Risk Of Drug-related Problems Research Articles

Drug-Related Problems and Recommendations Made during Home Medicines Reviews for Sick Day Medication Management in Australia.

Backgrounds and Objectives: Using certain medications during an intercurrent illness can increase the risk of drug related problems (DRP) occurring such as acute kidney injury (AKI). Medications that increase this risk include sulfonylureas, angiotensin converting enzyme inhibitors, diuretics, metformin, angiotensin receptor blockers, non-steroidal anti-inflammatories drugs, and sodium glucose co-transporter 2 inhibitors (SADMANS). Sick day medication guidance (SDMG) recommends withholding SADMANS medications during an intercurrent illness where adequate fluid intake cannot be maintained. But uptake of these recommendations is poor, and it is not known whether Australian pharmacists currently provide these recommendations during home medicine reviews (HMR) as per SDMG. We aimed to gain an understanding of the characteristics of DRP identified by pharmacists during HMR, especially those relating to SADMANS medications. Materials and Methods: We conducted a retrospective audit of 201 randomly selected HMR reports, conducted by accredited pharmacists from 2020 to 2022, that were analysed in 2023. All DRP and recommendations were categorised using a modified DOCUMENT system. Results: Overall, over 98% of participants experienced a DRP and a total of 710 DRP were found, where participants experienced an average of 4.0 ± 2.0 DRP each. Non-SADMANS medications accounted for 83.1% of all DRPs, with nervous system medications contributing the most. Common problems seen in non-SADMANS medications were related to toxicity, over/underdosing and undertreating. Diuretics contributed most to DRP in SADMANS medications. Problems with SADMANS were mainly related to toxicity and contraindications. No pharmacists provided SDMG despite 71.1% of participants using at least one SADMANS medication. Conclusions: We conclude that DRP remain prevalent in community pharmacy settings. Sick day recommendations were not provided in the HMRs included in our study, possibly due to lack of pharmacist knowledge and awareness. To ensure best practice, more research should be conducted to determine pharmacists' knowledge of and barriers to provision of sick day recommendations.

A survey on the implementation of clinical medication reviews in community pharmacies within a multidisciplinary setting

BackgroundPolypharmacy is common in chronic medication users, which increases the risk of drug related problems. A suitable intervention is the clinical medication review (CMR) that was introduced in the Netherlands in 2012, but the effectiveness might be hindered by limited implementation in community pharmacies. Therefore our aim was to describe the current implementation of CMRs in Dutch community pharmacies and to identify barriers to the implementation.MethodsAn online questionnaire was developed based on the Consolidated Framework for Implementation Research (CFIR) and consisted of 58 questions with open ended, multiple choice or Likert-scale answering options. It was sent out to all Dutch community pharmacies (n = 1,953) in January 2021. Descriptive statistics were used.ResultsA total of 289 (14.8%) community pharmacies filled out the questionnaire. Most of the pharmacists agreed that a CMR has a positive effect on the quality of pharmacotherapy (91.3%) and on medication adherence (64.3%). Pharmacists structured CMRs according to available selection criteria or guidelines (92%). Pharmacists (90%) believed that jointly conducting a CMR with a general practitioner (GP) improved their mutual relationship, whereas 21% believed it improved the relationship with a medical specialist. Lack of time was reported by 43% of pharmacists and 80% (fully) agreed conducting CMRs with a medical specialist was complicated. Most pharmacists indicated that pharmacy technicians can assist in performing CMRs, but they rarely do in practice.ConclusionsLack of time and suboptimal collaboration with medical specialists are the most important barriers to the implementation of CMRs.

Drug-related problems among transfusion-dependent thalassemia patients: A real-world evidence study.

