Prevalence Of Medication-related Problems Research Articles

The prevalence of medication-related problems in kidney transplant recipients at a tertiary care hospital in Saudi Arabia

BackgroundLimited data are available regarding the prevalence of medication-related problems (MRPs) in kidney transplant recipients. This study aimed to determine the prevalence and types of medication-related problems.MethodsA cross-sectional study was conducted including kidney transplant recipients aged ≥ 18 years who were receiving immunosuppressive agents for at least 3 months post-transplant. The primary outcome was to determine the prevalence of MRPs. The secondary outcomes were to identify the pharmacological classes, categories of medications contributing to MRPs, and predictors of developing > 3 MRPs.ResultsWe enrolled 107 kidney transplant recipients. The mean ± standard deviation (SD) of age and body mass index (BMI) were 50 ± 15.8 years and 28.9 ± 5.3 (kg/m2), respectively, and 66.3% were male. The prevalence of MRPs was 28.97% [95% confidence intervals (CI) 19.68%, 41.125] in 1393 prescriptions. The frequent types of MRPs were drug‒drug interactions (46.1%), duplication (12%), and medication use without an indication (11.7%). Immunosuppressive agents and cardiac medications were the main classes causing MRPs. The number of medications and the years post-kidney-transplant were significant predictors of developing > 3 MRPs.ConclusionThe results showed that drug‒drug interactions were the most frequent MRPs, with immunosuppressive agents being the most common class causing MRPs.

Medication Related-Problems and Associated Factors Among Patients with Hypertension at a Tertiary Care Hospital in Ethiopia: A Prospective Interventional Study.

Hypertension affects more than 1.4 billion people worldwide currently, with that number anticipated to climb to 1.6 billion by 2025 with high mortality and morbidity effects. Medication related problems in cardiovascular disease patients, especially among hypertension patients were found to be high and a critical problem which is associated with high mortality, complication, prolonged hospital stay, compromised quality of life and increase health care cost. To determine medication related problems and its predictors among hypertension patients on chronic follow-up at Jimma Medical Center. A prospective interventional study was conducted among hypertension patients from November 28, 2021 to June 30, 2022 at Jimma Medical Center. Medication related problems were classified and identified based on Pharmaceutical care network Europe drug classification tool version 9.0. Interventions were done through discussion with individual prescriber and patients. Consecutive sampling technique was used. Binary Logistic regression was used to identify independent predictors of medication related problems. Variables having P-values < 0.05 were considered statistically significant. Among 384 hypertension patients included in the study, 219 (57.1%) were male. The mean (SD) age was 49.06+17.79. Two thirds of study participants had at least one medication related problem. A total of 483 MRPs were identified among 231 (60.15%) patients. Treatment effectiveness related problem (55.48%) was the most common observed medication related problems. Alcoholism (AOR; 3.15, 95% CI [1.46-7.23]), stage II hypertension (AOR=2.77, 95% CI= [3.53-4.66]); comorbidity (AOR=2.88, 95% CI= [1.47-5.66]) and polypharmacy (AOR=3.07, 95% CI= [1.57-5.99]) were the independent predictors of medication related problems. The prevalence of medication related problems was high among hypertensive patients. Alcoholism, stage II hypertension, comorbidity and poly-pharmacy were the predictors of medication related problems. Therefore, to overcome the problems, clinical pharmacists, physicians and other health care professionals have to work in collaboration.

A Study to Assess the Prevalence of Medication Related Problems in Elderly Patients

