Outcomes Of Medication Use Research Articles

LIMITATIONS IN DAILY ACTIVITIES AS THE STRONGEST PREDICTOR OF PHARMACOTHERAPY USAGE FOR PAIN IN INDONESIA

Background: Many factors have been reported to contribute to a decrease in the use of pharmacotherapy to control pain, including the complexity of the medication regime, lack of efficacy, side effects, and cost considerations. Objective: The purpose of this study was to identify the significant factors associated with the use of pharmacotherapy in pain relief among Indonesian population. Methods: The data was obtained from the fifth wave of the Indonesian Family Life Survey (IFLS-5). The sample size was 11,516 persons aged 21-60 years with recent pain. Logistic regressions were utilized to explore the associations between independent characteristics and the outcome of medication use for pain complaints. Results: The majority of the participants were females between the ages of 31 and 40, had a high school diploma or less, were working, practiced Islam, and had no restrictions on their daily activities. The proportions of pharmacotherapy users and non- pharmacotherapy users were 51.44% and 48.56%, respectively. Female gender, older age, poor education level, and limitations in daily activities were all linked with a higher usage of medication. Conclusion: In the Indonesian population, having limitations in daily activities was the strongest predictor of pharmacotherapy usage for recent pain. Implication: People who are older, female, or have a poorer level of education should be the primary focus of education to enhance the pharmacological management of their pain.

Barriers to Medication Review Process Implementation-Cross-Sectional Study among Community Pharmacists in Jordan.

The medication review process (MRP) is an extended, vital role of community pharmacists in improving health outcomes of medication use, yet it is neither systematically nor comprehensively provided bycommunity pharmacies in Jordan. This study aimed to identify the potential barriers hinderingMRP implementation bycommunity pharmacists in Jordan. A total of 550 community pharmacists electronically received a previously constructed and validated Arabic questionnaire explicitly developed to assess the current medication review practices and factors hindering the MRP, of whom 417 answered the questionnaire, giving a response rate of 75.8%. Among the investigated six categories’ seventeen barriers tothe implementation of the MRP, the highest rating was found for remuneration barriers (55.8%), followed by barriers related to regulations and patients, which scored 52.3% and 48.8%, respectively. Resource-related barriers were recognizedby 44.6% of participants, while qualifications and barriers related to physicians scored 42.9% and 41.8%, respectively. Although community pharmacists in Jordan are eager to extend their roles from traditional to more patient-centered ones, they encounter various barriers hinderingsuch development. Regulation adjustments accompanied by cost-effective remuneration and proper training are strong facilitators for community pharmacists to initiate the medication review service; make available the needed resources; and invest efforts, time, and money to operate it.

ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration-2017.

The results of the 2017 ASHP national survey of pharmacy practice in hospital settings are described. Pharmacy directors at 4,828 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and e-mail. Survey completion was online, using Qualtrics (Qualtrics, Provo, UT). IMS Health supplied data on hospital characteristics; the survey sample was drawn from the IMS hospital database (IMS Health, Yardley, PA). The response rate was 14.4%. Drug distribution systems have evolved from centralized unit dose programs to decentralized programs based on the use of automated dispensing cabinets (ADCs). These systems have been made safer by the use of lidded pockets, by the use of machine-readable coding during ADC stocking, and by linking access to medications to results of pharmacist order review. Health-system pharmacists continue to improve quality practices for compounding sterile preparations, including the use of safeguards in handling hazardous drugs. While some hospitals are prepared for more stringent standards, including United States Pharmacopeia chapter 800 requirements, much still needs to be done to meet these standards. Pharmacists are taking an active role in improving the responsible use of medications through antimicrobial stewardship and controlled-substance diversion prevention programs. The quality of the pharmacy workforce continues to be improved through the increased credentialing of both pharmacists and pharmacy technicians. Health-system pharmacists continue to have a positive impact on improving healthcare through programs that improve efficiency, safety, and clinical outcomes of medication use in health systems.

Patient experiences with informational discontinuity of care: Bridging the gaps

Informational continuity of care is a central component of effective health care delivery and patient management but is often not achieved, leaving patients to compensate for or suffer from the burden of informational discontinuity of care. Fragmentation and siloed care delivery and communication within and across care settings present significant challenges to informational continuity of care. This is especially the case in the context of adverse drug events (ADEs), the harmful and unanticipated outcomes of medication use. This paper introduces a project called ActionADE that is intended to bridge informational gaps related to ADEs by enabling the documentation and communication of patient-specific ADE information. It contributes to literature concerned with information sharing in healthcare through a focus on patient views about sharing medication information through the design of an ADE reporting system, and explores implications for system design within a sociotechnical framework.

