Therapeutic Duplication Research Articles

RISK FACTORS FOR DUPLICATION OF NSAIDs WITHOUT GASTROPROTECTIVE IN ONE OF THE HOSPITALS IN INDONESIA

The use of dual NSAIDs without gastroprotective is one of the drug related problems that often occurs in hospitals, the purpose of giving dual NSAIDs is to increase the effectiveness of pain relief in reducing pain in patients. However, the use of dual NSAIDs without gastroprotective increases the risk of side effects on the gastrointestinal tract, kidneys, and cardiovascular system. This study aimed to examine the risk factors for duplication of NSAID therapy without gastroprotective in the outpatient pharmacy unit at a type C hospital in Banyuasin district. This analytical study used a cross-sectional research design to determine the influence of risk factors on the incidence of duplication of NSAIDs therapy without gastroprotective in the outpatient polyclinic. Data were analyzed using Pearson Chi Square analysis. The results of the bivariate analysis showed that older age, polypharmacy, and multipathology were factors associated with the incidence of NSAID duplication in outpatients with p values (OR) of 0.047 (1.101), 0.025 (2.63), 0.025 (2.63), and 0.025 (2.63), respectively. Keywords: Therapeutic duplications, Ibuprofen, Diclofenac, Gastroprotective agent

DDInter 2.0: an enhanced drug interaction resource with expanded data coverage, new interaction types, and improved user interface.

Drug interactions pose significant challenges in clinical practice, potentially leading to adverse drug reactions, reduced efficacy, and even life-threatening consequences. As polypharmacy becomes increasingly common, the risk of harmful drug interactions rises, underscoring the need for comprehensive and user-friendly drug interaction resources to ensure patient safety. To address these concerns and support healthcare professionals in optimizing drug therapy, we present DDInter 2.0, a significantly expanded and enhanced update to our drug interaction database. This new version incorporates additional interaction types, including drug-food interactions (DFIs), drug-disease interactions (DDSIs), and therapeutic duplications, providing a more complete resource for clinical decision-making. The updated database covers 2310 drugs, with 302 516 drug-drug interaction (DDI) records accompanied by 8398 distinct, high-quality mechanism descriptions and management recommendations. DDInter 2.0 also includes 857 DFIs, 8359 DDSIsand 6033 therapeutic duplication records, each supplemented with detailed information and guidance. Furthermore, the enhanced user interface and advanced filtering options in this second release facilitate easy access to and analysis of the comprehensive drug interaction data. By providing healthcare professionals and researchers with a more complete and user-friendly resource, DDInter 2.0 aims to support clinical decision-making and ultimately improve patient outcomes. DDInter 2.0 is freely accessible at https://ddinter2.scbdd.com.

Pharmacological treatments and medication-related problems in nursing homes in Catalonia: a multidisciplinary approach.

Background: Aging correlates with increased frailty, multi-morbidity, and chronic diseases. Furthermore, treating the aged often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Few guidelines and tools address the problem of polypharmacy and MRPs, mainly within the institutionalized elderly population. Routine pharmacological review is needed among institutionalized patients. This pharmacological review may improve with a multidisciplinary approach of a collaboration of multiple health professionals. This study aimed to describe institutionalized patients, systematically review their medication plans, and then give recommendations and identify MRPs. Methods: A cross-sectional study was performed using data obtained from patients living in five nursing homes in the northern area of Barcelona, Spain. The inclusion criteria comprised institutionalized patients with public health coverage provided by the Health Department of Catalonia. A detailed description of the clinical characteristics, chronic diseases, pharmacological treatments, recommendations, incomplete data, and MRPs, such as potential drug-drug interactions, therapeutic duplications, contraindications, and drugs deemed inappropriate or of doubtful efficacy, was made. The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs. Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8)years, and 72.0% were female individuals. All patients had at least three health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients. Of these recommendations, verification of adequate use was made for 69.3% and withdrawal of a drug for 49.5%. Conclusion: This study demonstrates a high prevalence of health-related problems and several prescribed drugs in nursing homes in Catalonia. Many recommendations were made, confirming the increased proportion of polypharmacy, MRPs, and the need for standardized interventions. A multidisciplinary team approach, including general practitioners, geriatric assessments, a clinical pharmacist, and a clinical pharmacologist, should address this problem.