Medication-related problems are referred to drug therapy that interferes with or can intervene with the preferred health outcomes for a patient. The geriatric populace that almost represents 21% of the whole populace, devours a remarkable deal of drug treatments due to the age-associated physiological changes, pharmacokinetic and pharmacodynamics alterations, consequently developing into medication related problems. The high prevalence of multiple drug use with age-related changes in pharmacokinetics and pharmacodynamics makes elderly patients vulnerable to medication-related problems. A community-based observational study was conducted among the residents who met the inclusion and exclusion criteria belonging to different regions of Dakshina Kannada district. The duration of the study was 6 months and enrolled 150 elderly patients aged 60 years and above of either sex and diagnosed to have any disease except cancer and being bedridden , to assess the prevalence of medication-related problems in elderly patients. Out of 150 elderly patients enrolled in the study, 107 were identified to have Medication Related Problems (MRPs). A total of 196 MRPs were identified amongst those 107 patients. The prevalence of patients with MRPs was found to be 72% in this study. The prevalence of MRPs was found to be varying among males (68.29%) and females (75%), across different age groups &amp; others. So, the study concluded that the number of elderly patients and multiple co-morbidities are increasing consequently with the increase in the number of medications and thus leading to increase in MRPs. So, it's vital to ensure optimum care for positive outcomes in the elderly. Keywords: Medication-related problems, MRPs, elderly patients, geriatric populace

Beyond dispensing: Better integration of pharmacists within the Australian primary healthcare system

A well-integrated primary health care system helps address the health needs of an ageing population with complex multiple health conditions. In Australia pharmacists provide services to maximise health gains from medication use, although they are not well integrated into primary care. Using the case of Australia, this study investigates why integrating pharmacists in primary care has not been addressed at the national level and also identifies strategies that could promote policy change. Using a unique dataset generated via 33 semi-structured interviews with healthcare leaders and policymakers across relevant disciplines, we undertake a systematic and comprehensive analysis of the policy with the Multiple Stream Framework. This framework examines the policy process with five elements: problem, policy, and political streams; policy entrepreneur; and policy window. The problem stream shows that the primary healthcare system struggles to cope with the increasing healthcare demand and the prevalence of medication-related problems. The policy stream suggests that the consumers would benefit from an integration of pharmacists into primary care to solve these problems; however, policy proposals cannot survive under current circumstances. The political stream reveals the political barriers come from conflicts among interest groups within the profession and the healthcare sector. To advocate their pet policy, policy entrepreneurs should have stronger roles in shaping the “policy idea” to gain its acceptance among the policy community, and to reduce political barriers. Strategies to overcome the barriers include evidence accumulation, role development in light of population needs, and interorganisational collaboration across members of the healthcare network.

Characterization of Medication Related Problems Among Patients with Cardiovascular Disease in Medical Ward of Mettu Karl Referral Hospital, South Western, Ethiopia: A Prospective Observational Study

Background: Medication related problem is defined as: ‘an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. Drug related problems are of a major concern in health care because of increased cost, morbidity and mortality. cardiovascular diseases are a group of disorders of the heart and blood vessels. Objective: To discover characterization of medication related problems and contributing factors among cardiovascular patients in the medical ward of Mettu Karl Referral Hospital. Methods: A facility based prospective observational study design was carried from April 07 /2021 to June 09/2021. Data was collected through employing check list and semi-structured questioner. Data was entered and descriptive statistical analysis was done using statistical packages for social sciences 25.0 version statistical software. Both bi-variable and multivariable analysis performed to determine the association between outcome and predictors variables. A p-value of less than 0.05 was considered significant. Results: The overall rate of medication related problems among cardiovascular patients in medical ward was 53 (58.2%). The patient’s age group was in line of 36-59 years 49 (53.8%). Unnecessary drug therapy 15 (28.3%) were the mostly identified type of drug therapy problem followed by dosage too high 11 (20.8%). ACEIs 229 (17.1%) was commonly prescribed medication and potassium sparing 19 (2.2%) was least prescribed drugs. Age ≥ 60 years (AOR: 2.76; 95%CI: 1.342-3.945; P=0.004), rural area residents (AOR: 2.76; 95%CI: 1.014-2.758; P=0.003), length of hospital stay >7 days (AO R: 4.75; 95%CI: 2.986-11.723; P=0.007), number of medication >5 (AOR: 3.632-17.893; 95%CI: 2.986-11.723; P=0.001) were associated factor significantly causes medication related problems. Conclusion and Recommendation: The prevalence of medication related problems amid cardiovascular patients in medical ward was high. Less than half of patients were found to have co-morbidities and were had have social substance users. Hospitals and ministry of Health should have to establish pharmaceutical care services for better patient care.