A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI.

BackgroundMedication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these disorders exist.ObjectiveOur objective was to compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea.Data SourcesElectronic databases were searched for relevant articles published until June 2013. Of 3867 screened records, 269 had an acceptable degree of relevance, quality of methodology, and strength of evidence. We found 56 chemical substances with a higher level of evidence and 50 with a moderate level of evidence of causing the above-mentioned disorders. At the first level of the Anatomical Therapeutic Chemical (ATC) classification system, 9 of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices.LimitationsWhile xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when administered in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or was not detected in our search.ConclusionsWe compiled a comprehensive list of medications with documented effects on salivary gland function or symptoms that may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful in helping practitioners anticipate adverse effects and consider alternative medications.

ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration--2014.

The results of the 2014 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are described. A stratified random sample of pharmacy directors at 1435 general and children's medical-surgical hospitals in the United States were surveyed by mail. In this national probability sample survey, the response rate was 29.7%. Ninety-seven percent of hospitals used automated dispensing cabinets in their medication distribution systems, 65.7% of which used individually secured lidded pockets as the predominant configuration. Overall, 44.8% of hospitals used some form of machine-readable coding to verify doses before dispensing in the pharmacy. Overall, 65% of hospital pharmacy departments reported having a cleanroom compliant with United States Pharmacopeia chapter 797. Pharmacists reviewed and approved all medication orders before the first dose was administered, either onsite or by remote order view, except in procedure areas and emergency situations, in 81.2% of hospitals. Adoption rates of electronic health information have rapidly increased, with the widespread use of electronic health records, computer prescriber order entry, barcodes, and smart pumps. Overall, 31.4% of hospitals had pharmacists practicing in ambulatory or primary care clinics. Transitions-of-care services offered by the pharmacy department have generally increased since 2012. Discharge prescription services increased from 11.8% of hospitals in 2012 to 21.5% in 2014. Approximately 15% of hospitals outsourced pharmacy management operations to a contract pharmacy services provider, an increase from 8% in 2011. Health-system pharmacists continue to have a positive impact on improving healthcare through programs that improve the efficiency, safety, and clinical outcomes of medication use in health systems.

A Systematic Review of Medication Exposure Assessment in Prospective Cohort Studies of Community Dwelling Older Australians

IntroductionIt is not known to what extent medication use has been comprehensively assessed in prospective cohort studies of older Australians. Understanding the varying methods to assess medication use is necessary to establish comparability and to understand the opportunities for pharmacoepidemiological analysis. The objective of this review was to compare and contrast how medication-related data have been collected in prospective cohorts of community-dwelling older Australians.MethodsMEDLINE and EMBASE (1990–2014) were systematically searched to identify prospective cohorts of ≥1000 older participants that commenced recruitment after 1990. The data collection tools used to assess medication use in each cohort were independently examined by two investigators using a structured approach.ResultsThirteen eligible cohorts were included. Baseline medication use was assessed in participant self-completed surveys (n = 3), by an investigator inspecting medications brought to a clinic interview (n = 7), and by interviewing participants in their home (n = 3). Five cohorts sought participant consent to access administrative claims data. Six cohorts used multiple methods to assess medication use across one or more study waves. All cohorts assessed medication use at baseline and 12 cohorts in follow-up waves. Twelve cohorts recorded prescription medications by trade or generic name; 12 cohorts recorded medication strength; and 9 recorded the daily medication dose in at least one wave of the cohort. Seven cohorts asked participants about their “current” medication use without providing a definition of “current”; and nine cohorts asked participants to report medication use over recall periods ranging from 1-week to 3-months in at least one wave of the cohort. Sixty-five original publications, that reported the prevalence or outcomes of medication use, in the 13 cohorts were identified (median = 3, range 1–21).ConclusionThere has been considerable variability in the assessment of medication use within and between cohorts. This may limit the comparability of medication data collected in these cohorts.

Concern beliefs in medications: Changes over time and medication use factors related to a change in beliefs

