Performing Medication Reviews Research Articles

Medication reviews by emergency department pharmacists in patients hospitalised for an adverse drug event: a cost study

ObjectiveTo perform a cost study of pharmacist-led medication reviews in patients with an acute hospitalization for adverse drug events.MethodEmergency department pharmacists performed medication reviews in patients hospitalized after visiting the emergency department for an adverse drug event (ADE). Control patients were hospitalized after an emergency department visit not related to an ADE and received usual care. The costs of the intervention were labour costs of the junior emergency department pharmacist and the cost savings consisted of costs of medication that was stopped or reduced during six months after the intervention. Sensitivity analyses were performed to evaluate different scenarios.ResultsIn the intervention group (n = 104) 113 medication changes led to stopping or reducing medication, accounting for averted costs of €22,850. In the control group (n = 112) 39 medication changes led to stopping or reducing medication, accounting for averted costs of €299. The mean labour costs of the intervention were €138 per patient, resulting in saved costs of €61 per patient per six months. Sensitivity analyses showed that if the intervention would be performed by a senior clinical pharmacist, there are no cost savings (€-21), if parts of the intervention would be executed by pharmacy technicians (e.g. administrative tasks), cost savings would be augmented to €87, if outliers in costs associated with medication reduction would be excluded, there are no cost savings (€-35) and if the costs of reduced medication were extrapolated to one year, cost savings would be €260.ConclusionIn this study, medication reviews by junior emergency department pharmacists in patients hospitalized after an emergency department visit for an ADE lead to a cost reduction over a six month period.Trial registrationThe main study is registered on the ISRCTN registry with trial ID ISRCTN12506329 on 06-03-2022.

Development of a quick guide for assessment of the most frequently used renal risk medication in Danish hospitals and primary care.

Due to changes in pharmacokinetics and pharmacodynamics, patients with impaired renal function suffer an increased risk of suboptimal and potentially harmful medication treatment. This necessitates careful consideration of medications affected by impaired renal function when performing medication reviews. The aim of this study was to develop a quick guide (a list of recommendations) for assessing renal risk medications in medication reviews led by hospital pharmacists. The list was based on the 100 most frequently used medications in Danish hospitals and primary care. After combining the 200 records, 29 duplicates were excluded resulting in a pool of 171 medications. Assessment by two clinical pharmacists led to the exclusion of 121 medications. Of the remaining 50 medications, seven were discussed among the two pharmacists, and two of these were also in the research group to reach a consensus. The renal risk quick guide comprised 50 medications. The most prevalent medications on the list were from Anatomical Therapeutic Chemical Classification System (ATC)-group N, C and L. Recommendations from two databases were included in the quick guide in order to provide clinical pharmacists with existing, updated evidence on medication use in impaired renal function. The next step is to test the feasibility of the quick guide in daily practice when performing medication reviews.

Medication Risks and Their Association with Patient-Reported Outcomes in Inpatients with Cancer.

We aimed to assess medication risks and determine factors influencing the health-related quality of life (HRQOL) in cancer inpatients. A retrospective analysis was conducted to identify drug-related problems (DRPs) based on medication reviews, including patient-reported outcomes (PROs). Multiple linear regression analyses were performed to identify sociodemographic, disease-related, and drug therapy-related factors influencing changes from hospital admission to discharge in the scales of the EORTC QLQ-C30 questionnaire. A total of 162 inpatients with various hematological and solid cancer diseases was analyzed. Patients received a mean of 11.6 drugs and 92.6% of patients exhibited polymedication resulting in a mean of 4.0 DRPs per patient. Based on PRO data, 21.5% of DRPs were identified. Multiple linear regression models described the variance of the changes in global HRQOL and physical function in a weak-to-moderate way. While drug therapy-related factors had no influence, relapse status and duration of hospital stay were identified as significant covariates for global HRQOL and physical function, respectively. This analysis describes underlying DRPs in a German cancer inpatient population. PROs provided valuable information for performing medication reviews. The multiple linear regression models for global HRQOL and physical function provided explanations for changes during hospital stay.

