Potential Drug-related Problems Research Articles

Medication optimization in nursing homes: the impact of education and interdisciplinary case conferencing

Introduction: Potentially inappropriate prescribing has shown to be highly prevalent in older adults, especially in nursing home residents. Previous research, such as the Come-On study, proved that a complex intervention, containing an educational component and interdisciplinary case conferencing, is effective in reducing this phenomenon. 
 Policy context and objective: Awaiting the structural implementation supported by the government, an initiative was set up in West-Flanders to locally implement such an intervention and explore its impact.
 Target population: This study targeted nursing home residents and nursing home staff.
 Innovation, impact, outcomes: The intervention included three components: 1) education of nursing home staff by the pharmacist with regard to medication use in nursing home residents, 2) interdisciplinary case conferencing during which medication plans of residents were discussed (i.e. medication review) by the resident’s general practitioner (or the nursing home’s coordinating physician), a nurse, and the pharmacist, and 3) intervision across nursing homes to discuss experiences. Nursing homes were encouraged to involve residents and family members as much as possible (e.g. to invite them to the interdisciplinary case conference). For each case conference, nursing homes were instructed to report the duration, the identified (potential) drug-related problems, and the proposed medication changes. Throughout the study, financial incentives were provided for pharmacists and nursing homes.
 Quantitative data were analyzed descriptively, while qualitative data were analyzed inductively. Furthermore, an economic evaluation was performed.
 Eight nursing homes participated in the study. Nursing home staff indicated to have better medication-related knowledge and to be more aware of potential drug-related problems thanks to their participation in the project. They also experienced better communication between all involved healthcare professionals and with residents and their families.
 So far, data with regard to the interdisciplinary case conferences has been collected from five nursing homes, encompassing 266 nursing home residents. An interdisciplinary case conference lasted on average about 30 minutes per resident. For 60% of these nursing home residents, at least one medication change was implemented (e.g. stopping of a drug, change of administration time or route, change of dosage form). The five most frequently stopped drugs included 1) vitamins and supplements, 2) psychotropic drugs, 3) pain killers, 4) PPIs, and 5) antihypertensive drugs. On average, this resulted in a saving of €105 per year per resident.
 It was noted that general practitioners only participated in the case conferences in one nursing home. Likewise, residents nor family members were present during the interdisciplinary meetings. Nevertheless, residents (and families) were interviewed regarding their medication use in preparation of the conference and were informed about medication changes afterwards. 
 Transferability and conclusion: The intervention was shown to be effective in optimizing the medication use of nursing home residents. Following steps will focus on the implementation of the intervention in a higher number of nursing homes, as well as in other home replacing settings. Additionally, opportunities for involvement of residents and their families, as well the participation of general practitioners will be further investigated.
 Key words: Residential care, interdisciplinary case conferences, inappropriate prescribing, medication review

Estimated Costs of Drug-Related Problems Prevented by Pharmacist Prescription Reviews Among Hospitalized Internal Medicine Patients.

Data are lacking on the estimated costs of pharmacist prescription reviews (PPRs) for hospitalized internal medicine patients. This study investigates the estimated costs of drug-related problems (DRPs) prevented by PPRs among hospitalized internal medicine patients. We reviewed all medication orders for patients at an academic teaching hospital in China for 2 years. DRPs were categorized using the Pharmaceutical Care Network Europe classification. The severity of the potential harm of DRPs was assessed by the Harm Associated with Medication Error Classification (HAMEC) tool. The estimated cost of PPRs was calculated. A total of 162426 medication orders for 4314 patients were reviewed, and 1338 DRPs were identified by pharmacists who spent 2230 hours performing PPRs. Among the 1080 DRPs that were prospectively intervened upon, 703 were resolved. The HAMEC tool showed that 47.1% of DRPs were assessed as level 2, 30.4% as level 3, 20.6% as level 1, and 0.6% carried a life-threatening risk. Pharmacist interventions contributed to the prevention of DRP errors and a reduction of $339 139.44. This resulted in a mean cost saving of $482.42 per patient at an input cost of $21 495.06 over the 2 years. The benefit-cost ratio was 15.8. PPRs are beneficial for detecting potential DRPs and creating potential cost savings among hospitalized internal medicine patients.

