Optimize Medication Use Research Articles

A realist review of medication optimisation of community dwelling service users with serious mental illness

BackgroundSevere mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main...

Medication use quality and safety in older adults: 2022 update.

Improving the quality of medication use and medication safety are important priorities for healthcare providers who care for older adults. The objective of this article was to identify four exemplary articles with this focus in 2022. We selected high-quality studies from an OVID search and hand searching of major high impact journals that advanced the field of research forward. The chosen articles cover domains related to deprescribing, medication safety, and optimizing medication use. The MedSafer Study, a cluster randomized clinical trial in Canada, evaluated whether patient specific deprescribing reports generated by electronic decision support software resulted in reduced adverse drug events in the 30 days post hospital discharge in older adults (domain: deprescribing). The second study, a retrospective cohort study using data from Premier Healthcare Database, examined in-hospital adverse clinical events associated with perioperative gabapentin use among older adults undergoing major surgery (domain: medication safety). The third study used an open-label parallel controlled trial in 39 Australian aged-care facilities to examine the effectiveness of a pharmacist-led intervention to reduce medication-induced deterioration and adverse reactions (domain: optimizing medication use). Lastly, the fourth study engaged experts in a Delphi method process to develop a consensus list of clinically important prescribing cascades that adversely affect older persons' health to aid clinicians to identify, prevent, and manage prescribing cascades (domain: optimizing medication use). Collectively, this review succinctly highlights pertinent topics related to promoting safe use of medications and promotes awareness of optimizing older adults' medication regimens.

Applying health behavior theories that explain elderly’ deprescribing behavior: a systematic review

Abstract Deprescribing is a strategy to optimize medication use. Despite the fact that behavioral theories have shown to be useful in explaining health behaviors, the literature on deprescribing relies almost exclusively on attitudes as an explanatory factor for this behavior. This systematic review aimed to assess the capacity of health behavior theories and concepts to explain patient's and caregivers’ deprescribe behavior. Two independent reviewers performed a search on Medline, Embase, Scopus, Psycinfo, Cochrane, and the grey literature, using the key words: older adults, informal caregivers, deprescribing, behavioral models, health belief model, theory of planned behavior, social cognitive theory, nudge, and health literacy, Interventional and non-interventional studies that applied at least one health behavior theory or at least one concept from these theories to older adults’ or their caregivers’ intention or deprescribing behavior were included. Quality screening of the identified records was done using the JBI critical appraisal tool. Ten non-interventional studies and twelve interventional studies were identified. Social Cognitive Theory was most often used to explain deprescribing intention, whereas self-efficacy was used most often to explain deprescribing behavior. Higher health literacy also predicted deprescribing intention, whereas internal locus of control was a barrier to deprescribing behavior. One study applied nudging to deprescribing but showed no significant effect. The only study involving informal caregivers revealed that the belief that relatives experienced side effects was a reason to support deprescribing. It is concluded that health behavior theories and concepts involved in these theories explain deprescribing intentions and behaviors more effectively than only relying on attitudes toward deprescribing. Key messages • Deprescribing behavior requires complexes changes to established patters of behaviors. • Health behavior theories and concepts from these theories can explain deprescribing intentions and behaviors more effectively than relying only on widely studied attitudes toward deprescribing.

Comprehension of prescription orders with and without pictograms: tool validation and comparative assessment among a sample of participants from a developing country