A mixed methods analysis of the medication review intervention centered around the use of the ‘Systematic Tool to Reduce Inappropriate Prescribing’ Assistant (STRIPA) in Swiss primary care practices

BackgroundElectronic clinical decision support systems (eCDSS), such as the ‘Systematic Tool to Reduce Inappropriate Prescribing’ Assistant (STRIPA), have become promising tools for assisting general practitioners (GPs) with conducting medication reviews in older adults. Little is known about how GPs perceive eCDSS-assisted recommendations for pharmacotherapy optimization. The aim of this study was to explore the implementation of a medication review intervention centered around STRIPA in the ‘Optimising PharmacoTherapy In the multimorbid elderly in primary CAre’ (OPTICA) trial.MethodsWe used an explanatory mixed methods design combining quantitative and qualitative data. First, quantitative data about the acceptance and implementation of eCDSS-generated recommendations from GPs (n = 21) and their patients (n = 160) in the OPTICA intervention group were collected. Then, semi-structured qualitative interviews were conducted with GPs from the OPTICA intervention group (n = 8), and interview data were analyzed through thematic analysis.ResultsIn quantitative findings, GPs reported averages of 13 min spent per patient preparing the eCDSS, 10 min performing medication reviews, and 5 min discussing prescribing recommendations with patients. On average, out of the mean generated 3.7 recommendations (SD=1.8). One recommendation to stop or start a medication was reported to be implemented per patient in the intervention group (SD=1.2). Overall, GPs found the STRIPA useful and acceptable. They particularly appreciated its ability to generate recommendations based on large amounts of patient information. During qualitative interviews, GPs reported the main reasons for limited implementation of STRIPA were related to problems with data sourcing (e.g., incomplete data imports), preparation of the eCDSS (e.g., time expenditure for updating and adapting information), its functionality (e.g., technical problems downloading PDF recommendation reports), and appropriateness of recommendations.ConclusionsQualitative findings help explain the relatively low implementation of recommendations demonstrated by quantitative findings, but also show GPs’ overall acceptance of STRIPA. Our results provide crucial insights for adapting STRIPA to make it more suitable for regular use in future primary care settings (e.g., necessity to improve data imports).Trial registrationClinicaltrials.gov NCT03724539, date of first registration: 29/10/2018.

Financial impact of medication reviews by clinical pharmacists to reduce in-hospital adverse drug events: a return-on-investment analysis

BackgroundAdverse drug events contribute to rising health care costs. Clinical pharmacists can reduce their risks by identifying and solving drug-related problems (DRPs) through medication review.AimTo develop an economic model to determine whether medication reviews performed by clinical pharmacists could lead to a reduction in health care costs associated with the prevention of potential adverse drug events.MethodTwo pharmacists performed medication reviews during ward rounds in an internal medicine setting over one year. Avoided costs were estimated by monetizing five categories of DRPs (improper drug selection, drug interactions, untreated indications, inadequate dosages, and drug use without an indication). An expert panel assessed potential adverse drug events and their probabilities of occurrence for 20 randomly selected DRPs in each category. The costs of adverse drug events were extracted from internal hospital financial data. A partial economic study from a hospital perspective then estimated the annual costs avoided by resolving DRPs identified by 3 part-time clinical pharmacists (0.9 full-time equivalent) from 2019 to 2020. The return on investment (ROI) of medication review was calculated.ResultsThe estimated annual avoided costs associated with the potential adverse drug events induced by 676 DRPs detected was € 304,170. The cost of a 0.9 full-time equivalent clinical pharmacist was € 112,408. Extrapolated to 1 full-time equivalent, the annual net savings was € 213,069 or an ROI of 1–1.71. Sensitivity analyses showed that the economic model was robust.ConclusionThis economic model revealed the positive financial impact and favorable return on investment of a medication review intervention performed by clinical pharmacists. These findings should encourage the future deployment of a pharmacist-led adverse drug events prevention program.