Assessment of potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients admitted to tertiary care hospitals.

Meningitis is an important cause of morbidity and mortality in children and adults. Its treatment strategy varies with age and gender. To assess potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients, a multicenter, clinical, descriptive, cross-sectional prospective observational study in 120 patients admitted to different tertiary care hospitals in Karachi was conducted. It includes both males 48% and females 52% belonging from all age groups i.e. peadiatrics (01 to 12 years), adults (18 to 65 years), and geriatrics (66 to 75 years). Out of these 72 patients were admitted in the public sector and 48 patients were admitted in private sector hospitals. Nosocomial infections were developed in 41% of patients during their stay at the hospital. Potentially nephrotoxic drugs were administered to all BM patients, these drugs should be administered carefully. Majorly Ceftriaxone was administered to 86% of patients, Vancomycin 71%, and meropenem 73% whereas 68% of patients were administered piperacillin-tazobactam. Organisms involved as causative agents in the majority of patients are Neisseria meningitides, Pseudomonas aeruginosa and, Streptococcus pneumoniae. DRPs impacted patient clinical outcomes in presence of many other factors like comorbidities, DDIs, Nis, administration of potentially nephrotoxic drugs, and administration of watch group and reserve group antibiotics without having culture sensitivity test, even after having CST no principles of de-escalation for antibiotics were done, which is a very important factor for hospitalized patients having IV antibiotics. The mortality rate among BM patients was 66%. The majority of patients (87%) stay at the hospital was 1-10 days. The present study helped in the identification of DRPs along with some other factors affecting the clinical outcomes in patients suffering from bacterial meningitis. Healthcare professionals should receive awareness and education on the importance of CST before initiating antibiotic therapy. Pharmacist-led medication review is necessary and should be followed to avoid negative outcomes and serious consequences related to DRPs.

Increasing the number of pharmacist-led medication order reviews using the available workforce: a retrospective study

BackgroundDue to staffing constraints, several hospitals have defined targeting strategies for pharmacist-led medication order review, leaving non-targeted patients exposed to potential harmful drug-related problems (DRPs). Using targeting criteria to stratify...

Dispensing metformin with other drugs and dietary supplements in pharmaceutical care in patients with multimorbidity

Pharmaceutical care is an activity aimed at protecting the patient’s health. The purpose of this benefit is to provide assistance in receiving and safely using the drug. The idea of pharmaceutical care originated in the United States in the 70s’ of the 20th century although the issue had already been discussed in the interwar period. The definition in force in Poland is contained in the Act on the Profession of Pharmacist (Act of September 10, 2020). The program includes pharmaceutical consultations, performing medications reviews, developing pharmaceutical care plans considering the patient’s drug-related problems, performing diagnostic tests and issuing prescriptions that are a continuation of a medical order(1). This paper reviews the current literature on the use of metformin in patients with multimorbidity. Special attention was given to the studies on probability of occurrence potential drug-related problems in the treatment of these diseases. The analysis shows that the most difficulties are caused by the lack of knowledge about the treatment used by patients. The result is often a reduction in the regularity of therapy or even resignation from it. The obtained observations related to the combined use of drugs from different therapeutic groups should help to systematize knowledge about the current needs and expectations of patients. Properly conducted pharmaceutical care, including the preparation of drug reviews and education, can significantly improve the effectiveness of treatment. The article emphasizes the importance of the cooperation of the patient, doctor and pharmacist in achieving and maintaining the proper quality of life of the patient.