Categorical Analysis of Database Consistency in Reporting Drug-Drug Interactions for Cardiovascular Diseases.

Drug-drug interactions (DDIs) can either enhance or diminish the positive or negative effects of the associated drugs. Multiple drug combinations create difficulties in identifying clinically relevant drug interactions; this is why electronic drug interaction checkers frequently report DDI results inconsistently. Our paper aims to analyze drug interactions in cardiovascular diseases by selecting drugs from pharmacotherapeutic subcategories of interest according to Level 2 of the Anatomical Therapeutic Chemical (ATC) classification system. We checked DDIs between 9316 pairs of cardiovascular drugs and 25,893 pairs of cardiovascular and other drugs. We then evaluated the overall agreement on DDI severity results between two electronic drug interaction checkers. Thus, we obtained a fair agreement for the DDIs between drugs in the cardiovascular category, as well as for the DDIs between drugs in the cardiovascular and other (i.e., non-cardiovascular) categories, as reflected by the Fleiss' kappa coefficients of κ=0.3363 and κ=0.3572, respectively. The categorical analysis of agreement between ATC-defined subcategories reveals Fleiss' kappa coefficients that indicate levels of agreement varying from poor agreement (κ<0) to perfect agreement (κ=1). The main drawback of the overall agreement assessment is that it includes DDIs between drugs in the same subcategory, a situation of therapeutic duplication seldom encountered in clinical practice. Our main conclusion is that the categorical analysis of the agreement on DDI is more insightful than the overall approach, as it allows a more thorough investigation of the disparities between DDI databases and better exposes the factors that influence the different responses of electronic drug interaction checkers. Using categorical analysis avoids potential inaccuracies caused by particularizing the results of an overall statistical analysis in a heterogeneous dataset.

Antimicrobial stewardship and clinical pharmacist interventions in an Indian tertiary care hospital

AbstractObjectiveComprehensive antimicrobial stewardship programs (ASPs) are needed in Indian healthcare settings due to high rates of communicable diseases and excessive antibiotic use. However, the implementation of both ASPs and clinical pharmacists (CPs) into the system is still in its nascent stages in India. Therefore, our study aims to evaluate the type and acceptance rates of CP interventions in the implementation of ASPs and its impact on antimicrobial utilization.MethodsA single‐center quasi‐experimental study was conducted at Jehangir Hospital, India, wherein prescribed antimicrobials were subjected to evaluation by CPs using the prospective audit and feedback approach. The antimicrobials were reviewed for loading dose, dosages as per creatinine clearance (CrCl), weight, suitability with site of infection, drug interactions, de‐escalations, and therapeutic duplications. Impact on antimicrobial utilization in pre‐intervention (April 2021 to March 2022) and intervention (April 2022 to March 2023) periods were compared using daily defined dose (DDD) per 1000 in‐patient days, following World Health Organization (WHO) guidelines.ResultsDuring the intervention period, 485 out of 609 proposed interventions (79.6%) were implemented. Of these, 417 (85.9%) pertained to intravenous (IV) antimicrobials, while the remaining 68 (14.1%) involved oral formulations. Notably, interventions proposing antibiotic de‐escalations showed higher acceptance rates on Days 3, 5, 7, and 10 compared with other days (p = 0.027). Dosing based on CrCl yielded the highest acceptance rate (50/56, 89.2%). Significant reductions were observed in the DDDs of polymyxins by 58% (3.48–1.29), carbapenems by 7% (57.09–52.85), and glycopeptides by 10% (47.44–42.73). The reduction in these three classes combined was statistically significant (p = 0.04, 95% confidence interval [CI] = 0.3–7.0).ConclusionThis study highlights the vital role of CP interventions within the healthcare team in optimizing antimicrobial pharmacotherapy. The noteworthy reduction in DDDs of restricted antimicrobials provides compelling evidence of the impact CPs can have on antimicrobial consumption and the fight against antimicrobial resistance.

Therapeutic Duplication as a Medication Error Risk in Fixed-Dose Combination Drugs for Dyslipidemia: A Nationwide Study

Therapeutic Duplication as a Medication Error Risk in Fixed-Dose Combination Drugs for Dyslipidemia: A Nationwide Study

Evaluation of the Prevalence and Risk Factors of Drug-Related Problems in Hypertension and Type 2 Diabetes Mellitus Patients at a Tertiary Care Hospital: A Cross-Sectional Study.