Patient-centered Pharmacist Care in the Hemodialysis Unit: a quasi-experimental interrupted time series study

BackgroundNonadherence to medications by patients requiring hemodialysis (HD) leads to unfavorable clinical outcomes. Limited data exist to demonstrate the effect of incorporating patient-centered interventions using concepts of medication therapy management and motivational interview by pharmacists on pharmacoadherence in patients requiring HD. Therefore, we assessed the impact of patient-centered pharmacist care on pharmacoadherence and its outcomes in patients requiring HD.MethodsAdult patients who had received outpatient HD for at least 3 months were enrolled. The study was conducted from October 2016 to April 2017. Pharmacists interviewed the patients at month 1, 2, 4 and 6, and the intervention (comprehensive review) occurred at months 3 and 5. The primary outcome was the change in pharmacoadherence as assessed by pre-HD serum phosphate levels and the differences in the number of medications between patient’ self-report and medications records at the electronic healthcare records (EHRs). The secondary outcomes included changes in systolic blood pressure (SBP), glycosylated hemoglobin levels, serum low-density lipoprotein (LDL) levels, and the prevalence and types of medication-related problems (MRPs).ResultsSeventy-two patients were enrolled. Their median age was 59 (interquartile range: 47–67.5) years, and 53% were men. Pre- and post-intervention pharmacoadherence, as indicated by serum phosphate levels and the differences in the number of medications between patient’ self-report and the medication records at the EHRs, did not significantly differ (p = 0.682 and 0.348, respectively). Mean SBP and mean LDL did not significantly change post-intervention. The median number of MRPs declined between Months 3 and 5 (p = 0.002): the prevalence of MRPs at Month 3 was 44.9% (95 confidence interval [CI]: 40.4–49.3) and decreased to 29.8% (95 CI: 25.6–34.3) at Month 5. Drug use without indication was the most frequent MRP (23.9%).ConclusionsPatient-centered pharmacist care did not result in significant changes in pharmacoadherence. However, its clinical utility as a tool to identify and mitigate MRPs in patients requiring HD is indisputable.Trial RegistrationClinicalTrials.gov identifier: NCT03576404 (retrospectively registered on July 3rd, 2018).

Provision of annual wellness visits with comprehensive medication management by a clinical pharmacist practitioner.

The effectiveness and financial benefit of pharmacist-led annual wellness visits (AWVs) in conjunction with comprehensive medication management (CMM) for older, high-risk patients were examined. Eligible patients were 65 years of age or older with three or more chronic medical conditions, taking five or more long-term prescription or nonprescription medications and receiving primary care in a retirement community clinic. The intervention involved two components, an AWV and CMM. The AWV included all Medicare-required components. All participants saw a clinical pharmacist practitioner for an AWV with CMM and additional CMM visits at three and six months. Outcomes included completion of required AWV components, prevalence of medication-related problems (MRPs), classic return on investment, patient satisfaction, and change in rate of hospitalization. Of the 60 eligible patients contacted, 53 (88%) agreed to participate. Patients' mean ± S.D. age was 82.1 ± 5.5 years, and patients used a median of 12 medications (range, 5-27) at baseline. The pharmacist identified at least 1 MRP in 90.6% of patients at the AWV; all patients had at least 1 MRP identified over six months. A total of 278 MRPs were identified: suboptimal drug (32.7%), insufficient therapeutic monitoring (25.2%), undertreatment of chronic condition (16.9%), and suboptimal dose, frequency, or administration (15.8%). Revenue generated by the pharmacist exceeded costs by 38.1%. The rate of hospitalizations did not significantly change after the intervention. Pharmacists played a beneficial role in the provision of both AWVs and CMM, facilitating the completion of wellness visits and identifying and addressing MRPs in an older, high-risk population.