Evaluation of burden of polypharmacy and potential drug related problems in patients with chronic kidney disease

Aim: The primary aim of the study is to analyze prevalence of polypharmacy, determine factors affecting polypharmacy and identify potential Drug Related Problems (DRPs) in patients with chronic kidney disease (CKD). Methods: A prospective observational study was conducted among 207 patients diagnosed with chronic kidney disease in a tertiary care hospital for a period of 6 months. Drug-Related Problems were identified, reported and categorized in accordance with the Helper and Strand, 1990 Classification. Binary logistic regression was used to identify the association between dependent variable and independent variables. Result: The mean age of the study population was 56.64 ±16.64 with male predominance (66%). The prevalence of polypharmacy was 76.8% and prescription pattern was analyzed in different stages of chronic kidney disease was found to be antiulcer drugs (84.5%) and antihypertensive (81.6%) were the most commonly prescribed class of drug. Age, gender, length of hospital stay, comorbidities such as diabetes mellitus and hypertension were determined as the main predictors for polypharmacy (p-value < 0.05). Drug interaction (93.2%) was identified as main Drug-related problem associated with polypharmacy (p-value of 0.022). Conclusion: Polypharmacy has a positive correlation with advancement of chronic kidney disease which put them at higher risk for drug-related problems. Drug Related Problems may be prevented or reduced by early detection and modification of the above-mentioned predictors.

Development of evidence-based indicators for the detection of drug-related problems among ovarian cancer patients.

Background: Antineoplastic drugs produce serious drug-related problems and their management is challenging. DRPs are critical, for saving on therapeutic costs, particularly in resource poor settings within low-middle-income countries such as India. Indicators are clues that helps to detect DRPs within the healthcare organization and minimize overall harm from medications. Indicators enable healthcare professionals to determine the future therapeutic course. And enable healthcare professionals to take a proactive stand, and stay informed and empowered to both prevent and manage DRPs. This study aims to develop evidence-based indicators for detecting potential drug-related problems in ovarian cancer patients. Patients and Methods: A retrospective study was conducted in the Department of Oncology of a tertiary care teaching hospital in South India. Based on literature search, we developed a list of indicators, which were validated by a Delphi panel of multidisciplinary healthcare professionals (16 members). Based on 2years of ovarian cancer data, we performed a feasibility test retrospectively and classified the DRPs according to the Pharmaceutical Care Network Europe classification of DRPs version-9.1. Results: The feasibility test identified 130 out of 200 indicators. A total of 803 pDRPs were identified under four main categories: drug selection problem, drug use problem, adverse drug reaction and drug-drug interaction The most frequently observed were ADR 381 (47.45%), DDIs 354 (44.08%), and drug selection problems 62 (7.72%). Conclusion: Indicators developed by us effectively identified pDRPs in ovarian cancer patients, which can potentially help healthcare professionals in the early detection, timely management, and attenuating severity of DRPs. Identifying the pDDIs can potentially improve interdisciplinary involvement and task sharing, including enhanced pharmacists' participation within the healthcare team.

Instrument development to determine student self-efficacy to present a patient to a pharmacy preceptor (4P)

IntroductionEffective patient assessment is often supported through simulated experiences where students identify potential drug-related problems (DRPs) through evaluation of the patient's electronic health record and verbally present their assessment and proposed resolutions for DRPs. This research aimed to initiate validation of a Patient Presentation to a Pharmacy Preceptor (4P) tool using exploratory factor analysis (EFA) to examine underlying constructs, refine items, and improve tool conciseness. The 4P tool was designed to assess student self-efficacy to identify, assess, resolve, and verbally present DRPs to a pharmacy preceptor. MethodsThe 4P instrument was administered to third-year doctor of pharmacy students in a performance-based skills laboratory course. EFA was conducted on student confidence data to examine underlying 4P constructs and improve survey conciseness. Laboratory faculty evaluated EFA results and came to consensus on factor extraction, item reduction and revision, and a finalized version of the 4P tool. ResultsFaculty interpretation of EFA results suggested elimination of two constructs resulting in a four-factor solution. Item evaluation further led to renaming the four constructs based on underlying factor themes. Out of the original 34-item tool, 13 items were eliminated, eight items were revised, and 1 new item was generated to retain relevant concepts. The refined 4P instrument contained four factors and 22 items. ConclusionsUse of EFA was useful to determine core 4P tool constructs and improved tool conciseness. This final four-factor model including 22 items will be used for a future confirmatory factor analysis.