Background Drug-related problems (DRPs) potentially interfere with the desired treatment goals which may lead to increased healthcare costs, morbidity, and mortality. Despite the negative consequences of DRPs, there is a lack of comprehensive research on their prevalence and risk factors, particularly in chronic diseases such as hypertension and type 2 diabetes mellitus (DM). This study aims to evaluate the prevalence and contributing factors of DRPs among hypertension, type 2 DM, and hypertension with type 2 DM in the outpatient general medicine department. Methodology A hospital-based, prospective, observational study was conducted over three months. DRPs were classified using the Helper-Strand classification. The potential risk factors contributing to DRPs were assessed using binary and multinomial logistic regression methods. A p-value <0.05 was considered statistically significant. Results Among the 236 study participants, DRPs were more prevalent in males, and the mean age of the participants was 51.73 ± 9.47 years. DRPs were found in 76% of the study participants, and the mean number of DRPs per patient was 1.16 ± 0.45. Among the identified DRPs, suboptimal therapeutic goals (33%) were the most frequently observed, followed by ineffective drugs (32%), medication non-adherence (23%), and drug-drug interaction (5%). Therapeutic duplication and overdose were less commonly encountered as DRPs. The presence of comorbidity (adjusted odds ratio (AOR) = 5.77), and smoking (AOR = 21.07) were found to be significant risk factors (p < 0.05) contributing to DRPs. Conclusions DRPs are more prevalent in hypertension, type 2 DM, and hypertension with type 2 DM. Age range (40-60 years), comorbidity, and smoking were found to be associated with a higher incidence of DRPs. The implementation of a multidisciplinary team approach involving clinical pharmacists and physicians can effectively identify the prevalence and determine the associated risk factors of DRPs and subsequently may help employ targeted interventions to mitigate the development of DRPs.

Rational Therapeutic Approaches for the Management of Congestive Cardiac Failure

Background: Heart failure is a serious and progressive condition where the heart's ventricle fails to pump sufficient blood to the body's tissues. Flaws in the rationality of medication use, particularly with narrow therapeutic index drugs like digoxin, have been observed. These include multiple drug-drug interactions, polypharmacy, and therapeutic duplication. Pharmacists play a crucial role in minimizing medication errors through dose adjustments, patient counseling, and ensuring proper administration. Aims and Objectives: The objective of this project was to assess the appropriateness of recommended pharmacotherapies and their implementation in a clinical setting, focusing on drug-drug interactions, polypharmacy, contraindications, and untreated conditions. Study Design: For this study, a specialized questionnaire-based approach was used to gather data on congestive heart failure (CHF) patients. The collected information included patient demographics (name, gender, and age), chief complaints, co-morbidities, past medical and medication history, biochemical tests, diagnosis, social history, allergies, family history, and past surgeries. Materials and Methods: From a collection of 20 patient histories, it was observed that the majority of cases involved congestive heart failure (43.57%), followed by left ventricular dysfunction (30.35%), myocardial infarction (17.23%), and atrial fibrillation (8.71%) as the primary causes of hospitalization. Among the patients, co-morbidities such as diabetes mellitus (31.71%) and hypertension (25.23%) were prevalent. The collected data was regularly examined and analyzed. Results were evaluated based on ±SD (Standard). Results and Conclusion: In this study, 60 drugs were identified as contraindicated for patients, and some drugs required monitoring due to their profiles. Among the identified drug-related errors, 56.66% were attributed to drug interactions, often resulting from the simultaneous prescription of two interacting drugs. The incidence of polypharmacy was found to be 8.88%. Narrow therapeutic index drugs accounted for 5.55% of the medications, which were not adequately monitored. The analysis revealed that 33.35% and 25.80% of patients had diabetes and hypertension, respectively, in addition to heart failure. Heart failure was most commonly observed in individuals aged 51-60 years. The study highlighted several irrationalities in prescription practices, including inadequate dose adjustment for patients with chronic renal failure, polypharmacy, drug duplication, adverse drug reactions, cost-related issues, unavailability of therapeutic alternatives, and lack of monitoring for narrow therapeutic index medications.