BackgroundMedication errors can often occur due to the patient’s inability to comprehend written or verbal medication orders. This study aimed to develop pictograms of selected medication orders and to validate the comprehension of prescription orders index and compare the comprehension scores with and without pictograms. In addition to determine the predictors that could be associated with a better or worse comprehension of prescription orders with pictograms versus that of their written counterparts.MethodsA cross-sectional study was conducted using a snowball sampling technique. Six pictograms were developed to depict specific medication orders. The comprehension of prescription orders index was constructed and validated. The study then compared the comprehension scores of prescription orders with and without pictograms, and identified the predicting factors score difference.ResultsA total of 1848 participants were included in the study. The structure of the comprehension of prescription orders index was validated over a solution of four factors, with an adequate Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.711 and a significant Bartlett’s test of sphericity (P < 0.001). The construct validity of the index was further confirmed by highly significant correlations between each item and the full index (P < 0.001). The study also found a significant association between the difference in comprehension scores for prescription orders with and without pictograms and several factors, including age, level of education, area of residence, number of children, and smoking status with the difference of comprehension scores (P < 0.001).ConclusionPictogram-based instructions of medication orders were better understood by the Lebanese population than written instructions, making the incorporation of pictograms in pharmacy practice paramount to optimize medication use by the patient and thus yielding better health outcomes.

Medication Safety Events After Acute Myocardial Infarction Among Veterans Treated at VA Versus Non-VA Hospitals.

Fragmentation of health care across systems can contribute to mistakes in prescribing and filling medications among patients treated for myocardial infarction (MI). We sought to compare omissions, duplications, and delays in outpatient medications used for secondary prevention among veterans treated for MI at Veterans Affairs (VA) versus non-VA hospitals. We utilized national VA and Centers for Medicare and Medicaid Services data (2012-2018) to identify veterans 65 years or older hospitalized for MI and measured the use of outpatient medications for secondary prevention in the 30 days after MI among those treated at VA versus non-VA hospitals. A total of 118,456 veterans experiencing MI were included; of which 102,209 were hospitalized at non-VA hospitals. An omission in any medication class occurred more frequently among veterans treated at non-VA versus VA hospitals (82.8% vs 67.8%, P < 0.001). In multivariable modeling, the odds of omissions in any medication class were higher among those treated at non-VA versus VA hospitals (odds ratio: 3.04; 95% CI: 2.88-3.20). Duplications occurred more frequently in veterans treated at non-VA versus VA hospitals: 1.9% versus 1.6% had 1 or more for non-VA versus VA hospitals ( P < 0.001). Veterans treated at non-VA hospitals were more likely to have delays of 3 days or more in prescription fills after hospital discharge (88.4% vs 70.6% across all classes, P < 0.001). Omissions, duplications, and delays in outpatient prescribing of secondary prevention medications were more common among 118,456 veterans treated at non-VA versus VA hospitals for MI. Interventions aimed at improving care transitions and optimizing medication use among veterans treated at non-VA hospitals should be implemented.

Evaluation of Pharmacotherapy Standards During Pregnancy Among Jordanian Pharmacy Colleges Graduates

Background: Pharmacists' knowledge of medication risks and benefits during pregnancy, as well as their competence in making appropriate therapeutic decisions to optimize medication use among pregnant women, is crucial. This study aims to evaluate the knowledge of Jordanian pharmacists regarding medication risks and safety during pregnancy and assess their abilities to make appropriate therapeutic decisions and optimize medication use. Methods: A self-administered questionnaire was sent to 400 randomly selected pharmacists practicing in Amman, Jordan. A validated questionnaire, consisting of six sections with predefined options, was employed. Results: A total of 233 pharmacists completed the questionnaire, resulting in a response rate of 58.2%. Nearly 73.4% of pharmacists (N = 171) correctly identified the drug of choice for hypertension during pregnancy. Over 70% of pharmacists (N = 169) determined the correct dose of aspirin to prevent preeclampsia. About 50% of pharmacists exhibited limited knowledge regarding drug risks and safety during pregnancy. There was a significant difference in the pharmacists' scores on all tests based on their marital status and years of experience (p = 0.04 and p = 0.01, respectively). Among pharmacists, 79.8% stated that they studied pharmacotherapy during pregnancy in their undergraduate courses. Conclusion: Pharmacists have demonstrated an inadequate level of preparedness in providing appropriate pharmaceutical care for pregnant women. Therefore, there is an urgent need to collaborate between national health authorities and academic institutions to empower pharmacists and enhance their knowledge and skills necessary to improve the health outcomes of pregnant women.