Potential Drug-Related Problems in Pediatric Patients—Describing the Use of a Clinical Decision Support System at Pharmacies in Sweden

The clinical support system Electronic Expert Support (EES) is available at all pharmacies in Sweden to examine electronic prescriptions when dispensing to prevent drug-related problems (DRPs). DRPs are common, and result in patient suffering and substantial costs for society. The aim of this research was to study the use of EES for the pediatric population (ages 0-12 years), by describing what types of alerts are generated for potential DRPs, how they are handled, and how the use of EES has changed over time. Data on the number and categories of EES analyses, alerts, and resolved alerts were provided by the Swedish eHealth Agency. The study shows that the use of EES has increased. The most common type of alert for a potential DRP among pediatric patients was regarding high doses in children (30.3% of all alerts generated). The most common type of alert for a potential DRP that was resolved among pediatrics was therapy duplication (4.6% of the alerts were resolved). The most common reason for closing an alert was dialogue with patient for verification of the treatment (66.3% of all closed alerts). Knowledge of which type of alerts are the most common may contribute to increased prescriber awareness of important potential DRPs.

Potential Drug-Related Problems in Ischemic Stroke Patients and Their Effect on Clinical Outcomes at RS X, East Jakarta, in 2019

Potential Drug-Related Problems in Ischemic Stroke Patients and Their Effect on Clinical Outcomes at RS X, East Jakarta, in 2019

A prospective study concerning the effect of pharmaceutical care services on patients with heart failure

Objective: Heart failure (HF), caused by an abnormality in cardiac function, is the inability of heart tissue to pump blood or deliver sufficient oxygen, resulting in abnormal diastolic volume. Drug-Related Problems (DRPs) can cause significant but preventable morbidity and mortality once specific medication errors and their contributing factors are identified. The aim of this prospective study is to determine the effect of pharmaceutical care in patients with heart failure in a Turkish hospital.
 Methods: A total of 160 patients with heart failure (80 patients in the control group, 80 patients in the intervention group) were examined at a university hospital. The results of the Pharmaceutical Care Survey were evaluated in accordance with the objective of the study. In addition, using the Pharmaceutical Care Network Europe (PCNE) classification system V8.01, the role and importance of the clinical pharmacist in identifying, preventing and resolving drug-related problems encountered during the treatment of two groups was assessed. The number and causes of potential DRPs were taken into scrutiny.
 Results: Comparing the results of the Pharmaceutical Care Survey in both groups at the end of the 6th month, the study group shows a 
 significant improvement in the rates of “forgetting to take medication” (2.9%) and “experiencing any side effects from your drug” (4.5%). Compared to other problems, ineffectiveness of the drugs used in treatment was reported as the most common drug-related problem (n=23; 28.7%) in the study group (p

Development and retrospective evaluation of a clinical decision support system for the efficient detection of drug-related problems by clinical pharmacists

BackgroundClinical decision support systems (CDSS) can help identify drug-related problems (DRPs). However, the alert specificity remains variable. Defining more relevant alerts for detecting DRPs would improve CDSS.AimDevelop electronic queries that assist pharmacists in conducting medication reviews and an assessment of the performance of this model to detect DRPs.MethodElectronic queries were set up in CDSS using “triggers” from electronic health records: drug prescriptions, laboratory values, medical problems, vital signs, demographics. They were based on a previous study where 315 patients admitted in internal medicine benefited from a multidisciplinary medication review (gold-standard) to highlight potential DRPs. Electronic queries were retrospectively tested to assess performance in detecting DRPs revealed with gold-standard. For each electronic query, sensitivity, specificity, positive and negative predictive value were computed.ResultsOf 909 DRPs, 700 (77.8%) were used to create 366 electronic queries. Electronic queries correctly detected 77.1% of DRPs, median sensitivity and specificity reached 100.0% (IQRs, 100.0%–100.0%) and 99.7% (IQRs, 97.0%–100.0%); median positive predictive value and negative predictive value reached 50.0% (IQRs, 12.5%–100.0%) and 100.0% (IQRs, 100.0%–100.0%). Performances varied according to “triggers” (p < 0.001, best performance in terms of predictive positive value when exclusively involving drug prescriptions).ConclusionElectronic queries based on electronic heath records had high sensitivity and negative predictive value and acceptable specificity and positive predictive value and may contribute to facilitate medication review. Implementing some of these electronic queries (the most effective and clinically relevant) in current practice will allow a better assessment of their impact on the efficiency of the clinical pharmacist.