Introduction: Thalassemia is among the most common genetic disorders globally and many patients suffer from iron overload (IOL) complications that mainly affect the heart, liver and endocrine system. These events may be further complicated by drug-related problems (DRP), an inherent issue among patients with chronic diseases. Objective: The study aimed to evaluate the burden, associated factors and impacts of DRP in transfusion-dependent thalassemia (TDT) patients. Method: Eligible TDT patients under follow-up in a tertiary hospital between 01 March 2020 to 30 April 2021 were interviewed and their medical records were reviewed retrospectively to identify any DRP. DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) classification version 9.1. The incidence and preventability of DRP were assessed and the associated risk factors were estimated by univariate and multivariate logistic regression. Results: A total of 200 patients were enrolled with a median (interquartile range: IQR) age of 28years at enrolment. Approximately 1 in 2 patients were observed to suffer from thalassemia-related complications. Throughout the study period, 308 DRPs were identified among 150 (75%) participants, with a median DRP per participant of 2.0 (IQR 1.0-3.0). Of the three DRP dimensions, treatment effectiveness was the most common DRP (55.8%) followed by treatment safety (39.6%) and other DRP (4.6%). The median serum ferritin level was statistically higher in patients with DRP compared with patients without DRP (3833.02 vs. 1104.98μg/L, p < 0.001). Three risk factors were found to be significantly associated with the presence of DRP. Patients with frequent blood transfusion, moderate to high Medication Complexity Index (MRCI) and of Malay ethnicity were associated with higher odds of having a DRP (AOR 4.09, 95% CI: 1.83, 9.15; AOR 4.50, 95% CI: 1.89, 10.75; and AOR 3.26, 95% CI: 1.43, 7.43, respectively). Conclusion: The prevalence of DRP was relatively high amongst TDT patients. Increased medication complexity, more severe form of the disease and Malay patients were more likely to experience DRP. Hence, more viable interventions targeted to these groups of patients should be undertaken to mitigate the risk of DRP and achieve better treatment outcomes.

Endocannabinoid-dependent decrease of GABAergic transmission on dopaminergic neurons is associated with susceptibility to cocaine stimulant effects in pre-adolescent male MAOA hypomorphic mice exposed to early life stress

Vulnerability to cocaine use disorder depends upon a combination of genetic and environmental risk factors. While early life adversity is a critical environmental vulnerability factor for drug misuse, allelic variants of the monoamine oxidase A (MAOA) gene have been shown to moderate its influence on the risk of drug-related problems. However, data on the interactions between MAOA variants and early life stress (ES) with respect to predisposition to cocaine abuse are limited. Here, we show that a mouse model capturing the interaction of genetic (low-activity alleles of the Maoa gene; MAOANeo) and environmental (i.e., ES) vulnerability factors displays an increased sensitivity to repeated in vivo cocaine psychomotor stimulant actions associated with a reduction of GABAA receptor-mediated inhibition of dopamine neurons of the ventral tegmental area (VTA). Depolarization-induced suppression of inhibition (DSI), a 2-arachidonoylglycerol (2AG)-dependent form of short-term plasticity, also becomes readily expressed by dopamine neurons from male MAOANeo ES mice repeatedly treated with cocaine. The activation of either dopamine D2 or CB1 receptors contributes to cocaine-induced DSI expression, decreased GABA synaptic efficacy, and hyperlocomotion. Next, in vivo pharmacological enhancement of 2AG signaling during repeated cocaine exposure occludes its actions both in vivo and ex vivo. This data extends our knowledge of the multifaceted sequelae imposed by this gene-environment interaction in VTA dopamine neurons of male pre-adolescent mice and contributes to our understanding of neural mechanisms of vulnerability for early onset cocaine use.

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Drug-related problems at the heart of cardiac surgery

ObjectivesOptimal perioperative success in cardiac surgery requires precise management of drug treatment. This study aimed to determine the prevalence, types and associated factors of drug-related problems (DRPs) during the entire...