The role of pharmacists in supporting service users to optimise antipsychotic medication.

Pharmacists have a contribution to make in improving optimising medication use for people on antipsychotic medication. The rates of prescribing antipsychotics have increased in England with an 18% rise from 2015 to 2020. People on antipsychotic medication are not treated as equal partners in conversations about their medications. This can leave people to make decisions about their antipsychotic medications without input from their prescribers which can have significant consequences for individuals. Involving people in the decision-making process, as experts on their own condition, has the potential to improve treatment outcomes. The evidence suggests that involving pharmacists in supporting people with serious mental illnesses will lead to improved clinical outcomes. Key areas for pharmacist involvement are providing information, education and counselling on antipsychotic medication and the side effects and reducing polypharmacy especially when antipsychotics are prescribed off license.

Systematic Review and Meta-analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults: An Update.

We previously reported that interventions to optimize medication use reduced adverse drug reactions (ADRs) by 21% and serious ADRs by 36% in older adults. With new evidence, we sought to update the systematic review and meta-analysis. We searched OVID, Cochrane Library, ClinicalTrials.gov and Google Scholar from 30 April 2017-30 April 2023. Included studies had to be randomized controlled trials of older adults (mean age ≥65 years) taking medications that examined the outcome of ADRs. Two authors independently reviewed all citations, extracted relevant data, and assessed studies for potential bias. The outcomes were any and serious ADRs. We performed subgroup analyses by intervention type and setting. Random-effects models were used to combine the results from multiple studies and create summary estimates. Six studies are new to the update, resulting in 19 total studies (15,675 participants). Interventions were pharmacist-led (10 studies), other healthcare professional-led (5 studies), technology based (3 studies), and educational (1 study). The interventions were implemented in various clinical settings, including hospitals, outpatient clinics, long-term care facilities/rehabilitation wards, and community pharmacies. In the pooled analysis, the intervention group participants were 19% less likely to experience an ADR (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.68-0.96) and 32% less likely to experience a serious ADR (OR 0.68, 95% CI 0.48-0.96). We also found that pharmacist-led interventions reduced the risk of any ADR by 35%, compared with 8% for other types of interventions. Interventions significantly and substantially reduced the risk of ADRs and serious ADRs in older adults. Future research should examine whether effectiveness of interventions vary across health care settings to identify those most likely to benefit. Implementation of successful interventions in health care systems may improve medication safety in older patients.

Policies Shaping Nursing Home Medication Practices: Involving Nurses to Advance Individualized Deprescribing.

Deprescribing is a common practice in the care of older adults, including those living in nursing homes (NHs). Deprescribing represents an individualized approach to optimizing medication use; it considers the risks, benefits, and goals of an individual, and can mitigate the effects of polypharmacy and potentially inappropriate medications. In NH settings, prescribing practices are shaped directly and indirectly by historical and contemporaneous policies at federal, state, and local levels, which have primarily targeted chemical restraints and unnecessary medications. Understanding these policies, their impact, and potentially unintended consequences is essential for gerontological nursing to transition toward individualized practices and approaches to deprescribing. [Journal of Gerontological Nursing, 49(9), 15-20.].

Nursing Home PRevention of Injury in DEmentia (NH PRIDE): A pilot study of a remote injury prevention service for NH residents.