A Pharmaceutical Care Plan to Minimize the Incidence of Potential Drug-Related Problems in Cancer Patients

A Pharmaceutical Care Plan to Minimize the Incidence of Potential Drug-Related Problems in Cancer Patients

Evaluation of Pharmacy Inquiries in Physician Order Reviews for Medication Safety: A Cross-Sectional Study.

Background and Objectives: Despite the effort to prevent drug-related problems (DRPs) in healthcare settings, prescribing errors are common in the medication use process. In a Korean teaching hospital, pharmacists verify prescription orders during their routine order review process and document the details in a homegrown health information system (HIS). The objectives of this study were to identify the annual trends in pharmacy inquiries and to evaluate the prevalence of the inquiries by drug ingredients, including a description of the “pharmacy inquiry” screen in the HIS. Materials and Methods: A retrospective cross-sectional study was conducted to describe pharmacy inquiries related to preventing potential DRPs during order reviews and to evaluate the associated factors for discontinuation of prescription orders on medication among inquiries using data from January 2008 to December 2021. A descriptive analysis was performed using 128,188 inquiries, documented by 245 pharmacists for 14 years. Results: The frequency of inquiry steadily increased annually. The most frequent cause was “inappropriate dose or regimen” (49.1%) and “piperacillin and beta-lactamase inhibitor” was the most mentioned drug ingredient in the inquiries (3.4%). The overall acceptance rate of the pharmacists’ recommendation was 82.4%, and the cause of the highest acceptance was “inappropriate mix solution” (96.5%). Hospitalization and certain inquiry topics were significantly associated with discontinuation of prescription orders on inquired medications by clinicians. Conclusions: The findings indicate that pharmacy inquiries with integrated HIS could resolve inaccuracy during physicians’ order reviews and ensure safe patient care. As a tool for preventing prescribing errors, the pharmacy inquiry data can help maximize consistent improvement and optimize the medication use process in healthcare settings.

Home care nurses’ perceptions about their role in interprofessional collaborative practice in clinical medication reviews

Regular clinical medication reviews (CMRs) are recommended for monitoring and addressing potential drug-related problems, especially in elderly people. Interprofessional collaborative practice (ICP) by general practitioners, community pharmacists, and nurses in a CMR is recommended and expected to produce more efficient CMRs. Involving home care nurses in ICP is not yet well implemented, and their perspectives are unclear. This study explores how they perceive their role in ICP in CMRs and the requirements to assume that role. Structured interviews were performed, using case-vignettes; data were analyzed with a thematic analysis approach. Twelve home care nurses were interviewed. Three themes regarding the nurses' role were identified: (1) observing, recognizing, and communicating information for a CMR to prescribers and community pharmacists (2); helping to provide patient information and education about implemented changes in the pharmaceutical care plan; and (3) the nurses’ level of involvement in ICP. Three themes regarding requirements were identified: (1) nursing competences, (2) periodic interprofessional consultation and ad hoc interprofessional communication, and (3) guidelines describing the role of nurses. Home care nurses could provide additional support in a CMR. Nursing competences, periodic interprofessional consultation and ad hoc interprofessional communication, and guidelines describing the role of home care nurses are required.

Drug-Related Problems of Children With Chronic Diseases in a Chinese Primary Health Care Institution: A Cross-Sectional Study.