Concern belief in medication is a construct that may characterize patients' attitude toward managing medicines, and this could change with time. Understanding the factors that would impact a change in concern beliefs would be helpful in interventions that could reframe patients' perceptions about their medicines. To examine if patient concern beliefs in medications change over time, assess the characteristics of individuals whose beliefs change, and determine what factors might impact a change in patient beliefs. Secondary data analysis using 2 longitudinal studies. The first study was an Internet-based survey of Medicare enrollees pre-post Medicare Part D. The second study was a randomized controlled trial evaluating a medication management intervention among adults with physical limitations. Respondents were classified as those whose beliefs remained stable and those whose beliefs increased and decreased over 2 separate periods. Chi-square analysis examined significant differences across the groups. Multiple linear regressions examined factors that influence changes in patient beliefs. Among older adults, there were differences in perceived health status (χ(2)=26.05, P=.001), number of pharmacies used (χ(2)=17.41, P=.008), and number of medicines used after the start of Medicare Part D. There were no significant differences among adults with physical limitations. Among older adults, having an increased number of medicines over time and reporting a self-reported adverse effect to a physician were positively associated with an increase in concern beliefs in medication. Having an increase in adherence was associated with a decrease in concern beliefs over time. Concern beliefs in medications may contribute independent information about individuals' response to drug programs and policies. Outcomes of medication use may influence patient anxieties about medicines. The instability of patient concerns in medications that occurs with prescription drug coverage changes, and the emergence of adverse outcomes of medication use may provide insight into the development of individualized interventions.

Terms used in patient safety related to medication: a literature review

There is a lack of homogeneity in the terminology used in the context of patient safety related to medication. The aim of this review was to identify the terms and definitions used in patient safety related to medication within the scientific literature. Original and review articles that were indexed between 1998 and 2008 in MEDLINE and EMBASE and contained terms used in patient safety related to medication were included. Terms and definitions were extracted and categorised according to whether its definition referred to the process of medication use, or to the clinical outcome of medication use, or both. Of 2564 articles, 147 were included. Sixty terms used in patient safety related to medication with 189 different definitions were identified. Among terms that referred only to the process of medication use (n = 23), medication error provided the greatest number of definitions (n = 29). Among terms that referred only to the clinical outcome of medication use (n = 31), adverse drug event provided the greatest number of definitions (n = 15). Finally, among terms that referred both to the process of use and to the clinical outcome of medication use (n = 13), drug-related problem provided the greatest number of definitions (n = 7). A multitude of terms and definitions are used in patient safety related to medication. This heterogeneity makes it difficult to compare the results among studies and to appreciate the true magnitude of the problem. Classifying and unifying the terminology is necessary to advance in patient safety strategies.

Reimbursement model for pharmacist-directed medication therapy management

To describe the development of a practice model with sustainable reimbursement for medication therapy management (MTM) services provided by pharmacists for beneficiaries of self-insured health care plans. The Auburn University Pharmaceutical Care Center (AUPCC) is a free-standing clinic located within the school of pharmacy that provides preventive care and MTM services for a population of 11,600 employees and dependents that subscribe to the university's self-insured health plan. The goal of patient care is to increase use of cost-effective pharmacotherapy and improve the outcomes of medication use among the population. Development and implementation of a practice model and reimbursement method that can be implemented in the employer setting for large self-insured employers and the community pharmacy practice setting. Since opening, AUPCC has developed into a model pharmaceutical care service that can be implemented in the workplace for other self-insured employers. AUPCC is also a model that can easily translate to the community pharmacy setting. In 2010, the model was adapted by Alabama for state employees. Pharmacists can negotiate directly with decision makers within large companies that are self-insured to provide MTM services for the employee population. This is an area of sustainable growth within our profession.

Frequency, types and severity of medication use-related problems among medical outpatients in Nigeria

To determine the frequency, types and severity of medications use-related problems among medical outpatients in a tertiary care setting in southwestern Nigeria. Medical outpatient clinics of a 900-bed Teaching Hospital located in Ibadan, Southwestern Nigeria. A prospective cross-sectional medication use review was conducted by ten pharmacists for 400 randomly selected medical outpatients over a 4 week period at a 900-bed premier teaching hospital located in Ibadan, Nigeria. Severity assessment of medication use-related problems was done by 3 independent assessors with a modified severity index. Frequency, types and severity of medication use-related problems identified through pharmacist-initiated medication use review. Of the 400 randomly selected patients, 324 (81.0%) consented and were interviewed. One hundred and sixty-three (50.3%) of the cohort were males and 161 (49.7%) were females; with mean ages 51.5 ± 17.6 and 52.1 ± 17.4 years respectively. Median no. of drugs prescribed per patient per day was 4 (Minimum-Maximum, 1-7). About 27.5% were self medicating with orthodox (prescription-only and over-the-counter) and/or herbal medicines; and only 14.6% claimed disclosure to their physicians. The proportion of patients self medicating with orthodox medicines was significantly higher (P < 0.0001). Two hundred and twenty-six medication use-related problems were identified from 58.6% of patients, but the highest number (5) was identified among 2.6% of patients. The frequency of medication use-related problems appear strongly related to the number of medicines prescribed (r = 0.71, P = 0.006). The majority of medication use-related problems were ranked as potentially harmful [Inter-rater reliability coefficient: Gwet AC1: 0.7214 (P ≤ 0.001)]. Non-adherence (43.8%), problems associated with self medication (39.3%) and adverse drug reactions (15.6%) were the most frequent. Unauthorized drug holidays (46.5%) and stoppage of prescribed prescription-only medications for local herbs (29.3%) were the major consequences of non-adherence. Potentially harmful drug-disease interactions were the most frequent medication use-related problems arising from self medication (40.4%). Potentially harmful medication use-related problems are frequently encountered among medical outpatients in Nigeria. The institutionalization of medication use review and the devolution of this task to pharmacists may prove beneficial in optimizing outcomes of medication use in Nigeria.