Medication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls. Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study. This was a non-randomized trial (pilot study) including NH staff and residents from five facilities. Long-stay residents at high-risk for injurious falls were identified using a validated risk calculator and staff referral. A remote team reviewed the electronic health record (EHR) and provided recommendations as Injury Prevention Plans (IPP). A research nurse served as a care coordinator focused on resident engagement and shared decision-making. Outcomes included implementation measures, as identified in the EHR, and surveys and interviews with staff. Across five facilities, 274 residents were screened for eligibility, and 46 residents (16.8%) were enrolled. Most residents were female (73.9%) and had dementia (63.0%). An IPP was completed for 45 residents (97.8%). The nurse made a total of 93 deprescribing recommendations in 36 residents (80% of residents had one or more deprescribing recommendation; mean 2.2 recommendations/resident). Twenty of 45 residents (44.4%) had a recommendation for osteoporosis treatment. Among residents with recommendations, 21/36 (58.3%) had one or more deprescribing orders written and 6/20 (30.0%) had an osteoporosis medication prescribed. At 4 months, most medication changes persisted. Adverse side effects were rare. Staff members identified several areas for program refinement, including aligning recommendations with provider workflow and engaging consultant psychiatrists. A remote injury prevention service is safe and feasible to enhance deprescribing and osteoporosis treatment in long-stay NH residents at risk for injury. Additional investigation is needed to determine if this model could reduce injurious falls when deployed across NH chains.

Oordeelkundig medicatiebeleid bij ouderen: aandacht voor geslachts- en genderaspecten

Judicious medication use in older people: pay attention to sex and gender aspects Polypharmacy is prevalent among older adults and the risk of inappropriate prescribing increases with age. Older adults, particularly women, are at high risk for medication-related problems. This review article focuses on optimizing medication use in older adults, proposes a practical approach for evaluating and managing the use of medication in daily practice and describes how sex and gender aspects can play a role in appropriate prescribing.

Translation, cultural adaptation and validation of the revised patients’ attitudes towards deprescribing (rPATD) questionnaire in Romanian older adults

BackgroundDeprescribing is part of ensuring appropriate medication use and may reduce medication-related harm. Capturing the beliefs and attitudes of patients towards deprescribing by using a validated tool may support optimizing medication use in practice. ObjectivesTo translate, culturally adapt and validate the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire in Romanian and to investigate the attitudes and beliefs of older adults towards deprescribing. MethodsThe rPATD questionnaire was translated using forward-backward translation into Romanian and culturally adapted. The psychometric properties were evaluated in older adults ≥65 years of age. Structural validity was assessed by item load on factors using an exploratory factor analysis (EFA) which was compared to the original English version and the internal consistency by Cronbach's alpha. Construct validity was evaluated by calculating the Spearman's rank correlation coefficients between the factor scores obtained using the revised version of the Romanian rPATD and scores on the Beliefs about Medicines Questionnaire (BMQ) Specific Concerns Romanian version. Floor and ceiling effect were also examined. ResultsWe translated the questionnaire and administered it to 224 participants (median age 72 years [interquartile range: 68.0; 77.0]). In the EFA individual items loaded onto 4 factors, grouped similarly to the English version (Involvement, Burden, Appropriateness, Concerns about Stopping factors). Two items from each of the Involvement and Appropriateness factors were removed to improve factor loading and avoid cross-loading. The Cronbach's alpha values for the 4 factors ranged between 0.522 and 0.773. The scores for Burden and Concerns about Stopping factors were found to be positively correlated with BMQ Specific Concerns score. We identified a ceiling effect for one of the four factors (Involvement) and no floor effects. ConclusionsThe Romanian rPATD was validated in 4 factor structure similar to the original English questionnaire. The Romanian version of the questionnaire may support the health care professionals in Romania to initiate and support patient-centered deprescribing.

Treatment of Seizure Clusters in Epilepsy: A Narrative Review on Rescue Therapies.