Clinical Pharmacists Performing Medication Review in Collaboration with General Practitioners in Primary Care: A Qualitative Evaluation

Clinical Pharmacists Performing Medication Review in Collaboration with General Practitioners in Primary Care: A Qualitative Evaluation

Adoption of electronic patient medication records in community pharmacies in the United Arab Emirates: A cross-sectional survey.

Access to accurate and relevant patient health information is crucial for community pharmacists to deliver high-quality care. The use of electronic patient medication records (e-PMR) in the United Arab Emirates (UAE) is currently limited to hospital settings, and community pharmacists do not have access to patient records. To evaluate the perceptions of community pharmacists regarding the potential benefits, barriers, and concerns associated with the implementation of the e-PMR system in community pharmacies in the UAE. A validated questionnaire was administered to a sample of licensed community pharmacists using proportionate random sampling. The survey was structured and consisted of 40 questions in four sections: characteristics of community pharmacists and pharmacies; perceived usefulness of e-PMR; perceived barriers; and concerns about the use of e-PMR. In total, 552 pharmacists filled out the questionnaire (82.1% response rate). The majority of participants somewhat or strongly agreed that e-PMR would reduce drug abuse (71.6%), dispensing errors (64.4%) and prescribing errors (69.0%), and believed that e-PMR would enhance pharmacists' ability to perform medication reviews (76.0%). Pharmacists in charge (adjusted odds ratio (AOR) = 2.5; 95% confidence interval (CI): 1.6-3.6), facing difficulty tracking the medical history of patients (AOR = 3.2; 95% CI: 2.8-3.9) and working in pharmacies providing telepharmacy services (AOR = 3.4; 95% CI: 2.7-3.8) were more likely to consider e-PMR useful. The implementation of the e-PMR system in community pharmacies has potential benefits for patient safety and medication therapy management in the UAE.

Impact of a Digital Tool on Pharmacy Students' Ability to Perform Medication Reviews: A Randomized Controlled Trial.

Digital Medication Review Tools (DMRTs) are increasingly important in pharmacy practice. To ensure that young pharmacists are sufficiently competent to perform medication reviews after graduation, the introduction of DMRTs teaching in academic education is necessary. The aim of our study was to demonstrate the effect of DMRTs use on pharmacy students' performance when conducting a medication review (MR) in a randomized controlled pre-post design. Forty-one pharmacy students were asked to complete a MR within 60 min, followed by a 10-min consultation with (intervention group) and without a DMRT (control group). The MR performance was subdivided into four categories: communication skills, subjective and objective patient data, assessment, and plan. Performance was assessed using objective structured clinical examinations (OSCEs) and analytical checklists. With the use of DMRTs, the overall performance was improved by 17.0% compared to the control group (p < 0.01). Improvement through DMRTs was seen in the subcategories "Assessment" and "Plan". Furthermore, pharmacy students liked using DMRTs and felt more confident overall. Our study results demonstrate that DMRTs improve the performance of MRs, hence DMRTs should become an integral part of pharmacy curriculum. Consequently, digitally enabled pharmacists using DMRTs will be better prepared for their professional careers in pharmacy practice.

Worldwide Impact of COVID-19 on Frontline Pharmacists’ Roles and Services: INSPIRE International Questionnaire