LONGITUDINAL ASSOCIATIONS OF SOCIAL CONNECTEDNESS, SOCIAL CONTRIBUTION, SOCIAL ENGAGEMENT, AND LATE-LIFE DRUG USE

Abstract Substance misuse among older adults is a growing and complex problem with implications for society, aging adults, and their families. It is understudied in research and clinical practice. Limited and mixed evidence exists that suggests relationships between changes in older adults’ social environment and their drug use over time. This study addressed this gap by examining potential associations between social environment and drug use among community-dwelling older adults. Data were drawn from 3-waves of the national longitudinal survey of Midlife Development in the United States (MIDUS) (N= 2,020; age range=55-94 years; Mean=63.10, SD=5.66 at Wave 1). We estimated multilevel logistic growth models to assess the relationships between social environment indicators (social connectedness, social contribution, social engagement) and drug use, controlling for age, marital status, race/ethnicity, education level, household income, employment status, and number of chronic conditions. Our findings showed significant odds of drug use over the 20-year period of study, which were increased among older adults with multiple chronic conditions with a 59.5% risk of drug-related problems. Social contribution (feelings of being valued by society) negatively predicted older adults’ drug use whereas social connectedness and social engagement were not significant predictors over time. The models also indicated a moderating effect of social contribution on drug use, showing low changes in drug use over time with low social contribution. Our findings illuminate the differential roles of social environment indicators in drug use. Future research, policy, and practice may particularly focus on the role of social contribution in late-life drug use.

Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic.

Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.

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.

A study on prescribing patterns in hemodialysis and renal transplantation patients

Background Patients treated with hemodialysis and renal transplant require complex therapy regimens that manage comorbid conditions such as diabetes, hypertension, and so on; as a result, they may develop drug-related issues. Inappropriate medication usage raises the risk of drug related problems, which can manifest as excessively extended hospital stays, higher expenses, and overuse of medical services. Prescribing pattern among the patients treated with hemodialysis and renal transplantation are not well characterized previously.Objectives The objective of the study is to investigate drug prescription trends in hemodialysis patients and to study the prescribing patterns of medications in kidney transplantation patients.Materials and methods The prospective observational study was conducted over a period of 8 months, i.e. from October 2021 to June 2022 in end stage CKD patients treating with maintenance hemodialysis and renal transplant. Different classes of drugs prescribed and percentage of drugs per prescription was estimated in this study. Data were analyzed descriptively.Results 105 patients recruited have been analyzed of which 76 (72.38%) were male and 29 (27.6%) were female. Polypharmacy (use of ≥5 medications) was observed in 91.5% in hemodialysis patients and 100% in renal transplant patients.The most prescribed drugs in hemodialysis patients were Cardiovascular Drugs 72 (100%), and in renal transplant patients, immunosuppressant were highly prescribed 33 (100%).Conclusion This study concludes that the cardiovascular agents and immunosuppressant were the most common drugs prescribed among the hemodialysis and renal transplant patients respectively. polypharmacy among overall patients were observed and it may initiate drug related problems.

Domiciliary medication review (ReMeDo): development, reliability and acceptability of a tool for community pharmacists.

Polymedication and medication hoarding in patients' homes may increase the risk of drug-related problems (DRPs). Community pharmacists can prevent DRPs through medication reconciliation and review. This study aims to (1) develop a tool for community pharmacists to perform domiciliary medication review (ReMeDo) and (2) assess the interrater and test-retest reliability and acceptability of the tool. The ReMeDo tool was first developed 6 years before this study to perform medication review during pharmacist home visits. A literature review was performed to update the content of the existing tool. Ten pharmacy students participated in the assessment of the interrater and test-retest reliability using three vignettes based on former ReMeDo patients. Test-retest reliability coefficients were calculated for the entire tool and each segment. Global and individual interrater reliability coefficients were also computed. Acceptability was assessed through a satisfaction survey. The ReMeDo tool was structured to guide the collection of information before, during and after the pharmacist home visit. The global kappa coefficients for interrater and test-retest reliability were 0.70 (95% confidence interval (CI), 0.67 to 0.73) and 0.71 (95% CI, 0.68 to 0.74), respectively. The test-retest reliability coefficients for each segment and the interrater reliability coefficients for participants were higher than 0.60 (except for one participant), demonstrating a moderate to substantial level of agreement. The tool was deemed acceptable by participants. The ReMeDo tool proved to be reliable and acceptable for use by community pharmacists to perform medication review in patients' homes.

Assessment of Drug related problems Encountered in Patients with Psychiatric disorders in a Secondary Care Hospital.