Epilepsy is a common neurological disorder in the United States, affecting approximately 1.2% of the population. Some people with epilepsy may experience seizure clusters, which are acute repetitive seizures that differ from the person's usual seizure pattern. Seizure clusters are unpredictable, are emotionally burdensome to patients and caregivers (including care partners), and require prompt treatment to prevent progression to serious outcomes, including status epilepticus and associated morbidity (e.g., lacerations, fractures due to falls) and mortality. Rescue medications for community use can be administered to terminate a seizure cluster, and benzodiazepines are the cornerstone of rescue treatment. Despite the effectiveness of benzodiazepines and the importance of a rapid treatment approach, as many as 80% of adult patients do not use rescue medication to treat seizure clusters. This narrative review provides an update on rescue medications used for treatment of seizure clusters, with an emphasis on clinical development and study programs for diazepam rectal gel, midazolam nasal spray, and diazepam nasal spray. Results from long-term clinical trials have shown that treatments for seizure clusters are effective. Intranasal benzodiazepines provide ease of use and patient and caregiver satisfaction in pediatric and adult patients. Adverse events attributed to acute rescue treatments have been characterized as mild to moderate, and no reports of respiratory depression have been attributed to treatment in long-term safety studies. The implementation of an acute seizure action plan to facilitate optimal use of rescue medications provides an opportunity for improved management of seizure clusters, allowing those affected to resume normal daily activities more quickly.

Using multi-criteria decision analysis to describe stakeholder preferences for new quality improvement initiatives that could optimise prescribing in England.

Hospital decision-makers have limited resources to implement quality improvement projects. To decide which interventions to take forward, trade-offs must be considered that inevitably turn on stakeholder preferences. The multi-criteria decision analysis (MCDA) approach could make this decision process more transparent. An MCDA was conducted to rank-order four types of interventions that could optimise medication use in England's National Healthcare System (NHS) hospitals, including Computerised Interface, Built Environment, Written Communication, and Face-to-Face Interactions. Initially, a core group of quality improvers (N = 10) was convened to determine criteria that could influence which interventions are taken forward according to the Consolidated Framework for Implementation Research. Next, to determine preference weightings, a preference survey was conducted with a diverse group of quality improvers (N = 356) according to the Potentially All Pairwise Ranking of All Possible Alternatives method. Then, rank orders of four intervention types were calculated according to models with criteria unweighted and weighted according to participant preferences using an additive function. Uncertainty was estimated by probabilistic sensitivity analysis using 1,000 Monte Carlo Simulation iterations. The most important criteria influencing what interventions were preferred was whether they addressed "patient needs" (17.6%)' and their financial "cost (11.5%)". The interventions' total scores (unweighted score out of 30 | weighted out of 100%) were: Computerised Interface (25 | 83.8%), Built Environment (24 | 79.6%), Written Communication (22 | 71.6%), and Face-to-Face (22 | 67.8%). The probabilistic sensitivity analysis revealed that the Computerised Interface would be the most preferred intervention over various degrees of uncertainty. An MCDA was conducted to rank order intervention types that stand to increase medication optimisation across hospitals in England. The top-ranked intervention type was the Computerised Interface. This finding does not imply Computerised Interface interventions are the most effective interventions but suggests that successfully implementing lower-ranked interventions may require more conversations that acknowledge stakeholder concerns.

Medication self-management behaviors of adolescents and young adults with cancer.

Adolescents and young adults (AYAs) with cancer are challenged to manage complex medication regimens during treatment. The aims of the study are to (1) describe the medication self-management behaviors of AYAs with cancer and (2) examine the barriers and facilitators to AYAs' optimal use of medications, including their self-efficacy to manage medications. This cross-sectional study enrolled 30 AYAs (18-29years) with cancer who were receiving chemotherapy. Participants electronically completed a demographic form, a health literacy screen, and the PROMIS Self-efficacy for Medication Management instrument. They completed a semi-structured interview to answer questions about their medication self-management behaviors. Participants (53% female, mean age = 21.9 y) had a variety of AYA cancer diagnoses. Over half (63%) had limited health literacy. Most AYAs had accurate knowledge about their medications and average self-efficacy for managing medications. These AYAs were managing an average of 6 scheduled and 3 unscheduled medications. Oral chemotherapy was prescribed for 13 AYAs; other medications were for prevention of complications and symptom management. Many AYAs relied on a parent for obtaining and paying for medications, used multiple reminders to take medications, and used a variety of strategies to store and organize medications. AYAs with cancer were knowledgeable and confident about managing complex medication regimens but needed support and reminders. Providers should review medication-taking strategies with AYAs and ensure a support person is available.