Introduction:Pharmacists have been recognized as essential healthcare professionals during the COVID-19 pandemic. However, evidence of the challenges that were faced by the profession and the way pharmacists adapted their roles throughout the pandemic are largely unknown. This study aimed to describe the impact of COVID-19 on pharmacy practice around the world.Method:A cross-sectional online questionnaire with pharmacists who provided direct patient care during the pandemic. Pharmacists were recruited through social media with assistance from national/international pharmacy organizations. The questionnaire was divided into three sections; 1) demographics, 2) pharmacists’ roles/services during the pandemic, and 3) practice challenges. The questionnaire was adapted from the established, piloted, and published INSPIRE Canadian Survey. The data were analyzed using SPSS 28. Descriptive statistics were used to report frequencies and percentages.Results:A total of 505 pharmacists practicing in 25 countries consented and completed the questionnaire. Only 26.4% (132/500) of participants were engaged with local disaster and public health agencies during the pandemic to coordinate pandemic response. The most common role that pharmacists undertook was responding to drug information requests (89.4%, 448/501), followed by allaying patients' fears/anxieties about COVID-19 (82.7%, 413/499), educating the public on reducing the spread of COVID-19 (81.3%, 409/503), and addressing misinformation on COVID-19 treatments/vaccinations (79.1%, 397/502). The most common services provided by pharmacists were performing medication reviews (78.5%, 391/498) and managing and/or monitoring patients’ chronic diseases (72.3%, 362/501). Almost half of the participants reported administering COVID-19 vaccines (44.9%, 225/501). The most common challenge that pharmacists encountered was increased stress level (82.2%, 415/505), followed by medication shortages (72.3%, 360/505).Conclusion:Despite the unprecedented nature of the COVID-19 pandemic and the various challenges associated with it, pharmacists around the world adapted their roles and services to continue to meet the needs of their patients and be their safe-haven for ongoing care.

Barriers and enablers to deprescribing for older people in care homes: The theory-based perspectives of pharmacist independent prescribers.

Over 70% of care home residents are prescribed potentially inappropriate medications (PIMs) associated with morbidity and mortality. Deprescribing is a common recommendation by pharmacists performing medication reviews in care homes, however requiring prescriber authorisation is a barrier. Care home Independent Pharmacist Prescribing Study (CHIPPS), a cluster randomised control trial integrated pharmacist independent prescriber (PIPs) into care homes to improve medication management, providing a unique opportunity to identify their barriers and enablers to deprescribing. To identify barriers and enablers to PIPs deprescribing medications in care homes. Secondary qualitative framework analysis was performed on interviews with CHIPPS' PIPs. A maximum variation sampling approach was used to select from the 14 PIPs included in the process evaluation to achieve diversity of PIPs' contextual factors e.g., previous experience in care homes. Transcripts were coded inductively for barriers and enablers to deprescribing and then mapped to Theoretical Domains Framework (TDF). Eleven PIP's interviews were sampled. Factors acted as enablers and barriers were PIP relationship with General Practitioner (GP), care home staff and residents/families, awareness of the PIP role and family trust in PIPs' deprescribing activities (social influences); PIPs' independent prescribing confidence, previous experience and ability dealing with residents' medications (beliefs about capabilities); understanding of PIP role and PIP confidence in their role as an independent prescriber (Social/professional role and identity); access to residents' records, deprescribing decision support, regular follow-up from care home staff, resident difficulties with medications, teamwork, and time restraints (Environmental context and resources). One factor acted as a barrier: believing negatives of deprescribing outweigh benefits regarding certain medications (Beliefs about consequences). PIPs' involvement in deprescribing within care homes is influenced by multiple barriers and enablers. Data mapped to TDF domains represent barriers that need addressing and enablers that should be highlighted to enhance PIPs' effectiveness in future interventions.

Prescribing errors in children: what is the impact of a computerized physician order entry?