The Effect on the Fetus of Medications Used to Treat Pregnant Inflammatory Bowel-Disease Patients

We reviewed data to investigate the effect of 5-ASA drugs, metronidazole, ciprofloxacin, prednisone, 6-mercaptopurine, azathioprine, and cyclosporine on pregnancy outcomes in patients with inflammatory bowel disease (IBD). One hundred and thirteen female patients with a total of 207 documented conceptions were studied. Treatment information included: smoking history (patient and spouse), dates of conception and termination, and outcome of pregnancy (spontaneous abortion, therapeutic abortion, maternal or fetal illness resulting in abortion, premature birth, healthy full-term birth, multiple births, ectopic pregnancy, congenital defects), weight of baby, type of delivery (cesarian section, vaginal), medication history during each trimester (mean dose, maximum dose, frequency). We analyzed the effect on pregnancy outcome of medication use during the first trimester or at any time during the pregnancy. Thirty-nine patients (34.5%) had ulcerative colitis (UC), 73 (64.5%) had crohn's disease (CD), and 1 patient (1%) had indeterminate colitis. For 100 of the 207 conceptions, the patients were on 5-ASA drugs at some time during the pregnancy, 49 on prednisone, 101 on an immunomodulator (6-MP/azathioprine), 27 on metronidazole, 18 on ciprofloxacin, and 2 on cyclosporine. In 85 (31%) of the conceptions, patients were on none of these medications. No significant differences were found among the groups in each pregnancy with respect to outcome (p values 0.091 to 0.9). In multivariate analyses controlling for age of mother, there was no evidence that 5-ASA type drugs or any type of drug influenced pregnancy outcome. In 113 female patients with 207 conceptions none of the drugs used to treat IBD is associated with poor pregnancy outcomes.

Women’s Mental Health: A Comprehensive Textbook

Back to table of contents Previous article Next article Book Forum: Gender IssuesFull AccessWomen’s Mental Health: A Comprehensive TextbookJUDITH H. GOLD, C.M., M.D., F.R.C.P.C., F.R.A.N.Z.C.P., D.Hum.L.(hc), JUDITH H. GOLDSearch for more papers by this author, C.M., M.D., F.R.C.P.C., F.R.A.N.Z.C.P., D.Hum.L.(hc), Brisbane, Queensland, AustraliaPublished Online:1 Jul 2003https://doi.org/10.1176/appi.ajp.160.7.1361AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail A textbook on women’s mental health! How far we have come in just two decades; in the 1980s and early 1990s the lack of mention of gender in papers and presentations was commonplace. Research was limited to epidemiological studies. Therefore, I looked forward to reading this new textbook.Coedited by Drs. Kornstein and Clayton, this book emanates from the Virginia Commonwealth University and the University of Virginia. The many chapter contributors are from all over the United States and from Canada. The book is divided into five sections: Women’s Psychobiology and Reproductive Life Cycle; Assessment and Treatment of Psychiatric Disorders in Women; Psychiatric Consultation With Women; Sociocultural Issues for Women; and Research and Health Policy Issues.Each chapter within these sections has its own reference list. Some of these lists do not contain references beyond 1999 or 2000, a common shortcoming in textbooks that reflects the length of the publication process. Although understandable, it does limit somewhat the usefulness of chapters such as the first, “Sex Differences in Neuroendocrine and Neurotransmitter Systems,” where there is a great deal of current research. In their preface, the editors state that the book is intended as “a comprehensive reference on women’s mental health for clinicians, researchers and students,” but the reader should be prepared to find that some chapters will serve to stimulate searches of the more recent literature rather than providing a complete review of the latest research findings.It is not possible to comment in depth on the many topics covered in this book other than selectively. I found Steiner and Born’s chapter, “Psychiatric Aspects of the Menstrual Cycle,” an easy and informative read. It was gratifying to see, in summary, the extensive research into the premenstrual disorders that has been conducted since APA’s DSM-IV workgroup struggled with the concept of premenstrual dysphoric disorder and placed the proposed diagnosis in an appendix for further study.The use of psychopharmacotherapy during pregnancy and the postpartum period is another area that has seen much recent research. Two chapters review the topics well, pointing out the need to consider the risks of discontinuing medications as well as discussing studies on the outcome of medication use during pregnancy and lactation. This is another area where studies are being published frequently. As I write this review, there are two recent papers in the Journal(1, 2) that will further the knowledge of all who begin by reading this book.The section on assessment and treatment of psychiatric disorders contains a brief chapter on complementary and alternative medicine. This is an important and timely inclusion. The section dealing with psychiatric consultation will be particularly useful for students and residents. Both this section and the section on sociocultural issues for women raise many important points. However, by necessity, both are brief reviews of important topics. Finally, there is a good discussion of research and health policy issues specific to women.I found this to be a useful and educational textbook, and I recommend it to those students, residents, and clinicians who want to know more about women’s mental health. I also recommend it to psychiatric educators everywhere as a text for their students.Edited by Susan G. Kornstein and Anita H. Clayton. New York, Guilford Publications, 2002, 638 pp., $65.00.