Classifying Polypharmacy According to Pharmacotherapeutic and Clinical Risks in Older Adults: A Latent Class Analysis in Quebec, Canada.

The simplistic definition of polypharmacy, often designated as the concomitant use of five medications or more, does not distinguish appropriate from inappropriate polypharmacy. Classifying polypharmacy according to varying levels of health risk would help optimise medication use. We aimed to characterise different types of polypharmacy among older adults and evaluate their association with mortality and institutionalisation. Using healthcare databases from the Quebec Integrated Chronic Disease Surveillance System, we selected a community-based random sample of the population ≥ 66 years old covered by the public drug plan. Categorical indicators used to describe polypharmacy included number of medications, potentially inappropriate medications (PIMs), drug-drug interactions, enhanced surveillance medications, complex route of administration medications, anticholinergic cognitive burden (ACB) score and use of blister cards. We used a latent class analysis to subdivide participants into distinct groups of polypharmacy. Their association with 3-year mortality and institutionalisation was assessed with adjusted Cox models. In total, 93,516 individuals were included. A four-class model was selected with groups described as (1) no polypharmacy (46% of our sample), (2) high-medium number of medications, low risk (33%), (3) medium number of medications, PIM use with or without high ACB score (8%) and (4) hyperpolypharmacy, complex use, high risk (13%). Using the class without polypharmacy as the reference, all polypharmacy classes were associated with 3-year mortality and institutionalisation, with the most complex/inappropriate classes denoting the highest risk (hazard ratio [HR] [95% confidence interval]: class 3, 70-year-old point estimate for mortality 1.52 [1.30-1.78] and institutionalisation 1.86 [1.52-2.29]; class 4, 70-year-old point estimate for mortality 2.74 [2.44-3.08] and institutionalisation 3.11 [2.60-3.70]). We distinguished three types of polypharmacy with varying pharmacotherapeutic and clinical appropriateness. Our results highlight the value of looking beyond the number of medications to assess polypharmacy.

Outcomes of Pharmacist-Led Pharmaceutical Care Interventions Within Community Pharmacies: Narrative Review.

Pharmaceutical care (PhC) services interventions led by pharmacists within community pharmacies (CPs) are essential in achieving optimal medication use outcomes. PhC is a concept related to medication use goals optimization through the reduction and prevention of drug-related problems (DRPs). This review paper summarized the literature on pharmacist-led PhC interventions within CPs. PubMed and Google Scholar publications were searched, identified, and summarized. Results showed that some studies handled community pharmacists' roles, and some talked about PhC interventions. However, some studies reviewed the use of medicines, adherence, and follow-up, while other groups were on counseling, patient education, and health promotion. Pharmacists integrated some studies concerning diagnosis and disease screening into community pharmacy services. Besides these studies, there were studies on system design and installation of PhC service models. Most of the identified research results showed pharmacist-led intervention benefits for patients. These benefits include reduced DRPs, clinical, economical, humane, education and knowledge, disease prevention and immunization, identification of practice process problems, and the need for current practice redesigning. In conclusion, pharmacists can help patients achieve optimal outcomes through pharmacist-led interventions. Despite mentioned results, We recommend researching comprehensively applied PhC services provision models within CPs for more pharmacists-led interventions and role activation.