Prescribing errors represent a safety risk for hospitalized patients, especially in pediatrics. Computerized physician order entry (CPOE) might reduce prescribing errors, although its effect has not yet been thoroughly studied on pediatric general wards. This study investigated the impact of a CPOE on prescribing errors in children on general wards at the University Children’s Hospital Zurich. We performed medication reviews on a total of 1000 patients before and after the implementation of a CPOE. The CPOE included limited clinical decision support (CDS) such as drug-drug interaction check and checks for duplicates. Prescribing errors, their type according to the PCNE classification, their severity (adapted NCC MERP index), as well as the interrater reliability (Cohen’s kappa), were analyzed. Potentially harmful errors were significantly reduced from 18 errors/100 prescriptions (95% CI: 17–20) to 11 errors/100 prescriptions (95% CI: 9–12) after CPOE implementation. A large number of errors with low potential for harm (e.g., “missing information”) was reduced after the introduction of the CPOE, and consequently, the overall severity of potential harm increased post-CPOE. Despite general error rate reduction, medication reconciliation problems (PCNE error 8), such as drugs prescribed on paper as well as electronically, significantly increased after the introduction of the CPOE. The most common pediatric prescribing errors, the dosing errors (PCNE errors 3), were not altered on a statistically significant level after the introduction of the CPOE. Interrater reliability showed moderate agreement (Κ = 0.48). Conclusion: Patient safety increased by reducing the rate of prescribing errors after CPOE implementation. The reason for the observed increase in medication reconciliation problems might be the hybrid system with remaining paper prescriptions for special medication. The lacking effect on dosing errors could be explained by the fact that a web application CDS covering dosing recommendations (PEDeDose) was already in use before the implementation of the CPOE. Further investigations should focus on eliminating hybrid systems, interventions to increase the usability of the CPOE, and full integration of CDS tools such as automated dose checks into the CPOE.What is Known:• Prescribing errors, especially dosing errors, are a common safety threat for pediatric inpatients.•The introduction of a CPOE may reduce prescribing errors, though pediatric general wards are poorly studied.What is New:•To our knowledge, this is the first study on prescribing errors in pediatric general wards in Switzerland investigating the impact of a CPOE.•We found that the overall error rate was significantly reduced after the implementation of the CPOE. The severity of potential harm was higher in the post-CPOE period, which implies that low-severity errors were substantially reduced after CPOE implementation. Dosing errors were not reduced, but missing information errors and drug selection errors were reduced. On the other hand, medication reconciliation problems increased.

Evaluating the role of a hospital pharmacist in a cardiac day ward.

To evaluate the role of clinical pharmacists in cardiac day wards. A service evaluation was conducted during 24 February 2020-27 March 2020 to assess the role of clinical pharmacists for all patients admitted to an Australian tertiary hospital cardiac day ward. Overall, 297 patients were included. Medication review occurred for 80% (237/297) and a best possible medication history was obtained for 65% (193/297) of patients. Acceptance of interventions for medication-related problems was 93% (84/90). When compared with medication plans outlined in standard catheterisation laboratory documentation without pharmacist input, a pharmacist medication review resulted in increased documentation of medication plans in the patient's medical record at the time of discharge (20% (1/5) versus 95% (142/150), P < 0.001). Pharmacists can optimise the medication management of patients in cardiac day wards by performing medication review, and facilitating implementation and communication of medication changes at hospital discharge to patients and primary healthcare providers.

Deprescribing initiative of NSAIDs (DIN): Pharmacist-led interventions for pain management in a federal correctional setting.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for management of pain and inflammation. However, these medications are associated with adverse outcomes such as dyspepsia and acute myocardial infarction, especially with long-term uses. We sought to determine the effect of a pharmacist-led deprescribing intervention on oral NSAID use among patients in federal custody. Clinical pharmacists from Correctional Services Canada (CSC) conducted a prospective case series of adult patients with chronic noncancer pain who were on long-term NSAIDs (defined as >90 days supply in the past 120 days) in 3 CSC institutions in British Columbia, Canada. CSC clinical pharmacists met with patients to perform medication reviews and identify drug-related problems, with a focus on analgesic therapy. Pharmacist-led interventions were implemented in consultation with the primary care team to address these drug-related problems. Patient progress was monitored weekly for 3 months. Function, quality of life and pain severity scores (modified SPAASMS, Patient-Specific Functional Scale [PSFS] and visual analog scale [VAS] scores) were compared at baseline, 6 weeks and 3 months postintervention. Patient satisfaction survey results were also collected at 3 months. A total of 53 patients received clinical pharmacist interventions. Modified SPAASMS, PSFS and VAS scores were collected at baseline, 6 weeks and 3 months from 38 patients (some were lost to follow-up when released back into the community). All 38 patients demonstrated clinically significant improvements to all 3 pain scales at 3 months (mean SPAASMS scores decreased by 7 points, mean PSFS scores increased by 2 points, mean VAS scores decreased by 2 points). Twenty-four of 31 patients who completed the patient satisfaction survey agreed that their overall health and well-being improved because of the visit they received from the pharmacist. Clinical pharmacist-led interventions in CSC have shown to reduce oral NSAID use as well as contribute positively to patient pain scores.

