations; however, 624 participants (39.59%) had limited information and awareness regarding pharmacist consultations and medication dispensing. Pharmacist trust as a healthcare expert in providing drug information was evaluated in participants without healthcare professionals or medical students as family members (62.46%), healthcare professional family members (76.74%) and medical student family members (75.21%) with a statistical significance between the first two groups (p <0.001) . Conclusions: The majority of our study population demonstrated inadequate attitude, knowledge, and practice related to safe use of medications. This was more pronounced especially in participants without family members as healthcare professionals or medical students. We recommend the adoption of immediate interventions by pharmacists in order to improve the awareness about attitude, drug knowledge. Therefore, leading to improvements in safe medication practices in the Saudi community. ​

Studying the impact of a medication use evaluation by the community pharmacist (Simenon): Drug-related problems and associated variables.

A medication use review (MUR) aims to optimize medication use, patient knowledge and can improve health outcomes. This pharmaceutical care service is not yet available in Belgium. To describe drug-related problems (DRPs) detected during a MUR, subsequent interventions proposed by pharmacists and evolution of DRPs until follow-up and to identify patient-related variables associated with the number of reported DRPs. Belgian community pharmacists provided a MUR to older polymedicated ambulatory patients and registered DRPs, interventions and resolution at follow-up using the PharmDISC classification. The relationship between 14 patient-related variables and the number of reported DRPs was investigated with univariate analysis. A prediction model was developed with significant variables using negative binomial regression analysis. Across 56 pharmacies, 453 patients received a MUR and 1196 DRPs were registered (median 3DRPs/patient, range 0-10). Only for 11.7% of patients no problems were identified. The top-3 causes were interaction (15.2%), inappropriate timing or frequency (13.5%) and adverse effect (11.9%). The top-3 recommended interventions by pharmacists were transmission of information (25.1%), in-depth patient counselling (15.0%) and therapy stop (8.2%). After six weeks, 42.6% of DRPs were resolved; data was missing for 33.3%. A higher number of chronic drugs, female gender and living alone were associated with more DRPs. The prediction model found that per additional chronic drug, the number of problems increases by 4.3% (95% CI: 2.0-6.6%). Male gender decreases DRPs by 22.1% (95% CI: 10.4-32.0%). Living alone provided no additional predictive value in the prediction model. Confounding process- and pharmacist-related variables also influenced the number of reported DRPs. A MUR appears an effective strategy to detect and resolve DRPs. The number of chronic medications and female gender predict a higher number of DRPs. These findings are a starting point for evidence-based eligibility criteria for a MUR service in Belgium.

Confraternal talks impact with general practitioners on the prescription for older adults

Abstract Issue 10% patients over 75 and patients aged from 66 to 75 years with a chronic disease take more than 10 concomitant drugs. Polypharmacy is a consistent risk factor of adverse drug events for elderly patients. Adverse drug reactions prevention is a national priority in view of quality of life and healthcare system costs increase. Description In Normandy, since November 2015, various interventions such as confraternal talks or letters send to general practitioners (GPs) have been examined to optimize medication use in older adults. More than 16 drugs prescriptions were discussed with the family practitioner and a health insurance fund’s physician-advisor. In addition, a prescription profile in elderly patients was given to this GP. Recommendations for good practices are also reminded. Results 10 weeks of physicians prescriptions were studied during one year (from september 2015 to september 2016). 686 general practitioners (GPs) had at least one prescription over 16 drugs and 265 GPs had at least two prescriptions over 16 drugs. 166 confraternal talks or phone calls between health insurance doctors and GPs have been leaded with a medication review. 233 letters have been sent to physicians to improve prescribing. 46% of GPs received a physician-advisor led intervention. After these interventions, prescriptions drugs number has decreased (p < 0,001) and the number of GPs having more than 16 prescriptions drugs has also decreased (p = 0,27). There is no significant difference between confraternal talks and letters. However, the physicians are more confortable with the confraternal talks to discuss their prescriptions. Lessons Confraternal talks continued in 2017 with medication review and profile’s delivery. A two years follow-up on these accompanying interventions will be made to optimize drugs prescriptions use for elderly patients. Key messages The physicians are more confortable with the confraternal talks to discuss their prescriptions. There is no significant difference between confraternal talks and letters.

Potentially inappropriate medications in older adults: a population-based cohort study.

Non-optimal medication use among older adults is a public health concern. A concrete picture of potentially inappropriate medication (PIM) use is imperative to ensure optimal medication use. To assess the prevalence of PIMs in community-dwelling older adults and identify associated factors. A retrospective population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System (QICDSS). The QICDSS includes data on drug claims for community-dwelling older adults with chronic diseases or at risk of developing chronic diseases aged ≥65 years who are insured by the public drug insurance plan. Individuals aged ≥66 years who were continuously insured with the public drug plan between 1 April 2014 and 31 March 2016 were included. PIMs were defined using the 2015 Beers criteria. We conducted multivariate robust Poisson regression analyses to explore factors associated with PIM use. A total of 1 105 295 individuals were included. Of these, 48.3% were prescribed at least one PIM. The most prevalent PIMs were benzodiazepines (25.7%), proton-pump inhibitors (21.3%), antipsychotics (5.6%), antidepressants (5.0%) and long-duration sulfonylureas (3.3%). Factors associated with PIM exposure included being a woman [rate ratio (RR): 1.20; 95% confidence interval (CI): 1.20-1.21], increased number of medications and having a high number of chronic diseases, especially mental disorders (RR: 1.50; 95% CI: 1.49-1.51). Almost one out of two community-dwelling older adults use a PIM. It is imperative to reduce the use of PIMs, by limiting their prescription and by promoting their deprescribing, which necessitates not only the active involvement of prescribers but also patients.