Use of preventive medication and supplements in general practice in patients in their last year of life: a Retrospective cohort study

BackgroundSeveral preventive medications and supplements become inappropriate in the last phase of life due to increased risk of adverse events caused by changed pharmacokinetics, drug-drug interactions, and changed care goals. Information on these preventive medication and supplements use in patients with a life-limiting illness in the home-care setting is limited. The primary aim of this study was to assess the use of four different groups of preventive drugs and supplements, which are inappropriate in adult patients with a life-limiting illness, living at home in the last year of life. The secondary aims were to assess reasons for discontinuing these drugs as documented in the general practitioners’ patient file and whether these reasons affected the time between medication discontinuation and death.MethodsWe performed a retrospective cohort study using the routine primary care database of the Julius General Practitioners’ Network of the University Medical Centre Utrecht, a database consisting of routine care data from GPs from the city of Utrecht and its vicinity. Patients in the homecare setting with a life-limiting illness, diagnosed at least one year before death, were included. Descriptive analyses were used to describe the study population and the frequency of starting, using, and discontinuing medication and supplements in the last year of life.ResultsA total of 458 of 666 included patients (69%) used at least one preventive drug in the last year of life. Vitamins were used by 36% of the patients, followed with 35% using cholesterol-lowering medication, 24% using calcium supplements and 9% using bisphosphonates. Bisphosphonates were discontinued by 70% of the users, calcium supplements by 61%, vitamins by 56% and cholesterol-lowering medication by 48% of the users, with a median interval between day of discontinuation and death of 119, 60, 110 and, 65 days, respectively. The median time between medication or supplement discontinuation and death was longest in patients with side effects and who had medication reviews.ConclusionMany patients in their last phase of life in the home-care setting use inappropriate medication and supplements. Timely medication review may contribute to optimise medication use in the last year of life.

ASHP commission examines data-driven healthcare.

The management of digital health technology for better patient care was on the agenda at the March 7 meeting of ASHP’s Commission on Goals, whose members offered strategic guidance on optimizing medication use through advanced analytics and data-driven healthcare. The interdisciplinary commission meets annually to provide critical guidance for the ASHP Board of Directors and to help shape ASHP’s strategic direction. This year’s commission roster included leaders in pharmacy, medicine, nursing, digital health technology, public health, industry, and government. The group was asked to provide guidance on 4 main topics: Commission members described having access to prescribing and dispensing information as well as data from electronic medical records, automated dispensing cabinets, infusion pumps, robotics, wearable devices, and many other sources. During the session on data prioritization, meeting participants discussed the need to establish policies and processes to ensure data security and protect patient privacy; uncertainty about the clinical and financial value of investments in technology; usability of data by clinicians; how to leverage data to improve health equity; and how to effectively allocate staff resources to manage data prioritization and use.

Clinical Pharmacist Led Approach on Enhancement of Medication Adherence Resolving the Drug Related Problems with Selective Serotonin Reuptake Inhibitors among the Patients with Psychiatric Illness. A Prospective, Pre and Post Non-Randomised Interventional

Abstract: Introduction: Non-adherence is one of the most common barriers to the successful completion of treatment and it can be worst in psychiatric patients. Objectives: To assess, compare and resolve drug-related problems and medication adherence among psychiatric patients with SSRI and to assess the association between non-adherence and drug-related problems. Materials and Methods: In this prospective, non-randomized interventional study 90 psychiatry patients which were on SSRI treatment of both gender, aged more than 18 years were included. Written informed consent was obtained from the patient prior to enrol in the study. Results: Out of 90 patients enrolled, 51 (56.7%) patients reported DRPs and after pharmacist intervention, it was reduced to 26 (28.9%). Results showed a significant association between drug-related problems and medication adherence. Baseline and follow-up MARS scores are compared and found that there is a significant increase in the adherence score of patients after pharmacist intervention. Conclusion: This study results show that through proper patient education it is possible to improve medication adherence and to optimize medication use, which may reduce the DRPs. It will help eventually help to decrease drug-related morbidity and mortality. Keywords: Medication adherence, Drug Related Problems, SSRI, Mood disorders, MARS.