Introduction: Patients with psychiatric disorders receives multiple medications associated with their comorbid conditions and mental illness increasing the risk of drug related problems leading to frequent hospitalization, healthcare expenditure and reduced quality of life. Aim/Objective: To assess and evaluate the Drug Related Problems (DRPs) encountered in patients with psychiatric disorders in a Secondary Care Hospital in Ras Al-Khaimah. Methodology: A prospective observational study was carried out for a period of six months in the department of psychiatry of a secondary care teaching hospital. All the necessary details including the demographics, drug therapy and laboratory parameters were collected from the patient case records. The patient medication orders were reviewed and screened for any DRPs. The identified DRPs were documented and later evaluated to identify the types, frequency, class of drugs involved and for the level of clinical significance by using the descriptive statistics. Results: A total of 61 DRPs were identified from 50 patients. Male predominance was noted over females. DRPs were commonly seen in patients aged between 21-40 years of age. Schizophrenia (42%) was the most common psychiatric illness identified in the study. The most common DRPs was found to be drug-drug interaction (36.06%) followed by adverse drug reaction (27.86%) and medication non-adherence (24.59%). The level of significance of DRPs was found to be ‘minor’ significance in the grade. Conclusion: The study identifies the DRPs in patients with psychiatric illness and necessitates the need for a regular medication review which will help to rationalize the drug therapy, achieve better therapeutic outcomes and improved quality of patient care.

External validation of the Medication Risk Score in polypharmacy patients in general practice: A tool for prioritizing patients at greatest risk of potential drug-related problems.

Drug-related problems are important causes of patient harm and increased healthcare costs. To assist general practitioners in prioritizing patients in need of a critical medication review, we aimed to assess the ability of the Medication Risk Score (MERIS) to stratify patients with polypharmacy in general practice according to their risk of drug-related problems. We conducted a cross-sectional multi-centre external validation study. Patients receiving more than five concomitant medications (polypharmacy) were eligible. The outcome was potentially serious drug-related problems as evaluated by expert consensus. Performance was assessed in terms of calibration and discrimination indices. Of 497 patients, 489 were included in the main analysis. The median age (interquartile range) was 70.5 years (60-79). In total, 372 potentially serious drug-related problems were observed in 253 patients (52%). The MERIS was well calibrated above a score level of 10. The area under the receiver operating characteristic curve was 0.70 (95% confidence interval: 0.65-0.74). The performance of the MERIS was fair in patients with polypharmacy in general practice. Given the scale of drug-related problems and the lack of efficient prioritization tools in this setting, the MERIS could be a useful risk indicator to complement usual practice.

A PROSPECTIVE OBSERVATIONAL AND INTERVENTIONAL STUDY ON THE ROLE OF DOCTOR OF PHARMACY/CLINICAL PHARMACIST IN IDENTIFICATION, REPORTING AND MINIMIZATION OF DRUG-RELATED PROBLEMS IN PULMONARY AND CARDIOLOGY DEPARTMENTS OF ESI HOSPITAL

Objective: The present study aims at implementing the doctor of pharmacy services in the identification and reporting of drug-related problems in the in-patient units of cardiology and pulmonary medicine departments of ESI Hospital, Bangalore.&#x0D; Methods: A prospective interventional study was conducted from September 2018 to March 2019. Determination and categorization of drug-related problems (DRPs) were performed by the pharmacist using the PCNE classification scheme for drug-related problems V5.01. The DRPs identified by the pharmacist were reported and interventions made were subsequently recorded.&#x0D; Results: 180 drug-related problems were identified in the study, among which the major problems were drug-drug interactions (13.88%), followed by generic substitution (10%). The mean drug-related problem per patient was found to be 1.06. A total of 196 interventions were made by the clinical pharmacists among which, 109 (55.61%), 56 (28.57%), 17 (8.67%) interventions were at the prescriber, drug, patient levels, and 14 (7.14%) cases were the rest of interventions or activities. Distributions based on type and degree of acceptance of interventions showed that among 56 drug regimen change interventions proposed by the pharmacist, only 55.35% were accepted. The results further indicated that out of 68 monitoring required interventions made by the pharmacist, and among 17 cases that required counseling by the pharmacist in verbal, 77.94% and 88.36% of cases were accepted, respectively. Also, regarding the cases that required communication between the pharmacists and other healthcare professionals, 85.36% of a total of 41 samples and all of 14 adverse drug reporting cases made in a formal note form were accepted.&#x0D; Conclusion: The clinical pharmacist’s/doctor of pharmacy professional’s timely interventions in the patient’s drug therapy is required to prevent or minimize the occurrence and the risk of DRP. Rational drug therapy and optimal medication safety can be achieved by clinical pharmacy services.

Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions

Drug-related problems (DRP) cause preventable negative health outcomes, especially during hospital admissions. The aim of our study was to examine the prevalence and characteristics of DRP in regular clinical pharmacy, as well as to determine those factors associated with a higher risk of DRP in the hospital setting. We analyzed data from a standardized registry database of regular pharmacy practice (2015- 2016). DRP were classified according to the Pharmaceutical Care Network Europe v6.2 classification. Cross-sectional data were obtained from 1602 adults admitted to medical wards. Crude and adjusted binary logistic regressions were performed to identify associations between potential risk factors and DRP. Overall DRP prevalence was high across medical specialties (45,1%), in a population characterized by advanced age, polypharmacy and multimorbidity. Problems leading to DRP were mainly classified into two domains (effectiveness and adverse reactions), being drug and dose selection the most frequent causes. Interventions were accepted and DRP were totally or partially solved in 74.1% and 4.81% of cases, respectively. In the adjusted model polypharmacy, allergies, BMI > 25 kg/m2 and clearance < 30 mL/min were associated with a higher risk of DRP. The participation of clinical pharmacists into multidisciplinary teams promotes the detection and solution of DRP. Polypharmacy, obesity, renal impairment and allergy are associated with a higher risk of DRP during admission.

Drug-Related Problems and Clinical Risk Factors Relation-Ship in Hepatic Cirrhosis Patients

Diffusion processes in hepatic cirrhosis is characterized with fibrosis and structural changed. Patients with cirrhosis are at risk to get problems because of the effects of the drugs used have drug-related problems (DRPs), due to changes in heart function that affects many aspects of drug pharmacokinetics. Therefore, treatment of patient with hepatic cirrhosis should consider the drug and dose adjustment so that subsequent problems could be avoided. The research method was prospective and descriptive, with a purposive sampling technique. Patients’s treatment were monitoring and analyzed. Significance of 0000 means that p (0000) <0.05, then the Pearson correlation test results are H1a, ie there was a relationship between the number of DRPs events by the total number of clinical risk factors of DRPs in patients with cirrhosis. Therefore from this relationship could be expected to know the possible risk of DRPs in patients. The increasing number of clinical risk factors DRPs in patients with cirrhosis, indicate thatthe patient should receive a more stringent monitoring of the provision of therapy because the risk of experiencing DRPs more.

Drug-Related Problems and Clinical Risk Factors Relation-Ship in Hepatic Cirrhosis Patients

Diffusion processes in hepatic cirrhosis is characterized with fibrosis and structural changed. Patients with cirrhosis are at risk to get problems because of the effects of the drugs used have drug-related problems (DRPs), due to changes in heart function that affects many aspects of drug pharmacokinetics. Therefore, treatment of patient with hepatic cirrhosis should consider the drug and dose adjustment so that subsequent problems could be avoided. The research method was prospective and descriptive, with a purposive sampling technique. Patients’s treatment were monitoring and analyzed. Significance of 0000 means that p (0000) &lt;0.05, then the Pearson correlation test results are H1a, ie there was a relationship between the number of DRPs events by the total number of clinical risk factors of DRPs in patients with cirrhosis. Therefore from this relationship could be expected to know the possible risk of DRPs in patients. The increasing number of clinical risk factors DRPs in patients with cirrhosis, indicate thatthe patient should receive a more stringent monitoring of the provision of therapy because the risk of experiencing DRPs more.

Characterization of drug-related problems and associated factors in ambulatory patients in China.

This study aimed to investigate the prevalence and the type of drug-related problems (DRPs) in ambulatory patients and identify factors that may be associated with risk of DRPs. Consecutive patients were enrolled from pharmacist outpatient clinics between January 2018 and June 2019. The pharmacists performed a comprehensive assessment of the patient's drug therapy. The DRPs and recommendations were evaluated using the DOCUMENT classification system. The study population consisted of 248 patients with a mean age of 72.55±6.29. The patients had a mean of 7.55±4.72 ongoing medications during patients' routine clinic visits. A total of 1188 DRPs were identified during the study period. An average of 4.79 DRPs per patient was detected. Sixty-two different traditional Chinese patent medicines (TCPMs) contributed to 102 DRPs. Drug selection (24.9%) was the most common DRP followed by under treated (24.2%) and monitoring needed (24.2%). The number of medications taken was the significant factor for DRPs. Pharmacists made 1092 recommendations to address the DRPs (an average 0.92 recommendations per DRP). A change in therapy was the most common recommendation (43.6%), followed by the category 'monitoring' (28.6%). The overall acceptance rate of clinical pharmacist recommendations was 88.7%. More than a half (51.6%) of all interventions were assigned a moderate level of clinical significance. Drug-related problems were commonly observed among ambulatory Chinese patients. Clinical pharmacists had a valuable role to play in identifying and solving the DRPs.