Community Pharmacist and Family Medicine Collaboration for Pre-Visit Planning for Shared Patients Receiving Chronic Care Management Services

Background: Pre-visit planning entails completing necessary tasks prior to clinic appointments. Community pharmacists (CPs) have unique knowledge about patients’ medication use but do not routinely provide drug therapy reviews before clinic visits. Objectives: (1) Create and implement a business partnership between a CP and family medicine clinic (FMC) for CP provision of pre-visit medication reviews, and (2) describe the billing experience for shared patients in the FMC chronic care management (CCM) program. Methods: A prospective 8-month study in one community pharmacy and FMC in Iowa. Eligible patients were enrolled in the clinic CCM program and received their prescriptions at the CP. CPs were granted access to the clinic electronic health record (EHR), performed medication reviews, and recorded drug therapy recommendations (DTRs) in the clinic EHR. FMC physicians reviewed CP DTRs before the patient encounter. Time tracking software in the EHR recorded CP and FMC time performing CCM services. CCM revenue was prorated between parties. FMC physicians completed a survey about their experience. Results: Overall, there were 129 CP reviews performed for 95 patients. These reviews resulted in 169 DTRs and 76% were accepted by the physician. There were 71 CCM claims billed and CCM revenue was $3596 ($1796 FMC, $1800 CP). More than 90% of physicians (N = 11) indicated they reviewed CP DTRs before the patient encounter and agreed they were helpful to their practice. Conclusion: CPs completed pre-visit medication reviews and made accepted medication therapy recommendations. CCM billing provided a mechanism for CPs to receive revenue for their services.

Improving the usability and usefulness of computerized decision support systems for medication review by clinical pharmacists: A convergent, parallel evaluation.

Computerized decision support systems (CDSSs) help hospital-based clinical pharmacists to perform medication reviews and so are promising tools for improving medication safety. However, their poor usability can reduce effectiveness and acceptability. To evaluate the usability and perceived usefulness of a CDSS for medication review by hospital-based pharmacists and to draw up guidelines on improving its usability. We performed a convergent, parallel evaluation. Firstly, three researchers conducted a heuristic evaluation of the CDSS. Secondly, clinical pharmacists who use the CDSS filled out the Usefulness, Satisfaction and Ease of Use (USE) questionnaire. Lastly, semi-structured interviews with the pharmacists enabled us to understand their opinions and experiences. The results of the heuristic evaluation were used to identify potential improvements in the CDSS. We performed a statistical analysis of the USE questionnaire data. Interviews were analyzed based on the unified theory of acceptance and use of technology (UTAUT), together with a task-technology fit model. The results generated by these three approaches were compared in order to determine convergences and divergences, identify challenges related to the usability and usefulness of the CDSS, and draw up guidelines for its improvement. Forty-seven usability problems were discovered; they variously concerned the graphical user interface, the pharmacists' needs, and the medication review model implemented in the CDSS. Only the "usefulness" dimension of the USE was not scored positively. All the UTAUT dimensions and the task-technology fit dimension emerged in the interviews. Cross-comparisons of the results from the three approaches led to the identification of four challenges and the corresponding formulation of 23 guidelines. The guidelines developed here should help to improve the design and acceptability of CDSSs. Hence, CDSSs will be able to assist clinical pharmacists more fully with their medication reviews and help to further improve patient safety.