HSD20 The Changes of Prescription Patterns after Providing Therapeutic Duplication Dur(DRUG UTILIZATION REVIEW) Information in Outpatient Veterans at Vhs Medical Center

Therapeutic duplication (TD) information is one of the drug utilization review (DUR) system provided by Health Insurance Review and Assessment Service (HIRA). TD provides information about duplicated agents in same therapeutic group used together in one patient over the same period. It cannot expect any additional medical effect and the risk of adverse effects could be increased. We figure out the changes in TD prescribing pattern through DUR in VHS medical center.

The Pattern of Drug Consumption in Community-Dwelling Older People in Tabriz, Iran: Data From Tabriz Older People Health Survey (TOPS)

Background: Multimorbidity in older people leads to an increase in the number of used drugs and leads to more drug interactions. If irrational and unsafe drug consumption is added to this situation, the burden of the problems of the older adults and the society will increase. So, studying the pattern of drug consumption can provide the possibility of designing interventions to improve it. The purpose of this study was to investigate the pattern of drug use among older adults living in Tabriz. Methods: This cross-sectional study was conducted using the data from a study entitled Tabriz Older People Health Survey (TOPS). The participants were selected from a representative sample of community-dwelling older people aged≥60 years who were living in Tabriz using the probability proportional to size sampling method. All the drugs used by the participants were checked, and their drug interactions and pattern of drug consumption were studied using the World Health Organization (WHO) prescribing guidelines. Results: The results indicated that on average, 4.6 drugs are consumed per person, 4.8 for women and 4.2 for men. Furthermore, 46% of the participants took five drugs or more which is significantly higher in women (P value=0.007). The most commonly used drug was Losartan, and most of the drugs were classified in the cardiovascular group. Moreover, there were 1128 cases of drug interactions and 213 cases of therapeutic duplication whit in the drugs used by the participants. Conclusion: Due to the increase in drug consumption in the older population, it is necessary to pay attention to the compatibility of the drug with the patient’s condition and plan for the training of health system employees regarding the proper prescription of medicine for older people.

Reducing Therapeutic Duplication in Inpatient Medication Orders.

Therapeutic duplication, the presence of multiple agents prescribed for the same indication without clarification for when each should be used, can contribute to serious medical errors. Joint Commission standards require that orders contain clarifying information about when each order should be given. In our system, as needed (PRN) acetaminophen and ibuprofen orders are major contributors to therapeutic duplication. Design and evaluate effectiveness of clinical decision support (CDS) to reduce therapeutic duplication with acetaminophen and ibuprofen orders. This study was done in a pediatric health system with 3 freestanding hospitals. We iteratively designed and implemented two CDS strategies aimed at reducing the therapeutic duplication with these agents: (1) interruptive alert prompting clinicians for clarifying PRN comments at order entry and (2) addition of discrete "first line", "second line" PRN reasons to orders. Therapeutic duplications were measured by manual review of orders for 30-day periods before and after each intervention and 6 months later. Therapeutic duplications decreased from 1485 in the 30 days prior to the first alert implementation to 818 in the 30 days after but rose back to 1208 in the 30 days prior to the second intervention. After discrete reasons were added to the order, therapeutic duplication decreased to 336 in the immediate 30 days and 6 months later remained at 277. Alerts firing rates decreased from 76.0 per 1,000 PRN acetaminophen or ibuprofen orders to 42.9 after the second intervention. Interruptive alerts may reduce therapeutic duplication but are associated with high rates of user frustration and alert fatigue. Leveraging discrete PRN reasons for "first line" and "second line" produced a greater reduction in therapeutic duplication as well as fewer interruptive alerts and less manual entry for providers.

Analysis of Costs Associated with the Use of Personalized Automated Dosing Systems versus Manual Preparation in a Residential Center for the Elderly in Extremadura.

During the SARS-CoV-2 pandemic, there has been a decrease in the supervision of the medication of subjects with chronic diseases. Customized automated dosing systems (SPDA) are devices that allow medication to be dispensed and administered, which have proven to be safe and effective for the patient and cost-effective for the healthcare system. an intervention study was carried out on patients from January to December 2019 in a residential centre for the elderly with more than 100 beds. The economic costs derived from manual dosing were compared with those of an automated preparation (Robotik Technology®). Of the 198 patients included, 195 (97.47%) of them were polymedicated. Of the total of 276 active substances of registered medicinal products, it was possible to include them in the process of automating the preparation of the SPDA 105 active pharmaceutical ingredients. A cost reduction of EUR 5062.39 per year was found using SPDA. Taking into account the active ingredients of emblistable and non-emblistable medicines, the use of SPDA resulted in savings of EUR 6120.40 per year. The system contributed to the detection of cases of therapeutic duplication and reduced the time to prepare the medication. the use of SPDA is a useful and economically profitable strategy for its use in residential centres for the elderly.