Risk factors for drug-related problems in a general hospital: A large prospective cohort.

ObjectiveTo identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients.MethodologyProspective cohort study conducted in adults patients hospitalized (May 2016 to May 2018) in a general tertiary care hospital in Brazil. Potential DRP were detected by daily review of 100% of electronic medication orders by hospital pharmacists and classified by the Pharmaceutical Care Network Europe classification system (PCNE version 6.2). For the identification of risk factors of potential DRP, backward stepwise logistic regression was used to identify the set of independent predictors among over 120 variables collected in the initial 48 hours after admission in a training set consisting of 2/3 of the study population. The model was validated in the remaining sample.ResultsThe study population consisted of 1686 patients aged 52.0+/- 18.3 years-old, 51.4% females, with a median length of stay of 3.24 days, and 4.5% in-hospital mortality. The cumulative incidence of potential DRP was 14.5%. Admission for elective surgery and main diagnosis of disease of the circulatory system were associated with reduced risk of DRP (OR 0.41 and 0.57, respectively, p<0.05). The independent risk factors of DRP are heart rate ≥ 80 bpm (OR 1.41, p = 0.05), prescription of more than seven drugs in day 2 (OR 1.63, p = 0.05), prescription in day 1 of drugs of the Anatomical Therapeutic Chemical Code (ATC) class A (alimentary tract and metabolism, OR 2.24, p = 0.003), prescription in day 2 of two or more ATC class A drugs (OR = 3.52, p<0.001), and in day 1 of ATC class J drugs (antiinfectives for systemic use, OR 1.97, p = 0.001). In the validation set, the c-statistic of the predictive model was 0.65, the sensitivity was 56.1% and the specificity was 65.2%.ConclusionThis study identified seven independent risk factors of potential DRP in patients hospitalized in a general hospital that have fair predictive performance for utilization in clinical practice.

Screening Tools Used by Clinical Pharmacists to Identify Elderly Patients at Risk of Drug-Related Problems on Hospital Admission: A Systematic Review.

In recent years, a number of studies have examined tools to identify elderly patients who are at increased risk of drug-related problems (DRPs). There has been interest in developing tools to prioritise patients for clinical pharmacist (CP) review. This systematic review (SR) aimed to identify published primary research in this area and critically evaluate the quality of prediction tools to identify elderly patients at increased risk of DRPs and/or likely to need CP intervention. The PubMed, EMBASE, OVID HMIC, Cochrane Library, PsychInfo, CINAHL PLUS, Web of Science and ProQuest databases were searched. Keeping up to date with research and citations, the reference lists of included articles were also searched to identify relevant studies. The studies involved the development, utilisation and/or validation of a prediction tool. The protocol for this SR, CRD42019115673, was registered on PROSPERO. Data were extracted and systematically assessed for quality by considering the four key stages involved in accurate risk prediction models—development, validation, impact and implementation—and following the Checklist for the critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). Nineteen studies met the inclusion criteria. Variations in study design, participant characteristics and outcomes made meta-analysis unsuitable. The tools varied in complexity. Most studies reported the sensitivity, specificity and/or discriminatory ability of the tool. Only four studies included external validation of the tool(s), namely of the BADRI model and the GerontoNet ADR Risk Score. The BADRI score demonstrated acceptable goodness of fit and good discrimination performance, whilst the GerontoNet ADR Risk Score showed poor reliability in external validation. None of the models met the four key stages required to create a quality risk prediction model. Further research is needed to either refine the tools developed to date or develop new ones that have good performance and have been externally validated before considering the potential impact and implementation of such tools.