Task sharing in an interprofessional medication management program – a survey of general practitioners and community pharmacists

BackgroundPharmacist-led medication review and medication management programs (MMP) are well-known strategies to improve medication safety and effectiveness. If performed interprofessionally, outcomes might even improve. However, little is known about task sharing in interprofessional MMP, in which general practitioners (GPs) and community pharmacists (CPs) collaboratively perform medication reviews and continuously follow-up on patients with designated medical and pharmaceutical tasks, respectively. In 2016, ARMIN (Arzneimittelinitiative Sachsen-Thüringen) an interprofessional MMP was launched in two German federal states, Saxony and Thuringia. The aim of this study was to understand how GPs and CPs share tasks in MMP when reviewing the patients’ medication.MethodsThis was a cross-sectional postal survey among GPs and CPs who participated in the MMP. Participants were asked who completed which MMP tasks, e.g., checking drug-drug interactions, dosing, and side effects. In total, 15 MMP tasks were surveyed using a 5-point Likert scale ranging from “I complete this task alone” to “GP/CP completes this task alone”. The study was conducted between 11/2020 and 04/2021. Data was analyzed using descriptive statistics.ResultsIn total, 114/165 (69.1%) GPs and 166/243 (68.3%) CPs returned a questionnaire. The majority of GPs and CPs reported (i) checking clinical parameters and medication overuse and underuse to be completed by GPs, (ii) checking storage conditions of drugs and initial compilation of the patient’s medication including brown bag review being mostly performed by CPs, and (iii) checking side-effects, non-adherence, and continuous updating of the medication list were carried out jointly. The responses differed most for problems with self-medication and adding and removing over-the-counter medicines from the medication list. In addition, the responses revealed that some MMP tasks were not sufficiently performed by either GPs or CPs.ConclusionsBoth GPs’ and CPs’ expertise are needed to perform MMP as comprehensively as possible. Future studies should explore how GPs and CPs can complement each other in MMP most efficiently.

Exploring the value of a multidisciplinary-led medication review for elderly individuals at a long-term care facility performed by four different health-care professions in an equal and closely integrated collaboration.

The increasing population of elderly individuals had led to an increasing number of polypharmacy patients. Polypharmacy increases the risk of adverse drug reactions and hospitalization. One means to combat polypharmacy involves performing medication reviews, which can be conducted by different methods and stakeholders. The study objective was to explore the value of involving different health-care professions in medication reviews at an equal and closely integrated collaborative physical meeting for elderly individuals at a long-term care facility. A specific focus was to explore the contributions and opinions of the different health-care professionals regarding the medication review process. A single case study was applied to perform an in-depth study of a group of health-care professionals performing medication reviews in collaboration. Hence, the study was performed in two settings: 1) the practical execution of medication reviews at a long-term care facility in an interprofessional team and 2) qualitative semi-structured interviews conducted to explore the forms of work done by different professional groups in performing an interdisciplinary medication review. Forty-nine residents from a long-term care facility were included in the study and were offered a medication review. In total, they reported 573 prescriptions, for which 150 changes were recommended by the interprofessional team. At the 3- and 8-month follow-ups, 30.0% and 49.5% of the accepted recommendations had been implemented, respectively. According to the interview, the results reveal that the interdisciplinarity of the interprofessional team was perceived as a great advantage to the results of the medication reviews. The results suggest that performing medication reviews in interprofessional collaboration improves the perceived quality of such reviews with a more complete picture of the residents and their medications, leading to more personalized recommendations and resulting in optimized medication reviews for the individual patients.

Development and assessment of PharmaCheck: an electronic screening tool for the prevention of twenty major adverse drug events