Creating innovative models for MTM

Key points The study site was a university-affi liated community-based primary care practice and teaching site for medical residents. The intervention was a 10-step individualized Medication Assessment and Planning (iMAP) program provided by residency-trained, boardcertifi ed clinical pharmacists who collectively provided clinical services at the clinic 2 days per week. The researchers conducted a prospective, observational 6-month study using a convenience sample of older adults from the clinic. The primary outcome was total number and prevalence of medication-related problems (MRPs) identifi ed by the clinical pharmacists at 6 months, and the secondary outcomes were acute health services utilized by study patients. During the 6-month period, the pharmacists identifi ed 419 MRPs for 64 patients enrolled in the program, proposing therapy-optimizing plans for each problem to the patients’ primary care physicians. The physicians accepted 94% (392) of these recommendations. There was a signifi cant reduction in mean MRPs per patient from baseline to 6 months (4.2 vs. 1.0). Acute health services utilized by study patients declined from 8.3 to 5.4 events per 100 person–months.

Individualized Medication Assessment and Planning: Optimizing Medication Use in Older Adults in the Primary Care Setting

To test the feasibility and effectiveness of an individualized Medication Assessment and Planning (iMAP) program integrated within a primary care practice on the number and prevalence of medication-related problems (MRPs) and acute health services utilization, defined as combined hospitalizations and emergency department visits. Six-month, prospective, observational pilot study. Community-based primary care medical practice. Convenience sample of 64 patients aged 65years and older who were taking at least five medications. Each patient was enrolled in the iMAP program-a collaborative, multifaceted intervention facilitated by a clinical pharmacist whereby patients receive comprehensive medication therapy management at baseline and 3 and 6months as part of routine clinical care. MRPs were assessed and recommendations proposed using the previously published MRP classification tool; physician acceptance of recommendations served to validate the assessments. There was a significant reduction in mean number of MRPs/patient (4.2 at baseline vs 1.0 at 6mo, p<0.0001) when adjusted for number of medications, race, and pharmacist. The prevalence of MRPs at 6months compared with baseline was also significant (p<0.0008). Acute health services utilization was assessed by medical record abstraction. The 64 patients experienced a rate of 8.3 events/100 person-months (64 total events) during the 12-month prestudy period. During the 6-month study period, the same patients experienced 5.4 events/100 person-months (20 total events). Thus, we noted a reduction in acute health services utilization of 35%. Physicians were enthusiastically supportive of iMAP. iMAP has the potential to address a significant and timely issue affecting older adults and primary care practices: the burden of managing and continuously monitoring multiple medications in medically complex older adults. A more rigorous evaluation of iMAP is warranted and planned to demonstrate sustained effectiveness and cost-benefit.

Prevalence of medication-related problems among patients with renal compromise in an Indian hospital

Patients suffering from renal dysfunction often have multiple medical conditions either as a cause or as a consequence of their renal disease. These patients receive an average of 10-12 medications daily leading to complex dosing schedules and are more likely to develop medication-related problems (MRPs). The objectives of this study were to determine the nature and extent of MRPs in renally compromised patients and to explore the potential clinical significance of the MRPs. The potential for a clinical pharmacist to contribute towards resolving or preventing some of these MRPs was also explored. A prospective study was conducted for a period of 9 months in the renal unit of Jagadguru Shri Shivaratheeshwara (JSS) Medical College Hospital, Mysore, India. Patients undergoing dialysis on outpatient basis and patients who were admitted under the care of or referred to the nephrologists for renal dysfunction from other specialties were reviewed. Patterns of the MRPs were identified using an adapted Hepler and Strand criteria. The potential clinical significance of the MRPs and the contribution of the clinical pharmacist in resolving or minimizing some of the MRPs were also explored. Three hundred and twenty-seven MRPs were identified with 308 patients reviewed. The incidence of MRPs was found to be 1·06 ± 0·85 per patient reviewed. The most common MRP identified in our study was overdose (19·3%) followed by adverse drug reactions (19·0%). Cardiovascular agents (33·6%) followed by anti-infective agents (26·3%) were the most common therapeutic classes of medication implicated in causing MRPs. Twenty-six per cent of the MRPs identified were explored to be potentially moderate or major in clinical significance. The clinical pharmacists' recommendations were accepted in 97% of the cases, which resulted in a change in therapy in 83% of the cases. Medication-related problems are frequent in renally compromised patients in our patient population. The high level of acceptance of clinical pharmacist's recommendations by the nephrologists demonstrates that clinical pharmacists may help improve overall patient care in this setting.