Implementation of pharmaceutical care service to elderly cancer patients in a tertiary care hospital in South India.

The goal of this study is to identify drug-related problems (DRPs) for elderly cancer patients receiving chemotherapy by implementing pharmaceutical care services. In this interventional study, patients were followed after each cycle till 12 weeks. The MOATT-MASCC teaching tool was used to educate patients about their therapy. The outcome measures included the occurrences of any DRPs such as inappropriate medication dose, dosage form, route of administration, therapeutic duplication, failure of the patient to adhere to the medication regimen, adverse drug reactions (ADRs), and drug-drug interactions (DDIs) and to resolve it. On 186 patients, there were 38% ADRs, 16% DDIs, 6% non-adherence to therapy, 4% medical conditions for which no medication was prescribed, and 1% therapeutic duplication and transcribing error was identified. A total of 226 ADRs were documented. Nausea and vomiting were the most frequently occurring ADRs (24%) and platinum compounds caused the highest number of ADRs. Assessments of causality showed that the majority of cases are 'probable' (50%). In evaluating the severity of ADRs, 53% of ADRs were 'moderate' and 51% of ADRs were 'probably' preventable. Upon assessing the DDIs, 35% of the prescriptions had 'monitor therapy'. All of the DRPs, that were identified were notified to the treating oncologists and resolved without any disagreement. Pharmaceutical care is essential for elderly cancer patients. Oncologists and pharmacists should work together to identify and manage DRPs as well as educate patients about their disease. This will help in improved patient care and a better therapeutic outcome.

Effect of Pharmacist Intervention on Emergency Department Geriatric Patients with Polypharmacy

Background: Polypharmacy is common within the geriatric population due to the commonality of multiple comorbidities and use of multiple providers. The emergency department (ED) is a prime location to capture these patients, especially when they present with chief complaints which may be medication related. Much of this population is prescribed potentially inappropriate medications which increases their risk for adverse drug reactions. Pharmacist review of patient home medication lists has been shown to decrease the number of potentially inappropriate medications, as well as medication-related problems, such as therapeutic duplications and drug interactions. These reductions can increase patient safety.

Association between cost-sharing and drug prescribing in Korean elderly veterans with chronic diseases: A real-world claims data study.

This study aimed to investigate the relationship between cost-sharing and drug prescribing and its appropriateness in Korean elderly veterans with chronic conditions. This is a cross-sectional study using real-world claims data. Veterans with primary hypertension or dyslipidemia were compared with two controls with higher levels of cost-sharing. Study subjects (age ≥65 years) were selected through stratified random sampling and matching the individual attributes. The primary outcome was the annual amount of drugs prescribed per patient, and the secondary outcomes included several other measures investigating multifaceted aspects of drug prescribing, medical institution utilization behavior, and prescribing appropriateness. Gamma regression models or logistic regression models were employed. Veterans were prescribed 59%~74% more drugs (exp (β) = 1.59 [95% confidence interval [CI] = 1.55–1.64] ~ 1.74 [1.70–1.79]) compared to the National Health Insurance (NHI) patients. This was attributed mainly to longer prescribing days (44%) and slightly more prescriptions (6%~7%) than NHI patients. Veterans spent 14%~15% higher medication costs. Veterans were less likely to visit multiple medical institutions by estimates of 0.77 (0.76–0.79) ~ 0.80 (0.79–0.82). Similar but smaller differences were observed between veterans and medical aid (MedAid) patients. The veteran patients showed a more than 50% increased risk of therapeutic duplication than the other two controls (adjusted odds ratio [ORs] = 1.47 [1.37–1.57] ~ 1.61 [1.50–1.72]). Inappropriate drug prescribing was also more common in veterans than the two controls (adjusted ORs = 1.20 [1.11–1.31] ~ 1.32 [1.22–1.43]). In Korean elderly veterans with chronic illnesses, a level of cost-sharing was associated with having more prescribed medicines, and increased inappropriate prescribing.