The Psychodynamics of gender and gender role

A textbook on women’s mental health! How far we have come in just two decades; in the 1980s and early 1990s the lack of mention of gender in papers and presentations was commonplace. Research was limited to epidemiological studies. Therefore, I looked forward to reading this new textbook. Coedited by Drs. Kornstein and Clayton, this book emanates from the Virginia Commonwealth University and the University of Virginia. The many chapter contributors are from all over the United States and from Canada. The book is divided into five sections: Women’s Psychobiology and Reproductive Life Cycle; Assessment and Treatment of Psychiatric Disorders in Women; Psychiatric Consultation With Women; Sociocultural Issues for Women; and Research and Health Policy Issues. Each chapter within these sections has its own reference list. Some of these lists do not contain references beyond 1999 or 2000, a common shortcoming in textbooks that reflects the length of the publication process. Although understandable, it does limit somewhat the usefulness of chapters such as the first, “Sex Differences in Neuroendocrine and Neurotransmitter Systems,” where there is a great deal of current research. In their preface, the editors state that the book is intended as “a comprehensive reference on women’s mental health for clinicians, researchers and students,” but the reader should be prepared to find that some chapters will serve to stimulate searches of the more recent literature rather than providing a complete review of the latest research findings. It is not possible to comment in depth on the many topics covered in this book other than selectively. I found Steiner and Born’s chapter, “Psychiatric Aspects of the Menstrual Cycle,” an easy and informative read. It was gratifying to see, in summary, the extensive research into the premenstrual disorders that has been conducted since APA’s DSM-IV workgroup struggled with the concept of premenstrual dysphoric disorder and placed the proposed diagnosis in an appendix for further study. The use of psychopharmacotherapy during pregnancy and the postpartum period is another area that has seen much recent research. Two chapters review the topics well, pointing out the need to consider the risks of discontinuing medications as well as discussing studies on the outcome of medication use during pregnancy and lactation. This is another area where studies are being published frequently. As I write this review, there are two recent papers in the Journal (1, 2) that will further the knowledge of all who begin by reading this book. The section on assessment and treatment of psychiatric disorders contains a brief chapter on complementary and alternative medicine. This is an important and timely inclusion. The section dealing with psychiatric consultation will be particularly useful for students and residents. Both this section and the section on sociocultural issues for women raise many important points. However, by necessity, both are brief reviews of important topics. Finally, there is a good discussion of research and health policy issues specific to women. I found this to be a useful and educational textbook, and I recommend it to those students, residents, and clinicians who want to know more about women’s mental health. I also recommend it to psychiatric educators everywhere as a text for their students.

Effects of Health Care Reform on Pharmacists

Pharmacists who work in components of integrated health care systems (eg, hospitals, health maintenance organizations, long-term care facilities, home care agencies) have unique perspectives on health care reform. They and others are fostering the concept of pharmaceutical care, a practice model under which pharmacists assume greater responsibility for the outcome of medication use. If outpatient medications are covered under health care reform legislation, the law should call upon pharmacists to practice in a way that helps people make the best use of medications. Private sector reform will have several effects of interest to pharmacists, including more consolidation of providers and suppliers, increased cost containment pressures, increased incentives for clinical services by pharmacists, and increased protocol-directed practice. To help advance pharmaceutical care, pharmacists should document medication useproblems, be assertive in assuming leadership on drug use issues, talk to patients about the pharmacist’s role in health care, and keep in mind why people need pharmacists.