Introduction: Drug-related problems (DRPs) refer to events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. DRPs might be severe for children with chronic diseases managed at primary health care institutions, but the relevant research is scarce. Objective: In this cross-sectional study, we aimed to explore the prevalence, types, causes, and influencing factors of DRPs in children with chronic diseases in a Chinese primary health care institution. Methods: We recruited children with chronic diseases who visited the pediatric outpatient department in a primary health care institution from July 1 to 12 October 2021. Clinical pharmacists identified DRPs through medication therapy reviews, classified the types and causes of DRPs, and distinguished the manifested DRPs that affected the outcome and potential DRPs that were going to affect the outcome. Results: A total of 188 children with chronic diseases was included, and 584 DRPs were identified in 89.89% of participants. The most common type of DRPs was “treatment effectiveness” (a manifested problem or potential problem with the effect of the pharmacotherapy; 83.56%), of which 67.29% were potential DRPs. The second common type was “treatment safety” (patient suffers or could suffer from an adverse drug event; 14.21%), of which 89.16% were potential DRPs. The most common cause of DRPs was related to the process of use (42.24%), such as “patient uses/takes less drug than prescribed or does not take the drug at all,” “patient stores drug inappropriately,” and “patient administers/uses the drug in a wrong way.” The second common cause was related to the process of dispensing (29.83%), such as “necessary information not provided or incorrect advice provided” and “prescribed drug is not available.” The third common cause was related to the process of prescribing (26.21%), such as “drug dose is too low” and “no or incomplete drug treatment despite an existing indication.” The number of combined medications was an influencing factor for the frequency of DRPs (p < 0.05). Conclusion: This cross-sectional study showed that the current situation regarding DRPs among children with chronic diseases managed in the primary health care institution was serious. The types of DRPs were mainly related to treatment effectiveness, and improper usage of medications was one of the main causes of DRPs. The number of combined drugs was the influencing factor for the frequency of DRPs. In the future, pharmacists should consider formulating pharmaceutical intervention strategies for this specific group according to the characteristics of DRPs.

Drug Related Problems Identified by Clinical Pharmacist in a Tertiary Care Hospital in South India: An Observational Study

Abstract: Introduction: Drug related problems (DRP) negatively impact the quality of life of the patient and increase the burden of illnesses in terms of economic and social factors. In order to reduce medication errors, adverse reactions, and length of stay, pharmacy services must identify and classify potential DRPs. The goals of this study are thus to identify DRPs by reviewing medical orders (MOs) given to each patient, and to analyses DRPs using PCNE classification. Materials and Methods: This study was conducted in eight medical wards in a multispeciality hospital using prospective observational cohort research. Pharmaceutical Care Network Europe’s version 9.1 classification system (version 9.1) was used to identify and classify potential DRPs based on the patients’ medical orders. Results: A total of 394 patients were admitted to the hospital wards for treatment of a variety of clinical conditions during the study period. From the total cohort, 190 (48%) medical orders were detected with DRP. A total of 324 DRPs were detected and classified among 190 patients using PCNE 9.1. Among them, drug-drug interactions (16.3%) account for the highest prevalence followed by incomplete drug treatment (15.4%), documentation error (12.3%), monitoring errors (13.8%). Conclusion: The current study emphasizes the importance of reporting DRPs to patients in order to provide better health care and advocates the significance of clinical pharmacists in pharmaceutical patient care. Keywords: Drug related problems, Medication errors, PCNE classification, Clinical pharmacists, Pharmaceutical patient care.

High-alert medications for hospitalised paediatric patients - a two-step survey among paediatric clinical expert pharmacists in Germany.