Utilization Review of Antibiotics in the Treatment of Urinary Tract Infection

Aim: To evaluate the rationality of pharmacotherapy of UTI and to identify drug related problems (DRPs) in the treatment of UTI. Methodology:, a prospective study was perfomed in Ayub Teaching Hospital Abbottabad Pakistan for a period of three months (December 2019 to March 2020) on 62 patients suffering from UTI. Data of patient disease and treatment was collected from patient medical chart record file and then pharmacotherapy was evaluated for accessing rationality and identification of DRP using standard book like British national formulary and standard treatment guidelines. Statistical analysis of the data was performed by using SPSS. Results: Result of this study showed that prevalence of UTI was more in female (67.74%) than males (32.25%). Patients belonging to the age group of 20-40 years were more prone to UTI. The most frequent problems were presence of drug interactions, dosage problems cases, overprescribing cases, therapeutic duplication cases and lack of cost effectiveness cases. After analyzing the use of antibiotics it was found that most widely used antibiotics in the treatment of UTI was ceftriaxone, followed by levofloxacin and ciprofloxacin. Culture Sensitivity test for appropriate selection of antibiotics was not perfomed in 80% of cases. Wrong dose of antibiotics was prescribed in 27.4% cases; therapeutic duplication of antibiotics was found in 6% of patient prescription and over usage of antibiotics was observed in 18% of cases. Conclusion: Irrational use of drugs especially antibiotics in the treatment of UTI can adversely affect desired therapeutic outcome, lead to therapy failure and emergence of resistance of antibiotics which is a major concern. Drugs for the treatment of UTI should be used rationally according to the need and standard prescribing protocol to improve patient therapeutic outcome and to decrease the adverse consequences of drug therapy. . Keywords: Urinary tract infection, drug related problems and antibiotic use

Addressing Opioid Range Order Use in Post Anesthesia Care Units (PACUs) Across a System

<h3>Background Information</h3> Range orders and therapeutic duplication are an ongoing issue in PACUs as we balance the unique needs of our patients with the restrictions of laws and regulatory bodies. At a previous Joint Commission visit, it had been identified there were issues with how range orders were interpreted and applied when treating patient's pain with opioid range orders in PACU Phase I recovery. <h3>Objectives of Project</h3> Identify and implement a tool to assist in standardization of PACU Phase I clinician interpretation and use of IV opioid range orders. <h3>Process of Implementation</h3> Multidisciplinary team convened to create the PACU/Recovery Room Opioid Order Management – Adult tool. Clinicians completed an in-depth Computer Based Training with a case study focus to become familiar with utilizing the tool with different patient scenarios encountered every day in the PACU. <h3>Statement of Successful Practice</h3> Chart reviews demonstrate consistency between clinicians with regard to dosing titration increments defined by the tool. The tool meets hospital policy requirements. During the most recent Joint Commission site survey, when a clinician was asked how range orders were utilized, the clinician was able to speak in detail to the tool and how IV opioid range orders are utilized in the PACU phase of care to treat pain. In the closing meeting with the Joint Commission surveyor, the tool was identified as a leading practice. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The PACU/Recovery Room Opioid Management Tool supports standardization of initial and consecutive doses of range ordered opioids, allowing nurses to continue to manage a patient's individual pain management needs with the flexibility range orders offer.

A Pharmacy Quality and Internal Audit Program Promoting Continuous Survey Readiness with Medication Management Standards.