BackgroundAdverse drug events (ADEs) can be prevented by deploying clinical decision support systems (CDSS) that directly assist physicians, via computerized order entry systems, and clinical pharmacists performing medication reviews as part of medical rounds. However, physicians using CDSS are known to be exposed to the alert-fatigue phenomenon. Our study aimed to assess the performance of PharmaCheck—a CDSS to help clinical pharmacists detect high-risk situations with the potential to lead to ADEs—and its impact on clinical pharmacists’ activities.MethodsTwenty clinical rules, divided into four risk classes, were set for the daily screening of high-risk situations in the electronic health records of patients admitted to our General Internal Medicine Department. Alerts to clinical pharmacists encouraged them to telephone prescribers and suggest any necessary treatment adjustments. PharmaCheck’s performance was assessed using the intervention’s positive predictive value (PPV), which characterizes the proportion of interventions for each alert triggered. PharmaCheck’s impact was assessed by considering clinical pharmacists as a filter for ruling out futile alerts and by comparing the final clinical PPV with a pharmacist (the proportion of interventions that led to a change in the medical regimen) to the final clinical PPV without a pharmacist.ResultsOver 132 days, 447 alerts were triggered for 383 patients, leading to 90 interventions (overall intervention PPV = 20.1%). By risk class, intervention PPVs made up 26.9% (n = 65/242) of abnormal laboratory value alerts, 3.1% (4/127) of alerts for contraindicated medications or medications to be used with caution, 28.2% (20/71) of drug–drug interaction alerts, and 14.3% (1/7) of inadequate mode of administration alerts. Clinical PPVs reached 71.0% (64/90) when pharmacists filtered alerts and 14% (64/242) if they were not doing it.ConclusionPharmaCheck enabled clinical pharmacists to improve their traditional processes and broaden their coverage by focusing on 20 high-risk situations. Alert management by pharmacists seemed to be a more effective way of preventing risky situations and alert-fatigue than a model addressing alerts to physicians exclusively. Some fine-tuning could enhance PharmaCheck's performance by considering the information quality of triggers, the variability of clinical settings, and the fact that some prescription processes are already highly secured.

A cost\u2013benefit analysis of hospital-wide medication reviews: a period prevalence study

Background For specific medical specialties it has been shown that clinical pharmacists can have a beneficial effect on the reduction of drug-related problems by performing medication reviews. However, little is known on the cost–benefit ratio of hospital-wide implementation of medication reviews. Aim To investigate the effect of conducting hospital-wide medication reviews on the detection and resolution of drug-related problems, and to calculate the cost–benefit ratio of the intervention. Method In this observational prospective period prevalence study, medication reviews were conducted during five consecutive working days in a Dutch university hospital. Patients admitted for more than 24 h were included. The cost–benefit ratio of conducting the medication reviews was calculated by dividing the total costs by the total savings. Results In 622 medication reviews, 709 potential drug-related problems (1.1 per patient) were detected. The most common advice was to stop medication (38.6%). Patients with a potentially drug-related problem were significantly older, had a higher median number of prescriptions, and the median number of days from admission to the time of medication reviews was longer. Conducting medication reviews showed a positive cost–benefit ratio of 9.7. Conclusions Hospital-wide medication reviews by clinical pharmacists have a positive cost–benefit ratio and contribute to the detection and the resolution of drug related problems (DRPs), mainly by reducing overtreatment.

Medication Review in Preventing Older Adults' Fall-Related Injury: a Systematic Review & Meta-Analysis.

BackgroundMedication review is essential in managing adverse drug reactions and improving drug safety in older adults. This systematic review evaluated medication review’s role as a single intervention or combined with other interventions in preventing fall-related injuries in older adults.MethodsElectronic databases search was conducted in PubMed, EMBASE, Scopus, and CINAHL. Two reviewers screened titles and abstracts, reviewed full texts, and performed data extraction and risk of bias assessment. Meta-analyses were conducted on studies with similar participants, interventions, outcomes or settings.ResultsFourteen randomized, controlled studies were included. The pooled results indicated that medication review as a stand-alone intervention was effective in preventing fall-related injuries in community-dwelling older adults (Risk Difference [RD] = −0.06, 95% CI: [−0.11, −0.00], I2 = 61%, p = .04). Medication review also had a positive impact on decreasing the risk of fall-related fractures (RD = −0.02, 95% CI: [−0.04, −0.01], I2 = 0%, p = .01).DiscussionThis systematic review and meta-analysis has demonstrated that medication review is effective in preventing fall-related injuries in general, and fractures specifically, in community-dwelling older adults. Future investigations focusing on the process of performing medication review will further inform fall-related injury prevention for older adults.