Paediatric patients are more vulnerable to be harmed by medication errors compared to adults due to pharmacokinetic and pharmacodynamic changes in their development, individual dosing calculations, and manipulation of ready to-use products intended for adult patients. According to the Institute of Safe Medication Practices, there are some "drugs that bear a heightened risk of causing significant patient harm when they are used in error"; these drugs are called high-alert medications (HAM). The two-step survey among paediatric clinical expert pharmacists presented here aimed to compile a nation-wide HAM list. To provide detailed guidance, this survey followed a drugbased approach, resulting in specific potential drug related problems (DRPs) and associated recommendations for prevention. In contrast to this approach, in the first round of the survey two drug classes were included that both were rated as HAM (i.e.chemotherapy and parenteral nutrition). Twenty single drugs were identified as HAM, 65% of which were cardiovascular or neurological drugs. The paediatric expert pharmacists mentioned in total 216 potential DRPs; in particular, they identified potential administration-related problems (28% of all DRPs), dosing-related problems (26%), and drug-choice-related problems (18%, e.g.drug confusion and drug monitoring). Moreover, they suggested 275 potential interventions to address these DRPs. Two thirds of all interventions dealt with the preparation by the hospital pharmacy, standardisation of processes (e.g.labelling), and education or training. In conclusion, this survey provided a German paediatric high-alert medication list from a paediatric pharmacist point of view. Moreover, the experts mentioned for the first time specific potential DRPs and associated interventions to guide a local multidisciplinary approach for preventing medication-related harm in children.

The Effect of a Structured Medication Review on Quality of Life in Parkinson's Disease.

Drug therapy is important for controlling symptoms in Parkinson's disease (PD). However, it often results in complex medication regimens and could easily lead to drug related problems (DRP), suboptimal adherence and reduced treatment efficacy. A structured medication review (SMR) could address these issues and optimize therapy, although little is known about clinical effects in PD patients. To analyze whether an SMR improves quality of life (QoL) in PD. In this multicenter randomized controlled trial, half of the 202 PD patients with polypharmacy received a community pharmacist-led SMR. The control group received usual care. Assessments at baseline, and after three and six months comprised six validated questionnaires. Primary outcome was PD specific QoL [(PDQ-39; range 0 (best QoL) - 100 (worst QoL)]. Secondary outcomes were disability score, non-motor symptoms, general health status, and personal care giver's QoL. Furthermore, DRPs, proposed interventions, and implemented modifications in medication schedules were analyzed. No improvement in QoL was seen six months after an SMR, with a non-significant treatment effect difference of 2.09 (-0.63;4.80) in favor of the control group. No differences were found in secondary outcomes. In total, 260 potential DRPs were identified (2.6 (±1.8) per patient), of which 62% led to drug therapy optimization. In the current setting, a community pharmacist-led SMR did not improve QoL in PD patients, nor improved other pre-specified outcomes.

Identifying Potential Drug-Related Problems Among Geriatric Patients With Use of an Integrated Clinical Decision Support Tool.

Background: Drug-related problems (DRPs) which arise from potentially inappropriate medications (PIMs) are a common problem in older people with multi-morbidity and polypharmacy. Aim: To develop an integrated PIM clinical decision support tool for identification of DRPs in geriatric multi-morbid polypharmacy patients, using the EU(7)-PIM and EURO-FORTA lists, with a focus on high-risk medications. Methods: The integrated PIM tool used the information on PIMs in both databases—the EU(7)-PIM and EURO-FORTA. PIMs were classified into four color groups based on risk profile: high-risk PIMs (should be avoided in older patients) as red, moderate-risk PIMs (require dose and/or treatment duration adjustment) as yellow, low-risk PIMs (low DRP risk) as green, and questionable PIMs (incomplete/missing information) as grey. Results: The summarized list of the high-risk (red and some grey) PIMs contained 81 active substances and medication classes. According to the ATC classification, most of the high-risk PIMs (n = 60, 74.1%) belong to the A, C, and N medication groups and 50.6% (n = 41) of the high-risk PIMs have currently marketing authorization in Estonia. The preliminary list of the moderate- and low-risk (yellow, green, and other grey) PIMs contained 240 active substances and medication classes, but sub-classification of this category into one or another group depends mainly on an individual patient´s clinical characteristics in a concrete analyzed study sample and needs further research. Conclusion: The integrated clinical decision support tool based on the EU(7)-PIM and EURO-FORTA criteria addresses the need for more efficient identification of DRPs. It can be applied to identify PIMs and geriatric prescribing problems in different health care settings, and also in a context of little clinical information available.