Showcasing compliance with Joint Commission Medication Management (MM) standards during accreditation visits is important, but it is equally vital to maintain a state of continuous survey readiness. This article describes a Pharmacy Quality and Internal Audit Program to promote continuous survey readiness and sustained compliance with MM standards. A comprehensive MM audit was developed to assess for compliance in all inpatient, ambulatory, and procedural areas that use medications, with each area undergoing the internal auditing process at least twice per calendar year. The audit is performed by an MM subject matter expert from the Department of Pharmacy and incorporates electronic chart review, clinical staff interviews, and observations of area-specific medication practices. Notable findings and recommendations are communicated to area-specific leadership. Institutionwide scorecards are compiled to track performance with MM standards, identify opportunities, and determine future focus areas to improve and sustain compliance. Results revealed consistent compliance (≥ 90%) with a majority of MM standards. These included hazardous medication management, controlled substances compliance, look-alike/sound-alike drugs, medication storage/security, and labeling of medication syringes. Several areas of opportunity were identified: awareness of high-alert medications and risk-reduction safety strategies, compliance with pill cutter standards, and therapeutic duplication of "as needed" medication orders. Subsequent implementation of corrective actions and mitigation strategies resulted in improved compliance rates from < 50% to ≥ 90% for awareness of high-alert medications and risk-reduction strategies, from < 60% to ≥ 80% for compliance with pill cutter standards, and from < 90% to ≥ 90% for therapeutic duplication of "as needed" orders. Establishment of a Pharmacy Quality and Internal Audit Program allowed for performance tracking, identification of compliance deficiencies, implementation of focused corrective actions, and promotion of continuous survey readiness with MM standards.

Identification of individuals benefiting from the kakaritsuke-yakuzaishi (family pharmacist) system in Japan: a retrospective cohort study using an employment-based health insurance claims database

BackgroundThe kakaritsuke-yakuzaishi system (henceforth, the family pharmacist system) which provides more health services than those by general pharmaceutical practice, was implemented in Japan in April 2016. To distribute medical resources and medical care expenditures appropriately, identifying the possible major beneficiaries of this system is essential. By analyzing administrative claims data through this retrospective cohort study, we identified modifiers of the potential benefits of the system. Further, we integrated the identified modifiers into a scoring system that indicates the possible benefitting subpopulations.MethodsWe obtained data about individuals under 75 years old routinely using community pharmacies in Japan from the JMDC database. We classified the individuals as users or non-users. We used claims related to “choufukutouyaku-sougosayoutou-boushi-kasan (additional therapeutic duplication and drug interaction [TDDI] prevention fees)” filed between April 2018 and March 2020, which indicate that individuals’ prescriptions were modified to adjust leftover drugs or to avoid TDDI as indicators of potential benefit. We estimated adjusted absolute risk differences and 95% confidence intervals for product terms using multiple generalized linear regression models. We included the factors whose 95% confidence interval lower limits did not reach 0 in the multiple logistic regression models for developing a scoring system.ResultsThe eligible cohort included 162,340 individuals (1,214 users and 161,126 non-users). The leftover drugs adjustment significantly increased for individuals prescribed antidepressants. However, as only one modifier was identified, we did not develop a scoring system for the leftover drugs adjustment. For TDDI prevention, the following factors were included in the scoring system: being female, being prescribed ≥ 6 drug types, using ≥ 2 medical institutions, and being prescribed proton pump inhibitors, antibiotics, probiotics, or traditional Japanese herbal medicines. The developed scoring system for TDDI prevention scored “female” and “traditional Japanese herbal medicines prescription” factors higher than other factors.ConclusionsIndividuals who are female or prescribed traditional Japanese herbal medicines, or antidepressants may benefit significantly from the family pharmacist system.

Evaluation of a Pharmacist-Led Telephonic Medication Therapy Management Program in Rural Arizona: Implications for Community Health Practice

This study evaluated a pharmacist-led telephonic Medication Therapy Management (MTM) program for rural patients in Arizona with poor access to healthcare services. A pharmacist provided telephonic MTM services to eligible adult patients living in rural Arizona communities with a diagnosis of diabetes and/or hypertension. Data were collected and summarized descriptively for demographic and health conditions, clinical values, and medication-related problems (MRPs) at the initial consultation, and follow-up data collected at 1 and 3 months. A total of 33 patients had baseline and one-month follow-up data, while 15 patients also had three-month follow-up data. At the initial consultation, the following MRPs were identified: medication adherence issues, dose-related concerns, adverse drug events (ADE), high-risk medications, and therapeutic duplications. Recommendations were made for patients to have the influenza, herpes zoster, and pneumonia vaccines; and to initiate a statin, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker, and/or rescue inhaler. In conclusion, this study demonstrated that while pharmacists can identify and make clinical recommendations to patients, the value of these interventions is not fully realized due to recommendations not being implemented and difficulties with patient follow-up, which may have been due to the COVID-19 pandemic. Additional efforts to address these shortcomings are therefore required.